example of importance of the study in research

How To Write Significance of the Study (With Examples) 

Whether you’re writing a research paper or thesis, a portion called Significance of the Study ensures your readers understand the impact of your work. Learn how to effectively write this vital part of your research paper or thesis through our detailed steps, guidelines, and examples.

Related: How to Write a Concept Paper for Academic Research

Table of Contents

What is the significance of the study.

The Significance of the Study presents the importance of your research. It allows you to prove the study’s impact on your field of research, the new knowledge it contributes, and the people who will benefit from it.

Related: How To Write Scope and Delimitation of a Research Paper (With Examples)

Where Should I Put the Significance of the Study?

The Significance of the Study is part of the first chapter or the Introduction. It comes after the research’s rationale, problem statement, and hypothesis.

Related: How to Make Conceptual Framework (with Examples and Templates)

Why Should I Include the Significance of the Study?

The purpose of the Significance of the Study is to give you space to explain to your readers how exactly your research will be contributing to the literature of the field you are studying 1 . It’s where you explain why your research is worth conducting and its significance to the community, the people, and various institutions.

How To Write Significance of the Study: 5 Steps

Below are the steps and guidelines for writing your research’s Significance of the Study.

1. Use Your Research Problem as a Starting Point

Your problem statement can provide clues to your research study’s outcome and who will benefit from it 2 .

Ask yourself, “How will the answers to my research problem be beneficial?”. In this manner, you will know how valuable it is to conduct your study. 

Let’s say your research problem is “What is the level of effectiveness of the lemongrass (Cymbopogon citratus) in lowering the blood glucose level of Swiss mice (Mus musculus)?”

Discovering a positive correlation between the use of lemongrass and lower blood glucose level may lead to the following results:

• Increased public understanding of the plant’s medical properties;
• Higher appreciation of the importance of lemongrass  by the community;
• Adoption of lemongrass tea as a cheap, readily available, and natural remedy to lower their blood glucose level.

Once you’ve zeroed in on the general benefits of your study, it’s time to break it down into specific beneficiaries.

2. State How Your Research Will Contribute to the Existing Literature in the Field

Think of the things that were not explored by previous studies. Then, write how your research tackles those unexplored areas. Through this, you can convince your readers that you are studying something new and adding value to the field.

3. Explain How Your Research Will Benefit Society

In this part, tell how your research will impact society. Think of how the results of your study will change something in your community. 

For example, in the study about using lemongrass tea to lower blood glucose levels, you may indicate that through your research, the community will realize the significance of lemongrass and other herbal plants. As a result, the community will be encouraged to promote the cultivation and use of medicinal plants.

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

Using the same example above, you may indicate that this research’s results will benefit those seeking an alternative supplement to prevent high blood glucose levels.

5. Indicate How Your Study May Help Future Studies in the Field

You must also specifically indicate how your research will be part of the literature of your field and how it will benefit future researchers. In our example above, you may indicate that through the data and analysis your research will provide, future researchers may explore other capabilities of herbal plants in preventing different diseases.

Tips and Warnings

• Think ahead . By visualizing your study in its complete form, it will be easier for you to connect the dots and identify the beneficiaries of your research.
• Write concisely. Make it straightforward, clear, and easy to understand so that the readers will appreciate the benefits of your research. Avoid making it too long and wordy.
• Go from general to specific . Like an inverted pyramid, you start from above by discussing the general contribution of your study and become more specific as you go along. For instance, if your research is about the effect of remote learning setup on the mental health of college students of a specific university , you may start by discussing the benefits of the research to society, to the educational institution, to the learning facilitators, and finally, to the students.
• Seek help . For example, you may ask your research adviser for insights on how your research may contribute to the existing literature. If you ask the right questions, your research adviser can point you in the right direction.
• Revise, revise, revise. Be ready to apply necessary changes to your research on the fly. Unexpected things require adaptability, whether it’s the respondents or variables involved in your study. There’s always room for improvement, so never assume your work is done until you have reached the finish line.

Significance of the Study Examples

This section presents examples of the Significance of the Study using the steps and guidelines presented above.

Example 1: STEM-Related Research

Research Topic: Level of Effectiveness of the Lemongrass ( Cymbopogon citratus ) Tea in Lowering the Blood Glucose Level of Swiss Mice ( Mus musculus ).

Significance of the Study .

This research will provide new insights into the medicinal benefit of lemongrass ( Cymbopogon citratus ), specifically on its hypoglycemic ability.

Through this research, the community will further realize promoting medicinal plants, especially lemongrass, as a preventive measure against various diseases. People and medical institutions may also consider lemongrass tea as an alternative supplement against hyperglycemia. 

Moreover, the analysis presented in this study will convey valuable information for future research exploring the medicinal benefits of lemongrass and other medicinal plants.  

Example 2: Business and Management-Related Research

Research Topic: A Comparative Analysis of Traditional and Social Media Marketing of Small Clothing Enterprises.

Significance of the Study:

By comparing the two marketing strategies presented by this research, there will be an expansion on the current understanding of the firms on these marketing strategies in terms of cost, acceptability, and sustainability. This study presents these marketing strategies for small clothing enterprises, giving them insights into which method is more appropriate and valuable for them. 

Specifically, this research will benefit start-up clothing enterprises in deciding which marketing strategy they should employ. Long-time clothing enterprises may also consider the result of this research to review their current marketing strategy.

Furthermore, a detailed presentation on the comparison of the marketing strategies involved in this research may serve as a tool for further studies to innovate the current method employed in the clothing Industry.

Example 3: Social Science -Related Research.

Research Topic:  Divide Et Impera : An Overview of How the Divide-and-Conquer Strategy Prevailed on Philippine Political History.

Significance of the Study :

Through the comprehensive exploration of this study on Philippine political history, the influence of the Divide et Impera, or political decentralization, on the political discernment across the history of the Philippines will be unraveled, emphasized, and scrutinized. Moreover, this research will elucidate how this principle prevailed until the current political theatre of the Philippines.

In this regard, this study will give awareness to society on how this principle might affect the current political context. Moreover, through the analysis made by this study, political entities and institutions will have a new approach to how to deal with this principle by learning about its influence in the past.

In addition, the overview presented in this research will push for new paradigms, which will be helpful for future discussion of the Divide et Impera principle and may lead to a more in-depth analysis.

Example 4: Humanities-Related Research

Research Topic: Effectiveness of Meditation on Reducing the Anxiety Levels of College Students.

Significance of the Study: 

This research will provide new perspectives in approaching anxiety issues of college students through meditation. 

Specifically, this research will benefit the following:

 Community – this study spreads awareness on recognizing anxiety as a mental health concern and how meditation can be a valuable approach to alleviating it.

Academic Institutions and Administrators – through this research, educational institutions and administrators may promote programs and advocacies regarding meditation to help students deal with their anxiety issues.

Mental health advocates – the result of this research will provide valuable information for the advocates to further their campaign on spreading awareness on dealing with various mental health issues, including anxiety, and how to stop stigmatizing those with mental health disorders.

Parents – this research may convince parents to consider programs involving meditation that may help the students deal with their anxiety issues.

Students will benefit directly from this research as its findings may encourage them to consider meditation to lower anxiety levels.

Future researchers – this study covers information involving meditation as an approach to reducing anxiety levels. Thus, the result of this study can be used for future discussions on the capabilities of meditation in alleviating other mental health concerns.

Frequently Asked Questions

1. what is the difference between the significance of the study and the rationale of the study.

Both aim to justify the conduct of the research. However, the Significance of the Study focuses on the specific benefits of your research in the field, society, and various people and institutions. On the other hand, the Rationale of the Study gives context on why the researcher initiated the conduct of the study.

Let’s take the research about the Effectiveness of Meditation in Reducing Anxiety Levels of College Students as an example. Suppose you are writing about the Significance of the Study. In that case, you must explain how your research will help society, the academic institution, and students deal with anxiety issues through meditation. Meanwhile, for the Rationale of the Study, you may state that due to the prevalence of anxiety attacks among college students, you’ve decided to make it the focal point of your research work.

2. What is the difference between Justification and the Significance of the Study?

In Justification, you express the logical reasoning behind the conduct of the study. On the other hand, the Significance of the Study aims to present to your readers the specific benefits your research will contribute to the field you are studying, community, people, and institutions.

Suppose again that your research is about the Effectiveness of Meditation in Reducing the Anxiety Levels of College Students. Suppose you are writing the Significance of the Study. In that case, you may state that your research will provide new insights and evidence regarding meditation’s ability to reduce college students’ anxiety levels. Meanwhile, you may note in the Justification that studies are saying how people used meditation in dealing with their mental health concerns. You may also indicate how meditation is a feasible approach to managing anxiety using the analysis presented by previous literature.

3. How should I start my research’s Significance of the Study section?

– This research will contribute… – The findings of this research… – This study aims to… – This study will provide… – Through the analysis presented in this study… – This study will benefit…

Moreover, you may start the Significance of the Study by elaborating on the contribution of your research in the field you are studying.

4. What is the difference between the Purpose of the Study and the Significance of the Study?

The Purpose of the Study focuses on why your research was conducted, while the Significance of the Study tells how the results of your research will benefit anyone.

Suppose your research is about the Effectiveness of Lemongrass Tea in Lowering the Blood Glucose Level of Swiss Mice . You may include in your Significance of the Study that the research results will provide new information and analysis on the medical ability of lemongrass to solve hyperglycemia. Meanwhile, you may include in your Purpose of the Study that your research wants to provide a cheaper and natural way to lower blood glucose levels since commercial supplements are expensive.

5. What is the Significance of the Study in Tagalog?

In Filipino research, the Significance of the Study is referred to as Kahalagahan ng Pag-aaral.

• Draft your Significance of the Study. Retrieved 18 April 2021, from http://dissertationedd.usc.edu/draft-your-significance-of-the-study.html
• Regoniel, P. (2015). Two Tips on How to Write the Significance of the Study. Retrieved 18 April 2021, from https://simplyeducate.me/2015/02/09/significance-of-the-study/

Written by Jewel Kyle Fabula

in Career and Education , Juander How

Jewel Kyle Fabula

Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.

Browse all articles written by Jewel Kyle Fabula

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The Savvy Scientist

Experiences of a London PhD student and beyond

What is the Significance of a Study? Examples and Guide

If you’re reading this post you’re probably wondering: what is the significance of a study?

No matter where you’re at with a piece of research, it is a good idea to think about the potential significance of your work. And sometimes you’ll have to explicitly write a statement of significance in your papers, it addition to it forming part of your thesis.

In this post I’ll cover what the significance of a study is, how to measure it, how to describe it with examples and add in some of my own experiences having now worked in research for over nine years.

If you’re reading this because you’re writing up your first paper, welcome! You may also like my how-to guide for all aspects of writing your first research paper .

Looking for guidance on writing the statement of significance for a paper or thesis? Click here to skip straight to that section.

What is the Significance of a Study?

For research papers, theses or dissertations it’s common to explicitly write a section describing the significance of the study. We’ll come onto what to include in that section in just a moment.

However the significance of a study can actually refer to several different things.

Working our way from the most technical to the broadest, depending on the context, the significance of a study may refer to:

• Within your study: Statistical significance. Can we trust the findings?
• Wider research field: Research significance. How does your study progress the field?
• Commercial / economic significance: Could there be business opportunities for your findings?
• Societal significance: What impact could your study have on the wider society.
• And probably other domain-specific significance!

We’ll shortly cover each of them in turn, including how they’re measured and some examples for each type of study significance.

But first, let’s touch on why you should consider the significance of your research at an early stage.

Why Care About the Significance of a Study?

No matter what is motivating you to carry out your research, it is sensible to think about the potential significance of your work. In the broadest sense this asks, how does the study contribute to the world?

After all, for many people research is only worth doing if it will result in some expected significance. For the vast majority of us our studies won’t be significant enough to reach the evening news, but most studies will help to enhance knowledge in a particular field and when research has at least some significance it makes for a far more fulfilling longterm pursuit.

Furthermore, a lot of us are carrying out research funded by the public. It therefore makes sense to keep an eye on what benefits the work could bring to the wider community.

Often in research you’ll come to a crossroads where you must decide which path of research to pursue. Thinking about the potential benefits of a strand of research can be useful for deciding how to spend your time, money and resources.

It’s worth noting though, that not all research activities have to work towards obvious significance. This is especially true while you’re a PhD student, where you’re figuring out what you enjoy and may simply be looking for an opportunity to learn a new skill.

However, if you’re trying to decide between two potential projects, it can be useful to weigh up the potential significance of each.

Let’s now dive into the different types of significance, starting with research significance.

Research Significance

What is the research significance of a study.

Unless someone specifies which type of significance they’re referring to, it is fair to assume that they want to know about the research significance of your study.

Research significance describes how your work has contributed to the field, how it could inform future studies and progress research.

Where should I write about my study’s significance in my thesis?

Typically you should write about your study’s significance in the Introduction and Conclusions sections of your thesis.

It’s important to mention it in the Introduction so that the relevance of your work and the potential impact and benefits it could have on the field are immediately apparent. Explaining why your work matters will help to engage readers (and examiners!) early on.

It’s also a good idea to detail the study’s significance in your Conclusions section. This adds weight to your findings and helps explain what your study contributes to the field.

On occasion you may also choose to include a brief description in your Abstract.

What is expected when submitting an article to a journal

It is common for journals to request a statement of significance, although this can sometimes be called other things such as:

• Impact statement
• Significance statement
• Advances in knowledge section

Here is one such example of what is expected:

Impact Statement:  An Impact Statement is required for all submissions.  Your impact statement will be evaluated by the Editor-in-Chief, Global Editors, and appropriate Associate Editor. For your manuscript to receive full review, the editors must be convinced that it is an important advance in for the field. The Impact Statement is not a restating of the abstract. It should address the following: Why is the work submitted important to the field? How does the work submitted advance the field? What new information does this work impart to the field? How does this new information impact the field? Experimental Biology and Medicine journal, author guidelines

Typically the impact statement will be shorter than the Abstract, around 150 words.

Defining the study’s significance is helpful not just for the impact statement (if the journal asks for one) but also for building a more compelling argument throughout your submission. For instance, usually you’ll start the Discussion section of a paper by highlighting the research significance of your work. You’ll also include a short description in your Abstract too.

How to describe the research significance of a study, with examples

Whether you’re writing a thesis or a journal article, the approach to writing about the significance of a study are broadly the same.

I’d therefore suggest using the questions above as a starting point to base your statements on.

• Why is the work submitted important to the field?
• How does the work submitted advance the field?
• What new information does this work impart to the field?
• How does this new information impact the field?

Answer those questions and you’ll have a much clearer idea of the research significance of your work.

When describing it, try to clearly state what is novel about your study’s contribution to the literature. Then go on to discuss what impact it could have on progressing the field along with recommendations for future work.

Potential sentence starters

If you’re not sure where to start, why not set a 10 minute timer and have a go at trying to finish a few of the following sentences. Not sure on what to put? Have a chat to your supervisor or lab mates and they may be able to suggest some ideas.

• This study is important to the field because…
• These findings advance the field by…
• Our results highlight the importance of…
• Our discoveries impact the field by…

Now you’ve had a go let’s have a look at some real life examples.

Statement of significance examples

A statement of significance / impact:

Impact Statement This review highlights the historical development of the concept of “ideal protein” that began in the 1950s and 1980s for poultry and swine diets, respectively, and the major conceptual deficiencies of the long-standing concept of “ideal protein” in animal nutrition based on recent advances in amino acid (AA) metabolism and functions. Nutritionists should move beyond the “ideal protein” concept to consider optimum ratios and amounts of all proteinogenic AAs in animal foods and, in the case of carnivores, also taurine. This will help formulate effective low-protein diets for livestock, poultry, and fish, while sustaining global animal production. Because they are not only species of agricultural importance, but also useful models to study the biology and diseases of humans as well as companion (e.g. dogs and cats), zoo, and extinct animals in the world, our work applies to a more general readership than the nutritionists and producers of farm animals. Wu G, Li P. The “ideal protein” concept is not ideal in animal nutrition.  Experimental Biology and Medicine . 2022;247(13):1191-1201. doi: 10.1177/15353702221082658

And the same type of section but this time called “Advances in knowledge”:

Advances in knowledge: According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders. Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change. Size changes of at least 6 mm or more in  T 1  weighted or  T 2  weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change. Wennmann M, Grözinger M, Weru V, et al. Test-retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma [published online ahead of print, 2023 Apr 12].  Br J Radiol . 2023;20220745. doi: 10.1259/bjr.20220745

Other examples of research significance

Moving beyond the formal statement of significance, here is how you can describe research significance more broadly within your paper.

Describing research impact in an Abstract of a paper:

Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration. Conclusions section of the abstract in my first paper .

In the Discussion section of a paper:

We report for the utility of a standard laboratory micro-CT scanner to visualise and quantify features of the chondrocyte population within intact articular cartilage in 3D. This study represents a complimentary addition to the growing body of evidence supporting the non-destructive imaging of the constituents of articular cartilage. This offers researchers the opportunity to image chondrocyte distributions in 3D without specialised synchrotron equipment, enabling investigations such as chondrocyte morphology across grades of cartilage damage, 3D strain mapping techniques such as digital volume correlation to evaluate mechanical properties  in situ , and models for 3D finite element analysis  in silico  simulations. This enables an objective quantification of chondrocyte distribution and morphology in three dimensions allowing greater insight for investigations into studies of cartilage development, degeneration and repair. One such application of our method, is as a means to provide a 3D pattern in the cartilage which, when combined with digital volume correlation, could determine 3D strain gradient measurements enabling potential treatment and repair of cartilage degeneration. Moreover, the method proposed here will allow evaluation of cartilage implanted with tissue engineered scaffolds designed to promote chondral repair, providing valuable insight into the induced regenerative process. The Discussion section of the paper is laced with references to research significance.

How is longer term research significance measured?

Looking beyond writing impact statements within papers, sometimes you’ll want to quantify the long term research significance of your work. For instance when applying for jobs.

The most obvious measure of a study’s long term research significance is the number of citations it receives from future publications. The thinking is that a study which receives more citations will have had more research impact, and therefore significance , than a study which received less citations. Citations can give a broad indication of how useful the work is to other researchers but citations aren’t really a good measure of significance.

Bear in mind that us researchers can be lazy folks and sometimes are simply looking to cite the first paper which backs up one of our claims. You can find studies which receive a lot of citations simply for packaging up the obvious in a form which can be easily found and referenced, for instance by having a catchy or optimised title.

Likewise, research activity varies wildly between fields. Therefore a certain study may have had a big impact on a particular field but receive a modest number of citations, simply because not many other researchers are working in the field.

Nevertheless, citations are a standard measure of significance and for better or worse it remains impressive for someone to be the first author of a publication receiving lots of citations.

Other measures for the research significance of a study include:

• Accolades: best paper awards at conferences, thesis awards, “most downloaded” titles for articles, press coverage.
• How much follow-on research the study creates. For instance, part of my PhD involved a novel material initially developed by another PhD student in the lab. That PhD student’s research had unlocked lots of potential new studies and now lots of people in the group were using the same material and developing it for different applications. The initial study may not receive a high number of citations yet long term it generated a lot of research activity.

That covers research significance, but you’ll often want to consider other types of significance for your study and we’ll cover those next.

Statistical Significance

What is the statistical significance of a study.

Often as part of a study you’ll carry out statistical tests and then state the statistical significance of your findings: think p-values eg <0.05. It is useful to describe the outcome of these tests within your report or paper, to give a measure of statistical significance.

Effectively you are trying to show whether the performance of your innovation is actually better than a control or baseline and not just chance. Statistical significance deserves a whole other post so I won’t go into a huge amount of depth here.

Things that make publication in  The BMJ  impossible or unlikely Internal validity/robustness of the study • It had insufficient statistical power, making interpretation difficult; • Lack of statistical power; The British Medical Journal’s guide for authors

Calculating statistical significance isn’t always necessary (or valid) for a study, such as if you have a very small number of samples, but it is a very common requirement for scientific articles.

Writing a journal article? Check the journal’s guide for authors to see what they expect. Generally if you have approximately five or more samples or replicates it makes sense to start thinking about statistical tests. Speak to your supervisor and lab mates for advice, and look at other published articles in your field.

How is statistical significance measured?

Statistical significance is quantified using p-values . Depending on your study design you’ll choose different statistical tests to compute the p-value.

A p-value of 0.05 is a common threshold value. The 0.05 means that there is a 1/20 chance that the difference in performance you’re reporting is just down to random chance.

• p-values above 0.05 mean that the result isn’t statistically significant enough to be trusted: it is too likely that the effect you’re showing is just luck.
• p-values less than or equal to 0.05 mean that the result is statistically significant. In other words: unlikely to just be chance, which is usually considered a good outcome.

Low p-values (eg p = 0.001) mean that it is highly unlikely to be random chance (1/1000 in the case of p = 0.001), therefore more statistically significant.

It is important to clarify that, although low p-values mean that your findings are statistically significant, it doesn’t automatically mean that the result is scientifically important. More on that in the next section on research significance.

How to describe the statistical significance of your study, with examples

In the first paper from my PhD I ran some statistical tests to see if different staining techniques (basically dyes) increased how well you could see cells in cow tissue using micro-CT scanning (a 3D imaging technique).

In your methods section you should mention the statistical tests you conducted and then in the results you will have statements such as:

Between mediums for the two scan protocols C/N [contrast to noise ratio] was greater for EtOH than the PBS in both scanning methods (both  p  < 0.0001) with mean differences of 1.243 (95% CI [confidence interval] 0.709 to 1.778) for absorption contrast and 6.231 (95% CI 5.772 to 6.690) for propagation contrast. … Two repeat propagation scans were taken of samples from the PTA-stained groups. No difference in mean C/N was found with either medium: PBS had a mean difference of 0.058 ( p  = 0.852, 95% CI -0.560 to 0.676), EtOH had a mean difference of 1.183 ( p  = 0.112, 95% CI 0.281 to 2.648). From the Results section of my first paper, available here . Square brackets added for this post to aid clarity.

From this text the reader can infer from the first paragraph that there was a statistically significant difference in using EtOH compared to PBS (really small p-value of <0.0001). However, from the second paragraph, the difference between two repeat scans was statistically insignificant for both PBS (p = 0.852) and EtOH (p = 0.112).

By conducting these statistical tests you have then earned your right to make bold statements, such as these from the discussion section:

Propagation phase-contrast increases the contrast of individual chondrocytes [cartilage cells] compared to using absorption contrast. From the Discussion section from the same paper.

Without statistical tests you have no evidence that your results are not just down to random chance.

Beyond describing the statistical significance of a study in the main body text of your work, you can also show it in your figures.

In figures such as bar charts you’ll often see asterisks to represent statistical significance, and “n.s.” to show differences between groups which are not statistically significant. Here is one such figure, with some subplots, from the same paper:

In this example an asterisk (*) between two bars represents p < 0.05. Two asterisks (**) represents p < 0.001 and three asterisks (***) represents p < 0.0001. This should always be stated in the caption of your figure since the values that each asterisk refers to can vary.

Now that we know if a study is showing statistically and research significance, let’s zoom out a little and consider the potential for commercial significance.

Commercial and Industrial Significance

What are commercial and industrial significance.

Moving beyond significance in relation to academia, your research may also have commercial or economic significance.

Simply put:

• Commercial significance: could the research be commercialised as a product or service? Perhaps the underlying technology described in your study could be licensed to a company or you could even start your own business using it.
• Industrial significance: more widely than just providing a product which could be sold, does your research provide insights which may affect a whole industry? Such as: revealing insights or issues with current practices, performance gains you don’t want to commercialise (e.g. solar power efficiency), providing suggested frameworks or improvements which could be employed industry-wide.

I’ve grouped these two together because there can certainly be overlap. For instance, perhaps your new technology could be commercialised whilst providing wider improvements for the whole industry.

Commercial and industrial significance are not relevant to most studies, so only write about it if you and your supervisor can think of reasonable routes to your work having an impact in these ways.

How are commercial and industrial significance measured?

Unlike statistical and research significances, the measures of commercial and industrial significance can be much more broad.

Here are some potential measures of significance:

Commercial significance:

• How much value does your technology bring to potential customers or users?
• How big is the potential market and how much revenue could the product potentially generate?
• Is the intellectual property protectable? i.e. patentable, or if not could the novelty be protected with trade secrets: if so publish your method with caution!
• If commercialised, could the product bring employment to a geographical area?

Industrial significance:

What impact could it have on the industry? For instance if you’re revealing an issue with something, such as unintended negative consequences of a drug , what does that mean for the industry and the public? This could be:

• Reduced overhead costs
• Better safety
• Faster production methods
• Improved scaleability

How to describe the commercial and industrial significance of a study, with examples

Commercial significance.

If your technology could be commercially viable, and you’ve got an interest in commercialising it yourself, it is likely that you and your university may not want to immediately publish the study in a journal.

You’ll probably want to consider routes to exploiting the technology and your university may have a “technology transfer” team to help researchers navigate the various options.

However, if instead of publishing a paper you’re submitting a thesis or dissertation then it can be useful to highlight the commercial significance of your work. In this instance you could include statements of commercial significance such as:

The measurement technology described in this study provides state of the art performance and could enable the development of low cost devices for aerospace applications. An example of commercial significance I invented for this post

Industrial significance

First, think about the industrial sectors who could benefit from the developments described in your study.

For example if you’re working to improve battery efficiency it is easy to think of how it could lead to performance gains for certain industries, like personal electronics or electric vehicles. In these instances you can describe the industrial significance relatively easily, based off your findings.

For example:

By utilising abundant materials in the described battery fabrication process we provide a framework for battery manufacturers to reduce dependence on rare earth components. Again, an invented example

For other technologies there may well be industrial applications but they are less immediately obvious and applicable. In these scenarios the best you can do is to simply reframe your research significance statement in terms of potential commercial applications in a broad way.

As a reminder: not all studies should address industrial significance, so don’t try to invent applications just for the sake of it!

Societal Significance

What is the societal significance of a study.

The most broad category of significance is the societal impact which could stem from it.

If you’re working in an applied field it may be quite easy to see a route for your research to impact society. For others, the route to societal significance may be less immediate or clear.

Studies can help with big issues facing society such as:

• Medical applications : vaccines, surgical implants, drugs, improving patient safety. For instance this medical device and drug combination I worked on which has a very direct route to societal significance.
• Political significance : Your research may provide insights which could contribute towards potential changes in policy or better understanding of issues facing society.
• Public health : for instance COVID-19 transmission and related decisions.
• Climate change : mitigation such as more efficient solar panels and lower cost battery solutions, and studying required adaptation efforts and technologies. Also, better understanding around related societal issues, for instance this study on the effects of temperature on hate speech.

How is societal significance measured?

Societal significance at a high level can be quantified by the size of its potential societal effect. Just like a lab risk assessment, you can think of it in terms of probability (or how many people it could help) and impact magnitude.

Societal impact = How many people it could help x the magnitude of the impact

Think about how widely applicable the findings are: for instance does it affect only certain people? Then think about the potential size of the impact: what kind of difference could it make to those people?

Between these two metrics you can get a pretty good overview of the potential societal significance of your research study.

How to describe the societal significance of a study, with examples

Quite often the broad societal significance of your study is what you’re setting the scene for in your Introduction. In addition to describing the existing literature, it is common to for the study’s motivation to touch on its wider impact for society.

For those of us working in healthcare research it is usually pretty easy to see a path towards societal significance.

Our CLOUT model has state-of-the-art performance in mortality prediction, surpassing other competitive NN models and a logistic regression model … Our results show that the risk factors identified by the CLOUT model agree with physicians’ assessment, suggesting that CLOUT could be used in real-world clinicalsettings. Our results strongly support that CLOUT may be a useful tool to generate clinical prediction models, especially among hospitalized and critically ill patient populations. Learning Latent Space Representations to Predict Patient Outcomes: Model Development and Validation

In other domains the societal significance may either take longer or be more indirect, meaning that it can be more difficult to describe the societal impact.

Even so, here are some examples I’ve found from studies in non-healthcare domains:

We examined food waste as an initial investigation and test of this methodology, and there is clear potential for the examination of not only other policy texts related to food waste (e.g., liability protection, tax incentives, etc.; Broad Leib et al., 2020) but related to sustainable fishing (Worm et al., 2006) and energy use (Hawken, 2017). These other areas are of obvious relevance to climate change… AI-Based Text Analysis for Evaluating Food Waste Policies

The continued development of state-of-the art NLP tools tailored to climate policy will allow climate researchers and policy makers to extract meaningful information from this growing body of text, to monitor trends over time and administrative units, and to identify potential policy improvements. BERT Classification of Paris Agreement Climate Action Plans

Top Tips For Identifying & Writing About the Significance of Your Study

• Writing a thesis? Describe the significance of your study in the Introduction and the Conclusion .
• Submitting a paper? Read the journal’s guidelines. If you’re writing a statement of significance for a journal, make sure you read any guidance they give for what they’re expecting.
• Take a step back from your research and consider your study’s main contributions.
• Read previously published studies in your field . Use this for inspiration and ideas on how to describe the significance of your own study
• Discuss the study with your supervisor and potential co-authors or collaborators and brainstorm potential types of significance for it.

Now you’ve finished reading up on the significance of a study you may also like my how-to guide for all aspects of writing your first research paper .

Writing an academic journal paper

I hope that you’ve learned something useful from this article about the significance of a study. If you have any more research-related questions let me know, I’m here to help.

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What is the Significance of the Study?

• By DiscoverPhDs
• August 25, 2020

• what the significance of the study means,
• why it’s important to include in your research work,
• where you would include it in your paper, thesis or dissertation,
• how you write one
• and finally an example of a well written section about the significance of the study.

What does Significance of the Study mean?

The significance of the study is a written statement that explains why your research was needed. It’s a justification of the importance of your work and impact it has on your research field, it’s contribution to new knowledge and how others will benefit from it.

Why is the Significance of the Study important?

The significance of the study, also known as the rationale of the study, is important to convey to the reader why the research work was important. This may be an academic reviewer assessing your manuscript under peer-review, an examiner reading your PhD thesis, a funder reading your grant application or another research group reading your published journal paper. Your academic writing should make clear to the reader what the significance of the research that you performed was, the contribution you made and the benefits of it.

How do you write the Significance of the Study?

When writing this section, first think about where the gaps in knowledge are in your research field. What are the areas that are poorly understood with little or no previously published literature? Or what topics have others previously published on that still require further work. This is often referred to as the problem statement.

The introduction section within the significance of the study should include you writing the problem statement and explaining to the reader where the gap in literature is.

Then think about the significance of your research and thesis study from two perspectives: (1) what is the general contribution of your research on your field and (2) what specific contribution have you made to the knowledge and who does this benefit the most.

For example, the gap in knowledge may be that the benefits of dumbbell exercises for patients recovering from a broken arm are not fully understood. You may have performed a study investigating the impact of dumbbell training in patients with fractures versus those that did not perform dumbbell exercises and shown there to be a benefit in their use. The broad significance of the study would be the improvement in the understanding of effective physiotherapy methods. Your specific contribution has been to show a significant improvement in the rate of recovery in patients with broken arms when performing certain dumbbell exercise routines.

This statement should be no more than 500 words in length when written for a thesis. Within a research paper, the statement should be shorter and around 200 words at most.

Significance of the Study: An example

Building on the above hypothetical academic study, the following is an example of a full statement of the significance of the study for you to consider when writing your own. Keep in mind though that there’s no single way of writing the perfect significance statement and it may well depend on the subject area and the study content.

Here’s another example to help demonstrate how a significance of the study can also be applied to non-technical fields:

The significance of this research lies in its potential to inform clinical practices and patient counseling. By understanding the psychological outcomes associated with non-surgical facial aesthetics, practitioners can better guide their patients in making informed decisions about their treatment plans. Additionally, this study contributes to the body of academic knowledge by providing empirical evidence on the effects of these cosmetic procedures, which have been largely anecdotal up to this point.

The statement of the significance of the study is used by students and researchers in academic writing to convey the importance of the research performed; this section is written at the end of the introduction and should describe the specific contribution made and who it benefits.

There’s no doubt about it – writing can be difficult. Whether you’re writing the first sentence of a paper or a grant proposal, it’s easy

This post explains where and how to write the list of figures in your thesis or dissertation.

How should you spend your first week as a PhD student? Here’s are 7 steps to help you get started on your journey.

Join thousands of other students and stay up to date with the latest PhD programmes, funding opportunities and advice.

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A well written figure legend will explain exactly what a figure means without having to refer to the main text. Our guide explains how to write one.

The purpose of research is to enhance society by advancing knowledge through developing scientific theories, concepts and ideas – find out more on what this involves.

Elmira is in the third year of her PhD program at the Moscow Institute of Physics and Technology; Engelhardt Institute of Molecular Biology, researching the mechanisms of acute myeloid leukemia cells resistance to targeted therapy.

Dr Grayson gained her PhD in Mechanical Engineering from Cornell University in 2016. She now works in industry as an Applications Portfolio Manager and is a STEM Speaker and Advocate.

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How To Write a Significance Statement for Your Research

A significance statement is an essential part of a research paper. It explains the importance and relevance of the study to the academic community and the world at large. To write a compelling significance statement, identify the research problem, explain why it is significant, provide evidence of its importance, and highlight its potential impact on future research, policy, or practice. A well-crafted significance statement should effectively communicate the value of the research to readers and help them understand why it matters.

Updated on May 4, 2023

A significance statement is a clearly stated, non-technical paragraph that explains why your research matters. It’s central in making the public aware of and gaining support for your research.

Write it in jargon-free language that a reader from any field can understand. Well-crafted, easily readable significance statements can improve your chances for citation and impact and make it easier for readers outside your field to find and understand your work.

Read on for more details on what a significance statement is, how it can enhance the impact of your research, and, of course, how to write one.

What is a significance statement in research?

A significance statement answers the question: How will your research advance scientific knowledge and impact society at large (as well as specific populations)? 

You might also see it called a “Significance of the study” statement. Some professional organizations in the STEM sciences and social sciences now recommended that journals in their disciplines make such statements a standard feature of each published article. Funding agencies also consider “significance” a key criterion for their awards.

Read some examples of significance statements from the Proceedings of the National Academy of Sciences (PNAS) here .

Depending upon the specific journal or funding agency’s requirements, your statement may be around 100 words and answer these questions:

1. What’s the purpose of this research?

2. What are its key findings?

3. Why do they matter?

4. Who benefits from the research results?

Readers will want to know: “What is interesting or important about this research?” Keep asking yourself that question.

Where to place the significance statement in your manuscript

Most journals ask you to place the significance statement before or after the abstract, so check with each journal’s guide. 

This article is focused on the formal significance statement, even though you’ll naturally highlight your project’s significance elsewhere in your manuscript. (In the introduction, you’ll set out your research aims, and in the conclusion, you’ll explain the potential applications of your research and recommend areas for future research. You’re building an overall case for the value of your work.)

Developing the significance statement

The main steps in planning and developing your statement are to assess the gaps to which your study contributes, and then define your work’s implications and impact.

Identify what gaps your study fills and what it contributes

Your literature review was a big part of how you planned your study. To develop your research aims and objectives, you identified gaps or unanswered questions in the preceding research and designed your study to address them.

Go back to that lit review and look at those gaps again. Review your research proposal to refresh your memory. Ask:

• How have my research findings advanced knowledge or provided notable new insights?
• How has my research helped to prove (or disprove) a hypothesis or answer a research question?
• Why are those results important?

Consider your study’s potential impact at two levels: 

• What contribution does my research make to my field?
• How does it specifically contribute to knowledge; that is, who will benefit the most from it?

Define the implications and potential impact

As you make notes, keep the reasons in mind for why you are writing this statement. Whom will it impact, and why?

The first audience for your significance statement will be journal reviewers when you submit your article for publishing. Many journals require one for manuscript submissions. Study the author’s guide of your desired journal to see its criteria ( here’s an example ). Peer reviewers who can clearly understand the value of your research will be more likely to recommend publication. 

Second, when you apply for funding, your significance statement will help justify why your research deserves a grant from a funding agency . The U.S. National Institutes of Health (NIH), for example, wants to see that a project will “exert a sustained, powerful influence on the research field(s) involved.” Clear, simple language is always valuable because not all reviewers will be specialists in your field.

Third, this concise statement about your study’s importance can affect how potential readers engage with your work. Science journalists and interested readers can promote and spread your work, enhancing your reputation and influence. Help them understand your work.

You’re now ready to express the importance of your research clearly and concisely. Time to start writing.

How to write a significance statement: Key elements 

When drafting your statement, focus on both the content and writing style.

• In terms of content, emphasize the importance, timeliness, and relevance of your research results. 
• Write the statement in plain, clear language rather than scientific or technical jargon. Your audience will include not just your fellow scientists but also non-specialists like journalists, funding reviewers, and members of the public. 

Follow the process we outline below to build a solid, well-crafted, and informative statement. 

Get started

Some suggested opening lines to help you get started might be:

• The implications of this study are… 
• Building upon previous contributions, our study moves the field forward because…
• Our study furthers previous understanding about…

Alternatively, you may start with a statement about the phenomenon you’re studying, leading to the problem statement.

Include these components

Next, draft some sentences that include the following elements. A good example, which we’ll use here, is a significance statement by Rogers et al. (2022) published in the Journal of Climate .

1. Briefly situate your research study in its larger context . Start by introducing the topic, leading to a problem statement. Here’s an example:

‘Heatwaves pose a major threat to human health, ecosystems, and human systems.”

2. State the research problem.

“Simultaneous heatwaves affecting multiple regions can exacerbate such threats. For example, multiple food-producing regions simultaneously undergoing heat-related crop damage could drive global food shortages.”

3. Tell what your study does to address it.

“We assess recent changes in the occurrence of simultaneous large heatwaves.”

4. Provide brief but powerful evidence to support the claims your statement is making , Use quantifiable terms rather than vague ones (e.g., instead of “This phenomenon is happening now more than ever,” see below how Rogers et al. (2022) explained it). This evidence intensifies and illustrates the problem more vividly:

“Such simultaneous heatwaves are 7 times more likely now than 40 years ago. They are also hotter and affect a larger area. Their increasing occurrence is mainly driven by warming baseline temperatures due to global heating, but changes in weather patterns contribute to disproportionate increases over parts of Europe, the eastern United States, and Asia.

5. Relate your study’s impact to the broader context , starting with its general significance to society—then, when possible, move to the particular as you name specific applications of your research findings. (Our example lacks this second level of application.) 

“Better understanding the drivers of weather pattern changes is therefore important for understanding future concurrent heatwave characteristics and their impacts.”

Refine your English

Don’t understate or overstate your findings – just make clear what your study contributes. When you have all the elements in place, review your draft to simplify and polish your language. Even better, get an expert AJE edit . Be sure to use “plain” language rather than academic jargon.

• Avoid acronyms, scientific jargon, and technical terms 
• Use active verbs in your sentence structure rather than passive voice (e.g., instead of “It was found that...”, use “We found...”)
• Make sentence structures short, easy to understand – readable
• Try to address only one idea in each sentence and keep sentences within 25 words (15 words is even better)
• Eliminate nonessential words and phrases (“fluff” and wordiness)

Enhance your significance statement’s impact

Always take time to review your draft multiple times. Make sure that you:

• Keep your language focused
• Provide evidence to support your claims
• Relate the significance to the broader research context in your field

After revising your significance statement, request feedback from a reading mentor about how to make it even clearer. If you’re not a native English speaker, seek help from a native-English-speaking colleague or use an editing service like AJE to make sure your work is at a native level.

Understanding the significance of your study

Your readers may have much less interest than you do in the specific details of your research methods and measures. Many readers will scan your article to learn how your findings might apply to them and their own research. 

Different types of significance

Your findings may have different types of significance, relevant to different populations or fields of study for different reasons. You can emphasize your work’s statistical, clinical, or practical significance. Editors or reviewers in the social sciences might also evaluate your work’s social or political significance.

Statistical significance means that the results are unlikely to have occurred randomly. Instead, it implies a true cause-and-effect relationship.

Clinical significance means that your findings are applicable for treating patients and improving quality of life.

Practical significance is when your research outcomes are meaningful to society at large, in the “real world.” Practical significance is usually measured by the study’s  effect size . Similarly, evaluators may attribute social or political significance to research that addresses “real and immediate” social problems.

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Significance of a Study: Revisiting the “So What” Question

• Open Access
• First Online: 03 December 2022

Cite this chapter

You have full access to this open access chapter

• James Hiebert 6 ,
• Jinfa Cai 7 ,
• Stephen Hwang 7 ,
• Anne K Morris 6 &
• Charles Hohensee 6  

Part of the book series: Research in Mathematics Education ((RME))

17k Accesses

Every researcher wants their study to matter—to make a positive difference for their professional communities. To ensure your study matters, you can formulate clear hypotheses and choose methods that will test them well, as described in Chaps. 1, 2, 3 and 4. You can go further, however, by considering some of the terms commonly used to describe the importance of studies, terms like significance, contributions, and implications. As you clarify for yourself the meanings of these terms, you learn that whether your study matters depends on how convincingly you can argue for its importance. Perhaps most surprising is that convincing others of its importance rests with the case you make before the data are ever gathered. The importance of your hypotheses should be apparent before you test them. Are your predictions about things the profession cares about? Can you make them with a striking degree of precision? Are the rationales that support them compelling? You are answering the “So what?” question as you formulate hypotheses and design tests of them. This means you can control the answer. You do not need to cross your fingers and hope as you collect data.

You have full access to this open access chapter,  Download chapter PDF

Part I. Setting the Groundwork

One of the most common questions asked of researchers is “So what?” What difference does your study make? Why are the findings important? The “so what” question is one of the most basic questions, often perceived by novice researchers as the most difficult question to answer. Indeed, addressing the “so what” question continues to challenge even experienced researchers. It is not always easy to articulate a convincing argument for the importance of your work. It can be especially difficult to describe its importance without falling into the trap of making claims that reach beyond the data.

That this issue is a challenge for researchers is illustrated by our analysis of reviewer comments for JRME . About one-third of the reviews for manuscripts that were ultimately rejected included concerns about the importance of the study. Said another way, reviewers felt the “So what?” question had not been answered. To paraphrase one journal reviewer, “The manuscript left me unsure of what the contribution of this work to the field’s knowledge is, and therefore I doubt its significance.” We expect this is a frequent concern of reviewers for all research journals.

Our goal in this chapter is to help you navigate the pressing demands of journal reviewers, editors, and readers for demonstrating the importance of your work while staying within the bounds of acceptable claims based on your results. We will begin by reviewing what we have said about these issues in previous chapters. We will then clarify one of the confusing aspects of developing appropriate arguments—the absence of consensus definitions of key terms such as significance, contributions, and implications. Based on the definitions we propose, we will examine the critical role of alignment for realizing the potential significance of your study. Because the importance of your study is communicated through your evolving research paper, we will fold suggestions for writing your paper into the discussion of creating and executing your study.

We laid the groundwork in Chap. 1 for what we consider to be important research in education:

In our view, the ultimate goal of education is to offer all students the best possible learning opportunities. So, we believe the ultimate purpose of scientific inquiry in education is to support the improvement of learning opportunities for all students…. If there is no way to imagine a connection to improving learning opportunities for students, even a distant connection, we recommend you reconsider whether it is an important hypothesis within the education community.

Of course, you might prefer another “ultimate purpose” for research in education. That’s fine. The critical point is that the argument for the importance of the hypotheses you are testing should be connected to the value of a long-term goal you can describe. As long as most of the educational community agrees with this goal, and you can show how testing your hypotheses will move the field forward to achieving this goal, you will have developed a convincing argument for the importance of your work.

In Chap. 2 , we argued the importance of your hypotheses can and should be established before you collect data. Your theoretical framework should carry the weight of your argument because it should describe how your hypotheses will extend what is already known. Your methods should then show that you will test your hypotheses in an appropriate way—in a way that will allow you to detect how the results did, and did not, confirm the hypotheses. This will, in turn, allow you to formulate revised hypotheses. We described establishing the importance of your study by saying, “The importance can come from the fact that, based on the results, you will be able to offer revised hypotheses that help the field better understand an issue relevant for improving all students’ learning opportunities.”

The ideas from Chaps. 1 , 2 , and 3 go a long way toward setting the parameters for what counts as an important study and how its importance can be determined. Chapter 4 focused on ensuring that the importance of a study can be realized. The next section fills in the details by proposing definitions for the most common terms used to claim importance: significance, contributions, and implications.

You might notice that we do not have a chapter dedicated to discussing the presentation of the findings—that is, a “results” chapter. We do not mean to imply that presenting results is trivial. However, we believe that if you follow our recommendations for writing your evolving research paper, presenting the results will be quite straightforward. The key is to present your results so they can be most easily compared with your predictions. This means, among other things, organizing your presentation of results according to your earlier presentation of hypotheses.

Part II. Clarifying Importance by Revisiting the Definitions of Key Terms

What does it mean to say your findings are significant? Statistical significance is clear. There are widely accepted standards for determining the statistical significance of findings. But what about educational significance? Is this the same as claiming that your study makes an important contribution? Or, that your study has important implications? Different researchers might answer these questions in different ways. When key terms like these are overused, their definitions gradually broaden or shift, and they can lose their meaning. That is unfortunate, because it creates confusion about how to develop claims for the importance of a study.

By clarifying the definitions, we hope to clarify what is required to claim that a study is significant , that it makes a contribution , and that it has important implications . Not everyone defines the terms as we do. Our definitions are probably a bit narrower or more targeted than those you may encounter elsewhere. Depending on where you want to publish your study, you may want to adapt your use of these terms to match more closely the expectations of a particular journal. But the way we define and address these terms is not antithetical to common uses. And we believe ridding the terms of unnecessary overlap allows us to discriminate among different key concepts with respect to claims for the importance of research studies. It is not necessary to define the terms exactly as we have, but it is critical that the ideas embedded in our definitions be distinguished and that all of them be taken into account when examining the importance of a study.

We will use the following definitions:

Significance: The importance of the problem, questions, and/or hypotheses for improving the learning opportunities for all students (you can substitute a different long-term goal if its value is widely shared). Significance can be determined before data are gathered. Significance is an attribute of the research problem , not the research findings .

Contributions : The value of the findings for revising the hypotheses, making clear what has been learned, what is now better understood.

Implications : Deductions about what can be concluded from the findings that are not already included in “contributions.” The most common deductions in educational research are for improving educational practice. Deductions for research practice that are not already defined as contributions are often suggestions about research methods that are especially useful or methods to avoid.

Significance

The significance of a study is built by formulating research questions and hypotheses you connect through a careful argument to a long-term goal of widely shared value (e.g., improving learning opportunities for all students). Significance applies both to the domain in which your study is located and to your individual study. The significance of the domain is established by choosing a goal of widely shared value and then identifying a domain you can show is connected to achieving the goal. For example, if the goal to which your study contributes is improving the learning opportunities for all students, your study might aim to understand more fully how things work in a domain such as teaching for conceptual understanding, or preparing teachers to attend to all students, or designing curricula to support all learners, or connecting learning opportunities to particular learning outcomes.

The significance of your individual study is something you build ; it is not predetermined or self-evident. Significance of a study is established by making a case for it, not by simply choosing hypotheses everyone already thinks are important. Although you might believe the significance of your study is obvious, readers will need to be convinced.

Significance is something you develop in your evolving research paper. The theoretical framework you present connects your study to what has been investigated previously. Your argument for significance of the domain comes from the significance of the line of research of which your study is a part. The significance of your study is developed by showing, through the presentation of your framework, how your study advances this line of research. This means the lion’s share of your answer to the “So what?” question will be developed as part of your theoretical framework.

Although defining significance as located in your paper prior to presenting results is not a definition universally shared among educational researchers, it is becoming an increasingly common view. In fact, there is movement toward evaluating the significance of a study based only on the first sections of a research paper—the sections prior to the results (Makel et al., 2021 ).

In addition to addressing the “So what?” question, your theoretical framework can address another common concern often voiced by readers: “What is so interesting? I could have predicted those results.” Predictions do not need to be surprising to be interesting and significant. The significance comes from the rationales that show how the predictions extend what is currently known. It is irrelevant how many researchers could have made the predictions. What makes a study significant is that the theoretical framework and the predictions make clear how the study will increase the field’s understanding toward achieving a goal of shared value.

An important consequence of interpreting significance as a carefully developed argument for the importance of your research study within a larger domain is that it reveals the advantage of conducting a series of connected studies rather than single, disconnected studies. Building the significance of a research study requires time and effort. Once you have established significance for a particular study, you can build on this same argument for related studies. This saves time, allows you to continue to refine your argument across studies, and increases the likelihood your studies will contribute to the field.

Contributions

As we have noted, in fields as complicated as education, it is unlikely that your predictions will be entirely accurate. If the problem you are investigating is significant, the hypotheses will be formulated in such a way that they extend a line of research to understand more deeply phenomena related to students’ learning opportunities or another goal of shared value. Often, this means investigating the conditions under which phenomena occur. This gets complicated very quickly, so the data you gather will likely differ from your predictions in a variety of ways. The contributions your study makes will depend on how you interpret these results in light of the original hypotheses.

Contributions Emerge from Revisions to your Hypotheses

We view interpreting results as a process of comparing the data with the predictions and then examining the way in which hypotheses should be revised to more fully account for the results. Revising will almost always be warranted because, as we noted, predictions are unlikely to be entirely accurate. For example, if researchers expect Outcome A to occur under specified conditions but find that it does not occur to the extent predicted or actually does occur but without all the conditions, they must ask what changes to the hypotheses are needed to predict more accurately the conditions under which Outcome A occurred. Are there, for example, essential conditions that were not anticipated and that should be included in the revised hypotheses?

Consider an example from a recently published study (Wang et al., 2021 ). A team of researchers investigated the following research question: “How are students’ perceptions of their parents’ expectations related to students’ mathematics-related beliefs and their perceived mathematics achievement?” The researchers predicted that students’ perceptions of their parents’ expectations would be highly related to students’ mathematics-related beliefs and their perceived mathematics achievement. The rationale was based largely on prior research that had consistently found parents’ general educational expectations to be highly correlated with students’ achievement.

The findings showed that Chinese high school students’ perceptions of their parents’ educational expectations were positively related to these students’ mathematics-related beliefs. In other words, students who believed their parents expected them to attain higher levels of education had more desirable mathematics-related beliefs.

However, students’ perceptions of their parents’ expectations about mathematics achievement were not related to students’ mathematics-related beliefs in the same way as the more general parental educational expectations. Students who reported that their parents had no specific expectations possessed more desirable mathematics-related beliefs than all other subgroups. In addition, these students tended to perceive their mathematics achievement rank in their class to be higher on average than students who reported that their parents expressed some level of expectation for mathematics achievement.

Because this finding was not predicted, the researchers revised the original hypothesis. Their new prediction was that students who believe their parents have no specific mathematics achievement expectations possess more positive mathematics-related beliefs and higher perceived mathematics achievement than students who believe their parents do have specific expectations. They developed a revised rationale that drew on research on parental pressure and mathematics anxiety, positing that parents’ specific mathematics achievement expectations might increase their children’s sense of pressure and anxiety, thus fostering less positive mathematics-related beliefs. The team then conducted a follow-up study. Their findings aligned more closely with the new predictions and affirmed the better explanatory power of the revised rationale. The contributions of the study are found in this increased explanatory power—in the new understandings of this phenomenon contained in the revisions to the rationale.

Interpreting findings in order to revise hypotheses is not a straightforward task. Usually, the rationales blend multiple constructs or variables and predict multiple outcomes, with different outcomes connected to different research questions and addressed by different sets of data. Nevertheless, the contributions of your study depend on specifying the differences between your original hypotheses and your revised hypotheses. What can you explain now that you could not explain before?

We believe that revising hypotheses is an optimal response to any question of contributions because a researcher’s initial hypotheses plus the revisions suggested by the data are the most productive way to tie a study into the larger chain of research of which it is a part. Revised hypotheses represent growth in knowledge. Building on other researchers’ revised hypotheses and revising them further by more explicitly and precisely describing the conditions that are expected to influence the outcomes in the next study accumulates knowledge in a form that can be recorded, shared, built upon, and improved.

The significance of your study is presented in the opening sections of your evolving research paper whereas the contributions are presented in the final section, after the results. In fact, the central focus in this “Discussion” section should be a specification of the contributions (note, though, that this guidance may not fully align with the requirements of some journals).

Contributions Answer the Question of Generalizability

A common and often contentious, confusing issue that can befuddle novice and experienced researchers alike is the generalizability of results. All researchers prefer to believe the results they report apply to more than the sample of participants in their study. How important would a study be if the results applied only to, say, two fourth-grade classrooms in one school, or to the exact same tasks used as measures? How do you decide to which larger population (of students or tasks) your results could generalize? How can you state your claims so they are precisely those justified by the data?

To illustrate the challenge faced by researchers in answering these questions, we return to the JRME reviewers. We found that 30% of the reviews expressed concerns about the match between the results and the claims. For manuscripts that ultimately received a decision of Reject, the majority of reviewers said the authors had overreached—the claims were not supported by the data. In other words, authors generalized their claims beyond those that could be justified.

The Connection Between Contributions and Generalizability

In our view, claims about contributions can be examined productively alongside considerations of generalizability. To make the case for this view, we need to back up a bit. Recall that the purpose of research is to understand a phenomenon. To understand a phenomenon, you need to determine the conditions under which it occurs. Consequently, productive hypotheses specify the conditions under which the predictions hold and explain why and how these conditions make a difference. And the conditions set the parameters on generalizability. They identify when, where, and for whom the effect or situation will occur. So, hypotheses describe the extent of expected generalizability, and revised hypotheses that contain the contributions recalibrate generalizability and offer new predictions within these parameters.

An Example That Illustrates the Connection

In Chap. 4 , we introduced an example with a research question asking whether second graders improve their understanding of place value after a specially designed instructional intervention. We suggested asking a few second and third graders to complete your tasks to see if they generated the expected variation in performance. Suppose you completed this pilot study and now have satisfactory tasks. What conditions might influence the effect of the intervention? After careful study, you developed rationales that supported three conditions: the entry level of students’ understanding, the way in which the intervention is implemented, and the classroom norms that set expectations for students’ participation.

Suppose your original hypotheses predicted the desired effect of the intervention only if the students possessed an understanding of several concepts on which place value is built, only if the intervention was implemented with fidelity to the detailed instructional guidelines, and only if classroom norms encouraged students to participate in small-group work and whole-class discussions. Your claims of generalizability will apply to second-grade settings with these characteristics.

Now suppose you designed the study so the intervention occurred in five second-grade classrooms that agreed to participate. The pre-intervention assessment showed all students with the minimal level of entry understanding. The same well-trained teacher was employed to teach the intervention in all five classrooms, none of which included her own students. And you learned from prior observations and reports of the classroom teachers that three of the classrooms operated with the desired classroom norms, but two did not. Because of these conditions, your study is now designed to test one of your hypotheses—the desired effect will occur only if classroom norms encouraged students to participate in small-group work and whole-class discussions. This is the only condition that will vary; the other two (prior level of understanding and fidelity of implementation) are the same across classrooms so you will not learn how these affect the results.

Suppose the classrooms performed equally well on the post-intervention assessments. You expected lower performance in the two classrooms with less student participation, so you need to revise your hypotheses. The challenge is to explain the higher-than-expected performance of these students. Because you were interested in understanding the effects of this condition, you observed several lessons in all the classrooms during the intervention. You can now use this information to explain why the intervention worked equally well in classrooms with different norms.

Your revised hypothesis captures this part of your study’s contribution. You can now say more about the ways in which the intervention can help students improve their understanding of place value because you have different information about the role of classroom norms. This, in turn, allows you to specify more precisely the nature and extent of the generalizability of your findings. You now can generalize your findings to classrooms with different norms. However, because you did not learn more about the impact of students’ entry level understandings or of different kinds of implementation, the generalizability along these dimensions remains as limited as before.

This example is simplified. In many studies, the findings will be more complicated, and more conditions will likely be identified, some of which were anticipated and some of which emerged while conducting the study and analyzing the data. Nevertheless, the point is that generalizability should be tied to the conditions that are expected to affect the results. Further, unanticipated conditions almost always appear, so generalizations should be conservative and made with caution and humility. They are likely to change after testing the new predictions.

Contributions Are Assured When Hypotheses Are Significant and Methods Are Appropriate and Aligned

We have argued that the contributions of your study are produced by the revised hypotheses you can formulate based on your results. Will these revisions always represent contributions to the field? What if the revisions are minor? What if your results do not inform revisions to your hypotheses?

We will answer these questions briefly now and then develop them further in Part IV of this chapter. The answer to the primary question is “yes,” your revisions will always be a contribution to the field if (1) your hypotheses are significant and (2) you crafted appropriate methods to test the hypotheses. This is true even if your revisions are minor or if your data are not as informative as you expected. However, this is true only if you meet the two conditions in the earlier sentence. The first condition (significant hypotheses) can be satisfied by following the suggestions in the earlier section on significance. The second condition (appropriate methods) is addressed further in Part III in this chapter.

Implications

Before examining the role of methods in connecting significance with important contributions, we elaborate briefly our definition of “implications.” We reserve implications for the conclusions you can logically deduce from your findings that are not already presented as contributions. This means that, like contributions, implications are presented in the Discussion section of your research paper.

Many educational researchers present two types of implications: implications for future research and implications for practice. Although we are aware of this common usage, we believe our definition of “contributions” cover these implications. Clarifying why we call these “contributions” will explain why we largely reserve the word “implications” for recommendations regarding methods.

Implications for Future Research

Implications for future research often include (1) recommendations for empirical studies that would extend the findings of this study, (2) inferences about the usefulness of theoretical constructs, and (3) conclusions about the advisability of using particular kinds of methods. Given our earlier definitions, we prefer to label the first two types of implications as contributions.

Consider recommendations for empirical studies. After analyzing the data and presenting the results, we have suggested you compare the results with those predicted, revise the rationales for the original predictions to account for the results, and make new predictions based on the revised rationales. It is precisely these new predictions that can form the basis for recommending future research. Testing these new predictions is what would most productively extend this line of research. It can sometimes sound as if researchers are recommending future studies based on hunches about what research might yield useful findings. But researchers can do better than this. It would be more productive to base recommendations on a careful analysis of how the predictions of the original study could be sharpened and improved.

Now consider inferences about the usefulness of theoretical constructs. Our argument for labeling these inferences as contributions is similar. Rationales for predictions are where the relevant theoretical constructs are located. Revisions to these rationales based on the differences between the results and the predictions reveal the theoretical constructs that were affirmed to support accurate predictions and those that must be revised. In our view, usefulness is determined through this revision process.

Implications that do not come under our meaning of contributions are in the third type of implications, namely the appropriateness of methods for generating rich contributions. These kinds of implications are produced by your evaluation of your methods: research design, sampling procedures, tasks, data collection procedures, and data analyses. Although not always included in the discussion of findings, we believe it would be helpful for researchers to identify particular methods that were useful for conducting their study and those that should be modified or avoided. We believe these are appropriately called implications.

Implications for Practice

If the purpose of research is to better understand how to improve learning opportunities for all students, then it is appropriate to consider whether implications for improving educational practice can be drawn from the results of a study. How are these implications formulated? This is an important question because, in our view, these claims often come across as an afterthought, “Oh, I need to add some implications for practice.” But here is the sobering reality facing researchers: By any measure, the history of educational research shows that identifying these implications has had little positive effect on practice.

Perhaps the most challenging task for researchers who attempt to draw implications for practice is to interpret their findings for appropriate settings. A researcher who studied the instructional intervention for second graders on place value and found that average performance in the intervention classrooms improved more than in the textbook classrooms might be tempted to draw implications for practice. What should the researcher say? That second-grade teachers should adopt the intervention? Such an implication would be an overreach because, as we noted earlier, the findings cannot be generalized to all second-grade classrooms. Moreover, an improvement in average performance does not mean the intervention was better for all students.

The challenge is to identify the conditions under which the intervention would improve the learning opportunities for all students. Some of these conditions will be identified as the theoretical framework is built because the predictions need to account for these conditions. But some will be unforeseen, and some that are identified will not be informed by the findings. Recall that, in the study described earlier, a condition of entry level of understanding was hypothesized but the design of the study did not allow the researcher to draw any conclusions about its effect.

What can researchers say about implications for practice given the complexities involved in generalizing findings to other settings? We offer two recommendations. First, because it is difficult to specify all the conditions under which a phenomenon occurs, it is rarely appropriate to prescribe an educational practice. Researchers cannot anticipate the conditions under which individual teachers operate, conditions that often require adaptation of a suggested practice rather than implementation of a practice as prescribed.

Our second recommendation comes from returning to the purpose for educational research—to understand more fully how to improve learning opportunities for all students (or to achieve another goal of widely shared value). As we have described, understanding comes primarily from building and reevaluating rationales for your predictions. If you reach a new understanding related to improving learning opportunities, an understanding that could have practical implications, we recommend you share this understanding as an implication for practice.

For example, suppose the researcher who found better average performance of second graders after the intervention on place value had also studied several conditions under which performance improved. And suppose the researcher found that most students who did not improve their performance misunderstood a concept that appeared early in the intervention (e.g., the multiplicative relationship between positional values of a numeral). An implication for practice the researcher might share would be to describe the potential importance of understanding this concept early in the sequence of activities if teachers try out this intervention.

If you use our definitions, these implications for practice would be presented as contributions because they emerge directly from reevaluating and revising your rationales. We believe it is appropriate to use “Contributions” as the heading for this section in the Discussion section of your research paper. However, if editors prefer “Implications” we recommend following their suggestion.

We want to be clear that the terms you use for the different ways your study is important is not critical. We chose to define the terms significance, contributions, and implications in very specific and not universally shared ways to distinguish all the meanings of importance you should consider. Some of these can be established through your theoretical framework, some by the revisions of your hypotheses, and some by reflecting on the value of particular methods. The important thing, from our point of view, is that the ideas we defined for each of these terms are distinguished and recognized as specific ways of determining the importance of your study.

Part III. The Role of Methods in Determining Contributions

We have argued that every part of the study (and of the evolving research paper) should be aligned. All parts should be connected through a coherent chain of reasoning. In this chapter, we argue that the chain of reasoning is not complete until the methods are presented and the results are interpreted and discussed. The methods of the study create a bridge that connects the introductory material (research questions, theoretical framework, literature review, hypotheses) with the results and interpretations.

The role that methods play in scientific inquiry is to ensure that your hypotheses will be tested appropriately so the significance of your study will yield its potential contributions. To do this, the methods must do more than follow the standard guidelines and be technically correct (see Chap. 4 ). They must also fit with the surrounding parts of the study. We call this coherence.

Coherence Across the Phases of Scientific Inquiry

Coherence means the parts of a whole are fully aligned. When doing scientific inquiry, the early parts or phases should motivate the later phases. The methods you use should be motivated or explained by the earlier phases (e.g., research questions, theoretical framework, hypotheses). Your methods, in turn, should produce results that can be interpreted by comparing them with your predictions. Methods are aligned with earlier phases when you can use the rationales contained in your hypotheses to decide what kinds of data are needed to test your predictions, how best to gather these kinds of data, and what analyses should be performed (see Chap. 4 and Cai et al., 2019a ).

For a visual representation of this coherence, see Fig. 5.1 . Each box identifies an aspect of scientific inquiry. Hypotheses (shown in Box 1) include the rationales and predictions. Because the rationales encompass the theoretical framework and the literature review, Box 1 establishes the significance of the study. Box 2 represents the methods, which we defined in Chap. 4 as the entire set of procedures you will use, including the basic design, measures for collecting data, and analytic approaches. In Fig. 5.1 , the hypothesis in Box 1 points you to the methods you will use. That is, you will choose methods that provide data for analyses that will generate results or findings (Box 3) that allow you to make comparisons against your predictions. Based on those comparisons, you will revise your hypotheses and derive the contributions and implications of your study (Box 4).

The Chain of Coherence That Runs Through All Parts of a Research Study

We intend Fig. 5.1 to carry several messages. One is that coherence of a study and the associated research paper require all aspects of the study to flow from one into the other. Each set of prior entries must motivate and justify the next one. For example, the data and analyses you intend to gather and use in Box 2 (Methods) must be those that are motivated and explained by the research question and hypothesis (prediction and rationale) in Box 1.

A second message in the figure is that coherence includes Box 4, “Discussion.” Aligned with the first three boxes, the fourth box flows from these boxes but is also constrained by them. The contributions and implications authors describe in the Discussion section of the paper cannot go beyond what is allowed by the original hypotheses and the revisions to these hypotheses indicated by the findings.

Methods Enable Significance to Yield Contributions

We begin this section by identifying a third message conveyed in Fig. 5.1 . The methods of the study, represented by Box 2, provide a bridge that connects the significance of the study (Box 1) with the contributions of the study (Box 4). The results (Box 3) indicate the nature of the contributions by determining the revisions to the original hypotheses.

In our view, the connecting role played by the methods is often underappreciated. Crafting appropriate methods aligned with the significance of the study, on one hand, and the interpretations, on the other, can determine whether a study is judged to make a contribution.

If the hypotheses are established as significant, and if appropriate methods are used to test the predictions, the study will make important contributions even if the data are not statistically significant. We can say this another way. When researchers establish the significance of the hypotheses (i.e., convince readers they are of interest to the field) and use methods that provide a sound test of these hypotheses, the data they present will be of interest regardless of how they turn out. This is why Makel et al. ( 2021 ) endorse a review process for publication that emphasizes the significance of the study as presented in the first sections of a research paper.

Treating the methods as connecting the introductory arguments to the interpretations of data prevent researchers from making a common mistake: When writing the research paper, some researchers lose track of the research questions and/or the predictions. In other words, results are presented but are not interpreted as answers to the research questions or compared with the predictions. It is as if the introductory material of the paper begins one story, and the interpretations of results ends a different story. Lack of alignment makes it impossible to tell one coherent story.

A final point is that the alignment of a study cannot be evaluated and appreciated if the methods are not fully described. Methods must be described clearly and completely in the research paper so readers can see how they flow from the earlier phases of the study and how they yield the data presented. We suggested in Chap. 4 a rule of thumb for deciding whether the methods have been fully described: “Readers should be able to replicate the study if they wish.”

Part IV. Special Considerations that Affect a Study’s Contributions

We conclude Chap. 5 by addressing two additional issues that can affect how researchers interpret the results and make claims about the contributions of a study. Usually, researchers deal with these issues in the Discussion section of their research paper, but we believe it is useful to consider them as you plan and conduct your study. The issues can be posed as questions: How should I treat the limitations of my study? How should I deal with findings that are completely unexpected?

Limitations of a Study

We can identify two kinds of limitations: (1) limitations that constrain your ability to interpret your results because of unfortunate choices you made, and (2) limitations that constrain your ability to generalize your results because of missing variables you could not fit into the scope of your study or did not anticipate. We recommend different ways of dealing with these.

Limitations Due to Unfortunate Choices

All researchers make unfortunate choices. These are mistakes that could have been prevented. Often, they are choices in how a study was designed and/or executed. Maybe the sample did not have the characteristics assumed, or a task did not assess what was expected, or the intervention was not implemented as planned. Although many unfortunate choices can be prevented by thinking through the consequences of every decision or by conducting a well-designed pilot study or two, some will occur anyway. How should you deal with them?

The consequence of unfortunate choices is that the data do not test the hypotheses as precisely or completely as hoped. When this happens, the data must be interpreted with these constraints in mind. Almost always, this limits the researcher to making fewer or narrower claims than desired about differences and similarities between the results and the predictions. Usually this means conclusions about the ways in which the rationales must be revised require extra qualifications. In other words, claims about contributions of the study must be made with extra caution.

Research papers frequently include a subsection in the Discussion called “Limitations of the Study.” Researchers often use this subsection to identify the study’s limitations by describing the unfortunate choices, but they do not always spell out how these limitations should affect the contributions of the paper. Sometimes, it appears that researchers are simply checking off a requirement to identify the limitations by saying something like “The results should be interpreted with caution.” But this does not help readers understand exactly what cautions should be applied and it does not hold researchers accountable for the limitations.

We recommend something different. We suggest you do the hard work of figuring out how the data should be interpreted in light of the limitations and share these details with the readers. You might do this when the results are presented or when you interpret them. Rather than presenting your claims about the contributions of the study and then saying readers should interpret these with “caution” because of the study’s limitations, we suggest presenting only those interpretations and claims of contributions that can be made with the limitations in mind.

One way to think about the constraints you will likely need to impose on your interpretations is in terms of generalizability. Recall that earlier in this chapter, we described the close relationship between contributions and generalizability. When generalizability is restricted, so are contributions.

Limitations Due to Missing Variables

Because of the complexity of problems, questions, and hypotheses explored in educational research, researchers are unlikely to anticipate in their studies all the variables that affect the data and results. In addition, tradeoffs often must be made. Researchers cannot study everything at once, so decisions must be made about which variables to study carefully and which to either control or ignore.

In the earlier example of studying whether second graders improve their understanding of place value after a specially designed instructional intervention, the researcher identified three variables that were expected to influence the effect of the intervention: students’ entry level of understanding, implementation of the intervention, and norms of the classrooms in which the intervention was implemented. The researcher decided to control the implementation variable by hiring one experienced teacher to implement the intervention in all the classrooms. This meant the variable of individual teacher differences was not included in the study and the researcher could not generalize to classrooms with these differences.

Some researchers might see controlling the implementation of the intervention as a limitation. We do not. As a factor that is not allowed to vary, it constrains the generalizations a researcher can make, but we believe these kinds of controlled variables are better treated as opportunities for future research. Perhaps the researcher’s observations in the classroom provided information that could be used to make some predictions about which elements of the intervention are essential and which are optional—about which aspects of the intervention must be implemented as written and which can vary with different teachers. When revising the rationales to show what was learned in this study, the researcher could include rationales for new, tentative predictions about the effects of the intervention in classrooms where implementation differed in specified ways. These predictions create a genuine contribution of the study. If you use our definitions, these new predictions, often presented under “implications for future research,” would be presented as “contributions.”

Notice that if you follow our advice, you would not need to include a separate section in the Discussion of your paper labeled “Limitations.” We acknowledge, however, that some journal editors recommend such a subsection. In this case, we suggest you include this subsection along with treating the two different kinds of limitations as we recommend. You can do both.

Dealing with Unexpected Findings

Researchers are often faced with unexpected and perhaps surprising results, even when they have developed a convincing theoretical framework, posed research questions tightly connected to this framework, presented predictions about expected outcomes, and selected methods that appropriately test these predictions. Indeed, the unexpected findings can be the most interesting and valuable products of the study. They can range from mildly surprising to “Wow. I didn’t expect that.” How should researchers treat such findings? Our answer is based on two principles.

The first principle is that the value of research does not lie in whether the predictions are completely accurate but in helping the field learn more about the explanatory power of theoretical frameworks. That is, the value lies in the increased understanding of phenomena generated by examining the ability of theoretical frameworks (or rationales) to predict outcomes and explain results. The second principle, a corollary to the first, is to treat unexpected findings in a way that is most educative for the reader.

Based on our arguments to this point, you could guess we will say there will always be unexpected findings. Predicted answers to significant research questions in education will rarely, if ever, be entirely accurate. So, you can count on dealing with unexpected findings.

Consistent with the two principles above, your goal should be to use unexpected findings to understand more fully the phenomenon under investigation. We recommend one of three different paths. The choice of which path to take depends on what you decide after reflecting again on the decisions you made at each phase of the study.

The first path is appropriate when researchers reexamine their theoretical framework in light of the unexpected findings and decide that it is still a compelling framework based on previous work. They reason that readers are likely to have been convinced by this framework and would likely have made similar predictions. In this case, we believe that it is educative for researchers to (a) summarize their initial framework, (b) present the findings and distinguish those that were aligned with the predictions from those that were not, and (c) explain why the theoretical framework was inadequate and propose changes to the framework that would have created more alignment with the unexpected findings.

Revisions to initial hypotheses are especially useful if they include explanations for why a researcher might have been wrong (and researchers who ask significant questions in domains as complex as education are almost always wrong in some way). Depending on the ways in which the revised framework differs from the original, the authors have two options. If the revised framework is an expansion of the original, it would be appropriate for the authors to propose directions for future research that would extend this study. Alternatively, if the revised framework is still largely within the scope of the original study and consists of revisions to the original hypotheses, the revisions could guide a second study to check the adequacy of the revisions. This second study could be conducted by the same researchers (perhaps before the final manuscript is written and presented as two parts of the same report) or it could be proposed in the Discussion as a specific study that could be conducted by other researchers.

The second path is appropriate when researchers reexamine their theoretical framework in light of the unexpected findings and recognize serious flaws in the framework. The flaws could result from a number of factors, including defining elements of the framework in too general a way to formulate well-grounded hypotheses, failing to include a variable, or not accounting carefully enough for the previous work in this domain, both theoretical and empirical. In many of these cases, readers would not be well served by reading a poorly developed framework and then learning that the framework, which had not been convincing, did not accurately predict the results. Before scrapping the study and starting over, we suggest stepping back and reexamining the framework. Is it possible to develop a more coherent, complete, and convincing framework? Would this framework predict the results more accurately? If the findings remain unexpected based on the predictions generated by this revised, more compelling framework, then the first path applies.

It is likely that the new framework will better predict the findings. After all, the researchers now know the findings they will report. However, it is unlikely that the framework will accurately predict all the findings. This is because the framework is not built around the findings of this study of which authors are now aware (but have not yet been presented). Frameworks are built on research and theory already published. This means the redesigned framework is built from exactly the same empirical findings and theoretical arguments available before the study was conducted. The redesigned framework also is constrained by needing to justify exactly those methods used in the study. The redesigned framework cannot justify different methods or even slightly altered methods. The task for researchers is to show how the new theoretical framework necessarily generates, using the same methods, the predictions they present in the research paper. Just as before, it is unlikely this framework can account for all the findings. Just as before, after presenting the results the researchers should explain why they believe particular hypotheses were confirmed and why others should be revised, even in small ways, based on the findings reported. Researchers can now use these findings to revise the hypotheses presented in the paper. The point we are making is that we believe it is acceptable to reconstruct frameworks before writing research reports if doing so would be more educative for the reader.

Finally, the third path becomes appropriate when researchers, in reexamining their theoretical framework, trace the problem to a misalignment between the methods they used and the theoretical framework or the research questions. Perhaps the researchers recognize that the tasks they used did not yield data that could test the predictions and address the research questions. Or perhaps the researchers realize that the sample they selected would likely have been heavily influenced by a factor they failed to take into account. In other words, the researchers decide that the unexpected findings were due to a problem with the methods they used, not with the framework or the accompanying predictions. In this case, we recommend that the researchers correct the methodological problems and conduct the study again.

Part V. A Few Suggestions for Structuring Your Discussion Section

Writing the Discussion section of your research paper can be overwhelming given all our suggestions about what to include in this section. Here are a few tips that might help you create a simple template for this section.

We recommend the Discussion begin with a brief summary of the main results, especially those you will interpret in this section. This summary should not contain new data or results not previously presented in the paper.

The Discussion could then move to presenting the contributions in the ways we have described. To do this you could point out the ways in which the results differed from the predictions and suggest revisions to your rationales that would have better predicted the results. Doing this will show how the contributions of your study extend what is known beyond the research you drew on to build your original rationale. You can then propose how to extend your contributions to research by proposing future research studies that would test your new predictions. If you believe the revisions you make to your rationales produce new insights or understandings that could be helpful for educational practitioners, you can identify these contributions to practice as well. This comprises the bulk of the Discussion section.

If you have embedded the limitations in earlier sections of the paper, you will have presented your results and interpreted your findings constrained by these limitations. If you choose (or are asked) to describe limitations in the Discussion, you could identify the limitations and then point to the ways they affected your interpretations of the findings. Finally, the Discussion could conclude with the implications of the study for methodological choices that could improve research in the domain in which your study is located or how future studies could overcome the limitations you identified.

Because we are providing guidance on writing your research paper for publication, we will reiterate here that you should investigate the expectations and conventions of the journal to which you will submit your paper. Usually, it will be acceptable to use the terms “significance,” “contributions,” and “implications” as we have defined them. However, if the editors expect you to use the terms differently, follow the editors’ expectations. Our definitions in this chapter are meant to help you think clearly about the different ways you can make a case for the importance of your research. What matters is that you have carefully built and described a coherent chain of scientific inquiry that allows your study to translate the significance of your research problem into contributions to the field.

We began the chapter with the “So what?” question. The question looks simple and straightforward but is challenging and complicated. Its simple appearance can lead researchers to believe it should have a simple answer. But it almost never does. In this chapter, we tried to address the many complications that arise when answering the question. We hope you now have some new insights and new tools for answering the question in your next study.

Cai, J., Morris, A., Hohensee, C., Hwang, S., Robison, V., Cirillo, M., Kramer, S. L., & Hiebert, J. (2019a). Choosing and justifying robust methods for educational research. Journal for Research in Mathematics Education, 50 (4), 342–348. https://doi.org/10.5951/jresematheduc.50.2.0114

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Hiebert, J., Cai, J., Hwang, S., Morris, A.K., Hohensee, C. (2023). Significance of a Study: Revisiting the “So What” Question. In: Doing Research: A New Researcher’s Guide. Research in Mathematics Education. Springer, Cham. https://doi.org/10.1007/978-3-031-19078-0_5

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• Writing Tips

How to Discuss the Significance of Your Research

• 6-minute read
• 10th April 2023

Introduction

Research papers can be a real headache for college students . As a student, your research needs to be credible enough to support your thesis statement. You must also ensure you’ve discussed the literature review, findings, and results.

However, it’s also important to discuss the significance of your research . Your potential audience will care deeply about this. It will also help you conduct your research. By knowing the impact of your research, you’ll understand what important questions to answer.

If you’d like to know more about the impact of your research, read on! We’ll talk about why it’s important and how to discuss it in your paper.

What Is the Significance of Research?

This is the potential impact of your research on the field of study. It includes contributions from new knowledge from the research and those who would benefit from it. You should present this before conducting research, so you need to be aware of current issues associated with the thesis before discussing the significance of the research.

Why Does the Significance of Research Matter?

Potential readers need to know why your research is worth pursuing. Discussing the significance of research answers the following questions:

●  Why should people read your research paper ?

●  How will your research contribute to the current knowledge related to your topic?

●  What potential impact will it have on the community and professionals in the field?

Not including the significance of research in your paper would be like a knight trying to fight a dragon without weapons.

Where Do I Discuss the Significance of Research in My Paper?

As previously mentioned, the significance of research comes before you conduct it. Therefore, you should discuss the significance of your research in the Introduction section. Your reader should know the problem statement and hypothesis beforehand.

Steps to Discussing the Significance of Your Research

Discussing the significance of research might seem like a loaded question, so we’ve outlined some steps to help you tackle it.

Step 1: The Research Problem

The problem statement can reveal clues about the outcome of your research. Your research should provide answers to the problem, which is beneficial to all those concerned. For example, imagine the problem statement is, “To what extent do elementary and high school teachers believe cyberbullying affects student performance?”

Learning teachers’ opinions on the effects of cyberbullying on student performance could result in the following:

●  Increased public awareness of cyberbullying in elementary and high schools

●  Teachers’ perceptions of cyberbullying negatively affecting student performance

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●  Whether cyberbullying is more prevalent in elementary or high schools

The research problem will steer your research in the right direction, so it’s best to start with the problem statement.

Step 2: Existing Literature in the Field

Think about current information on your topic, and then find out what information is missing. Are there any areas that haven’t been explored? Your research should add new information to the literature, so be sure to state this in your discussion. You’ll need to know the current literature on your topic anyway, as this is part of your literature review section .

Step 3: Your Research’s Impact on Society

Inform your readers about the impact on society your research could have on it. For example, in the study about teachers’ opinions on cyberbullying, you could mention that your research will educate the community about teachers’ perceptions of cyberbullying as it affects student performance. As a result, the community will know how many teachers believe cyberbullying affects student performance.

You can also mention specific individuals and institutions that would benefit from your study. In the example of cyberbullying, you might indicate that school principals and superintendents would benefit from your research.

Step 4: Future Studies in the Field

Next, discuss how the significance of your research will benefit future studies, which is especially helpful for future researchers in your field. In the example of cyberbullying affecting student performance, your research could provide further opportunities to assess teacher perceptions of cyberbullying and its effects on students from larger populations. This prepares future researchers for data collection and analysis.

Discussing the significance of your research may sound daunting when you haven’t conducted it yet. However, an audience might not read your paper if they don’t know the significance of the research. By focusing on the problem statement and the research benefits to society and future studies, you can convince your audience of the value of your research.

Remember that everything you write doesn’t have to be set in stone. You can go back and tweak the significance of your research after conducting it. At first, you might only include general contributions of your study, but as you research, your contributions will become more specific.

You should have a solid understanding of your topic in general, its associated problems, and the literature review before tackling the significance of your research. However, you’re not trying to prove your thesis statement at this point. The significance of research just convinces the audience that your study is worth reading.

Finally, we always recommend seeking help from your research advisor whenever you’re struggling with ideas. For a more visual idea of how to discuss the significance of your research, we suggest checking out this video .

1. Do I need to do my research before discussing its significance?

No, you’re discussing the significance of your research before you conduct it. However, you should be knowledgeable about your topic and the related literature.

2. Is the significance of research the same as its implications?

No, the research implications are potential questions from your study that justify further exploration, which comes after conducting the research.

 3. Discussing the significance of research seems overwhelming. Where should I start?

We recommend the problem statement as a starting point, which reveals clues to the potential outcome of your research.

4. How can I get feedback on my discussion of the significance of my research?

Our proofreading experts can help. They’ll check your writing for grammar, punctuation errors, spelling, and concision. Submit a 500-word document for free today!

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Home » Background of The Study – Examples and Writing Guide

Background of The Study – Examples and Writing Guide

Table of Contents

Background of The Study

Definition:

Background of the study refers to the context, circumstances, and history that led to the research problem or topic being studied. It provides the reader with a comprehensive understanding of the subject matter and the significance of the study.

The background of the study usually includes a discussion of the relevant literature, the gap in knowledge or understanding, and the research questions or hypotheses to be addressed. It also highlights the importance of the research topic and its potential contributions to the field. A well-written background of the study sets the stage for the research and helps the reader to appreciate the need for the study and its potential significance.

How to Write Background of The Study

Here are some steps to help you write the background of the study:

Identify the Research Problem

Start by identifying the research problem you are trying to address. This problem should be significant and relevant to your field of study.

Provide Context

Once you have identified the research problem, provide some context. This could include the historical, social, or political context of the problem.

Review Literature

Conduct a thorough review of the existing literature on the topic. This will help you understand what has been studied and what gaps exist in the current research.

Identify Research Gap

Based on your literature review, identify the gap in knowledge or understanding that your research aims to address. This gap will be the focus of your research question or hypothesis.

State Objectives

Clearly state the objectives of your research . These should be specific, measurable, achievable, relevant, and time-bound (SMART).

Discuss Significance

Explain the significance of your research. This could include its potential impact on theory , practice, policy, or society.

Finally, summarize the key points of the background of the study. This will help the reader understand the research problem, its context, and its significance.

How to Write Background of The Study in Proposal

The background of the study is an essential part of any proposal as it sets the stage for the research project and provides the context and justification for why the research is needed. Here are the steps to write a compelling background of the study in your proposal:

• Identify the problem: Clearly state the research problem or gap in the current knowledge that you intend to address through your research.
• Provide context: Provide a brief overview of the research area and highlight its significance in the field.
• Review literature: Summarize the relevant literature related to the research problem and provide a critical evaluation of the current state of knowledge.
• Identify gaps : Identify the gaps or limitations in the existing literature and explain how your research will contribute to filling these gaps.
• Justify the study : Explain why your research is important and what practical or theoretical contributions it can make to the field.
• Highlight objectives: Clearly state the objectives of the study and how they relate to the research problem.
• Discuss methodology: Provide an overview of the methodology you will use to collect and analyze data, and explain why it is appropriate for the research problem.
• Conclude : Summarize the key points of the background of the study and explain how they support your research proposal.

How to Write Background of The Study In Thesis

The background of the study is a critical component of a thesis as it provides context for the research problem, rationale for conducting the study, and the significance of the research. Here are some steps to help you write a strong background of the study:

• Identify the research problem : Start by identifying the research problem that your thesis is addressing. What is the issue that you are trying to solve or explore? Be specific and concise in your problem statement.
• Review the literature: Conduct a thorough review of the relevant literature on the topic. This should include scholarly articles, books, and other sources that are directly related to your research question.
• I dentify gaps in the literature: After reviewing the literature, identify any gaps in the existing research. What questions remain unanswered? What areas have not been explored? This will help you to establish the need for your research.
• Establish the significance of the research: Clearly state the significance of your research. Why is it important to address this research problem? What are the potential implications of your research? How will it contribute to the field?
• Provide an overview of the research design: Provide an overview of the research design and methodology that you will be using in your study. This should include a brief explanation of the research approach, data collection methods, and data analysis techniques.
• State the research objectives and research questions: Clearly state the research objectives and research questions that your study aims to answer. These should be specific, measurable, achievable, relevant, and time-bound.
• Summarize the chapter: Summarize the chapter by highlighting the key points and linking them back to the research problem, significance of the study, and research questions.

How to Write Background of The Study in Research Paper

Here are the steps to write the background of the study in a research paper:

• Identify the research problem: Start by identifying the research problem that your study aims to address. This can be a particular issue, a gap in the literature, or a need for further investigation.
• Conduct a literature review: Conduct a thorough literature review to gather information on the topic, identify existing studies, and understand the current state of research. This will help you identify the gap in the literature that your study aims to fill.
• Explain the significance of the study: Explain why your study is important and why it is necessary. This can include the potential impact on the field, the importance to society, or the need to address a particular issue.
• Provide context: Provide context for the research problem by discussing the broader social, economic, or political context that the study is situated in. This can help the reader understand the relevance of the study and its potential implications.
• State the research questions and objectives: State the research questions and objectives that your study aims to address. This will help the reader understand the scope of the study and its purpose.
• Summarize the methodology : Briefly summarize the methodology you used to conduct the study, including the data collection and analysis methods. This can help the reader understand how the study was conducted and its reliability.

Examples of Background of The Study

Here are some examples of the background of the study:

Problem : The prevalence of obesity among children in the United States has reached alarming levels, with nearly one in five children classified as obese.

Significance : Obesity in childhood is associated with numerous negative health outcomes, including increased risk of type 2 diabetes, cardiovascular disease, and certain cancers.

Gap in knowledge : Despite efforts to address the obesity epidemic, rates continue to rise. There is a need for effective interventions that target the unique needs of children and their families.

Problem : The use of antibiotics in agriculture has contributed to the development of antibiotic-resistant bacteria, which poses a significant threat to human health.

Significance : Antibiotic-resistant infections are responsible for thousands of deaths each year and are a major public health concern.

Gap in knowledge: While there is a growing body of research on the use of antibiotics in agriculture, there is still much to be learned about the mechanisms of resistance and the most effective strategies for reducing antibiotic use.

Edxample 3:

Problem : Many low-income communities lack access to healthy food options, leading to high rates of food insecurity and diet-related diseases.

Significance : Poor nutrition is a major contributor to chronic diseases such as obesity, type 2 diabetes, and cardiovascular disease.

Gap in knowledge : While there have been efforts to address food insecurity, there is a need for more research on the barriers to accessing healthy food in low-income communities and effective strategies for increasing access.

Examples of Background of The Study In Research

Here are some real-life examples of how the background of the study can be written in different fields of study:

Example 1 : “There has been a significant increase in the incidence of diabetes in recent years. This has led to an increased demand for effective diabetes management strategies. The purpose of this study is to evaluate the effectiveness of a new diabetes management program in improving patient outcomes.”

Example 2 : “The use of social media has become increasingly prevalent in modern society. Despite its popularity, little is known about the effects of social media use on mental health. This study aims to investigate the relationship between social media use and mental health in young adults.”

Example 3: “Despite significant advancements in cancer treatment, the survival rate for patients with pancreatic cancer remains low. The purpose of this study is to identify potential biomarkers that can be used to improve early detection and treatment of pancreatic cancer.”

Examples of Background of The Study in Proposal

Here are some real-time examples of the background of the study in a proposal:

Example 1 : The prevalence of mental health issues among university students has been increasing over the past decade. This study aims to investigate the causes and impacts of mental health issues on academic performance and wellbeing.

Example 2 : Climate change is a global issue that has significant implications for agriculture in developing countries. This study aims to examine the adaptive capacity of smallholder farmers to climate change and identify effective strategies to enhance their resilience.

Example 3 : The use of social media in political campaigns has become increasingly common in recent years. This study aims to analyze the effectiveness of social media campaigns in mobilizing young voters and influencing their voting behavior.

Example 4 : Employee turnover is a major challenge for organizations, especially in the service sector. This study aims to identify the key factors that influence employee turnover in the hospitality industry and explore effective strategies for reducing turnover rates.

Examples of Background of The Study in Thesis

Here are some real-time examples of the background of the study in the thesis:

Example 1 : “Women’s participation in the workforce has increased significantly over the past few decades. However, women continue to be underrepresented in leadership positions, particularly in male-dominated industries such as technology. This study aims to examine the factors that contribute to the underrepresentation of women in leadership roles in the technology industry, with a focus on organizational culture and gender bias.”

Example 2 : “Mental health is a critical component of overall health and well-being. Despite increased awareness of the importance of mental health, there are still significant gaps in access to mental health services, particularly in low-income and rural communities. This study aims to evaluate the effectiveness of a community-based mental health intervention in improving mental health outcomes in underserved populations.”

Example 3: “The use of technology in education has become increasingly widespread, with many schools adopting online learning platforms and digital resources. However, there is limited research on the impact of technology on student learning outcomes and engagement. This study aims to explore the relationship between technology use and academic achievement among middle school students, as well as the factors that mediate this relationship.”

Examples of Background of The Study in Research Paper

Here are some examples of how the background of the study can be written in various fields:

Example 1: The prevalence of obesity has been on the rise globally, with the World Health Organization reporting that approximately 650 million adults were obese in 2016. Obesity is a major risk factor for several chronic diseases such as diabetes, cardiovascular diseases, and cancer. In recent years, several interventions have been proposed to address this issue, including lifestyle changes, pharmacotherapy, and bariatric surgery. However, there is a lack of consensus on the most effective intervention for obesity management. This study aims to investigate the efficacy of different interventions for obesity management and identify the most effective one.

Example 2: Antibiotic resistance has become a major public health threat worldwide. Infections caused by antibiotic-resistant bacteria are associated with longer hospital stays, higher healthcare costs, and increased mortality. The inappropriate use of antibiotics is one of the main factors contributing to the development of antibiotic resistance. Despite numerous efforts to promote the rational use of antibiotics, studies have shown that many healthcare providers continue to prescribe antibiotics inappropriately. This study aims to explore the factors influencing healthcare providers’ prescribing behavior and identify strategies to improve antibiotic prescribing practices.

Example 3: Social media has become an integral part of modern communication, with millions of people worldwide using platforms such as Facebook, Twitter, and Instagram. Social media has several advantages, including facilitating communication, connecting people, and disseminating information. However, social media use has also been associated with several negative outcomes, including cyberbullying, addiction, and mental health problems. This study aims to investigate the impact of social media use on mental health and identify the factors that mediate this relationship.

Purpose of Background of The Study

The primary purpose of the background of the study is to help the reader understand the rationale for the research by presenting the historical, theoretical, and empirical background of the problem.

More specifically, the background of the study aims to:

• Provide a clear understanding of the research problem and its context.
• Identify the gap in knowledge that the study intends to fill.
• Establish the significance of the research problem and its potential contribution to the field.
• Highlight the key concepts, theories, and research findings related to the problem.
• Provide a rationale for the research questions or hypotheses and the research design.
• Identify the limitations and scope of the study.

When to Write Background of The Study

The background of the study should be written early on in the research process, ideally before the research design is finalized and data collection begins. This allows the researcher to clearly articulate the rationale for the study and establish a strong foundation for the research.

The background of the study typically comes after the introduction but before the literature review section. It should provide an overview of the research problem and its context, and also introduce the key concepts, theories, and research findings related to the problem.

Writing the background of the study early on in the research process also helps to identify potential gaps in knowledge and areas for further investigation, which can guide the development of the research questions or hypotheses and the research design. By establishing the significance of the research problem and its potential contribution to the field, the background of the study can also help to justify the research and secure funding or support from stakeholders.

Advantage of Background of The Study

The background of the study has several advantages, including:

• Provides context: The background of the study provides context for the research problem by highlighting the historical, theoretical, and empirical background of the problem. This allows the reader to understand the research problem in its broader context and appreciate its significance.
• Identifies gaps in knowledge: By reviewing the existing literature related to the research problem, the background of the study can identify gaps in knowledge that the study intends to fill. This helps to establish the novelty and originality of the research and its potential contribution to the field.
• Justifies the research : The background of the study helps to justify the research by demonstrating its significance and potential impact. This can be useful in securing funding or support for the research.
• Guides the research design: The background of the study can guide the development of the research questions or hypotheses and the research design by identifying key concepts, theories, and research findings related to the problem. This ensures that the research is grounded in existing knowledge and is designed to address the research problem effectively.
• Establishes credibility: By demonstrating the researcher’s knowledge of the field and the research problem, the background of the study can establish the researcher’s credibility and expertise, which can enhance the trustworthiness and validity of the research.

Disadvantages of Background of The Study

Some Disadvantages of Background of The Study are as follows:

• Time-consuming : Writing a comprehensive background of the study can be time-consuming, especially if the research problem is complex and multifaceted. This can delay the research process and impact the timeline for completing the study.
• Repetitive: The background of the study can sometimes be repetitive, as it often involves summarizing existing research and theories related to the research problem. This can be tedious for the reader and may make the section less engaging.
• Limitations of existing research: The background of the study can reveal the limitations of existing research related to the problem. This can create challenges for the researcher in developing research questions or hypotheses that address the gaps in knowledge identified in the background of the study.
• Bias : The researcher’s biases and perspectives can influence the content and tone of the background of the study. This can impact the reader’s perception of the research problem and may influence the validity of the research.
• Accessibility: Accessing and reviewing the literature related to the research problem can be challenging, especially if the researcher does not have access to a comprehensive database or if the literature is not available in the researcher’s language. This can limit the depth and scope of the background of the study.

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The significance of a study is its importance . It refers to the contribution(s) to and impact of the study on a research field. The significance also signals who benefits from the research findings and how.

Purpose of writing the significance of a study

A study’s significance should spark the interest of the reader. Researchers will be able to appreciate your work better when they understand the relevance and its (potential) impact. Peer reviewers also assess the significance of the work, which will influence the decision made (acceptance/rejection) on the manuscript. 

Sections in which the significance of the study is written

Introduction.

In the Introduction of your paper, the significance appears where you talk about the potential importance and impact of the study. It should flow naturally from the problem , aims and objectives, and rationale .

The significance is described in more detail in the concluding paragraph(s) of the Discussion or the dedicated Conclusions section. Here, you put the findings into perspective and outline the contributions of the findings in terms of implications and applications.

The significance may or may not appear in the abstract . When it does, it is written in the concluding lines of the abstract.

Significance vs. other introductory elements of your paper

In the Introduction…

• The problem statement outlines the concern that needs to be addressed.
• The research aim describes the purpose of the study.
• The objectives indicate how that aim will be achieved.
• The rationale explains why you are performing the study.
• The significance tells the reader how the findings affect the topic/broad field. In other words, the significance is about how much the findings matter.

How to write the significance of the study

A good significance statement may be written in different ways. The approach to writing it also depends on the study area. In the arts and humanities , the significance statement might be longer and more descriptive. In applied sciences , it might be more direct.

a. Suggested sequence for writing the significance statement

• Think of the gaps your study is setting out to address.
• Look at your research from general and specific angles in terms of its (potential) contribution .
• Once you have these points ready, start writing them, connecting them to your study as a whole.

b. Some ways to begin your statement(s) of significance

Here are some opening lines to build on:

• The particular significance of this study lies in the… 
• We argue that this study moves the field forward because…
• This study makes some important contributions to…
• Our findings deepen the current understanding about…

c. Don’ts of writing a significance statement

• Don’t make it too long .
• Don’t repeat any information that has been presented in other sections.
• Don’t overstate or exaggerat e the importance; it should match your actual findings.

Example of significance of a study

Note the significance statements highlighted in the following fictional study.

Significance in the Introduction

The effects of Miyawaki forests on local biodiversity in urban housing complexes remain poorly understood. No formal studies on negative impacts on insect activity, populations or diversity have been undertaken thus far. In this study, we compared the effects that Miyawaki forests in urban dwellings have on local pollinator activity. The findings of this study will help improve the design of this afforestation technique in a way that balances local fauna, particularly pollinators, which are highly sensitive to microclimatic changes.

Significance in the Conclusion

[…] The findings provide valuable insights for guiding and informing Miyawaki afforestation in urban dwellings. We demonstrate that urban planning and landscaping policies need to consider potential declines.

A study’s significance usually appears at the end of the Introduction and in the Conclusion to describe the importance of the research findings. A strong and clear significance statement will pique the interest of readers, as well as that of relevant stakeholders.

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Home » Feature » Thesis » Significance of the Study Samples | Writing Tips

Significance of the Study Samples | Writing Tips

When you write a thesis , there is a section there that is allocated for the significance of the study. This article will provide different  significance of the study examples and will discuss tips on how to write this part.

Tips in Writing the Significance of the Study

Here are the tips that may be helpful when writing the significance of the study. These tips will tell you the basic components expected to be seen in the significance of the study content.

1. Refer to the Problem Statement

In writing the significance of the study, always refer to the statement of the problem. This way, you can clearly define the contribution of your study. To simplify, your research should answer this question, “What are the benefits or advantages of the study based on the statement of the problem?”

Start by explaining the problem that your study aimed to solve. For example, if you conducted a research study on obesity rates among elementary school students, you would start by explaining that obesity is a major health concern in the Philippines and discuss why it is important to find ways to address this issue.

2. Write it from General to Particular

Determine the specific contribution of your thesis study to society as well as to the individual. Write it deductively, starting from general to specific. Start your significance of the study broadly then narrow it out to a specific group or person. This is done by looking into the general contribution of your study, such as its importance to society as a whole, then moving towards its contribution to individuals like yourself as a researcher.

Discuss how your study fills a gap in the literature. If you conducted an experiment on the effects of a certain type of food on children, for example, you might start by explaining that no research has been done on this topic before. This section would also include a discussion about why your study is important.

Your problem statement might help you determine the unique contribution of your research. This can be accomplished by ensuring that the aim of the problem and the study’s objectives are identical. For instance, if your research question is “Is there a significant relationship between the use of Facebook Messenger and the performance of students in English spelling? “, you could write as one of the contributions of your study: “The study will identify common errors in spelling and grammar by Messenger users and recommend its appropriate use in a way that can improve performance in spelling.”

You may also read: How to Make a Conceptual Framework

Significance of the Study Samples

Here are some examples to help you draft your own introduction:

Title: Number of Clinical Internship Hours: A Determinant of Student’s Effectiveness and Skill  Acquisition in the Hospital Area for Velez College Students

Significance of the study.

The results of the study will be of great benefit to the following:

College of Nursing Dean . Data given will provide the dean with information on how the number of duty hours in a week affects the student’s academic and RLE performance. The results will enable the dean to improve the scheduling of RLE and different academic subjects. Data gathered will help the dean initiate collaboration among faculty and chairpersons to help plan the advancement of nursing education in relation to the new curriculum.

Clinical Instructors . The results of the study will help the clinical instructors evaluate the quality of care rendered by the nursing students, academic performance, attitude and skills acquired in relation to the number of hours given in a week. Results would also develop the clinical instructor’s teaching-learning and evaluating strategies in enhancing knowledge, skills and attitude to the students in the time frame given.

Students . This study will provide information regarding which time arrangement is effective: 8-hr of clinical internship from the 5-hr clinical internship with additional academic classes. This study will evaluate the academic performance, the student nurse’s attitude and approach, the skills learned in the clinical area, and the quality of care rendered in the given time frame. Data gathered will also help the students improve both academic and clinical performance.

Velez College . This study will improve the school in the development of nursing education. This study will foster new ways of enhancing knowledge, skills, and attitude, thus preparing globally-competitive nurses in the future. This study will also help in the advancement of school management, clinical leadership, and the teaching-evaluation approach.

Title: The Effectiveness of Isuzu’s Blue Power Technology in Fuel Efficiency of Diesel Engines

The generalization of this study would be a great contribution to the vast knowledge in relation to the brand awareness of Isuzu’s Blue Power Euro 4 Technology. Furthermore, the results of this investigation could be highly significant and beneficial for the following:

Current Customers

They refer to consumers that have already bought products from Isuzu. They are considered to be the main beneficiaries of the business. The findings of this study would provide them with adequate information about the product, most especially for those clients that have already bought units with the Blue Power Euro 4 Technology but have no idea of its benefits and advantages.

Potential Customer

They are the consumers that have not yet purchased this brand. This study aims to give them insights and overviews of the product and would help them choose the right variant to purchase.

They are the main beneficiaries of this study, which may help them to improve their marketing strategies. It would provide substantial data to the business that they could make use of in boosting their sales. Moreover, developing brand awareness will cater to more demands and loyalty in the future.

For they also play a vital role in the business and as consumers. This research would give them the idea that such private vehicles exist, which helps them to conserve energy rather than exploit it. Hence, giving back to the community and making it a better place to live.

Proponents of the Study

This refers to the students conducting the study. They will find self-fulfillment and gain knowledge and skills in this study. This study will help and inspire more researchers to be more innovative and creative in their future endeavors.

Future Researchers

This study will serve as a reference for researchers on the subject of research in the field of marketing. This will serve as a guide to further developing the research with the connection to the variables used.

The significance of a study is a key component of a strong scientific paper. By following these tips, you can create a clear and concise explanation of the importance of your work. I hope that these tips and samples will help you create a perfect Significance of the Study for your thesis. Apply these tips to prevent your mind from wandering aimlessly as you draft the significance of the study. It will allow you to focus on the next section of your thesis, helping you finish it on time. Good luck!

good and interesting

thanks for information

Very useful. Thanks

Thank you for a very informative article

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The importance of crafting a good introduction to scholarly research: strategies for creating an effective and impactful opening statement

Mohsen tavakol.

1 Medical Education Centre, School of Medicine, The University of Nottingham, UK

David O'Brien

Introduction.

The introduction section is arguably one of the most critical elements of a written piece of research work, often setting the tone for the remainder of any dissertation or research article. The primary purpose of an introduction is to provide the reader with a clear understanding of the research question, in addition to the scope, rationale, aims and objectives of the study. This ensures the reader can more easily comprehend the context of the research, which will consequently help them better interpret and evaluate the study results. One could liken an introduction to a trailer for a movie, where the plot of the film (the research topic) is introduced by setting the scene (outlining the significance of the topic) and enticing you to watch the full movie (understanding the research and its importance).

Despite this, our experience suggests that students frequently pay insufficient attention to the introduction section of their dissertation or omit elements which we consider essential to address. This editorial aims to help researchers appreciate the importance of a comprehensive dissertation introduction in medical education research and learn how to effectively manage this key section of their work.  Although it focuses purely on the introduction section of a written research submission, readers interested in learning more about the other primary steps of the research process are encouraged to read AMEE Guide No. 90 1 , 2 textbooks on research methods and both consult and seek constructive feedback from colleagues with expertise in research methods and writing for publication.

Here we aim to provide the reader with a simple structure of how best to construct the introduction for a dissertation and recommend that this should typically include the following essential components and principles.

Background to the research topic

The purpose of providing background information in an introduction is to supply the context and other essential information concerning the research topic, and thus allow the reader to understand the significance of the specific research question and where it sits within the broader field of study. This aids the reader to better understand how the research question contributes to the existing body of knowledge and why it is, necessary to investigate this specific aspect further. For example, suppose the study concerns the effectiveness of simulation-based training in medical education. In this case, the broader field of the study may include relevant areas such as medical simulation, medical education research, health care education, standardised patients, simulation-based training, and curriculum development based on simulation training. After providing the reader with an understanding of the context and relevance of the topic of interest, the researcher must then establish a theoretical or conceptual framework. This underpins the study topic in order that the reader can understand how any research questions and objectives are formulated. It is important to distinguish between these two frameworks. A theoretical framework describes the rationale for applying a particular theory to provide support and structure for the topic being studied. In the absence of an applicable theory, a conceptual framework substantiates the significance of a particular problem, context or phenomenon within a specific area of the study by illustrating its relevance and connection to research topic. 3 A conceptual framework highlights the importance of a research topic by showing how it relates to the larger body of knowledge in a particular field. Here is an example to demonstrate the use of a theoretical framework in a research context.

When considering Social Cognitive Theory (SCT), one of the key constructs is self-efficacy, as described by Albert Bandura, 4 and refers to the belief that a person has it within their own ability to accomplish a specific task successfully. This is not related to what a person does, but more how they perceive their ability to use these skills. So, based on this construct of self-efficacy, a researcher may formulate a research hypothesis; that examiners with higher self-efficacy in OSCEs will demonstrate improved performance in subsequent exams compared to those with lower self-efficacy. Now the researcher is in a position to identify the fundamental concepts of the research, i.e., self-efficacy (personal factors), examiner performance (behavioural factors) and examination conditions and examiner scaffolding support (environmental factors). Identifying key concepts helps the researcher find the relationship between these, and develop appropriate research questions, e.g., 1) How does an examiner's self-efficacy in OSCEs affect their ability to assess students in subsequent exams? 2) How does the support provided to examiners and exam conditions influence the link between self-efficacy and examiner performance in OSCEs? 3) Do examiners with high self-efficacy provide fairer scores than those with low self-efficacy in OSCEs? By having a theoretical framework, researchers can establish a foundation for their research and provide a clear picture of the relationship between the key concepts involved in the study. Researchers must also provide any conceptual and operational definitions for key concepts or variables that will be used in the study. Clearly defining key concepts and variables in the background section of a dissertation can also help establish the significance of the research question and its relevance to the broader field of study. As the name implies, a conceptual definition refers to a variable's meaning in a conceptual, abstract, or theoretical sense. Conceptual definitions are often used to describe concepts which cannot be directly measured, such as active learning, rote learning, inter-professional learning, inter-professional education, or constructs such as clinical performance. Conversely, operational definitions define the steps researchers must take in order to collect data to measure a phenomenon or concept. 5 For example, clinical performance can be considered a conceptual construct but may also be defined operationally as the ability of students to pass 12 out of 16 stations of an OSCE. The researcher having already pre-specified specific the criteria for classifying students as pass/fail in order to determine the ability of students to perform clinically. This operational definition provides a clear method for evaluating and measuring student ability, which can then be used to give feedback and guide further learning or to establish clear expectations for students and provide a basis for evaluating and assessing their performance. In general, it can be beneficial for medical education programs to define aspects such as clinical performance operationally in this way in rather than conceptually, especially if there is a need to ensure that students meet a required standard of competence and are prepared for the demands of real-world clinical practice. These definitions can also then be used to establish the methods and criteria by which the variables of the study will subsequently be measured or altered.

Citing the existing literature to support the research aim

A literature review is the process of critically evaluating existing research and utilising it to inform and guide the research proposal under investigation. Taking this approach enables researchers to ensure that their research is not only grounded in, but also contributes meaningfully to, any existing knowledge as a whole. Critically reviewing the literature provides evidence and justification for any research and is essential when formulating a hypothesis, question, or study objectives. In addition, and perhaps most importantly, it helps identify any gaps or inconsistencies in the existing knowledge base. Determining the knowledge gap is critical in justifying the necessity for our research and advancing knowledge. A comprehensive literature review also helps establish the theoretical or conceptual frameworks to ground any subsequent research, providing researchers with guidance and direction on how best to conduct their future studies. Understanding from the literature what has worked previously and what may pose challenges or limitations assists researchers when exploring the best methods and techniques for answering new research questions. To clarify, consider a hypothetical study in which researchers wish to examine the effectiveness of a specific educational intervention in medical students to improve patient safety. Based on the existing literature, let's assume that researchers learned that most studies had only focused on short-term outcomes rather than long-term ones. The long-term effects of any intervention in medical students on patient safety therefore remain uncertain. Researchers may therefore wish to consider conducting longitudinal studies months after interventions have been carried out, rather than simply repeating research based on short-term outcomes, in order to address the current knowledge gap. A review of existing literature may highlight hitherto previously unconsidered logistical difficulties in conducting longitudinal studies in this area that the researcher may need to be aware of.

Stating the significance of the research

More than simply reporting the existing research, one of the key objectives in any literature review is to summarise and synthesise existing research on the intended topic in order to analyse the significance of the research in question. In this process, diverse ideas can be merged to form fresh new perspectives. Any gaps, limitations, or controversies in medical education can be identified, and potential future benefits and implications of the proposed research explained to the reader. Based on any potential impact or perceived importance, the introduction provides an excellent opportunity for the researcher to affirm the significance of the research study and why it should be conducted.

By way of an example, the significance of a study concerning feedback given to examiners for Objective Structured Clinical Examinations (OSCEs) is used to illustrate this point further. The potential significance of this research lies in improving the validity and reliability of OSCE scores in medical education. As a result of reviewing different types of feedback given to examiners, the research may assist in identifying the most effective strategies for improving the quality of OSCEs in medical education. By providing new insights into how feedback can improve the reliability and validity of OSCE results, the research could also contribute to the broader knowledge of assessment in general. This may result in the development of more accurate and robust medical education assessments, which in turn may potentially enhance delivery of healthcare and improve patient outcomes and safety. It may also address the current challenges and gaps in medical education assessment by providing evidence-based approaches for improving OSCE quality.

Formulating Research Questions and Objectives

Researchers formulate research questions and objectives based on the topic they are seeking to address. As noted previously, these will have already been derived as a result of a comprehensive literature review of any existing knowledge and based on a theoretical or conceptual framework. Furthermore, in medical education, the literature review provides researchers with the opportunity to formulate new research questions or research objectives to address any gaps or limitations in the existing literature and add something new to the current body of knowledge. Research questions and objectives should be stated clearly, being both specific, and measurable. These should then guide the subsequent selection of appropriate research methods, data collection and any subsequent analytical process. Clear, focused, and rigorous research questions and objectives will ensure the study is well-designed and make a valuable contribution to the existing body of knowledge.

Qualitative research questions should be open-ended and exploratory rather than focused on a specific hypothesis or proposition. It is common for qualitative studies to focus on understanding how and why certain phenomena occur, rather than simply describing what has occurred. These should be formulated to elicit rich, detailed, and context-specific data that can provide insights into the experiences, perspectives, and meanings of the participants. In contrast, quantitative research questions are more specific and are designed to test a particular hypothesis or relationship. In medical education, it is imperative to emphasise the importance of both qualitative and quantitative research questions when it comes to generating new knowledge. Combining both quantitative and qualitative research methods (mixed methods) can be particularly powerful in providing a more comprehensive understanding of any phenomena under study. Assume again that we are examining the effectiveness of feedback on the performance of medical students and adopt a mixed-methods approach using a combination of qualitative and quantitative research methods. A quantitative research question may be, what is the impact of feedback on the performance of medical students as measured by OSCE mark? How the experience of receiving feedback on performance contributes to the future professional development of medical students is a more qualitative research question. This combination of quantitative and qualitative research questions will provide an in depth understanding of the effectiveness of feedback on medical student performance. It is important to note that in qualitative research methods particularly, there can be a wide variety of research question types. For example, grounded theory researchers may ask so-called "process questions", such as 'how do students interpret and use the feedback they are given?' Phenomenologists, on the other hand, are concerned with lived experience of research subjects and frequently ask questions looking to understand the "meaning" of any such experience, often aiming to attribute feelings to this experience, for example, ‘how do students feel when they receive feedback?’ Ethnographers look to understand how culture contributes to an experience, and may ask more "descriptive questions" 5 for example, ‘how does the culture within a specific medical school affect students receiving feedback on their performance?’

For ease of reference, the key points we recommended are considered in any dissertation introduction are summarised below:

1.       Set the context for the research

2.       Establish a theoretical or conceptual framework to support your study

3.       Define key variables both conceptually and theoretically

4.       Critically appraise relevant papers during the literature review

5.       Review previous studies to identify and define the knowledge gap by assessing what has already been studied and what areas remain unexplored

6.       Clearly articulate the rationale behind your study, emphasising its importance in the intended field

7.       Clearly define your research objectives, questions, and hypotheses

Conclusions

Whilst crafting a research introduction may seem a challenging and time-consuming task, it is well worth the effort to convey your research clearly and engage potential readers. Providing sufficient background information on the research topic, conducting a comprehensive review of the existing research, determining the knowledge gap, understanding any limitations or controversies in the topic of interest, before then exploring any theoretical or conceptual frameworks to develop the research concepts, research questions and methodology are fundamental steps. Articulating any conceptual and operational definitions of key concepts and clearly defining any key terms, including explanations of how these will be used in the study is also paramount to a good introduction. It is essential to clearly present the rationale behind the research and why this is significant, clarifying what it adds to the existing body of knowledge in medical education and exploring any potential future implications. Lastly, it is vital to ensure that any research questions are clearly stated and are open-ended and exploratory in the case of qualitative studies, or specific and measurable in the case of quantitative studies.

We feel that observing these basic principles and adhering to these few simple steps will hopefully set the stage for a highly successful piece of research and will certainly go some way to achieving a favourable editorial outcome for possible subsequent publication of the work.

Conflict of Interest

The authors declare that they have no conflict of interest.

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How to Write the Rationale of the Study in Research (Examples)

What is the Rationale of the Study?

The rationale of the study is the justification for taking on a given study. It explains the reason the study was conducted or should be conducted. This means the study rationale should explain to the reader or examiner why the study is/was necessary. It is also sometimes called the “purpose” or “justification” of a study. While this is not difficult to grasp in itself, you might wonder how the rationale of the study is different from your research question or from the statement of the problem of your study, and how it fits into the rest of your thesis or research paper. 

The rationale of the study links the background of the study to your specific research question and justifies the need for the latter on the basis of the former. In brief, you first provide and discuss existing data on the topic, and then you tell the reader, based on the background evidence you just presented, where you identified gaps or issues and why you think it is important to address those. The problem statement, lastly, is the formulation of the specific research question you choose to investigate, following logically from your rationale, and the approach you are planning to use to do that.

Table of Contents:

How to write a rationale for a research paper , how do you justify the need for a research study.

• Study Rationale Example: Where Does It Go In Your Paper?

The basis for writing a research rationale is preliminary data or a clear description of an observation. If you are doing basic/theoretical research, then a literature review will help you identify gaps in current knowledge. In applied/practical research, you base your rationale on an existing issue with a certain process (e.g., vaccine proof registration) or practice (e.g., patient treatment) that is well documented and needs to be addressed. By presenting the reader with earlier evidence or observations, you can (and have to) convince them that you are not just repeating what other people have already done or said and that your ideas are not coming out of thin air. 

Once you have explained where you are coming from, you should justify the need for doing additional research–this is essentially the rationale of your study. Finally, when you have convinced the reader of the purpose of your work, you can end your introduction section with the statement of the problem of your research that contains clear aims and objectives and also briefly describes (and justifies) your methodological approach. 

When is the Rationale for Research Written?

The author can present the study rationale both before and after the research is conducted. 

• Before conducting research : The study rationale is a central component of the research proposal . It represents the plan of your work, constructed before the study is actually executed.
• Once research has been conducted : After the study is completed, the rationale is presented in a research article or  PhD dissertation  to explain why you focused on this specific research question. When writing the study rationale for this purpose, the author should link the rationale of the research to the aims and outcomes of the study.

What to Include in the Study Rationale

Although every study rationale is different and discusses different specific elements of a study’s method or approach, there are some elements that should be included to write a good rationale. Make sure to touch on the following:

• A summary of conclusions from your review of the relevant literature
• What is currently unknown (gaps in knowledge)
• Inconclusive or contested results  from previous studies on the same or similar topic
• The necessity to improve or build on previous research, such as to improve methodology or utilize newer techniques and/or technologies

There are different types of limitations that you can use to justify the need for your study. In applied/practical research, the justification for investigating something is always that an existing process/practice has a problem or is not satisfactory. Let’s say, for example, that people in a certain country/city/community commonly complain about hospital care on weekends (not enough staff, not enough attention, no decisions being made), but you looked into it and realized that nobody ever investigated whether these perceived problems are actually based on objective shortages/non-availabilities of care or whether the lower numbers of patients who are treated during weekends are commensurate with the provided services.

In this case, “lack of data” is your justification for digging deeper into the problem. Or, if it is obvious that there is a shortage of staff and provided services on weekends, you could decide to investigate which of the usual procedures are skipped during weekends as a result and what the negative consequences are. 

In basic/theoretical research, lack of knowledge is of course a common and accepted justification for additional research—but make sure that it is not your only motivation. “Nobody has ever done this” is only a convincing reason for a study if you explain to the reader why you think we should know more about this specific phenomenon. If there is earlier research but you think it has limitations, then those can usually be classified into “methodological”, “contextual”, and “conceptual” limitations. To identify such limitations, you can ask specific questions and let those questions guide you when you explain to the reader why your study was necessary:

Methodological limitations

• Did earlier studies try but failed to measure/identify a specific phenomenon?
• Was earlier research based on incorrect conceptualizations of variables?
• Were earlier studies based on questionable operationalizations of key concepts?
• Did earlier studies use questionable or inappropriate research designs?

Contextual limitations

• Have recent changes in the studied problem made previous studies irrelevant?
• Are you studying a new/particular context that previous findings do not apply to?

Conceptual limitations

• Do previous findings only make sense within a specific framework or ideology?

Study Rationale Examples

Let’s look at an example from one of our earlier articles on the statement of the problem to clarify how your rationale fits into your introduction section. This is a very short introduction for a practical research study on the challenges of online learning. Your introduction might be much longer (especially the context/background section), and this example does not contain any sources (which you will have to provide for all claims you make and all earlier studies you cite)—but please pay attention to how the background presentation , rationale, and problem statement blend into each other in a logical way so that the reader can follow and has no reason to question your motivation or the foundation of your research.

Background presentation

Since the beginning of the Covid pandemic, most educational institutions around the world have transitioned to a fully online study model, at least during peak times of infections and social distancing measures. This transition has not been easy and even two years into the pandemic, problems with online teaching and studying persist (reference needed) . 

While the increasing gap between those with access to technology and equipment and those without access has been determined to be one of the main challenges (reference needed) , others claim that online learning offers more opportunities for many students by breaking down barriers of location and distance (reference needed) .  

Rationale of the study

Since teachers and students cannot wait for circumstances to go back to normal, the measures that schools and universities have implemented during the last two years, their advantages and disadvantages, and the impact of those measures on students’ progress, satisfaction, and well-being need to be understood so that improvements can be made and demographics that have been left behind can receive the support they need as soon as possible.

Statement of the problem

To identify what changes in the learning environment were considered the most challenging and how those changes relate to a variety of student outcome measures, we conducted surveys and interviews among teachers and students at ten institutions of higher education in four different major cities, two in the US (New York and Chicago), one in South Korea (Seoul), and one in the UK (London). Responses were analyzed with a focus on different student demographics and how they might have been affected differently by the current situation.

How long is a study rationale?

In a research article bound for journal publication, your rationale should not be longer than a few sentences (no longer than one brief paragraph). A  dissertation or thesis  usually allows for a longer description; depending on the length and nature of your document, this could be up to a couple of paragraphs in length. A completely novel or unconventional approach might warrant a longer and more detailed justification than an approach that slightly deviates from well-established methods and approaches.

Consider Using Professional Academic Editing Services

Now that you know how to write the rationale of the study for a research proposal or paper, you should make use of our free AI grammar checker , Wordvice AI, or receive professional academic proofreading services from Wordvice, including research paper editing services and manuscript editing services to polish your submitted research documents.

You can also find many more articles, for example on writing the other parts of your research paper , on choosing a title , or on making sure you understand and adhere to the author instructions before you submit to a journal, on the Wordvice academic resources pages.

Research Writing and Analysis

• NVivo Group and Study Sessions
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• Step 1: Seek Out Evidence
• Step 2: Explain
• Step 3: The Big Picture
• Step 4: Own It
• Step 5: Illustrate
• Annotated Bibliography
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• Systematic Reviews & Meta-Analyses
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• Problem Statement
• Purpose Statement
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Jump to DSE Guide

Purpose statement overview.

The purpose statement succinctly explains (on no more than 1 page) the objectives of the research study. These objectives must directly address the problem and help close the stated gap. Expressed as a formula:

Good purpose statements:

• Flow from the problem statement and actually address the proposed problem
• Are concise and clear
• Answer the question ‘Why are you doing this research?’
• Match the methodology (similar to research questions)
• Have a ‘hook’ to get the reader’s attention
• Set the stage by clearly stating, “The purpose of this (qualitative or quantitative) study is to ...

In PhD studies, the purpose usually involves applying a theory to solve the problem. In other words, the purpose tells the reader what the goal of the study is, and what your study will accomplish, through which theoretical lens. The purpose statement also includes brief information about direction, scope, and where the data will come from.

A problem and gap in combination can lead to different research objectives, and hence, different purpose statements. In the example from above where the problem was severe underrepresentation of female CEOs in Fortune 500 companies and the identified gap related to lack of research of male-dominated boards; one purpose might be to explore implicit biases in male-dominated boards through the lens of feminist theory. Another purpose may be to determine how board members rated female and male candidates on scales of competency, professionalism, and experience to predict which candidate will be selected for the CEO position. The first purpose may involve a qualitative ethnographic study in which the researcher observes board meetings and hiring interviews; the second may involve a quantitative regression analysis. The outcomes will be very different, so it’s important that you find out exactly how you want to address a problem and help close a gap!

The purpose of the study must not only align with the problem and address a gap; it must also align with the chosen research method. In fact, the DP/DM template requires you to name the  research method at the very beginning of the purpose statement. The research verb must match the chosen method. In general, quantitative studies involve “closed-ended” research verbs such as determine , measure , correlate , explain , compare , validate , identify , or examine ; whereas qualitative studies involve “open-ended” research verbs such as explore , understand , narrate , articulate [meanings], discover , or develop .

A qualitative purpose statement following the color-coded problem statement (assumed here to be low well-being among financial sector employees) + gap (lack of research on followers of mid-level managers), might start like this:

In response to declining levels of employee well-being, the purpose of the qualitative phenomenology was to explore and understand the lived experiences related to the well-being of the followers of novice mid-level managers in the financial services industry. The levels of follower well-being have been shown to correlate to employee morale, turnover intention, and customer orientation (Eren et al., 2013). A combined framework of Leader-Member Exchange (LMX) Theory and the employee well-being concept informed the research questions and supported the inquiry, analysis, and interpretation of the experiences of followers of novice managers in the financial services industry.

A quantitative purpose statement for the same problem and gap might start like this:

In response to declining levels of employee well-being, the purpose of the quantitative correlational study was to determine which leadership factors predict employee well-being of the followers of novice mid-level managers in the financial services industry. Leadership factors were measured by the Leader-Member Exchange (LMX) assessment framework  by Mantlekow (2015), and employee well-being was conceptualized as a compound variable consisting of self-reported turnover-intent and psychological test scores from the Mental Health Survey (MHS) developed by Johns Hopkins University researchers.

Both of these purpose statements reflect viable research strategies and both align with the problem and gap so it’s up to the researcher to design a study in a manner that reflects personal preferences and desired study outcomes. Note that the quantitative research purpose incorporates operationalized concepts  or variables ; that reflect the way the researcher intends to measure the key concepts under study; whereas the qualitative purpose statement isn’t about translating the concepts under study as variables but instead aim to explore and understand the core research phenomenon.  

Best Practices for Writing your Purpose Statement

Always keep in mind that the dissertation process is iterative, and your writing, over time, will be refined as clarity is gradually achieved. Most of the time, greater clarity for the purpose statement and other components of the Dissertation is the result of a growing understanding of the literature in the field. As you increasingly master the literature you will also increasingly clarify the purpose of your study.

The purpose statement should flow directly from the problem statement. There should be clear and obvious alignment between the two and that alignment will get tighter and more pronounced as your work progresses.

The purpose statement should specifically address the reason for conducting the study, with emphasis on the word specifically. There should not be any doubt in your readers’ minds as to the purpose of your study. To achieve this level of clarity you will need to also insure there is no doubt in your mind as to the purpose of your study.

Many researchers benefit from stopping your work during the research process when insight strikes you and write about it while it is still fresh in your mind. This can help you clarify all aspects of a dissertation, including clarifying its purpose.

Your Chair and your committee members can help you to clarify your study’s purpose so carefully attend to any feedback they offer.

The purpose statement should reflect the research questions and vice versa. The chain of alignment that began with the research problem description and continues on to the research purpose, research questions, and methodology must be respected at all times during dissertation development. You are to succinctly describe the overarching goal of the study that reflects the research questions. Each research question narrows and focuses the purpose statement. Conversely, the purpose statement encompasses all of the research questions.

Identify in the purpose statement the research method as quantitative, qualitative or mixed (i.e., “The purpose of this [qualitative/quantitative/mixed] study is to ...)

Avoid the use of the phrase “research study” since the two words together are redundant.

Follow the initial declaration of purpose with a brief overview of how, with what instruments/data, with whom and where (as applicable) the study will be conducted. Identify variables/constructs and/or phenomenon/concept/idea. Since this section is to be a concise paragraph, emphasis must be placed on the word brief. However, adding these details will give your readers a very clear picture of the purpose of your research.

Developing the purpose section of your dissertation is usually not achieved in a single flash of insight. The process involves a great deal of reading to find out what other scholars have done to address the research topic and problem you have identified. The purpose section of your dissertation could well be the most important paragraph you write during your academic career, and every word should be carefully selected. Think of it as the DNA of your dissertation. Everything else you write should emerge directly and clearly from your purpose statement. In turn, your purpose statement should emerge directly and clearly from your research problem description. It is good practice to print out your problem statement and purpose statement and keep them in front of you as you work on each part of your dissertation in order to insure alignment.

It is helpful to collect several dissertations similar to the one you envision creating. Extract the problem descriptions and purpose statements of other dissertation authors and compare them in order to sharpen your thinking about your own work.  Comparing how other dissertation authors have handled the many challenges you are facing can be an invaluable exercise. Keep in mind that individual universities use their own tailored protocols for presenting key components of the dissertation so your review of these purpose statements should focus on content rather than form.

Once your purpose statement is set it must be consistently presented throughout the dissertation. This may require some recursive editing because the way you articulate your purpose may evolve as you work on various aspects of your dissertation. Whenever you make an adjustment to your purpose statement you should carefully follow up on the editing and conceptual ramifications throughout the entire document.

In establishing your purpose you should NOT advocate for a particular outcome. Research should be done to answer questions not prove a point. As a researcher, you are to inquire with an open mind, and even when you come to the work with clear assumptions, your job is to prove the validity of the conclusions reached. For example, you would not say the purpose of your research project is to demonstrate that there is a relationship between two variables. Such a statement presupposes you know the answer before your research is conducted and promotes or supports (advocates on behalf of) a particular outcome. A more appropriate purpose statement would be to examine or explore the relationship between two variables.

Your purpose statement should not imply that you are going to prove something. You may be surprised to learn that we cannot prove anything in scholarly research for two reasons. First, in quantitative analyses, statistical tests calculate the probability that something is true rather than establishing it as true. Second, in qualitative research, the study can only purport to describe what is occurring from the perspective of the participants. Whether or not the phenomenon they are describing is true in a larger context is not knowable. We cannot observe the phenomenon in all settings and in all circumstances.

Writing your Purpose Statement

It is important to distinguish in your mind the differences between the Problem Statement and Purpose Statement.

The Problem Statement is why I am doing the research

The Purpose Statement is what type of research I am doing to fit or address the problem

The Purpose Statement includes:

• Method of Study
• Specific Population

Remember, as you are contemplating what to include in your purpose statement and then when you are writing it, the purpose statement is a concise paragraph that describes the intent of the study, and it should flow directly from the problem statement.  It should specifically address the reason for conducting the study, and reflect the research questions.  Further, it should identify the research method as qualitative, quantitative, or mixed.  Then provide a brief overview of how the study will be conducted, with what instruments/data collection methods, and with whom (subjects) and where (as applicable). Finally, you should identify variables/constructs and/or phenomenon/concept/idea.

Qualitative Purpose Statement

Creswell (2002) suggested for writing purpose statements in qualitative research include using deliberate phrasing to alert the reader to the purpose statement. Verbs that indicate what will take place in the research and the use of non-directional language that do not suggest an outcome are key. A purpose statement should focus on a single idea or concept, with a broad definition of the idea or concept. How the concept was investigated should also be included, as well as participants in the study and locations for the research to give the reader a sense of with whom and where the study took place. 

Creswell (2003) advised the following script for purpose statements in qualitative research:

“The purpose of this qualitative_________________ (strategy of inquiry, such as ethnography, case study, or other type) study is (was? will be?) to ________________ (understand? describe? develop? discover?) the _________________(central phenomenon being studied) for ______________ (the participants, such as the individual, groups, organization) at __________(research site). At this stage in the research, the __________ (central phenomenon being studied) will be generally defined as ___________________ (provide a general definition)” (pg. 90).

Quantitative Purpose Statement

Creswell (2003) offers vast differences between the purpose statements written for qualitative research and those written for quantitative research, particularly with respect to language and the inclusion of variables. The comparison of variables is often a focus of quantitative research, with the variables distinguishable by either the temporal order or how they are measured. As with qualitative research purpose statements, Creswell (2003) recommends the use of deliberate language to alert the reader to the purpose of the study, but quantitative purpose statements also include the theory or conceptual framework guiding the study and the variables that are being studied and how they are related. 

Creswell (2003) suggests the following script for drafting purpose statements in quantitative research:

“The purpose of this _____________________ (experiment? survey?) study is (was? will be?) to test the theory of _________________that _________________ (compares? relates?) the ___________(independent variable) to _________________________(dependent variable), controlling for _______________________ (control variables) for ___________________ (participants) at _________________________ (the research site). The independent variable(s) _____________________ will be generally defined as _______________________ (provide a general definition). The dependent variable(s) will be generally defined as _____________________ (provide a general definition), and the control and intervening variables(s), _________________ (identify the control and intervening variables) will be statistically controlled in this study” (pg. 97).

Sample Purpose Statements

• The purpose of this qualitative study was to determine how participation in service-learning in an alternative school impacted students academically, civically, and personally.  There is ample evidence demonstrating the failure of schools for students at-risk; however, there is still a need to demonstrate why these students are successful in non-traditional educational programs like the service-learning model used at TDS.  This study was unique in that it examined one alternative school’s approach to service-learning in a setting where students not only serve, but faculty serve as volunteer teachers.  The use of a constructivist approach in service-learning in an alternative school setting was examined in an effort to determine whether service-learning participation contributes positively to academic, personal, and civic gain for students, and to examine student and teacher views regarding the overall outcomes of service-learning.  This study was completed using an ethnographic approach that included observations, content analysis, and interviews with teachers at The David School.
• The purpose of this quantitative non-experimental cross-sectional linear multiple regression design was to investigate the relationship among early childhood teachers’ self-reported assessment of multicultural awareness as measured by responses from the Teacher Multicultural Attitude Survey (TMAS) and supervisors’ observed assessment of teachers’ multicultural competency skills as measured by the Multicultural Teaching Competency Scale (MTCS) survey. Demographic data such as number of multicultural training hours, years teaching in Dubai, curriculum program at current school, and age were also examined and their relationship to multicultural teaching competency. The study took place in the emirate of Dubai where there were 14,333 expatriate teachers employed in private schools (KHDA, 2013b).
• The purpose of this quantitative, non-experimental study is to examine the degree to which stages of change, gender, acculturation level and trauma types predicts the reluctance of Arab refugees, aged 18 and over, in the Dearborn, MI area, to seek professional help for their mental health needs. This study will utilize four instruments to measure these variables: University of Rhode Island Change Assessment (URICA: DiClemente & Hughes, 1990); Cumulative Trauma Scale (Kira, 2012); Acculturation Rating Scale for Arabic Americans-II Arabic and English (ARSAA-IIA, ARSAA-IIE: Jadalla & Lee, 2013), and a demographic survey. This study will examine 1) the relationship between stages of change, gender, acculturation levels, and trauma types and Arab refugees’ help-seeking behavior, 2) the degree to which any of these variables can predict Arab refugee help-seeking behavior.  Additionally, the outcome of this study could provide researchers and clinicians with a stage-based model, TTM, for measuring Arab refugees’ help-seeking behavior and lay a foundation for how TTM can help target the clinical needs of Arab refugees. Lastly, this attempt to apply the TTM model to Arab refugees’ condition could lay the foundation for future research to investigate the application of TTM to clinical work among refugee populations.
• The purpose of this qualitative, phenomenological study is to describe the lived experiences of LLM for 10 EFL learners in rural Guatemala and to utilize that data to determine how it conforms to, or possibly challenges, current theoretical conceptions of LLM. In accordance with Morse’s (1994) suggestion that a phenomenological study should utilize at least six participants, this study utilized semi-structured interviews with 10 EFL learners to explore why and how they have experienced the motivation to learn English throughout their lives. The methodology of horizontalization was used to break the interview protocols into individual units of meaning before analyzing these units to extract the overarching themes (Moustakas, 1994). These themes were then interpreted into a detailed description of LLM as experienced by EFL students in this context. Finally, the resulting description was analyzed to discover how these learners’ lived experiences with LLM conformed with and/or diverged from current theories of LLM.
• The purpose of this qualitative, embedded, multiple case study was to examine how both parent-child attachment relationships are impacted by the quality of the paternal and maternal caregiver-child interactions that occur throughout a maternal deployment, within the context of dual-military couples. In order to examine this phenomenon, an embedded, multiple case study was conducted, utilizing an attachment systems metatheory perspective. The study included four dual-military couples who experienced a maternal deployment to Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) when they had at least one child between 8 weeks-old to 5 years-old.  Each member of the couple participated in an individual, semi-structured interview with the researcher and completed the Parenting Relationship Questionnaire (PRQ). “The PRQ is designed to capture a parent’s perspective on the parent-child relationship” (Pearson, 2012, para. 1) and was used within the proposed study for this purpose. The PRQ was utilized to triangulate the data (Bekhet & Zauszniewski, 2012) as well as to provide some additional information on the parents’ perspective of the quality of the parent-child attachment relationship in regards to communication, discipline, parenting confidence, relationship satisfaction, and time spent together (Pearson, 2012). The researcher utilized the semi-structured interview to collect information regarding the parents' perspectives of the quality of their parental caregiver behaviors during the deployment cycle, the mother's parent-child interactions while deployed, the behavior of the child or children at time of reunification, and the strategies or behaviors the parents believe may have contributed to their child's behavior at the time of reunification. The results of this study may be utilized by the military, and by civilian providers, to develop proactive and preventive measures that both providers and parents can implement, to address any potential adverse effects on the parent-child attachment relationship, identified through the proposed study. The results of this study may also be utilized to further refine and understand the integration of attachment theory and systems theory, in both clinical and research settings, within the field of marriage and family therapy.

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• Open access
• Published: 13 May 2024

What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

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There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

Peer Review reports

Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

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Olivia R. Phillips and Cerian Harries share joint first authorship.

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Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

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Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

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Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

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Investigating young children’s physical activity through time and place

• T. Remmers 1 ,
• P. Koolwijk 2 ,
• I. Fassaert 1 , 8 ,
• J. Nolles 3 ,
• W. de Groot 3 ,
• S. B. Vos 1 , 4 ,
• S. I. de Vries 2 , 5 ,
• R. Mombarg 3 , 6 &
• D. H. H. Van Kann 1 , 7  

International Journal of Health Geographics volume  23 , Article number:  12 ( 2024 ) Cite this article

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Metrics details

Previous research indicates the start of primary school (4-5-year-old) as an essential period for the development of children’s physical activity (PA) patterns, as from this point, the age-related decline of PA is most often observed. During this period, young children are exposed to a wider variety of environmental- and social contexts and therefore their PA is influenced by more diverse factors. However, in order to understand children’s daily PA patterns and identify relevant opportunities for PA promotion, it is important to further unravel in which (social) contexts throughout the day, PA of young children takes place.

We included a cross-national sample of 21 primary schools from the Startvaardig study. In total, 248 children provided valid accelerometer and global positioning (GPS) data. Geospatial analyses were conducted to quantify PA in (social) environments based on their school and home. Transport-related PA was evaluated using GPS speed-algorithms. PA was analysed at different environments, time-periods and for week- and weekend days separately.

Children accumulated an average of 60 min of moderate-to-vigorous PA (MVPA), both during week- and weekend days. Schools contributed to approximately half of daily MVPA during weekdays. During weekends, environments within 100 m from home were important, as well as locations outside the home-school neighbourhood. Pedestrian trips contributed to almost half of the daily MVPA.

Conclusions

We identified several social contexts relevant for children’s daily MVPA. Schools have the potential to significantly contribute to young children’s PA patterns and are therefore encouraged to systematically evaluate and implement parts of the school-system that stimulate PA and potentially also learning processes. Pedestrian trips also have substantial contribution to daily MVPA of young children, which highlights the importance of daily active transport in school- and parental routines.

Early childhood (i.e. from birth until five years old) has recently become a prominent health-promotion target group as there is increased recognition that establishing health-supporting environments in early childhood can reduce subsequent population-level risk factors and disease [ 1 ]. Within these health-supporting environments, physical activity (PA) and sedentary behaviours contribute to the development of children’s physical-, psychosocial and cognitive abilities [ 2 , 3 , 4 ]. The consistency, quality and timing of these interconnected behaviours are formed in early childhood and the accompanied habits tend to track from childhood through adolescence [ 5 , 6 ].

In early childhood, the role of PA is of particular interest because through PA a child interacts with the surrounding environment and experiences the capabilities of its own body. By doing so, PA acts as an initiator of various learning processes [ 7 ]. In addition, sufficient- and appropriate variation of PA leads to the development of fundamental motor skills [ 8 ] which are important building blocks for more complex motor skills later in life [ 9 , 10 , 11 ]. Research suggests that PA and the development of motor skills may be more intertwined with cognitive development than previously assumed [ 12 , 13 , 14 ]. In addition, more PA in early childhood is associated with a broad range of favourable indicators relating to cardiometabolic-, skeletal- and morphological health [ 15 , 16 , 17 ]. In 2020, the WHO formulated specific international guidelines for early childhood [ 18 ]. For 3-4-year-old children, at least 180 daily minutes of PA (of which 60 min of moderate-to-vigorous intensity) and no more than 60 min of daily sedentary screen time are recommended [ 19 ]. Before five- to six years of age, children seem to be sufficiently active, especially at light intensity [ 20 , 21 ]. However, already around the age of 6 years, children’s PA levels decline while sedentary activities such as screen-related behaviours increase [ 21 ]. To understand the mechanism behind this age-related decline, it is vital to gain more insight in the daily PA patterns of young children [ 22 , 23 , 24 ].

Previous longitudinal studies showed that the onset of primary school is crucial in the development of healthy PA patterns of children, as notable increases in sedentary patterns were observed in this phase [ 25 , 26 ]. In primary school, children are exposed to a wider social- and physical environment (both in- and out of school), extending the potential of barriers and affordances for PA. Also, previous research showed that sedentary time predominantly increased during school hours, suggesting that in-school practices are probably responsible for decreasing PA [ 27 , 28 , 29 ]. Other studies have reported that variability between children’s PA was highest out of school [ 28 , 30 , 31 ]. This illustrates that the start of primary school is an interesting phase in which a complex and dynamic system of environmental factors have great influence of children’s emerging PA patterns [ 26 , 32 , 33 ]. In addition, the context in which PA occurs greatly influences the potential of these factors in influencing PA [ 34 ]. For example, children’s PA at school and PA at home are influenced by different environmental factors [ 34 ]. This means that in order to understand children’s PA patterns and how to effectively promote PA, more contextual information about the type of PA is essential [ 35 ]. However, investigating context-specific PA of young children is complex, because they predominantly perform PA in short sporadic bursts, sometimes without clear motives [ 36 ]. This makes the application of subjective assessment (e.g. parental recall) challenging and susceptible for social-desirability bias [ 37 , 38 ]. On the other hand, objective measurements (e.g. accelerometry) fail to capture essential contextual information (e.g. location) about the type of PA performed [ 16 ]. One way of overcoming these issues is by combined accelerometer and GPS methodology, which simultaneously combines information about PA and the geographic context [ 39 ]. Previous studies that have used this methodology in young children are scarce and have either focused on places for PA within childcare centers [ 40 ] or residential neighbourhoods separately [ 41 ]. Results showed that within childcare centers, larger open areas with portable equipment (e.g. balls, toys) were associated with children’s PA-hotspots [ 40 ] and that approximately 60% of the daily moderate-to-vigorous PA (MVPA) of 3-year-old Western-Australian children occurred < 500 m from their home, while 30% of daily MVPA occurred outside their neighbourhood (> 1600 m from their home) [ 41 ]. Although this provides valuable insights in where children’s PA takes place within the childcare and neighbourhood context, integrated information from both contexts is warranted to evaluate the degree to which each of these contexts contribute to children’s daily PA. Therefore, the purpose of this study was to investigate context-specific PA patterns of 4-6-year-old children (i.e. onset of primary school in the Netherlands) to improve our understanding of how to effectively promote these PA patterns.

Design and participants

In this cross-sectional study, a convenience sample of 21 primary schools in medium- to large scale cities of the Netherlands (i.e. 5 schools located in Eindhoven, 7 schools in the vicinity of The Hague, 9 schools in the vicinity of Groningen) were selected from the cross-national ‘Start Vaardig’ project (Dutch for ‘Skilful Start’). The three cities lie relatively close to each other (i.e. 370 km of driving distance to visit all three cities), with comparable climate during the period of measurement. Participating schools represented a wide variation of predominantly suburban areas in the north, middle, and south of the Netherlands (Fig.  1 ). In terms of PA- or transport related geography (e.g. percentage greenness, flat land, degree of urbanization) the suburban areas of the participating schools were comparable. The Dutch primary school system ranges from grade 1 (for 4-year-old children) till grade 8 (for 12-year-old children), and in our study children from grades 1 and 2 were eligible for participation. Schools provided detailed information about schedules and break times.

Geographical distribution of participating schools

All participating schools were visited four times by a team of two trained researchers. At the first visit, children and teachers were informed about the project and shown how to wear the accelerometer (Actigraph GT3X+, Pensacola, FL, USA) and GPS devices (Qstarz BT1000XT, Tapei, Taiwan). Children were provided with a written information letter and informed consent form. Parents were given the possibility to sign and return the written informed consent form to their child’s teacher or to sign online. Teachers were provided with additional written instruction about the purpose of the project and how to collect the informed consent forms. At the second visit, consent forms were collected, and reminders were handed out to the children. At the third visit, children received the devices with verbal instruction and parents were provided with written instructions. We instructed children to wear the devices at the right hip using an elastic belt during waking hours, for six consecutive days (containing two weekend days). We instructed to only remove the devices during sleep or water-related activities (e.g. swimming, showering) and to recharge the GPS logger every day just before going to bed. Additionally, parents of all participating children received a paper questionnaire, as well as an online version of the questionnaire. At the fourth and last visit, devices were returned, and paper questionnaires were collected.

Data collection took place between the 26th of May and the 15th of July 2021, in-between restrictions caused by the COVID-19 pandemic. Daily average temperature was 18.1 degrees Celsius (SD = 3.1) with average precipitation of 3.7 mm per day (69% of days with < 1 mm). Sunset times during this period were between 21:38 and 21:48 h ( www.timeanddate.com ). Ethical approval was obtained by the Ethical Research Committee of the VU Medical Centre in Amsterdam, the Netherlands (VCWE-2020-137).

Measurements

Parents provided socio-demographic information in the questionnaire, such as their child’s date of birth and gender, postal code and number of spouses. In addition, questions were asked about the frequency and reason that the accelerometer- and GPS devices were taken off (e.g. swimming, showering, discomfort) as well as the days on which their child did not sleep at home during the night.

Numerous studies have supported validity and accuracy of the accelerometer and GPS devices [ 42 , 43 , 44 , 45 ]. We used the manufacturer’s software to initialize devices and export data to CSV-files, for the accelerometer (Actilife version 6.13.4) and GPS logger (QTravel version 1.54) separately. Devices were set to record data every 10 s epochs. GPS loggers were initialized to record data between 6 AM and 10 PM to optimize battery life and storage capacity and to stop logging when storage capacity was full. We processed accelerometer data using R-package GGIR (version 3.0–1) [ 46 ], which included algorithms regarding autocalibration of accelerometers [ 47 ] and standard weartime detection algorithms. Namely, non-wear time was investigated per 15-minute time blocks, while the definition of non-wear time was based on the standard deviation (i.e. <13 milli gravity (mg)) and range (i.e. <50 mg) of the 60-minute time window that centered each 15-minute time block. Intensity-classification of PA was based on the vertical-axis classification of Evenson et al. (2008) [ 48 ] and were adjusted for the 10 s epoch by linear interpolation. We processed combined GPS and accelerometer output using the HABITUS (hbGPS) software [ 49 , 50 ], inspired by functionality from the earlier PALMS system [ 44 , 51 ]. GPS data was cleaned by removing outliers based on (1) missing values in speed estimates, (2) speed greater than 130 km/h with a speed-difference > 30 km/h, and (3) elevation change between successive values > 1000 m [ 50 ]. Trips were identified by a consistent speed of at least 1 kmph for any sequence of three successive datapoints (i.e. 30 s). We furthermore identified trip pause points with insufficient speed (see sentence above) for a maximum of 2 min. When the pause time exceeded 2 min, we classified this as a trip end point. Alternatively, we treated this as one common trip. We subsequently removed trips with (1) distance < 100 m, (2) duration < 60 s, (3) no available GPS data (time gaps) of > 30 s between each datapoint and the preceding datapoint. GPS data were exported as latitude, longitude, and trip-characteristics. Finally, accelerometer- and GPS data were matched based on timestamp of the accelerometer. Trip mode was based on the 90th percentile speed-thresholds of 1, 10- and 35 kmph for walking, cycling and vehicle respectively [ 52 ].

Data analyses

In total, 358 parents (26.2% from total potential sample) provided written informed consent for their child to participate in combined accelerometer and GPS measurements. After accounting for participant refusal and device malfunctioning, our sample of analysis consisted of 311 4-6-year-old children (84.5% from the sample of parents with informed consent, see Fig.  2 ). Next, a total of 281 parents filled in the questionnaire at the start of the study and 248 children provided valid combined accelerometer- and GPS data (i.e. sensor-data), defined as weekdays with 8 h- and weekend days with 6 h of combined accelerometer and GPS data. We defined these criteria because during weekend days, we observed less weartime due to a delayed start of weartime in the morning. From the 281 children with questionnaire-data, 85 children had insufficient sensor-data. From the 248 children with valid sensor-data, questionnaire-data were missing for 52 children. Consequently, for 196 children we had both valid sensor-data and questionnaire-data. Slight differences between the drop-out percentage between the cities were caused by the fact that in Eindhoven, accelerometers were handed out to the classroom teacher for individual children from parents that provided informed consent but were absent during the day of measurement (e.g. often due to COVID-19 restrictions). This led to an increased number of participants not meeting the 3-day valid data criteria, whereas in Groningen and The Hague, these children were considered missing a-priori and not treated as drop-out.

We imported combined accelerometer and GPS datasets for each school into ArcGIS Pro version 3.1.0 (ESRI, Redlands, CA, USA) for additional geospatial analyses. We geocoded the location of schools based on the school’s registry and extracted polygons of the school building and surrounding parcel. For the residential location of children, parents provided their six-digit postal code (i.e. identifies street-level area of 15- to 20 addresses without house number). In addition, we extracted the average centroid point of GPS data on week- and weekend days between 6- and 8 AM, during days that the child slept at home. These locations were validated by calculating Euclidean distances between the centroid point and the six-digit postal codes that parents provided in the questionnaire (median distance was 52.2 m for weekdays and 54.1 for weekend days). Next, for each datapoint, we calculated Euclidean- (i.e. < 10 m) and network distances (i.e. remaining distance categories) between children’s home and school. To investigate distances of children’s datapoints based on the combined home-school environment (not based on home and school separately), we integrated these distance-categories from both home and school (see Fig.  3 ). In addition, based on the Dutch national registry of large-scale topography (i.e. BGT), polygons identified as parks, sports terrains and public playgrounds were extracted and we subsequently performed ‘spatial join’ analyses to identify the datapoints that were within 10-meters from these parks, sports terrains, or playground parcels.

Example of distance-categories integrating both home and school locations

Parents indicated that children were awake for an average of 12 h per day and that water activities such as swimming were the primary reason for non-weartime during waking hours, while 11 parents (8.0%) reported their child experiencing discomfort when wearing the devices. Finally, only data points containing both valid accelerometer- and GPS data were retained, which resulted in a final sample of 248 children (1017 days of measurement; with 762 weekdays and 255 weekend days). We used days as the unit of analysis as this allows variation between days within children. We presented PA as minutes and percentage in light (LPA) and moderate-to-vigorous (MVPA) intensities.

Slightly more boys (54.3%) than girls participated in the study. The mean age of children was 5.56-year-old (SD = 0.75). Almost all children had either one- (57.8%) or two or more siblings (34.5%), and 61 children (40.0%) had at least one older sibling. Parents reported that 82.3% of the children slept home for all days during measurement. In total, 49.8% reported that the child had visited afterschool childcare at school for at least one day during measurement and 15.7% had visited afterschool childcare outside the school’s parcel (e.g. childcare at other location or other organization). Regarding the use of bicycles, 45.2% indicated that their child was able to cycle without supervision. In terms of organized sports, 55.6% of the children was a member of a sports club, while 30.6%- and 49.5% participated in organized sports and swimming lessons during the measurement period, respectively (see Table  1 ).

School start times were 8.30 am (19 schools) and 8.40 am (2 schools), while school bell times ranged from 2.00 pm to 3.15 pm. In total, 15 schools used a shortened schedule on Wednesdays (i.e. bell times ranging from 12.00 am to 12.35 pm) and 5 schools used a shortened schedule on Fridays (i.e. bell times ranging from 12.00 am to 12.30 pm). All schools provided breaks at the school parcel, so children were not allowed to leave school before school bell time. On average children lived at 2.76 km (SD = 0.33 km) pedestrian network-distance from their school (median = 604 m). Alternatively, when categorized in distance-categories, 30.8% lived within 400 m, 29.1% lived between 400- and 800 m (i.e., approximately 8 min walking time) and 40.1% lived more than 800 m from their school.

When looking at the temporal distribution of PA, average daily weartime of combined sensor-data was 713.26 min (SD = 116.07) during weekdays and 670.34 min (SD = 117.38) during weekend days, while children performed an average of 63.00 min (8.9%) and 65.37 min (9.8%) of MVPA during week- and weekend days, respectively. On weekdays, children spent an average of 294.88 min (SD = 78.90) in the temporal school-schedule, which makes the average distribution of time during weekdays approximately 50% for combined before- and in school and 50% for afterschool till sleep (data not shown). Within weekdays, schooltime contributed to almost half of the daily MVPA (i.e. 29 min), while after school time periods approximately contributed to the other half (Fig.  4 ). The minutes of MVPA after school, as well as its relative percentage, gradually declined during the day. During weekends, the absolute and relative contribution of MVPA slightly increased across the day, with the most active part in the early afternoon. After 16:00 h, intensity of MVPA dropped to 7.2% on average.

Temporal distribution of mean daily minutes of MVPA in week- and weekend days

When looking at the geographical distribution of PA during weekdays, percentages of LPA and MVPA were about twice as high at school versus at home (Table  2 ). At school, children spent on average 21.99 min in MVPA, which is 10.7% from the total daily weartime at school. Very little time was spent in the overlapping home-school neighbourhood and in the home neighbourhood outside the school neighbourhood. During weekdays, the vast majority of weartime was spent at- or close to home and school parcels. Children reported most daily minutes of MVPA at their school-parcel (i.e. approximately 22 min). Another 5.8 min of MVPA occurred within 100 m from their school, summing up to approximately 28 min. Also, compared to all other environments, the absolute- and relative contribution of LPA was highest at school, meaning that children were least sedentary at- and around their school (data not shown). At home, absolute- and relative contributions of LPA, as well as MVPA, were lower. Children spent more LPA and MVPA outside their home (but within 100 m from home) compared to their direct home location. In addition, children spent on average 70 min outside the home-school neighbourhood, with a relatively high amount of 7.5 min in MVPA (i.e. 10.6% of time spent outside home-school neighbourhood). Obviously, during weekend days the influence of school on PA disappeared, but this resulted in higher absolute- and slightly higher relative contribution of the home location in children’s LPA and MVPA (Table  2 ). Children spent especially more time at the ‘close to home’ location, resulting in approximately 23 min of MVPA. The percentage of MVPA that occurred at home remained relatively stable (i.e. 4.5% during weekdays versus 5.8% during weekend days). During weekends children also spent more time outside the home-school neighbourhood, while the percentage MVPA remained stable compared to weekdays. This resulted in another 23 min of MVPA performed outside the home-school neighbourhood (i.e. 12.0% of time spent at this location).

Transport-related pedestrian trips were responsible for approximately 45% (i.e. 26 min) and 38% (i.e. 22 min) of children’s average daily MVPA during weekdays and weekend days respectively (Table  3 ). Higher daily mean minutes of pedestrian trips were found during weekdays compared to weekends. During weekdays, additional analyses revealed that slightly more minutes of daily pedestrian trips were observed during in-school time zones (82.25, SD = 80.22 min) compared to afterschool time zones (66.29, SD = 61.36 min). The influence of bicycle- and motorized trips to MVPA was substantially lower. In general, this also means that approximately 30 min of MVPA during weekdays- and 34 min during weekend days was spent relatively stationary (i.e. not identified by GPS-based algorithm as a transport trip). The percentage MVPA was higher in pedestrian trips compared to stationary activities (e.g. 12.3% versus 6.8%, respectively).

Public open spaces equipped for PA (i.e. parks, sports terrains, and playgrounds) played a minor role in young children’s daily PA patterns. Although playgrounds showed a relatively high percentage of time spent in MVPA, absolute time spent at playgrounds was relatively low (2.8 and 5.1 daily minutes during week- and weekend days, respectively).

This study demonstrated context-specific PA patterns of young children by investigating their PA through space and time. More specifically, we showed that at the onset of primary school, half of children’s daily amount of MVPA during weekdays occurred at school or within 100 m from school, while the other half was divided between home or within 100 m from home and environments outside children’s home-school neighbourhood. During weekend days, from the daily amount of MVPA (i.e., approximately 65 min), slightly over half was performed at home or within 100 m from home. Only a marginal part of total daily MVPA occurred outside the home-school neighbourhood. These findings are in line with the study of Bai and colleagues, who showed that about 60% of 3-year-old children’s daily weekday MVPA of approximately 76 min occurred within 500 m from their home [ 41 ]. Furthermore, this shows that although the school-context was responsible for over 50% of MVPA during weekdays, these children seem to be able to reallocate this with PA around home and outside the home-school neighbourhood during weekend days. This is not in line with the Structured Days Hypothesis [ 53 ], stating that the presence of structure and routine of pre-scheduled activities (e.g. physical education, active travel, limited screen time) may positively influence children’s PA. Future studies are encouraged to further unravel within-person mechanisms (both between-day and within-day) in order to tailor future PA interventions [ 54 , 55 ].

Our study demonstrated the importance of pedestrian-trips in daily MVPA of young children. Urban planners, school boards, policy-makers and health scientists are encouraged to co-develop initiatives that persuade parents and children to use active mobility instead of passive forms while exploiting the potential of supportive social- and physical environments [ 56 ]. Sensitivity analyses revealed that during weekdays most of time spent in pedestrian trips were during school time. However, we also showed that in our sample, cycling played a minor role in daily MVPA, which is in contrast with studies in older Dutch children [ 57 ] showing that cycling being one of the major contributors to daily PA in Dutch children [ 58 ]. This is in accordance with the long history of normalization of daily cycling mobility in the Netherlands [ 59 , 60 ]. Children usually learn to cycle around the age of 5–7 years [ 61 ]. According to our questionnaire-data, parents reported that most of the children in our study was technically already able to ride a bike with- (32%) or without supervision (45%), but 98.5% reported supervision of parents- or siblings in home-school trips. An alternative explanation for this finding may be the use of the uniaxial signal of our hip-worn accelerometer in our study, as this underestimates PA during cycling [ 62 ]. Future studies, especially in older populations, are encouraged to improve measurement of cycling (e.g. using alternative placement, tri-axial signals, or multiple measurements). In addition, future studies may continue to distinguish between transport trips and relative stationary PA (i.e. not identified as a trip), potentially also leading to associations with motor development of young children.

The present study contributed to the understanding of how children’s integrated school- and home environments contribute to their daily PA, in both week- and weekend days. Previous studies have investigated PA from either one of these environments [ 63 , 64 ], but to our knowledge, this is the first study that applied this combination of contexts. In particular, this study showed that especially during weekends, a considerable proportion of MVPA was performed > 800 m from both home- and school locations. This is again in line with preschool-data from Bai and colleagues, who showed that almost 30% of daily MVPA occurred at residential locations outside children’s neighbourhoods [ 41 ]. Our data showed that young children’s daily exposure during both week- and weekend days in parks, sports terrains, and playgrounds was very low but the percentage of MVPA at these locations was relatively high. This may require specific interventions focusing on increasing young children’s exposure at these environments, potentially as a multi-component involving both the home/family- and the school setting [ 65 ]. In addition, based on the same findings regarding the low daily minutes of PA that occurred in parks, sports terrains, and playgrounds, it seems unlikely that MVPA outside home-school neighbourhood would relate to these specific locations. Furthermore, it seems also unlikely that afterschool childcare or care by grandparents outside the neighbourhood may be responsible for this, since our questionnaire-data showed that only 15% of the parents reported a visit to non-school childcare for at least one day during measurement. Another suggestion may be that these children often participated in pre-arranged play sessions at a friend’s house outside their own neighbourhood or more informal play-spaces around their residential neighbourhood, but future research should provide additional insight in this type of affordance [ 41 ].

One of the strengths of this study is the inclusion of multiple study-sites surrounding three cities in the Netherlands, which allowed us to study children’s PA patterns in diverse settings, increasing the variability in environmental exposure [ 34 ]. In addition, the use of the combined accelerometer GPS methodology allowed us to objectively monitor context-specific PA patterns throughout multiple days, minimizing potential recall bias. The additional use of geospatial analyses yielded further understanding of where young children are active. Although efforts were made to include a diverse and representative sample of young children by recruiting schools from multiple Dutch cities and the fact that daily PA of our sample was relatively comparable to international literature, it still may be that wearing accelerometer- and GPS devices was most interesting for active children or parents that perceive their child as relatively active. Future technological advancements such as smaller wrist-worn devices may have potential to be suitable and interesting for all children. Another potential weakness of this study was the use of a descriptive approach that elaborated on mean daily patterns for all children in multiple contexts, while future studies may implement a more evaluative approach to investigate differences between subgroups of children or evaluate determinants of specific behaviours (e.g. active transport to- and from school) or environments. For example, the relative contribution of school times to children’s daily PA may vary between types of children and environments where they live, allowing increased tailoring of PA intervention to the target group. We showed that MVPA at- and around children’s home was low. As previous research indicated that there is a lack of knowledge about facilitators and barriers in the home-based family environment (e.g. related to practices of both active and sedentary behaviours) [ 66 ] Previous studies showed that parents act as key gatekeepers for children’s spatial freedom [ 67 , 68 ], while this study demonstrated the importance of the environment within 100 m from home. Hence, it seems essential to get a better understanding of how parental rearing-constructs such as perception of traffic safety or ‘stranger danger’, but also social- and environmental factors influence parent-practices regarding independent mobility and, in turn, influences children’s PA [ 69 ]. Indications from our questionnaire data show that approximately 50% of the parents allowed their child to independently play in their neighbourhood, while 27% allowed their child to independently travel to visit family or friends. Supervision of siblings or peers increased the percentages above to approximately 68% and 42%, respectively. Future studies are encouraged to progress this field by combining data from parents (e.g. child-rearing constructs) and objective PA- and location data from children, with specific interest for home and school environments.

Our sample of 5.5-year-old children reported approximately 29 min of weekday MVPA during schooltime. Conversely, a previous review suggested that in older children, less than a quarter reached 30 min schooltime MVPA and that adolescents even reported lower levels [ 70 ]. Additionally, a previous study showed that in a sample of 7-11-year-old children with relatively low motor competence, school was the least active time period of their day. compared to before- and after school [ 71 ]. In turn, recent research showed that longer-term integration of PA in curricula, such as active breaks and physically active learning, fosters important pre-requisites of academic learning (e.g. time on task) [ 72 , 73 ]. Therefore, schools are well-suited for addressing important PA-related health inequalities of young children [ 74 ] and are therefore encouraged to implement evidence-based policies and to systematically evaluate which parts of the school-system hamper and stimulate their pupil’s PA as well as academic performance.

Overall, our study demonstrated the importance of schools in supporting PA of young children during weekdays. During weekends, the environment within 100 m from young children’s home was important, as well as locations outside the home-school neighbourhood. During- week and weekend days, walking contributed to almost half of the daily MVPA, emphasizing the importance of active school transportation- but also habitual daily walking and cycling (during week- and weekend days) for sustainable and PA promotion in children.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Dutch Organization for Scientific Research

Physical Activity

Moderate-to-vigorous Physical Activity

Global Positioning System

Geographic Information System

Personal Activity Location Measurement System

Human Activity Behavior Identification Tool and data Unification System

Software R-package to process raw accelerometer data

Standard Deviation

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Acknowledgements

We are grateful to all schools and children participating in the Start Vaardig study.

The Start Vaardig study was funded by the Dutch Organization for Scientific Research (NWO) (RAAKPRO03.123).

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T. Remmers, I. Fassaert, S. B. Vos & D. H. H. Van Kann

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Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands

Department of Public Health and Primary Care, Leiden University Medical Centre, Health Campus The Hague, The Hague, The Netherlands

S. I. de Vries

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TR analyzed and interpreted the data and drafted the original manuscript. PK assisted in the ethical approval and managed data collection. IF managed data collection and assisted in analyses. JN managed data collection and assisted in drafting the manuscript. WdG assisted in data collection and assisted in ethical approval. SV supervised the project and assisted in funding. SdV managed the project and supervised the funding. RM supervised the project and assisted in funding. DVK supervised the project, assisted in funding, and assisted in drafting the manuscript. All authors read and approved the final manuscript.

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Remmers, T., Koolwijk, P., Fassaert, I. et al. Investigating young children’s physical activity through time and place. Int J Health Geogr 23 , 12 (2024). https://doi.org/10.1186/s12942-024-00373-8

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Predictors for interest to participate in digital mental health therapy: a cross-sectional survey of individuals with anxiety and depression

• Tharidu Gunawardena 1 ,
• Marilyn M. Bartholmae 1 , 2 ,
• Matvey V. Karpov 1 ,
• Rohan Dod 1 ,
• Kripa Ahuja 1 ,
• Aishwarya Rajendran 1 ,
• Mayuri Kathrotia 1 &
• Sunita Dodani 1 , 3  

BMC Digital Health volume  2 , Article number:  21 ( 2024 ) Cite this article

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Metrics details

Due to a multitude of factors, the onset of the COVID-19 pandemic resulted in a significant increase in mental health issues within society, including depression and anxiety. Due to the increased trend of mental health disorders in society, digital mental health therapies are more useful than ever. With the emergence of programs utilizing Internet Cognitive Behavioral Therapy (iCBT), mental health resources are easily accessible and can be widely implemented to those in need.

The aim of this study was to identify predictors for interest to participate in SilverCloud digital mental health therapy among individuals with mild to severe anxiety and/or depression based on preliminary findings from the COVIDsmart study.

COVIDSmart participants who had moderate to severe anxiety and/or depression based on the PHQ-9 and GAD-7 scores, and who consented to be contacted for future studies, were invited to complete a needs assessment survey via Research Electronic Data Capture (REDCap). This assessment used self-reported measures including medical diagnoses, mental health services received, reasons for anxiety and/or depression, the use of coping strategies, suicidal ideology using the Ask Suicide Questions tool, and whether they would be interested in receiving free digital mental therapy. Descriptive statistics were used to report participants’ demographics and a logistic regression was used to find predictors for interest in participation in SilverCloud. SAS 9.4 was used and p values < 0.05 were considered significant.

Out of the original 782 COVIDsmart participants, 634 consented to be contacted for future studies, 280 were subsequently invited to complete the SilverCloud needs assessment, and 120 individuals completed it. The largest demographic among these participants were females (70.83%) who identified as White (80.83%). The mean age was 48.74 years ( SD  = 14.66). Results revealed that having a mental health comorbidity significantly predicted the likelihood of interest in participating in the SilverCloud digital mental health program ( p  = 0.027).

Conclusions

In this study, mental illness comorbidities predicted the interest to participate in digital mental therapy. Fragmented healthcare and perceptions of unmet care needs are likely contributor factors. Further research with a diverse sample of participants is necessary for generalizability. Findings may have important implications for healthcare best practices.

Peer Review reports

Introduction

Repeatedly, it has been evident that periods of widespread human catastrophe or disaster often result in large-scale detrimental impacts on mental health. During the COVID-19 pandemic, there were not only new cases of mental health disorders but also an exacerbation of existing mental health conditions [ 1 ]. According to a briefing released by the World Health Organization in March 2022, during the first year of the COVID-19 pandemic, the prevalence of major depressive disorders and anxiety disorders had increased significantly [ 2 ]. There were multiple factors leading to a significant spike in mental health disorders. Common stressors were social isolationism, perpetual fear of COVID-19 infection, loss of employment, death of a loved one or friend and uncertainty about the future [ 3 ]. Despite many of the COVID-19 restrictions and lockdowns being relaxed since March of 2020, the damaging adverse mental health effects of the pandemic seem to have persisted throughout the United States (U.S). According to a CDC report, the prevalence of anxiety and depressive disorders has been three and four times higher, respectively, compared to pre-pandemic levels within the U.S.[ 4 ]. In 2021, mental health screenings were taken by over 5.4 million people, indicating a near 500% increase since 2019 and a 103% increase since 2020 [ 5 ].

In the state of Virginia, the COVIDsmart study was initiated to assess the effects of COVID-19 on health, behavioral and economic status of individuals in Virginia. The study gathered data from March 2021 to November 2021 through longitudinal surveys. The surveys comprised the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), a condensed version of the UCLA Loneliness Scale, and a condensed version of the Social Network Index [ 6 ]. 782 Virginia residents, spanning from 18 to 87 years, registered in the COVIDsmart study. The COVIDsmart sample consisted of mostly White (81.5%), middle aged (mean age 51), middle income (51% with income of $100,000 or higher), college educated (62.6%) females (78.6%) [ 6 , 7 ]. The COVIDsmart preliminary results revealed that 21% of participants had moderate to severe anxiety and 25% had moderate to severe depression [ 7 ]. It was evident that there was a significant presence of mental disorders among Virginia residents after the COVID-19 pandemic. This prompted us to believe that there was a considerable number of individuals that required mental health services, but simply did not receive adequate counseling or therapy, leading to unmet health needs.

Based on these preliminary findings, a significant percentage of the participants of the COVIDsmart study had experienced some level of depression or anxiety, therefore the SilverCloud study was conceived and was funded by Eastern Virginia Medical School (EVMS) to alleviate the high rates of anxiety and depression among Virginians. Designed to alleviate depression and anxiety, SilverCloud is a digital mental health program that uses Internet Cognitive Behavioral Therapy (iCBT). CBT has been a highly effective form of psychological therapy for over 50 years. As patient requirements have increased, mental healthcare delivery has evolved significantly in the past decade with the introduction of new tools. Psychological interventions, specifically CBT, have become easier to implement in the form of iCBT [ 8 ]. The benefits of iCBT include cost effectiveness and global use [ 9 ]. Additionally, patients can utilize iCBT programs from the comfort of their homes, without the need for any in-person interaction. This can be particularly useful for those who have busy schedules or reside in more remote locations.

Although the mental health digital landscape is full of CBT-based apps and other digital interventions, meta-analyses and systematic reviews suggest that iCBT targeting anxiety and depression is not always effective. For example, a 2020 study by Etzelmueller et al., provided evidence for efficacy of iCBT interventions via randomized clinical trials [ 10 ] while Liu et al., 2022, suggested some iCBT-based modules are effective in treating anxiety and depression but other modules are not. Implementation science highlighting specialized needs, resources, and training to operate digital services is necessary for the success of digital therapeutics in healthcare [ 11 ]. SilverCloud Health has achieved global reach by using implementation science strategies and is the global leader in developing and delivering evidence-based mental health interventions across healthcare systems, payors such as insurance companies and government plans, providers, employer organizations, and charity/advocacy agencies [ 12 ]. SilverCloud delivers a vast array of personalized interventions to meet the specific mental health needs of individuals. Compared to other traditional digital platforms, SilverCloud offers self-guided programs, digital coaching, progress tracking tools and mobile accessibility in a secure environment. SilverCloud programs for anxiety and depression are recommended based on PHQ-9 and GAD-7 scores. These programs encourage the development of awareness and understanding of emotions, while increasing daily enjoyable activities and motivation. CBT is used to teach healthy thinking, feelings, behaviors, and to make positive changes to overcome anxiety and/or depression. SilverCloud programs include 10 modules: Getting Started, Understanding Depression and Anxiety, Noticing Feelings, Boosting Behavior, Spotting Thoughts, Challenging Thoughts, Managing Worry, Core Beliefs (unlockable by Coach), Facing Your Fears (unlockable by coach), and Bringing It All Together. SilverCloud coaches are licensed mental health professionals who provide weekly support to motivate users to engage in the SilverCloud programs, provide daily and weekly goals, and help users apply their learnings into everyday life [ 13 ]. The preliminary randomized controlled trials, which utilized SilverCloud, indicate that this therapy is effective as a stand-alone treatment for mild to moderate anxiety and depression [ 14 ].

The objective of this study was to determine the factors that can predict interest in participating in the SilverCloud program by COVIDsmart participants. Additionally, a secondary objective was to recognize the particular traits that enhance the probability of people seeking digital mental health care. This data could have significant clinical implications as it would enable healthcare professionals to gain better insights into the mental health needs of Virginians. With a greater understanding of the characteristics of these individuals in local communities, clinicians can customize digital interventions that cater to specific groups. This approach could enhance the rates of mental health screening and treatment accessibility among vulnerable populations, leading to better patient outcomes. Additionally, utilizing this information may enable digital mental health professionals to provide tailored and suitable treatment to their patients in the future. The implementation of these strategies could potentially have a notable effect in alleviating the continuous mental health emergency at a local, national, and conceivably worldwide scale.

Study design and recruitment

In order to conduct the SilverCloud study, the participants were recruited from the original COVIDSmart study. There were several recruitment strategies implemented in the COVIDSmart study, particularly to increase the likelihood of including ethnic minorities, individuals from rural areas, and individuals from lower socioeconomic backgrounds. The strategies implemented included online articles, employer e-newsletters, purchased email lists, social media posts, television, radio, paper flyers, and digital flyers. As an incentive, electronic gift cards were used to garner participation in the study. The data collection was conducted via an online HIPAA compliant platform designed by Vibrent Health Inc. The study was a joint effort with EVMS-Sentara Healthcare Analytics and Delivery Science Institute (HADSI), George Mason University, and Vibrent Health. 782 residents of Virginia enrolled in the COVIDSmart registry from March to May 2021.

The SilverCloud study was created to address the COVIDSmart study’s preliminary results showing 21% of participants had moderate to severe anxiety and 25% had moderate to severe depression [ 15 ]. Figure 1 shows the demographics for COVIDSmart participants.

Demographics of COVIDsmart participants, N =771

Out of the 782 original COVIDsmart participants, 634 of them consented to be contacted for future studies. 280 of the COVIDSmart participants who had moderate to severe anxiety and/or depression based on the PHQ-9 and GAD-7 scores, and who consented to be contacted for future studies, were invited to complete a needs assessment questionnaire to further determine eligibility to the SilverCloud study. 120 individuals completed the SilverCloud needs assessment. The needs assessment (Appendix 1 ) evaluated self-reported measures such as medical diagnoses, mental health services received, reasons for anxiety and/or depression, the use of coping strategies, suicidal ideology (using the Ask Suicide Questions (ASQ) survey), and whether they would be interested in receiving free digital mental therapy.

Thus, the purpose of this survey was twofold: to determine their eligibility for the 8-week SilverCloud study and to assess the factors contributing to their elevated levels of anxiety and/or depression during the COVID-19 pandemic (Fig. 2 ).

Procedure for participant recruitment and enrollment

COVIDsmart participants who had an acute suicide screening based on the ASQ survey or self-reported substance abuse and dependence were not eligible to participate in SilverCloud. However, they were provided with a list of resources they could reach for immediate assistance (Appendix 2 ). This study was approved by the Eastern Virginia Medical School Institutional Review Board (IRB# 21–07-FB-0185).

Data collection

The SilverCloud needs assessment survey was created using Research Electronic Data Capture (REDCap). REDCap is a secure web-based application used to create forms and manage databases in order to support data capture and surveys for research. REDCap data is stored securely at EVMS on private, protected servers, and meets requirements for the Health Insurance Portability and Accountability Act for collection of personal health information. The needs assessment was sent via REDcap to identified potential participants.

Statistical analysis

Descriptive statistics were used to analyze the demographics of participants. To find predictors for interest to participate in SilverCloud, we used a logistic regression including the independent variables: receiving mental health care (yes or no), having coping strategies (yes or no), severity categories for GAD-7 and PHQ-9 (moderate to severe), mental illness comorbidity (yes or no), current medications for anxiety and/or depression (yes or no), race, sex, and age. The dependent variable was interest to enroll in SilverCloud (yes or no). We conducted the analysis using SAS 9.4, and p values < 0.05 were considered significant.

A total of 120 participants who were part of the COVIDsmart program completed a needs assessment for SilverCloud. Table 1 shows that the majority of SilverCloud participants were female (70.83%) and White (80.83%). The mean age of participants was 48.74 years ( SD  = 14.66, Table  2 ).

The study found that having a co-existing mental health condition was a significant predictor of the likelihood of showing interest in participating in the digital mental health SilverCloud program (p = 0.027). Among participants with moderate to severe anxiety and/or depression who were enrolled in COVIDsmart, those with a comorbidity of mental illness were 378% more inclined to be interested in SilverCloud as compared to those without a mental illness comorbidity. The mental health comorbidities reported by SilverCloud participants had a wide range, but the most common comorbidity was Posttraumatic Stress Disorder (PTSD) (28.6%), followed by eating disorder (21.4%) and Attention Deficit Hyperactivity Disorder (ADHD) (14.3%), as presented in Table  3 . These reported comorbidities were based off of self-reported survey data, and were not verified diagnoses.

However, factors such as race, gender, age, taking medication for anxiety or depression, anxiety severity, depression severity, use of coping strategies, and receiving mental health services did not have any predictive value in terms of interest in participating in SilverCloud ( p  ≥ 0.05), as shown in Table  4 .

Principle results

This study showed that the only significant factor that led COVIDsmart participants to be interested in participating in SilverCloud for depression and anxiety treatment was a mental illness comorbidity. The most common comorbidities reported included PTSD, eating disorders, and ADHD. Individuals with comorbid mental illnesses experience a cumulative medical burden, often requiring multiple physical and mental health services [ 15 , 16 ]. These individuals are more likely to experience unintegrated and uncoordinated healthcare delivery [ 17 , 18 ]. Furthermore, individuals with multiple mental health comorbidities are more likely to have perceived unmet needs for care [ 19 , 20 ]. Thus, we hypothesize that individuals who experience fragmented healthcare and perceived unmet care needs may be more willing to accept mental health treatment for new conditions.

In addition, participants who had high levels of anxiety and/or depression, but no prior experience with mental health counseling, may be more apprehensive to receive treatment due to societal stigma about treatment for mental disorders. Participants with mental disorders with high levels of experienced stigma have lower rates of recovery since they are less likely to receive mental health services for their condition [ 21 ]. In this study, it seemed as if participants with multiple mental conditions were more likely to accept digital mental health treatment. The digital therapeutic setting may remove the stigma barrier for individuals with comorbid mental illnesses.

The PHQ-9 and GAD-7 scores did not have a significant predictive value for participating in mental health therapy. Unfortunately, it is unclear as to why this is. We hypothesize that since PHQ-9 and GAD-7 scores are only indicators for depression and anxiety alone, respectively, it is possible that despite a high level of depression and/or anxiety, the mental burden on these participants may not be as taxing as it is for participants with multiple mental health comorbidities, therefore, these participants were less likely to enroll in digital mental health therapy compared to participants with multiple comorbid mental illness. The individuals who chose to enroll in digital mental therapy may require integrated healthcare approaches to address their physical/mental multi-comorbidity healthcare needs. Additionally, participants who were already receiving mental health care services as well as those who were using coping strategies such as exercising and drinking less alcohol, were not likely to be interested in digital mental therapy.

The majority of participants in the COVIDsmart study were Non-Hispanic Whites and females, which explains why a similar demographic makeup was observed in the SilverCloud study. However, the SilverCloud study had a slightly higher percentage of female and Non-Hispanic White participants compared to the COVIDsmart study. Additionally, the greatest percentage of COVIDsmart participants fell into the 46–55 age range (Fig. 1 ). This corresponds accordingly with the mean age of SilverCloud participants being 48.74 years old (Table  2 ). Despite this, neither race nor gender nor age were significant predictors of participation in digital mental health therapy. It is not clear why these particular demographics were more likely to participate in both studies. Non-Hispanic Whites are known to have higher rates of mental disorders compared to people of color, although this may be due to various factors such as discriminatory medical practices, negative cultural attitudes towards mental illness, lack of insurance, and language barriers that minorities face [ 22 , 23 ].

Future directions

Our findings suggest healthcare workers should especially turn their attention towards individuals who are already suffering from coexisting mental conditions. It is very possible that the introduction of future large-scale stressors can result in new cases or the exacerbation of milder forms of depression and anxiety in these patients. Mental health counselors, psychiatrists, and therapists should regularly screen patients with existing mental health conditions with the PHQ-9 and GAD-7 for any new developments regarding depression and anxiety. Moreover, future research is needed to further evaluate the role of healthcare fragmentation and perceptions of unmet medical care needs in the enrollment of digital mental therapies. Findings could have important implications for healthcare best practices.

Future research should expand the scope and demographics of this study. While the cause of the increase in the percentage of highly-educated female and Non-Hispanic White participants in the SilverCloud study remains unknown, it is important to consider this metric on a global scale. Large nationally representative US surveys have found that mental health of Black, Hispanic, and Asian respondents worsened relative to White respondents during the pandemic, including significant increases in depression and anxiety among racialized minorities compared to White people [ 24 ]. These surveys also showed that White respondents were the most likely to receive professional mental health care before and during the pandemic, while minority respondents demonstrated higher levels of unmet mental health care needs during the pandemic than White respondents [ 24 ]. The findings of our study showed a similar trend, wherein there was an increase in the number of White participants seeking mental health care. Although our study was limited in size compared to a nationwide study, the outcomes are comparable. Securing a diverse socio-economic and racial participation is important for generalizability of future studies.

Limitations

The study has several limitations. Firstly, it only included participants from the COVIDsmart study, which means that the sample was restricted to residents of Virginia. Secondly, research fatigue from the six-month longitudinal COVIDsmart study could have deterred some participants from taking part in the SilverCloud study, thus resulting in a smaller sample size. Thirdly, the socioeconomic and racial diversity of the SilverCloud study participants did not accurately reflect the Virginia population, as there was an overrepresentation of highly educated White females and an underrepresentation of minority groups, including those living in rural areas. The lack of participant diversity and limited scope of this study may significantly hamper its generalizability to broader populations.

Fourthly, because the SilverCloud program was only accessible online, participants without internet access in Virginia may have been less likely to participate. In the future, alternative treatment options such as traditional in-person face-to-face therapy could be considered, although this would require additional resources and higher costs. Fifth, the mental illness comorbidity was self-reported. We included the variable comorbidity (yes or no) in the logistic regression model to determine whether having a mental illness comorbidity would influence the outcome: interest to participate in SilverCloud. Sixth, high risk respondents to the needs assessment could only be provided with available resources to receive help, rather than being provided with an on demand consultation with an available clinician.

Individuals with mental illness comorbidities may have a higher tendency to seek and participate in digital mental health programs amid the COVID-19 pandemic. Digital CBT-based programs can potentially improve the accessibility of care for this group. However, programs should prepare to address the needs of patients with mental illness comorbidities as they may require multidisciplinary healthcare services. Mental health professionals and researchers need to gain a deeper understanding of the unique needs of this population.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Abbreviations

Attention Deficit Hyperactive Disorder

Eastern Virginia Medical School

Internet cognitive behavioral therapy

Posttraumatic Stress Disorder

Research Electronic Data Capture

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Acknowledgements

We thank all of the participants who took part in the SilverCloud study. A preprint version of this manuscript has been published in JMIR Publications and is provided as #15 in the list of references.

SilverCloud did not provide any funding for this project. All funding was provided internally by Eastern Virginia Medical School.

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Tharidu Gunawardena, Marilyn M. Bartholmae, Matvey V. Karpov, Rohan Dod, Kripa Ahuja, Aishwarya Rajendran, Mayuri Kathrotia & Sunita Dodani

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MB, MK, and SD contributed to the study design, data collection, and data analysis. TG, RD, KA, AR, MK, MB, MK, and SD wrote and revised the main manuscript. All authors contributed to the article and approved the submitted version.

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The study was conducted in accordance with the ethical principles laid out in the Declaration of Helsinki. The participants gave informed consent to participate in the study. The study protocol was approved by the Eastern Virginia Medical School institutional review board (IRB# 21–07-FB-0185) and was conducted in compliance with all applicable laws and regulations.

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Gunawardena, T., Bartholmae, M.M., Karpov, M.V. et al. Predictors for interest to participate in digital mental health therapy: a cross-sectional survey of individuals with anxiety and depression. BMC Digit Health 2 , 21 (2024). https://doi.org/10.1186/s44247-024-00080-1

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Internet use statistically associated with higher wellbeing, finds new global Oxford study

Links between internet adoption and wellbeing are likely to be positive, despite popular concerns to the contrary, according to a major new international study from researchers at the Oxford Internet Institute, part of the University of Oxford.

The study encompassed more than two million participants psychological wellbeing from 2006-2021 across 168 countries, in relation to internet use and psychological well-being across 33,792 different statistical models and subsets of data, 84.9% of associations between internet connectivity and wellbeing were positive and statistically significant. 

The study analysed data from two million individuals aged 15 to 99 in 168 countries, including Latin America, Asia, and Africa and found internet access and use was consistently associated with positive wellbeing.   

Assistant Professor Matti Vuorre, Tilburg University and Research Associate, Oxford Internet Institute and Professor Andrew Przybylski, Oxford Internet Institute carried out the study to assess how technology relates to wellbeing in parts of the world that are rarely studied.

Professor Przybylski said: 'Whilst internet technologies and platforms and their potential psychological consequences remain debated, research to date has been inconclusive and of limited geographic and demographic scope. The overwhelming majority of studies have focused on the Global North and younger people thereby ignoring the fact that the penetration of the internet has been, and continues to be, a global phenomenon'. 

'We set out to address this gap by analysing how internet access, mobile internet access and active internet use might predict psychological wellbeing on a global level across the life stages. To our knowledge, no other research has directly grappled with these issues and addressed the worldwide scope of the debate.' 

The researchers studied eight indicators of well-being: life satisfaction, daily negative and positive experiences, two indices of social well-being, physical wellbeing, community wellbeing and experiences of purpose.   

Commenting on the findings, Professor Vuorre said, “We were surprised to find a positive correlation between well-being and internet use across the majority of the thousands of models we used for our analysis.”

Whilst the associations between internet access and use for the average country was very consistently positive, the researchers did find some variation by gender and wellbeing indicators: The researchers found that 4.9% of associations linking internet use and community well-being were negative, with most of those observed among young women aged 15-24yrs.

Whilst not identified by the researchers as a causal relation, the paper notes that this specific finding is consistent with previous reports of increased cyberbullying and more negative associations between social media use and depressive symptoms among young women. 

Adds Przybylski, 'Overall we found that average associations were consistent across internet adoption predictors and wellbeing outcomes, with those who had access to or actively used the internet reporting meaningfully greater wellbeing than those who did not'.

'We hope our findings bring some greater context to the screentime debate however further work is still needed in this important area.  We urge platform providers to share their detailed data on user behaviour with social scientists working in this field for transparent and independent scientific enquiry, to enable a more comprehensive understanding of internet technologies in our daily lives.' 

In the study, the researchers examined data from the Gallup World Poll, from 2,414,294 individuals from 168 countries, from 2006-2021.  The poll assessed well-being with face-to-face and phone surveys by local interviewers in the respondents’ native languages.  The researchers applied statistical modelling techniques to the data using wellbeing indicators to test the association between internet adoption and wellbeing outcomes. 

Watch the  American Psychological Association (APA) video  highlighting the key findings from the research.

Download the paper ‘ A multiverse analysis of the associations between internet use and well-being ’ published in the journal Technology, Mind and Behaviour, American Psychological Association.

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• Published: 14 May 2024

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

• Jocelyn Schroeder 1 ,
• Barbara Pesut 1 , 2 ,
• Lise Olsen 2 ,
• Nelly D. Oelke 2 &
• Helen Sharp 2  

BMC Nursing volume  23 , Article number:  326 ( 2024 ) Cite this article

161 Accesses

Metrics details

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Peer Review reports

Medical Assistance in Dying (MAiD) is permitted under an amendment to Canada’s Criminal Code which was passed in 2016 [ 1 ]. MAiD is defined in the legislation as both self-administered and clinician-administered medication for the purpose of causing death. In the 2016 Bill C-14 legislation one of the eligibility criteria was that an applicant for MAiD must have a reasonably foreseeable natural death although this term was not defined. It was left to the clinical judgement of MAiD assessors and providers to determine the time frame that constitutes reasonably foreseeable [ 2 ]. However, in 2021 under Bill C-7, the eligibility criteria for MAiD were changed to allow individuals with irreversible medical conditions, declining health, and suffering, but whose natural death was not reasonably foreseeable, to receive MAiD [ 3 ]. This population of MAiD applicants are referred to as Track 2 MAiD (those whose natural death is foreseeable are referred to as Track 1). Track 2 applicants are subject to additional safeguards under the 2021 C-7 legislation.

Three additional proposed changes to the legislation have been extensively studied by Canadian Expert Panels (Council of Canadian Academics [CCA]) [ 4 , 5 , 6 ] First, under the legislation that defines Track 2, individuals with mental disease as their sole underlying medical condition may apply for MAiD, but implementation of this practice is embargoed until March 2027 [ 4 ]. Second, there is consideration of allowing MAiD to be implemented through advanced consent. This would make it possible for persons living with dementia to receive MAID after they have lost the capacity to consent to the procedure [ 5 ]. Third, there is consideration of extending MAiD to mature minors. A mature minor is defined as “a person under the age of majority…and who has the capacity to understand and appreciate the nature and consequences of a decision” ([ 6 ] p. 5). In summary, since the legalization of MAiD in 2016 the eligibility criteria and safeguards have evolved significantly with consequent implications for nurses and nursing care. Further, the number of Canadians who access MAiD shows steady increases since 2016 [ 7 ] and it is expected that these increases will continue in the foreseeable future.

Nurses have been integral to MAiD care in the Canadian context. While other countries such as Belgium and the Netherlands also permit euthanasia, Canada is the first country to allow Nurse Practitioners (Registered Nurses with additional preparation typically achieved at the graduate level) to act independently as assessors and providers of MAiD [ 1 ]. Although the role of Registered Nurses (RNs) in MAiD is not defined in federal legislation, it has been addressed at the provincial/territorial-level with variability in scope of practice by region [ 8 , 9 ]. For example, there are differences with respect to the obligation of the nurse to provide information to patients about MAiD, and to the degree that nurses are expected to ensure that patient eligibility criteria and safeguards are met prior to their participation [ 10 ]. Studies conducted in the Canadian context indicate that RNs perform essential roles in MAiD care coordination; client and family teaching and support; MAiD procedural quality; healthcare provider and public education; and bereavement care for family [ 9 , 11 ]. Nurse practitioners and RNs are integral to a robust MAiD care system in Canada and hence need to be well-prepared for their role [ 12 ].

Previous studies have found that end of life care, and MAiD specifically, raise complex moral and ethical issues for nurses [ 13 , 14 , 15 , 16 ]. The knowledge, attitudes, and beliefs of nurses are important across practice settings because nurses have consistent, ongoing, and direct contact with patients who experience chronic or life-limiting health conditions. Canadian studies exploring nurses’ moral and ethical decision-making in relation to MAiD reveal that although some nurses are clear in their support for, or opposition to, MAiD, others are unclear on what they believe to be good and right [ 14 ]. Empirical findings suggest that nurses go through a period of moral sense-making that is often informed by their family, peers, and initial experiences with MAID [ 17 , 18 ]. Canadian legislation and policy specifies that nurses are not required to participate in MAiD and may recuse themselves as conscientious objectors with appropriate steps to ensure ongoing and safe care of patients [ 1 , 19 ]. However, with so many nurses having to reflect on and make sense of their moral position, it is essential that they are given adequate time and preparation to make an informed and thoughtful decision before they participate in a MAID death [ 20 , 21 ].

It is well established that nursing students receive inconsistent exposure to end of life care issues [ 22 ] and little or no training related to MAiD [ 23 ]. Without such education and reflection time in pre-entry nursing preparation, nurses are at significant risk for moral harm. An important first step in providing this preparation is to be able to assess the knowledge, values, and beliefs of nursing students regarding MAID and end of life care. As demand for MAiD increases along with the complexities of MAiD, it is critical to understand the knowledge, attitudes, and likelihood of engagement with MAiD among nursing students as a baseline upon which to build curriculum and as a means to track these variables over time.

Aim, design, and setting

The aim of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context. We sought to explore both their willingness to be involved in the registered nursing role and in the nurse practitioner role should they chose to prepare themselves to that level of education. The design was a mixed-method, modified e-Delphi method that entailed item generation, item refinement through an expert faculty panel [ 24 , 25 , 26 ], and initial item validation through a cognitive focus group interview with nursing students [ 27 ]. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

Participants

A panel of 10 faculty from the two nursing education programs were recruited for Phase 2 of the e-Delphi. To be included, faculty were required to have a minimum of three years of experience in nurse education, be employed as nursing faculty, and self-identify as having experience with MAiD. A convenience sample of 5 fourth-year nursing students were recruited to participate in Phase 3. Students had to be in good standing in the nursing program and be willing to share their experiences of the survey in an online group interview format.

The modified e-Delphi was conducted in 3 phases: Phase 1 entailed item generation through literature and existing survey review. Phase 2 entailed item refinement through a faculty expert panel review with focus on content validity, prioritization, and revision of item wording [ 25 ]. Phase 3 entailed an assessment of face validity through focus group-based cognitive interview with nursing students.

Phase I. Item generation through literature review

The goal of phase 1 was to develop a bank of survey items that would represent the variables of interest and which could be provided to expert faculty in Phase 2. Initial survey items were generated through a literature review of similar surveys designed to assess knowledge and attitudes toward MAiD/euthanasia in healthcare providers; Canadian empirical studies on nurses’ roles and/or experiences with MAiD; and legislative and expert panel documents that outlined proposed changes to the legislative eligibility criteria and safeguards. The literature review was conducted in three online databases: CINAHL, PsycINFO, and Medline. Key words for the search included nurses , nursing students , medical students , NPs, MAiD , euthanasia , assisted death , and end-of-life care . Only articles written in English were reviewed. The legalization and legislation of MAiD is new in many countries; therefore, studies that were greater than twenty years old were excluded, no further exclusion criteria set for country.

Items from surveys designed to measure similar variables in other health care providers and geographic contexts were placed in a table and similar items were collated and revised into a single item. Then key variables were identified from the empirical literature on nurses and MAiD in Canada and checked against the items derived from the surveys to ensure that each of the key variables were represented. For example, conscientious objection has figured prominently in the Canadian literature, but there were few items that assessed knowledge of conscientious objection in other surveys and so items were added [ 15 , 21 , 28 , 29 ]. Finally, four case studies were added to the survey to address the anticipated changes to the Canadian legislation. The case studies were based upon the inclusion of mature minors, advanced consent, and mental disorder as the sole underlying medical condition. The intention was to assess nurses’ beliefs and comfort with these potential legislative changes.

Phase 2. Item refinement through expert panel review

The goal of phase 2 was to refine and prioritize the proposed survey items identified in phase 1 using a modified e-Delphi approach to achieve consensus among an expert panel [ 26 ]. Items from phase 1 were presented to an expert faculty panel using a Qualtrics (Provo, UT) online survey. Panel members were asked to review each item to determine if it should be: included, excluded or adapted for the survey. When adapted was selected faculty experts were asked to provide rationale and suggestions for adaptation through the use of an open text box. Items that reached a level of 75% consensus for either inclusion or adaptation were retained [ 25 , 26 ]. New items were categorized and added, and a revised survey was presented to the panel of experts in round 2. Panel members were again asked to review items, including new items, to determine if it should be: included, excluded, or adapted for the survey. Round 2 of the modified e-Delphi approach also included an item prioritization activity, where participants were then asked to rate the importance of each item, based on a 5-point Likert scale (low to high importance), which De Vaus [ 30 ] states is helpful for increasing the reliability of responses. Items that reached a 75% consensus on inclusion were then considered in relation to the importance it was given by the expert panel. Quantitative data were managed using SPSS (IBM Corp).

Phase 3. Face validity through cognitive interviews with nursing students

The goal of phase 3 was to obtain initial face validity of the proposed survey using a sample of nursing student informants. More specifically, student participants were asked to discuss how items were interpreted, to identify confusing wording or other problematic construction of items, and to provide feedback about the survey as a whole including readability and organization [ 31 , 32 , 33 ]. The focus group was held online and audio recorded. A semi-structured interview guide was developed for this study that focused on clarity, meaning, order and wording of questions; emotions evoked by the questions; and overall survey cohesion and length was used to obtain data (see Supplementary Material 2  for the interview guide). A prompt to “think aloud” was used to limit interviewer-imposed bias and encourage participants to describe their thoughts and response to a given item as they reviewed survey items [ 27 ]. Where needed, verbal probes such as “could you expand on that” were used to encourage participants to expand on their responses [ 27 ]. Student participants’ feedback was collated verbatim and presented to the research team where potential survey modifications were negotiated and finalized among team members. Conventional content analysis [ 34 ] of focus group data was conducted to identify key themes that emerged through discussion with students. Themes were derived from the data by grouping common responses and then using those common responses to modify survey items.

Ten nursing faculty participated in the expert panel. Eight of the 10 faculty self-identified as female. No faculty panel members reported conscientious objector status and ninety percent reported general agreement with MAiD with one respondent who indicated their view as “unsure.” Six of the 10 faculty experts had 16 years of experience or more working as a nurse educator.

Five nursing students participated in the cognitive interview focus group. The duration of the focus group was 2.5 h. All participants identified that they were born in Canada, self-identified as female (one preferred not to say) and reported having received some instruction about MAiD as part of their nursing curriculum. See Tables  1 and 2 for the demographic descriptors of the study sample. Study results will be reported in accordance with the study phases. See Fig.  1 for an overview of the results from each phase.

Fig. 1  Overview of survey development findings

Phase 1: survey item generation

Review of the literature identified that no existing survey was available for use with nursing students in the Canadian context. However, an analysis of themes across qualitative and quantitative studies of physicians, medical students, nurses, and nursing students provided sufficient data to develop a preliminary set of items suitable for adaptation to a population of nursing students.

Four major themes and factors that influence knowledge, attitudes, and beliefs about MAiD were evident from the literature: (i) endogenous or individual factors such as age, gender, personally held values, religion, religiosity, and/or spirituality [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], (ii) experience with death and dying in personal and/or professional life [ 35 , 40 , 41 , 43 , 44 , 45 ], (iii) training including curricular instruction about clinical role, scope of practice, or the law [ 23 , 36 , 39 ], and (iv) exogenous or social factors such as the influence of key leaders, colleagues, friends and/or family, professional and licensure organizations, support within professional settings, and/or engagement in MAiD in an interdisciplinary team context [ 9 , 35 , 46 ].

Studies of nursing students also suggest overlap across these categories. For example, value for patient autonomy [ 23 ] and the moral complexity of decision-making [ 37 ] are important factors that contribute to attitudes about MAiD and may stem from a blend of personally held values coupled with curricular content, professional training and norms, and clinical exposure. For example, students report that participation in end of life care allows for personal growth, shifts in perception, and opportunities to build therapeutic relationships with their clients [ 44 , 47 , 48 ].

Preliminary items generated from the literature resulted in 56 questions from 11 published sources (See Table  3 ). These items were constructed across four main categories: (i) socio-demographic questions; (ii) end of life care questions; (iii) knowledge about MAiD; or (iv) comfort and willingness to participate in MAiD. Knowledge questions were refined to reflect current MAiD legislation, policies, and regulatory frameworks. Falconer [ 39 ] and Freeman [ 45 ] studies were foundational sources for item selection. Additionally, four case studies were written to reflect the most recent anticipated changes to MAiD legislation and all used the same open-ended core questions to address respondents’ perspectives about the patient’s right to make the decision, comfort in assisting a physician or NP to administer MAiD in that scenario, and hypothesized comfort about serving as a primary provider if qualified as an NP in future. Response options for the survey were also constructed during this stage and included: open text, categorical, yes/no , and Likert scales.

Phase 2: faculty expert panel review

Of the 56 items presented to the faculty panel, 54 questions reached 75% consensus. However, based upon the qualitative responses 9 items were removed largely because they were felt to be repetitive. Items that generated the most controversy were related to measuring religion and spirituality in the Canadian context, defining end of life care when there is no agreed upon time frames (e.g., last days, months, or years), and predicting willingness to be involved in a future events – thus predicting their future selves. Phase 2, round 1 resulted in an initial set of 47 items which were then presented back to the faculty panel in round 2.

Of the 47 initial questions presented to the panel in round 2, 45 reached a level of consensus of 75% or greater, and 34 of these questions reached a level of 100% consensus [ 27 ] of which all participants chose to include without any adaptations) For each question, level of importance was determined based on a 5-point Likert scale (1 = very unimportant, 2 = somewhat unimportant, 3 = neutral, 4 = somewhat important, and 5 = very important). Figure  2 provides an overview of the level of importance assigned to each item.

Ranking level of importance for survey items

After round 2, a careful analysis of participant comments and level of importance was completed by the research team. While the main method of survey item development came from participants’ response to the first round of Delphi consensus ratings, level of importance was used to assist in the decision of whether to keep or modify questions that created controversy, or that rated lower in the include/exclude/adapt portion of the Delphi. Survey items that rated low in level of importance included questions about future roles, sex and gender, and religion/spirituality. After deliberation by the research committee, these questions were retained in the survey based upon the importance of these variables in the scientific literature.

Of the 47 questions remaining from Phase 2, round 2, four were revised. In addition, the two questions that did not meet the 75% cut off level for consensus were reviewed by the research team. The first question reviewed was What is your comfort level with providing a MAiD death in the future if you were a qualified NP ? Based on a review of participant comments, it was decided to retain this question for the cognitive interviews with students in the final phase of testing. The second question asked about impacts on respondents’ views of MAiD and was changed from one item with 4 subcategories into 4 separate items, resulting in a final total of 51 items for phase 3. The revised survey was then brought forward to the cognitive interviews with student participants in Phase 3. (see Supplementary Material 1 for a complete description of item modification during round 2).

Phase 3. Outcomes of cognitive interview focus group

Of the 51 items reviewed by student participants, 29 were identified as clear with little or no discussion. Participant comments for the remaining 22 questions were noted and verified against the audio recording. Following content analysis of the comments, four key themes emerged through the student discussion: unclear or ambiguous wording; difficult to answer questions; need for additional response options; and emotional response evoked by questions. An example of unclear or ambiguous wording was a request for clarity in the use of the word “sufficient” in the context of assessing an item that read “My nursing education has provided sufficient content about the nursing role in MAiD.” “Sufficient” was viewed as subjective and “laden with…complexity that distracted me from the question.” The group recommended rewording the item to read “My nursing education has provided enough content for me to care for a patient considering or requesting MAiD.”

An example of having difficulty answering questions related to limited knowledge related to terms used in the legislation such as such as safeguards , mature minor , eligibility criteria , and conscientious objection. Students were unclear about what these words meant relative to the legislation and indicated that this lack of clarity would hamper appropriate responses to the survey. To ensure that respondents are able to answer relevant questions, student participants recommended that the final survey include explanation of key terms such as mature minor and conscientious objection and an overview of current legislation.

Response options were also a point of discussion. Participants noted a lack of distinction between response options of unsure and unable to say . Additionally, scaling of attitudes was noted as important since perspectives about MAiD are dynamic and not dichotomous “agree or disagree” responses. Although the faculty expert panel recommended the integration of the demographic variables of religious and/or spiritual remain as a single item, the student group stated a preference to have religion and spirituality appear as separate items. The student focus group also took issue with separate items for the variables of sex and gender, specifically that non-binary respondents might feel othered or “outed” particularly when asked to identify their sex. These variables had been created based upon best practices in health research but students did not feel they were appropriate in this context [ 49 ]. Finally, students agreed with the faculty expert panel in terms of the complexity of projecting their future involvement as a Nurse Practitioner. One participant stated: “I certainly had to like, whoa, whoa, whoa. Now let me finish this degree first, please.” Another stated, “I'm still imagining myself, my future career as an RN.”

Finally, student participants acknowledged the array of emotions that some of the items produced for them. For example, one student described positive feelings when interacting with the survey. “Brought me a little bit of feeling of joy. Like it reminded me that this is the last piece of independence that people grab on to.” Another participant, described the freedom that the idea of an advance request gave her. “The advance request gives the most comfort for me, just with early onset Alzheimer’s and knowing what it can do.” But other participants described less positive feelings. For example, the mature minor case study yielded a comment: “This whole scenario just made my heart hurt with the idea of a child requesting that.”

Based on the data gathered from the cognitive interview focus group of nursing students, revisions were made to 11 closed-ended questions (see Table  4 ) and 3 items were excluded. In the four case studies, the open-ended question related to a respondents’ hypothesized actions in a future role as NP were removed. The final survey consists of 45 items including 4 case studies (see Supplementary Material 3 ).

The aim of this study was to develop and validate a survey that can be used to track the growth of knowledge about MAiD among nursing students over time, inform training programs about curricular needs, and evaluate attitudes and willingness to participate in MAiD at time-points during training or across nursing programs over time.

The faculty expert panel and student participants in the cognitive interview focus group identified a need to establish core knowledge of the terminology and legislative rules related to MAiD. For example, within the cognitive interview group of student participants, several acknowledged lack of clear understanding of specific terms such as “conscientious objector” and “safeguards.” Participants acknowledged discomfort with the uncertainty of not knowing and their inclination to look up these terms to assist with answering the questions. This survey can be administered to nursing or pre-nursing students at any phase of their training within a program or across training programs. However, in doing so it is important to acknowledge that their baseline knowledge of MAiD will vary. A response option of “not sure” is important and provides a means for respondents to convey uncertainty. If this survey is used to inform curricular needs, respondents should be given explicit instructions not to conduct online searches to inform their responses, but rather to provide an honest appraisal of their current knowledge and these instructions are included in the survey (see Supplementary Material 3 ).

Some provincial regulatory bodies have established core competencies for entry-level nurses that include MAiD. For example, the BC College of Nurses and Midwives (BCCNM) requires “knowledge about ethical, legal, and regulatory implications of medical assistance in dying (MAiD) when providing nursing care.” (10 p. 6) However, across Canada curricular content and coverage related to end of life care and MAiD is variable [ 23 ]. Given the dynamic nature of the legislation that includes portions of the law that are embargoed until 2024, it is important to ensure that respondents are guided by current and accurate information. As the law changes, nursing curricula, and public attitudes continue to evolve, inclusion of core knowledge and content is essential and relevant for investigators to be able to interpret the portions of the survey focused on attitudes and beliefs about MAiD. Content knowledge portions of the survey may need to be modified over time as legislation and training change and to meet the specific purposes of the investigator.

Given the sensitive nature of the topic, it is strongly recommended that surveys be conducted anonymously and that students be provided with an opportunity to discuss their responses to the survey. A majority of feedback from both the expert panel of faculty and from student participants related to the wording and inclusion of demographic variables, in particular religion, religiosity, gender identity, and sex assigned at birth. These and other demographic variables have the potential to be highly identifying in small samples. In any instance in which the survey could be expected to yield demographic group sizes less than 5, users should eliminate the demographic variables from the survey. For example, the profession of nursing is highly dominated by females with over 90% of nurses who identify as female [ 50 ]. Thus, a survey within a single class of students or even across classes in a single institution is likely to yield a small number of male respondents and/or respondents who report a difference between sex assigned at birth and gender identity. When variables that serve to identify respondents are included, respondents are less likely to complete or submit the survey, to obscure their responses so as not to be identifiable, or to be influenced by social desirability bias in their responses rather than to convey their attitudes accurately [ 51 ]. Further, small samples do not allow for conclusive analyses or interpretation of apparent group differences. Although these variables are often included in surveys, such demographics should be included only when anonymity can be sustained. In small and/or known samples, highly identifying variables should be omitted.

There are several limitations associated with the development of this survey. The expert panel was comprised of faculty who teach nursing students and are knowledgeable about MAiD and curricular content, however none identified as a conscientious objector to MAiD. Ideally, our expert panel would have included one or more conscientious objectors to MAiD to provide a broader perspective. Review by practitioners who participate in MAiD, those who are neutral or undecided, and practitioners who are conscientious objectors would ensure broad applicability of the survey. This study included one student cognitive interview focus group with 5 self-selected participants. All student participants had held discussions about end of life care with at least one patient, 4 of 5 participants had worked with a patient who requested MAiD, and one had been present for a MAiD death. It is not clear that these participants are representative of nursing students demographically or by experience with end of life care. It is possible that the students who elected to participate hold perspectives and reflections on patient care and MAiD that differ from students with little or no exposure to end of life care and/or MAiD. However, previous studies find that most nursing students have been involved with end of life care including meaningful discussions about patients’ preferences and care needs during their education [ 40 , 44 , 47 , 48 , 52 ]. Data collection with additional student focus groups with students early in their training and drawn from other training contexts would contribute to further validation of survey items.

Future studies should incorporate pilot testing with small sample of nursing students followed by a larger cross-program sample to allow evaluation of the psychometric properties of specific items and further refinement of the survey tool. Consistent with literature about the importance of leadership in the context of MAiD [ 12 , 53 , 54 ], a study of faculty knowledge, beliefs, and attitudes toward MAiD would provide context for understanding student perspectives within and across programs. Additional research is also needed to understand the timing and content coverage of MAiD across Canadian nurse training programs’ curricula.

The implementation of MAiD is complex and requires understanding of the perspectives of multiple stakeholders. Within the field of nursing this includes clinical providers, educators, and students who will deliver clinical care. A survey to assess nursing students’ attitudes toward and willingness to participate in MAiD in the Canadian context is timely, due to the legislation enacted in 2016 and subsequent modifications to the law in 2021 with portions of the law to be enacted in 2027. Further development of this survey could be undertaken to allow for use in settings with practicing nurses or to allow longitudinal follow up with students as they enter practice. As the Canadian landscape changes, ongoing assessment of the perspectives and needs of health professionals and students in the health professions is needed to inform policy makers, leaders in practice, curricular needs, and to monitor changes in attitudes and practice patterns over time.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to small sample sizes, but are available from the corresponding author on reasonable request.

Abbreviations

British Columbia College of Nurses and Midwives

Medical assistance in dying

Nurse practitioner

Registered nurse

University of British Columbia Okanagan

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We would like to acknowledge the faculty and students who generously contributed their time to this work.

JS received a student traineeship through the Principal Research Chairs program at the University of British Columbia Okanagan.

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JS made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. JS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. BP made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. BP has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. LO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. LO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. NDO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. NDO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. HS made substantial contributions to drafting and substantively revising the work. HS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

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Schroeder, J., Pesut, B., Olsen, L. et al. Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study. BMC Nurs 23 , 326 (2024). https://doi.org/10.1186/s12912-024-01984-z

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