conclusion of interview in research

A Step-By-Step Guide To Conducting A Successful Research Interview

Human beings are inquisitive by nature. Besides reading and observation, verbal interactions like conversations and interviews help us gain more knowledge. That's why they're an essential part of conducting research.  

Every study poses a question that needs to be addressed. Often, these queries rely on interviews to gather detailed participant data—which is crucial for developing credible analysis and results. The difference between a bad and a great interview could make or break an inquiry.

In this article, we'll discuss the basics of the interview process and provide some tips for developing your skills as a researcher.

I. Preparing for a research interview  

Preparation is just as important as data gathering in research. Deciding the framework of your study sets you in the right direction and helps you focus on the problem you want to solve. Seven major steps are involved in this stage:  

1. Defining research objectives

Your study's primary aims are the general objectives , which are the foundation for the specific objectives. The former includes an overview of your research goals, while the latter breaks down the concepts into relevant points.

Together, these goals will explain the core research aspects, helping you explain:

• Why the inquiry is worth pursuing
• How your study can contribute to available resources  
• The scope and depth of your research  
• The formats and channels you'll use when gathering data  
• When you're supposed to finish
• Who is involved

Identifying these details can help you proceed with the right course of action—including the questions to ask, the type of data required, how to establish your arguments and form a conclusion.  

2. Identifying target interviewees

Your participants must be directly involved in the topic you want to discuss. Consider their demographics (age, gender, location, etc.), experience, and roles, depending on the nature and type of information you hope to collect. Seek to have an equal representation to get diverse inputs.    

For instance, if you're discussing job satisfaction and inflation, recruit staff members who had to resign, were let go, and continued working during the period covered. You can also invite human resource executives from different business niches that were slightly, moderately, and heavily affected by the closures and policy shifts due to operational cuts.      

There's no one-size-fits-all approach to reaching saturation—the point where sufficient data can be collected—in qualitative studies. However, a review published in 2022 suggested that most research should conduct 9 to 17 interviews or 4 to 8 focus group discussions to reach this desired level.  

3. Developing interview questions

Questions raised during a discussion can facilitate a deeper understanding of the issue. Generally, quantitative research utilizes close-ended questions, while qualitative studies use open-ended and probing questions.    

a. Close-ended questions

Close-ended questions can be answered by yes or no or through pre-defined options. They work perfectly for quantitative research because you can assign a numerical value to each option—facilitating quick analysis.    

b. open-ended questions

These queries encourage interviewees to provide more information. Questions that start with 'how' offer more detailed responses that boost your data-collection methods and uncover insights that are easy to miss.

c. Probing questions

As the name implies, probing questions take interviewing to the next level by encouraging participants to provide more details. They typically start with 'why' and 'what.'  

When formulating research interview questions, you must consider the following points:

• Your questions must always align with research objectives, even if you're using open-ended or probing queries.
• Use clear, simple, and concise language to make it easier for your participants to understand. Avoid jargon and technical phrases.
• Additionally, avoid misleading or complex questions that confuse your participant—resulting in ambiguous responses.
• Use neutral terms.
• Refrain from using leading questions that reflect your bias.
• Arrange your questions logically to promote a cohesive discussion.  
• Consider the interviewee's comfort level when discussing sensitive or taboo subjects.

Run a test interview with your colleagues or have your questions reviewed by a supervisor. Ask for their feedback and revise as necessary.

Keeping these considerations in mind helps you develop questions that effectively elicit valuable, insightful responses from your participants. They also contribute to the overall success of your research project.  

4. Choosing the interview format

Identifying how you'd want the interview to be conducted saves time and ensures you can collect the required data. Three primary modes come to mind:

a. Structured interviews

Structured interviews work well for research activities that seek to get similar specific information. These interviews often use close-ended questions and work well for specific research types, including clinical studies. Job screening interviews, especially automated ones, also use this tool. You can read more about structured interviews to understand their applications, pros and cons, and the processes involved—from designing, analyzing, and presenting your findings.

b. Semi-structured interviews

This interview format sits in between structured and unstructured interviews. Thus, it uses closing questions and open-ended or probing queries—depending on a participant's answers. Semi-structured discussions are ideal if researchers want to get pre-determined datasets and explore interviewees' insights further.  

c. Unstructured interviews

It might sound like you can ask any question when conducting unstructured interviews, but this isn't the case. This interview type is still purposive and needs to stick to your study objectives. As such, it requires more experienced interviewers to make it work.  

Characterized by a free-flowing conversation, unstructured interviews are useful when drilling into the issue's whys and hows. Its very nature allows participants to express themselves more freely by answering open-ended and probing questions. These interactions may be time-consuming and might branch into several off-topic issues. But if you're seeking authentic and insightful data, this could be your top choice.          

5. Picking the right interview channels

Research interviews can be done in person, through phone, or online. Choose one that fits your study objectives. Tapping social media platforms to conduct virtual surveys and interviews is sometimes a good idea. However, determine how your target interviewees might feel about it before starting.  

For example, a study published in 2022 about the differences between online interview modes (audio, video, chat, email, and survey) revealed that participants are less likely to agree to a webcam interview. Only 49% of those surveyed with webcam access agreed to go on video, likely because of anonymity issues. The study also revealed that audio and video interviews had the lowest completion rate, below 40%, among the modes tested. (See 'Logistical differences across mode are important.')          

6. Scheduling research interviews

An interview schedule guides you in collecting key information about the participant. Determining how long you'll take can be difficult—especially when conducting unstructured interviews. Digital health product interviews, for instance, could take 20 minutes to 1 hour . It could take longer for studies that require more participant data and information.

When estimating, include the time it takes to make your introduction, interview questions, discussion time, and closing statement.  

7. Preparing the necessary materials

Your tools will depend on your chosen interview channel. For instance:

• Transcripts from electronic interviews (emails and chats)
• Software transcriber for online audio and video interviews using the software

It would help if you reviewed the notes if taking this route.

In-person interviews

You or another team member can also use audio and video recorders for personal conversations. Let the participant sign a consent form before starting.        

II. Conducting the interview

As part of the ethical standards of research, you must only proceed with the interview after a participant's agreement. Once you've secured a consent form and have the tools ready, it's time to start the conversation.

1. Establishing connection

Building rapport breaks down the walls between you and your participant. However, it's also important to maintain professional boundaries to ensure that the gathered data is reliable. With good interview skills, you can make anyone comfortable enough to share their honest ideas, experiences, and opinions while also ensuring data integrity.  

Introduce yourself and explain the purpose of the research. You can also briefly touch on the format and the covered topics. Indicate what types of data will be collected and where you plan on using it. At the same time, confidentiality and anonymity should be ensured to gain their trust and ensure a more open and honest discussion. You must also employ all means to ensure you keep these promises.    

2. Asking questions

Always keep the interview on track by holding a guide for in-person interviews. Use active listening to understand what your participant. Avoid being robotic and probe for more information when necessary. More importantly, gauge the interviewee's comfort level by analyzing non-verbal cues.  

3. Taking notes

Use a recording device, but remember to capture key points and quotes. It's good to have a backup file in case the equipment malfunctions.

4. Wrapping up the interview

After ensuring you've met your interview goals, ask for validation from your participant. To ensure accuracy:

• Summarize the main points.

• Ask if the interviewee has any questions or additional comments, and if you got some of the points inadvertently wrong.

Thank the individual for participating in the interview. You may also ensure confidentiality and anonymity at this stage.

III. Best practices for research interviews

Before anything else, though, provide a safe space for participants to share their experiences and opinions. After ensuring a conducive setting, remember to:

• Be prepared and organized
• Build trust
• Ask clear and concise questions
• Practice active listening
• Remain neutral and unbiased
• Respect the interviewee's time and privacy
• Most importantly, refrain from putting words into your participant's mouth.

IV. Post-interview

Start reviewing the transcriptions to analyze the data. This is one of the most time-consuming and crucial parts of the research.

1. Assessing and cleaning data

Note that not all data is useful for your study. To save time and ensure you're on track, evaluate and retain the relevant ones.

2. Choosing your data analysis strategy

Ensure that your data analysis addresses the question or problem comprehensively. You can then use any of these methods, depending on your objectives.

• Causal analysis measures cause and effect.
• Descriptive analysis interprets data to explain what happened.
• Diagnostic analysis discusses why something happened.  
• Exploratory analysis determines relationships between variables.
• Inferential analysis forms generalizations by sampling a small group.
• Mechanistic analysis identifies certain datasets that impact other variables.
• Predictive analysis aims to uncover future trends.  
• Prescriptive analysis gathers insights from other analysis strategies to form a plan of action based on potential outcomes.

A good rule of thumb is to compare and contrast specific datasets to identify themes and patterns. You can also follow up with interviewees for some clarifications, if necessary.

3. Drawing conclusions

Review your research aims, hypothesis, and analysis before formulating a conclusion. Avoid showing your biases when writing one, and stick to the results—which may not always show the results you expect. Keep an open mind and always consider other perspectives when explaining your findings.    

V. Compelling reasons for developing your research interview skills

In the context of research, developing good interview skills is essential for several reasons:

• Ensuring quality data

Effective interviewing techniques facilitate the collection of accurate, detailed, and relevant information from the person you're interviewing. This ensures that your research is based on high-quality data.

• Minimizing biases

We all have biases. And it can be difficult to stay objective when conducting a study. A skilled research interviewer can hurdle this challenge by being aware of their differences and the participant's status, culture, and belief systems.  

• Learning to adapt

As a researcher, you'll likely meet persons from different backgrounds. You'll learn how to deal with these individuals more effectively with time and practice. For instance, you can adjust your communication style or tone to generate the answers you seek.

• Managing time effectively

Research activities are often time-bounded, which can be a challenge for qualitative studies—which rely primarily on interviews and discussions when gathering research data. An experienced interviewer can manage time and still arrive with productive conversations.      

• Improving research outcomes

Learning how to conduct research interviews more effectively also improves your data-gathering activities—allowing you to gather more accurate and comprehensive data. With no stone left unturned, you can put together a valuable inquiry.

Final thoughts

Strong interview skills are crucial to obtaining meaningful research data and arriving at credible conclusions. And this goes beyond asking the right questions. The points discussed above not only explain the process for conducting interviews. They also show relevant insights on how to improve your interviewing skills.  

But here's the catch: they can only be sharpened with constant practice. So use them whether or not you're conducting formal research. Doing so helps enrich your knowledge and build meaningful connections with almost anyone.

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How to carry out great interviews in qualitative research.

11 min read An interview is one of the most versatile methods used in qualitative research. Here’s what you need to know about conducting great qualitative interviews.

What is a qualitative research interview?

Qualitative research interviews are a mainstay among q ualitative research techniques, and have been in use for decades either as a primary data collection method or as an adjunct to a wider research process. A qualitative research interview is a one-to-one data collection session between a researcher and a participant. Interviews may be carried out face-to-face, over the phone or via video call using a service like Skype or Zoom.

There are three main types of qualitative research interview – structured, unstructured or semi-structured.

• Structured interviews Structured interviews are based around a schedule of predetermined questions and talking points that the researcher has developed. At their most rigid, structured interviews may have a precise wording and question order, meaning that they can be replicated across many different interviewers and participants with relatively consistent results.
• Unstructured interviews Unstructured interviews have no predetermined format, although that doesn’t mean they’re ad hoc or unplanned. An unstructured interview may outwardly resemble a normal conversation, but the interviewer will in fact be working carefully to make sure the right topics are addressed during the interaction while putting the participant at ease with a natural manner.
• Semi-structured interviews Semi-structured interviews are the most common type of qualitative research interview, combining the informality and rapport of an unstructured interview with the consistency and replicability of a structured interview. The researcher will come prepared with questions and topics, but will not need to stick to precise wording. This blended approach can work well for in-depth interviews.

Free eBook: The qualitative research design handbook

What are the pros and cons of interviews in qualitative research?

As a qualitative research method interviewing is hard to beat, with applications in social research, market research, and even basic and clinical pharmacy. But like any aspect of the research process, it’s not without its limitations. Before choosing qualitative interviewing as your research method, it’s worth weighing up the pros and cons.

Pros of qualitative interviews:

• provide in-depth information and context
• can be used effectively when their are low numbers of participants
• provide an opportunity to discuss and explain questions
• useful for complex topics
• rich in data – in the case of in-person or video interviews , the researcher can observe body language and facial expression as well as the answers to questions

Cons of qualitative interviews:

• can be time-consuming to carry out
• costly when compared to some other research methods
• because of time and cost constraints, they often limit you to a small number of participants
• difficult to standardize your data across different researchers and participants unless the interviews are very tightly structured
• As the Open University of Hong Kong notes, qualitative interviews may take an emotional toll on interviewers

Qualitative interview guides

Semi-structured interviews are based on a qualitative interview guide, which acts as a road map for the researcher. While conducting interviews, the researcher can use the interview guide to help them stay focused on their research questions and make sure they cover all the topics they intend to.

An interview guide may include a list of questions written out in full, or it may be a set of bullet points grouped around particular topics. It can prompt the interviewer to dig deeper and ask probing questions during the interview if appropriate.

Consider writing out the project’s research question at the top of your interview guide, ahead of the interview questions. This may help you steer the interview in the right direction if it threatens to head off on a tangent.

Avoid bias in qualitative research interviews

According to Duke University , bias can create significant problems in your qualitative interview.

• Acquiescence bias is common to many qualitative methods, including focus groups. It occurs when the participant feels obliged to say what they think the researcher wants to hear. This can be especially problematic when there is a perceived power imbalance between participant and interviewer. To counteract this, Duke University’s experts recommend emphasizing the participant’s expertise in the subject being discussed, and the value of their contributions.
• Interviewer bias is when the interviewer’s own feelings about the topic come to light through hand gestures, facial expressions or turns of phrase. Duke’s recommendation is to stick to scripted phrases where this is an issue, and to make sure researchers become very familiar with the interview guide or script before conducting interviews, so that they can hone their delivery.

What kinds of questions should you ask in a qualitative interview?

The interview questions you ask need to be carefully considered both before and during the data collection process. As well as considering the topics you’ll cover, you will need to think carefully about the way you ask questions.

Open-ended interview questions – which cannot be answered with a ‘yes’ ‘no’ or ‘maybe’ – are recommended by many researchers as a way to pursue in depth information.

An example of an open-ended question is “What made you want to move to the East Coast?” This will prompt the participant to consider different factors and select at least one. Having thought about it carefully, they may give you more detailed information about their reasoning.

A closed-ended question , such as “Would you recommend your neighborhood to a friend?” can be answered without too much deliberation, and without giving much information about personal thoughts, opinions and feelings.

Follow-up questions can be used to delve deeper into the research topic and to get more detail from open-ended questions. Examples of follow-up questions include:

• What makes you say that?
• What do you mean by that?
• Can you tell me more about X?
• What did/does that mean to you?

As well as avoiding closed-ended questions, be wary of leading questions. As with other qualitative research techniques such as surveys or focus groups, these can introduce bias in your data. Leading questions presume a certain point of view shared by the interviewer and participant, and may even suggest a foregone conclusion.

An example of a leading question might be: “You moved to New York in 1990, didn’t you?” In answering the question, the participant is much more likely to agree than disagree. This may be down to acquiescence bias or a belief that the interviewer has checked the information and already knows the correct answer.

Other leading questions involve adjectival phrases or other wording that introduces negative or positive connotations about a particular topic. An example of this kind of leading question is: “Many employees dislike wearing masks to work. How do you feel about this?” It presumes a positive opinion and the participant may be swayed by it, or not want to contradict the interviewer.

Harvard University’s guidelines for qualitative interview research add that you shouldn’t be afraid to ask embarrassing questions – “if you don’t ask, they won’t tell.” Bear in mind though that too much probing around sensitive topics may cause the interview participant to withdraw. The Harvard guidelines recommend leaving sensitive questions til the later stages of the interview when a rapport has been established.

More tips for conducting qualitative interviews

Observing a participant’s body language can give you important data about their thoughts and feelings. It can also help you decide when to broach a topic, and whether to use a follow-up question or return to the subject later in the interview.

Be conscious that the participant may regard you as the expert, not themselves. In order to make sure they express their opinions openly, use active listening skills like verbal encouragement and paraphrasing and clarifying their meaning to show how much you value what they are saying.

Remember that part of the goal is to leave the interview participant feeling good about volunteering their time and their thought process to your research. Aim to make them feel empowered , respected and heard.

Unstructured interviews can demand a lot of a researcher, both cognitively and emotionally. Be sure to leave time in between in-depth interviews when scheduling your data collection to make sure you maintain the quality of your data, as well as your own well-being .

Recording and transcribing interviews

Historically, recording qualitative research interviews and then transcribing the conversation manually would have represented a significant part of the cost and time involved in research projects that collect qualitative data.

Fortunately, researchers now have access to digital recording tools, and even speech-to-text technology that can automatically transcribe interview data using AI and machine learning. This type of tool can also be used to capture qualitative data from qualitative research (focus groups,ect.) making this kind of social research or market research much less time consuming.

Data analysis

Qualitative interview data is unstructured, rich in content and difficult to analyze without the appropriate tools. Fortunately, machine learning and AI can once again make things faster and easier when you use qualitative methods like the research interview.

Text analysis tools and natural language processing software can ‘read’ your transcripts and voice data and identify patterns and trends across large volumes of text or speech. They can also perform khttps://www.qualtrics.com/experience-management/research/sentiment-analysis/

which assesses overall trends in opinion and provides an unbiased overall summary of how participants are feeling.

Another feature of text analysis tools is their ability to categorize information by topic, sorting it into groupings that help you organize your data according to the topic discussed.

All in all, interviews are a valuable technique for qualitative research in business, yielding rich and detailed unstructured data. Historically, they have only been limited by the human capacity to interpret and communicate results and conclusions, which demands considerable time and skill.

When you combine this data with AI tools that can interpret it quickly and automatically, it becomes easy to analyze and structure, dovetailing perfectly with your other business data. An additional benefit of natural language analysis tools is that they are free of subjective biases, and can replicate the same approach across as much data as you choose. By combining human research skills with machine analysis, qualitative research methods such as interviews are more valuable than ever to your business.

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Understanding the Various Types of Interviews in Research

Table of Contents

Have you ever considered the intricacies of a conversation? When it comes to research, particularly in psychology , interviews are not just simple conversations—they are carefully crafted tools designed to extract information, understanding, and insights. But not all interviews are created equal. Each type serves a unique purpose in the quest for knowledge. Let’s delve into the various types of interviews used in research and understand how each paves the way for discoveries within the human psyche.

Informal Conversational Interviews

Imagine a chat over coffee with a friend where the conversation flows naturally, without a rigid structure. This is the essence of an informal conversational interview. Here, the interviewer has no set questions but allows the dialogue to be guided by the interviewee’s responses and the natural course of the conversation. This flexibility can unveil rich, detailed insights, making it ideal for exploratory research.

• Spontaneous Interaction : Questions are developed spontaneously and are highly adaptable to the interviewee’s thoughts and feelings.
• Contextual Richness : The setting and flow can yield deep understanding, as interviewees often feel more comfortable and open.
• Challenges: This type of interview requires skilled interviewers who can guide the conversation effectively without leading it astray.

General Interview Guides

Shifting towards a bit more structure, general interview guides come into play. While still maintaining a conversational quality, this approach involves a prepared set of questions or topics to ensure that certain areas are explored. It strikes a balance between the natural flow of an informal interview and the focused inquiry of a more structured approach.

• Guided Flexibility : The interviewer follows a guide but has the freedom to probe deeper or ask follow-up questions.
• Consistency : Ensures that all areas of interest are covered with each participant, aiding in comparative analysis.
• Preparation: Requires careful planning to construct a guide that’s comprehensive yet flexible.

Standardized Open\-Ended Interviews

When researchers seek to combine the depth of open-ended questions with the comparability of structured interviews, standardized open-ended interviews come into the picture. This format involves a set of open-ended questions asked in the same way and order to every interviewee, allowing for rich, nuanced answers that can still be compared across different participants.

• Consistent Inquiry : The same questions ensure that each interviewee has the same opportunity to provide information.
• Open\-Ended Responses : Participants can express their thoughts freely, offering deeper insight than closed-ended questions.
• Data Analysis : While offering depth, the standardized nature of these interviews facilitates easier analysis and comparison.

Closed Fixed\-Response Interviews

For research that requires quantifiable data, closed fixed-response interviews are the go-to format. These interviews consist of a set of predetermined questions with a limited set of possible answers, much like a multiple-choice test. The rigidity of this structure makes it less suitable for exploratory research but excellent for statistical analysis.

• Quantifiable Data : Responses are easy to categorize and quantify, making them ideal for statistical analysis.
• Comparability : The uniformity of responses allows for straightforward comparison across a large number of interviewees.
• Limited Depth: The predefined responses can restrict the depth of understanding and may not capture the nuances of participants’ experiences.

Telephone Interviews

In today’s digital age , telephone interviews have become increasingly prevalent. They offer a practical and cost-effective alternative to face-to-face interviews, especially when geographical barriers exist. Telephone interviews can follow any of the aforementioned structures but require a particular set of skills given the absence of visual cues and potential for distractions.

• Accessibility : Overcomes geographical limitations and can be more convenient for participants.
• Audio\-Only Dynamics : The interviewer must rely solely on verbal cues, which can be both a limitation and an advantage for skilled interviewers.
• Considerations: The lack of visual interaction can affect rapport and the interviewer’s ability to observe non-verbal cues.

Choosing the Right Interview Type

Selecting the appropriate type of interview for a research study is an art in itself. It requires a thorough understanding of the research objectives, the nature of the subject matter, and the context within which the information will be used. Each type of interview offers a different lens through which to view the research question, and the choice must align with the research goals and the characteristics of the participant population.

Interviews in research are far from one-size-fits-all. Each type—from the free-flowing informal conversational interview to the precisely structured closed fixed-response interview—has its place in the researcher’s toolkit. The key is in knowing when and how to use each one to uncover the layers of human thought and behavior that lie beneath the surface. As we’ve seen, the art of interviewing is as much about asking the right questions as it is about choosing the right approach to asking them.

Which type of interview do you think would be most effective for understanding your own thoughts and experiences? Have you ever been part of a research study that used one of these methods, and if so, what was your experience like?

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Research Methods in Psychology

1 Introduction to Psychological Research – Objectives and Goals, Problems, Hypothesis and Variables

• Nature of Psychological Research
• The Context of Discovery
• Context of Justification
• Characteristics of Psychological Research
• Goals and Objectives of Psychological Research

2 Introduction to Psychological Experiments and Tests

• Independent and Dependent Variables
• Extraneous Variables
• Experimental and Control Groups
• Introduction of Test
• Types of Psychological Test
• Uses of Psychological Tests

3 Steps in Research

• Research Process
• Identification of the Problem
• Review of Literature
• Formulating a Hypothesis
• Identifying Manipulating and Controlling Variables
• Formulating a Research Design
• Constructing Devices for Observation and Measurement
• Sample Selection and Data Collection
• Data Analysis and Interpretation
• Hypothesis Testing
• Drawing Conclusion

4 Types of Research and Methods of Research

• Historical Research
• Descriptive Research
• Correlational Research
• Qualitative Research
• Ex-Post Facto Research
• True Experimental Research
• Quasi-Experimental Research

5 Definition and Description Research Design, Quality of Research Design

• Research Design
• Purpose of Research Design
• Design Selection
• Criteria of Research Design
• Qualities of Research Design

6 Experimental Design (Control Group Design and Two Factor Design)

• Experimental Design
• Control Group Design
• Two Factor Design

7 Survey Design

• Survey Research Designs
• Steps in Survey Design
• Structuring and Designing the Questionnaire
• Interviewing Methodology
• Data Analysis
• Final Report

8 Single Subject Design

• Single Subject Design: Definition and Meaning
• Phases Within Single Subject Design
• Requirements of Single Subject Design
• Characteristics of Single Subject Design
• Types of Single Subject Design
• Advantages of Single Subject Design
• Disadvantages of Single Subject Design

9 Observation Method

• Definition and Meaning of Observation
• Characteristics of Observation
• Types of Observation
• Advantages and Disadvantages of Observation
• Guides for Observation Method

10 Interview and Interviewing

• Definition of Interview
• Types of Interview
• Aspects of Qualitative Research Interviews
• Interview Questions
• Convergent Interviewing as Action Research
• Research Team

11 Questionnaire Method

• Definition and Description of Questionnaires
• Types of Questionnaires
• Purpose of Questionnaire Studies
• Designing Research Questionnaires
• The Methods to Make a Questionnaire Efficient
• The Types of Questionnaire to be Included in the Questionnaire
• Advantages and Disadvantages of Questionnaire
• When to Use a Questionnaire?

12 Case Study

• Definition and Description of Case Study Method
• Historical Account of Case Study Method
• Designing Case Study
• Requirements for Case Studies
• Guideline to Follow in Case Study Method
• Other Important Measures in Case Study Method
• Case Reports

13 Report Writing

• Purpose of a Report
• Writing Style of the Report
• Report Writing – the Do’s and the Don’ts
• Format for Report in Psychology Area
• Major Sections in a Report

14 Review of Literature

• Purposes of Review of Literature
• Sources of Review of Literature
• Types of Literature
• Writing Process of the Review of Literature
• Preparation of Index Card for Reviewing and Abstracting

15 Methodology

• Definition and Purpose of Methodology
• Participants (Sample)
• Apparatus and Materials

16 Result, Analysis and Discussion of the Data

• Definition and Description of Results
• Statistical Presentation
• Tables and Figures

17 Summary and Conclusion

• Summary Definition and Description
• Guidelines for Writing a Summary
• Writing the Summary and Choosing Words
• A Process for Paraphrasing and Summarising
• Summary of a Report
• Writing Conclusions

18 References in Research Report

• Reference List (the Format)
• References (Process of Writing)
• Reference List and Print Sources
• Electronic Sources
• Book on CD Tape and Movie
• Reference Specifications
• General Guidelines to Write References

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• Published: 05 October 2018

Interviews and focus groups in qualitative research: an update for the digital age

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Highlights that qualitative research is used increasingly in dentistry. Interviews and focus groups remain the most common qualitative methods of data collection.

Suggests the advent of digital technologies has transformed how qualitative research can now be undertaken.

Suggests interviews and focus groups can offer significant, meaningful insight into participants' experiences, beliefs and perspectives, which can help to inform developments in dental practice.

Qualitative research is used increasingly in dentistry, due to its potential to provide meaningful, in-depth insights into participants' experiences, perspectives, beliefs and behaviours. These insights can subsequently help to inform developments in dental practice and further related research. The most common methods of data collection used in qualitative research are interviews and focus groups. While these are primarily conducted face-to-face, the ongoing evolution of digital technologies, such as video chat and online forums, has further transformed these methods of data collection. This paper therefore discusses interviews and focus groups in detail, outlines how they can be used in practice, how digital technologies can further inform the data collection process, and what these methods can offer dentistry.

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Interviews in the social sciences

Professionalism in dentistry: deconstructing common terminology

A review of technical and quality assessment considerations of audio-visual and web-conferencing focus groups in qualitative health research, introduction.

Traditionally, research in dentistry has primarily been quantitative in nature. 1 However, in recent years, there has been a growing interest in qualitative research within the profession, due to its potential to further inform developments in practice, policy, education and training. Consequently, in 2008, the British Dental Journal (BDJ) published a four paper qualitative research series, 2 , 3 , 4 , 5 to help increase awareness and understanding of this particular methodological approach.

Since the papers were originally published, two scoping reviews have demonstrated the ongoing proliferation in the use of qualitative research within the field of oral healthcare. 1 , 6 To date, the original four paper series continue to be well cited and two of the main papers remain widely accessed among the BDJ readership. 2 , 3 The potential value of well-conducted qualitative research to evidence-based practice is now also widely recognised by service providers, policy makers, funding bodies and those who commission, support and use healthcare research.

Besides increasing standalone use, qualitative methods are now also routinely incorporated into larger mixed method study designs, such as clinical trials, as they can offer additional, meaningful insights into complex problems that simply could not be provided by quantitative methods alone. Qualitative methods can also be used to further facilitate in-depth understanding of important aspects of clinical trial processes, such as recruitment. For example, Ellis et al . investigated why edentulous older patients, dissatisfied with conventional dentures, decline implant treatment, despite its established efficacy, and frequently refuse to participate in related randomised clinical trials, even when financial constraints are removed. 7 Through the use of focus groups in Canada and the UK, the authors found that fears of pain and potential complications, along with perceived embarrassment, exacerbated by age, are common reasons why older patients typically refuse dental implants. 7

The last decade has also seen further developments in qualitative research, due to the ongoing evolution of digital technologies. These developments have transformed how researchers can access and share information, communicate and collaborate, recruit and engage participants, collect and analyse data and disseminate and translate research findings. 8 Where appropriate, such technologies are therefore capable of extending and enhancing how qualitative research is undertaken. 9 For example, it is now possible to collect qualitative data via instant messaging, email or online/video chat, using appropriate online platforms.

These innovative approaches to research are therefore cost-effective, convenient, reduce geographical constraints and are often useful for accessing 'hard to reach' participants (for example, those who are immobile or socially isolated). 8 , 9 However, digital technologies are still relatively new and constantly evolving and therefore present a variety of pragmatic and methodological challenges. Furthermore, given their very nature, their use in many qualitative studies and/or with certain participant groups may be inappropriate and should therefore always be carefully considered. While it is beyond the scope of this paper to provide a detailed explication regarding the use of digital technologies in qualitative research, insight is provided into how such technologies can be used to facilitate the data collection process in interviews and focus groups.

In light of such developments, it is perhaps therefore timely to update the main paper 3 of the original BDJ series. As with the previous publications, this paper has been purposely written in an accessible style, to enhance readability, particularly for those who are new to qualitative research. While the focus remains on the most common qualitative methods of data collection – interviews and focus groups – appropriate revisions have been made to provide a novel perspective, and should therefore be helpful to those who would like to know more about qualitative research. This paper specifically focuses on undertaking qualitative research with adult participants only.

Overview of qualitative research

Qualitative research is an approach that focuses on people and their experiences, behaviours and opinions. 10 , 11 The qualitative researcher seeks to answer questions of 'how' and 'why', providing detailed insight and understanding, 11 which quantitative methods cannot reach. 12 Within qualitative research, there are distinct methodologies influencing how the researcher approaches the research question, data collection and data analysis. 13 For example, phenomenological studies focus on the lived experience of individuals, explored through their description of the phenomenon. Ethnographic studies explore the culture of a group and typically involve the use of multiple methods to uncover the issues. 14

While methodology is the 'thinking tool', the methods are the 'doing tools'; 13 the ways in which data are collected and analysed. There are multiple qualitative data collection methods, including interviews, focus groups, observations, documentary analysis, participant diaries, photography and videography. Two of the most commonly used qualitative methods are interviews and focus groups, which are explored in this article. The data generated through these methods can be analysed in one of many ways, according to the methodological approach chosen. A common approach is thematic data analysis, involving the identification of themes and subthemes across the data set. Further information on approaches to qualitative data analysis has been discussed elsewhere. 1

Qualitative research is an evolving and adaptable approach, used by different disciplines for different purposes. Traditionally, qualitative data, specifically interviews, focus groups and observations, have been collected face-to-face with participants. In more recent years, digital technologies have contributed to the ongoing evolution of qualitative research. Digital technologies offer researchers different ways of recruiting participants and collecting data, and offer participants opportunities to be involved in research that is not necessarily face-to-face.

Research interviews are a fundamental qualitative research method 15 and are utilised across methodological approaches. Interviews enable the researcher to learn in depth about the perspectives, experiences, beliefs and motivations of the participant. 3 , 16 Examples include, exploring patients' perspectives of fear/anxiety triggers in dental treatment, 17 patients' experiences of oral health and diabetes, 18 and dental students' motivations for their choice of career. 19

Interviews may be structured, semi-structured or unstructured, 3 according to the purpose of the study, with less structured interviews facilitating a more in depth and flexible interviewing approach. 20 Structured interviews are similar to verbal questionnaires and are used if the researcher requires clarification on a topic; however they produce less in-depth data about a participant's experience. 3 Unstructured interviews may be used when little is known about a topic and involves the researcher asking an opening question; 3 the participant then leads the discussion. 20 Semi-structured interviews are commonly used in healthcare research, enabling the researcher to ask predetermined questions, 20 while ensuring the participant discusses issues they feel are important.

Interviews can be undertaken face-to-face or using digital methods when the researcher and participant are in different locations. Audio-recording the interview, with the consent of the participant, is essential for all interviews regardless of the medium as it enables accurate transcription; the process of turning the audio file into a word-for-word transcript. This transcript is the data, which the researcher then analyses according to the chosen approach.

Types of interview

Qualitative studies often utilise one-to-one, face-to-face interviews with research participants. This involves arranging a mutually convenient time and place to meet the participant, signing a consent form and audio-recording the interview. However, digital technologies have expanded the potential for interviews in research, enabling individuals to participate in qualitative research regardless of location.

Telephone interviews can be a useful alternative to face-to-face interviews and are commonly used in qualitative research. They enable participants from different geographical areas to participate and may be less onerous for participants than meeting a researcher in person. 15 A qualitative study explored patients' perspectives of dental implants and utilised telephone interviews due to the quality of the data that could be yielded. 21 The researcher needs to consider how they will audio record the interview, which can be facilitated by purchasing a recorder that connects directly to the telephone. One potential disadvantage of telephone interviews is the inability of the interviewer and researcher to see each other. This is resolved using software for audio and video calls online – such as Skype – to conduct interviews with participants in qualitative studies. Advantages of this approach include being able to see the participant if video calls are used, enabling observation of non-verbal communication, and the software can be free to use. However, participants are required to have a device and internet connection, as well as being computer literate, potentially limiting who can participate in the study. One qualitative study explored the role of dental hygienists in reducing oral health disparities in Canada. 22 The researcher conducted interviews using Skype, which enabled dental hygienists from across Canada to be interviewed within the research budget, accommodating the participants' schedules. 22

A less commonly used approach to qualitative interviews is the use of social virtual worlds. A qualitative study accessed a social virtual world – Second Life – to explore the health literacy skills of individuals who use social virtual worlds to access health information. 23 The researcher created an avatar and interview room, and undertook interviews with participants using voice and text methods. 23 This approach to recruitment and data collection enables individuals from diverse geographical locations to participate, while remaining anonymous if they wish. Furthermore, for interviews conducted using text methods, transcription of the interview is not required as the researcher can save the written conversation with the participant, with the participant's consent. However, the researcher and participant need to be familiar with how the social virtual world works to engage in an interview this way.

Conducting an interview

Ensuring informed consent before any interview is a fundamental aspect of the research process. Participants in research must be afforded autonomy and respect; consent should be informed and voluntary. 24 Individuals should have the opportunity to read an information sheet about the study, ask questions, understand how their data will be stored and used, and know that they are free to withdraw at any point without reprisal. The qualitative researcher should take written consent before undertaking the interview. In a face-to-face interview, this is straightforward: the researcher and participant both sign copies of the consent form, keeping one each. However, this approach is less straightforward when the researcher and participant do not meet in person. A recent protocol paper outlined an approach for taking consent for telephone interviews, which involved: audio recording the participant agreeing to each point on the consent form; the researcher signing the consent form and keeping a copy; and posting a copy to the participant. 25 This process could be replicated in other interview studies using digital methods.

There are advantages and disadvantages of using face-to-face and digital methods for research interviews. Ultimately, for both approaches, the quality of the interview is determined by the researcher. 16 Appropriate training and preparation are thus required. Healthcare professionals can use their interpersonal communication skills when undertaking a research interview, particularly questioning, listening and conversing. 3 However, the purpose of an interview is to gain information about the study topic, 26 rather than offering help and advice. 3 The researcher therefore needs to listen attentively to participants, enabling them to describe their experience without interruption. 3 The use of active listening skills also help to facilitate the interview. 14 Spradley outlined elements and strategies for research interviews, 27 which are a useful guide for qualitative researchers:

Greeting and explaining the project/interview

Asking descriptive (broad), structural (explore response to descriptive) and contrast (difference between) questions

Asymmetry between the researcher and participant talking

Expressing interest and cultural ignorance

Repeating, restating and incorporating the participant's words when asking questions

Creating hypothetical situations

Asking friendly questions

Knowing when to leave.

For semi-structured interviews, a topic guide (also called an interview schedule) is used to guide the content of the interview – an example of a topic guide is outlined in Box 1 . The topic guide, usually based on the research questions, existing literature and, for healthcare professionals, their clinical experience, is developed by the research team. The topic guide should include open ended questions that elicit in-depth information, and offer participants the opportunity to talk about issues important to them. This is vital in qualitative research where the researcher is interested in exploring the experiences and perspectives of participants. It can be useful for qualitative researchers to pilot the topic guide with the first participants, 10 to ensure the questions are relevant and understandable, and amending the questions if required.

Regardless of the medium of interview, the researcher must consider the setting of the interview. For face-to-face interviews, this could be in the participant's home, in an office or another mutually convenient location. A quiet location is preferable to promote confidentiality, enable the researcher and participant to concentrate on the conversation, and to facilitate accurate audio-recording of the interview. For interviews using digital methods the same principles apply: a quiet, private space where the researcher and participant feel comfortable and confident to participate in an interview.

Box 1: Example of a topic guide

Study focus: Parents' experiences of brushing their child's (aged 0–5) teeth

1. Can you tell me about your experience of cleaning your child's teeth?

How old was your child when you started cleaning their teeth?

Why did you start cleaning their teeth at that point?

How often do you brush their teeth?

What do you use to brush their teeth and why?

2. Could you explain how you find cleaning your child's teeth?

Do you find anything difficult?

What makes cleaning their teeth easier for you?

3. How has your experience of cleaning your child's teeth changed over time?

Has it become easier or harder?

Have you changed how often and how you clean their teeth? If so, why?

4. Could you describe how your child finds having their teeth cleaned?

What do they enjoy about having their teeth cleaned?

Is there anything they find upsetting about having their teeth cleaned?

5. Where do you look for information/advice about cleaning your child's teeth?

What did your health visitor tell you about cleaning your child's teeth? (If anything)

What has the dentist told you about caring for your child's teeth? (If visited)

Have any family members given you advice about how to clean your child's teeth? If so, what did they tell you? Did you follow their advice?

6. Is there anything else you would like to discuss about this?

Focus groups

A focus group is a moderated group discussion on a pre-defined topic, for research purposes. 28 , 29 While not aligned to a particular qualitative methodology (for example, grounded theory or phenomenology) as such, focus groups are used increasingly in healthcare research, as they are useful for exploring collective perspectives, attitudes, behaviours and experiences. Consequently, they can yield rich, in-depth data and illuminate agreement and inconsistencies 28 within and, where appropriate, between groups. Examples include public perceptions of dental implants and subsequent impact on help-seeking and decision making, 30 and general dental practitioners' views on patient safety in dentistry. 31

Focus groups can be used alone or in conjunction with other methods, such as interviews or observations, and can therefore help to confirm, extend or enrich understanding and provide alternative insights. 28 The social interaction between participants often results in lively discussion and can therefore facilitate the collection of rich, meaningful data. However, they are complex to organise and manage, due to the number of participants, and may also be inappropriate for exploring particularly sensitive issues that many participants may feel uncomfortable about discussing in a group environment.

Focus groups are primarily undertaken face-to-face but can now also be undertaken online, using appropriate technologies such as email, bulletin boards, online research communities, chat rooms, discussion forums, social media and video conferencing. 32 Using such technologies, data collection can also be synchronous (for example, online discussions in 'real time') or, unlike traditional face-to-face focus groups, asynchronous (for example, online/email discussions in 'non-real time'). While many of the fundamental principles of focus group research are the same, regardless of how they are conducted, a number of subtle nuances are associated with the online medium. 32 Some of which are discussed further in the following sections.

Focus group considerations

Some key considerations associated with face-to-face focus groups are: how many participants are required; should participants within each group know each other (or not) and how many focus groups are needed within a single study? These issues are much debated and there is no definitive answer. However, the number of focus groups required will largely depend on the topic area, the depth and breadth of data needed, the desired level of participation required 29 and the necessity (or not) for data saturation.

The optimum group size is around six to eight participants (excluding researchers) but can work effectively with between three and 14 participants. 3 If the group is too small, it may limit discussion, but if it is too large, it may become disorganised and difficult to manage. It is, however, prudent to over-recruit for a focus group by approximately two to three participants, to allow for potential non-attenders. For many researchers, particularly novice researchers, group size may also be informed by pragmatic considerations, such as the type of study, resources available and moderator experience. 28 Similar size and mix considerations exist for online focus groups. Typically, synchronous online focus groups will have around three to eight participants but, as the discussion does not happen simultaneously, asynchronous groups may have as many as 10–30 participants. 33

The topic area and potential group interaction should guide group composition considerations. Pre-existing groups, where participants know each other (for example, work colleagues) may be easier to recruit, have shared experiences and may enjoy a familiarity, which facilitates discussion and/or the ability to challenge each other courteously. 3 However, if there is a potential power imbalance within the group or if existing group norms and hierarchies may adversely affect the ability of participants to speak freely, then 'stranger groups' (that is, where participants do not already know each other) may be more appropriate. 34 , 35

Focus group management

Face-to-face focus groups should normally be conducted by two researchers; a moderator and an observer. 28 The moderator facilitates group discussion, while the observer typically monitors group dynamics, behaviours, non-verbal cues, seating arrangements and speaking order, which is essential for transcription and analysis. The same principles of informed consent, as discussed in the interview section, also apply to focus groups, regardless of medium. However, the consent process for online discussions will probably be managed somewhat differently. For example, while an appropriate participant information leaflet (and consent form) would still be required, the process is likely to be managed electronically (for example, via email) and would need to specifically address issues relating to technology (for example, anonymity and use, storage and access to online data). 32

The venue in which a face to face focus group is conducted should be of a suitable size, private, quiet, free from distractions and in a collectively convenient location. It should also be conducted at a time appropriate for participants, 28 as this is likely to promote attendance. As with interviews, the same ethical considerations apply (as discussed earlier). However, online focus groups may present additional ethical challenges associated with issues such as informed consent, appropriate access and secure data storage. Further guidance can be found elsewhere. 8 , 32

Before the focus group commences, the researchers should establish rapport with participants, as this will help to put them at ease and result in a more meaningful discussion. Consequently, researchers should introduce themselves, provide further clarity about the study and how the process will work in practice and outline the 'ground rules'. Ground rules are designed to assist, not hinder, group discussion and typically include: 3 , 28 , 29

Discussions within the group are confidential to the group

Only one person can speak at a time

All participants should have sufficient opportunity to contribute

There should be no unnecessary interruptions while someone is speaking

Everyone can be expected to be listened to and their views respected

Challenging contrary opinions is appropriate, but ridiculing is not.

Moderating a focus group requires considered management and good interpersonal skills to help guide the discussion and, where appropriate, keep it sufficiently focused. Avoid, therefore, participating, leading, expressing personal opinions or correcting participants' knowledge 3 , 28 as this may bias the process. A relaxed, interested demeanour will also help participants to feel comfortable and promote candid discourse. Moderators should also prevent the discussion being dominated by any one person, ensure differences of opinions are discussed fairly and, if required, encourage reticent participants to contribute. 3 Asking open questions, reflecting on significant issues, inviting further debate, probing responses accordingly, and seeking further clarification, as and where appropriate, will help to obtain sufficient depth and insight into the topic area.

Moderating online focus groups requires comparable skills, particularly if the discussion is synchronous, as the discussion may be dominated by those who can type proficiently. 36 It is therefore important that sufficient time and respect is accorded to those who may not be able to type as quickly. Asynchronous discussions are usually less problematic in this respect, as interactions are less instant. However, moderating an asynchronous discussion presents additional challenges, particularly if participants are geographically dispersed, as they may be online at different times. Consequently, the moderator will not always be present and the discussion may therefore need to occur over several days, which can be difficult to manage and facilitate and invariably requires considerable flexibility. 32 It is also worth recognising that establishing rapport with participants via online medium is often more challenging than via face-to-face and may therefore require additional time, skills, effort and consideration.

As with research interviews, focus groups should be guided by an appropriate interview schedule, as discussed earlier in the paper. For example, the schedule will usually be informed by the review of the literature and study aims, and will merely provide a topic guide to help inform subsequent discussions. To provide a verbatim account of the discussion, focus groups must be recorded, using an audio-recorder with a good quality multi-directional microphone. While videotaping is possible, some participants may find it obtrusive, 3 which may adversely affect group dynamics. The use (or not) of a video recorder, should therefore be carefully considered.

At the end of the focus group, a few minutes should be spent rounding up and reflecting on the discussion. 28 Depending on the topic area, it is possible that some participants may have revealed deeply personal issues and may therefore require further help and support, such as a constructive debrief or possibly even referral on to a relevant third party. It is also possible that some participants may feel that the discussion did not adequately reflect their views and, consequently, may no longer wish to be associated with the study. 28 Such occurrences are likely to be uncommon, but should they arise, it is important to further discuss any concerns and, if appropriate, offer them the opportunity to withdraw (including any data relating to them) from the study. Immediately after the discussion, researchers should compile notes regarding thoughts and ideas about the focus group, which can assist with data analysis and, if appropriate, any further data collection.

Qualitative research is increasingly being utilised within dental research to explore the experiences, perspectives, motivations and beliefs of participants. The contributions of qualitative research to evidence-based practice are increasingly being recognised, both as standalone research and as part of larger mixed-method studies, including clinical trials. Interviews and focus groups remain commonly used data collection methods in qualitative research, and with the advent of digital technologies, their utilisation continues to evolve. However, digital methods of qualitative data collection present additional methodological, ethical and practical considerations, but also potentially offer considerable flexibility to participants and researchers. Consequently, regardless of format, qualitative methods have significant potential to inform important areas of dental practice, policy and further related research.

Gussy M, Dickson-Swift V, Adams J . A scoping review of qualitative research in peer-reviewed dental publications. Int J Dent Hygiene 2013; 11 : 174–179.

Article   Google Scholar  

Burnard P, Gill P, Stewart K, Treasure E, Chadwick B . Analysing and presenting qualitative data. Br Dent J 2008; 204 : 429–432.

Gill P, Stewart K, Treasure E, Chadwick B . Methods of data collection in qualitative research: interviews and focus groups. Br Dent J 2008; 204 : 291–295.

Gill P, Stewart K, Treasure E, Chadwick B . Conducting qualitative interviews with school children in dental research. Br Dent J 2008; 204 : 371–374.

Stewart K, Gill P, Chadwick B, Treasure E . Qualitative research in dentistry. Br Dent J 2008; 204 : 235–239.

Masood M, Thaliath E, Bower E, Newton J . An appraisal of the quality of published qualitative dental research. Community Dent Oral Epidemiol 2011; 39 : 193–203.

Ellis J, Levine A, Bedos C et al. Refusal of implant supported mandibular overdentures by elderly patients. Gerodontology 2011; 28 : 62–68.

Macfarlane S, Bucknall T . Digital Technologies in Research. In Gerrish K, Lathlean J (editors) The Research Process in Nursing . 7th edition. pp. 71–86. Oxford: Wiley Blackwell; 2015.

Google Scholar  

Lee R, Fielding N, Blank G . Online Research Methods in the Social Sciences: An Editorial Introduction. In Fielding N, Lee R, Blank G (editors) The Sage Handbook of Online Research Methods . pp. 3–16. London: Sage Publications; 2016.

Creswell J . Qualitative inquiry and research design: Choosing among five designs . Thousand Oaks, CA: Sage, 1998.

Guest G, Namey E, Mitchell M . Qualitative research: Defining and designing In Guest G, Namey E, Mitchell M (editors) Collecting Qualitative Data: A Field Manual For Applied Research . pp. 1–40. London: Sage Publications, 2013.

Chapter   Google Scholar  

Pope C, Mays N . Qualitative research: Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ 1995; 311 : 42–45.

Giddings L, Grant B . A Trojan Horse for positivism? A critique of mixed methods research. Adv Nurs Sci 2007; 30 : 52–60.

Hammersley M, Atkinson P . Ethnography: Principles in Practice . London: Routledge, 1995.

Oltmann S . Qualitative interviews: A methodological discussion of the interviewer and respondent contexts Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2016; 17 : Art. 15.

Patton M . Qualitative Research and Evaluation Methods . Thousand Oaks, CA: Sage, 2002.

Wang M, Vinall-Collier K, Csikar J, Douglas G . A qualitative study of patients' views of techniques to reduce dental anxiety. J Dent 2017; 66 : 45–51.

Lindenmeyer A, Bowyer V, Roscoe J, Dale J, Sutcliffe P . Oral health awareness and care preferences in patients with diabetes: a qualitative study. Fam Pract 2013; 30 : 113–118.

Gallagher J, Clarke W, Wilson N . Understanding the motivation: a qualitative study of dental students' choice of professional career. Eur J Dent Educ 2008; 12 : 89–98.

Tod A . Interviewing. In Gerrish K, Lacey A (editors) The Research Process in Nursing . Oxford: Blackwell Publishing, 2006.

Grey E, Harcourt D, O'Sullivan D, Buchanan H, Kipatrick N . A qualitative study of patients' motivations and expectations for dental implants. Br Dent J 2013; 214 : 10.1038/sj.bdj.2012.1178.

Farmer J, Peressini S, Lawrence H . Exploring the role of the dental hygienist in reducing oral health disparities in Canada: A qualitative study. Int J Dent Hygiene 2017; 10.1111/idh.12276.

McElhinney E, Cheater F, Kidd L . Undertaking qualitative health research in social virtual worlds. J Adv Nurs 2013; 70 : 1267–1275.

Health Research Authority. UK Policy Framework for Health and Social Care Research. Available at https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/ (accessed September 2017).

Baillie J, Gill P, Courtenay P . Knowledge, understanding and experiences of peritonitis among patients, and their families, undertaking peritoneal dialysis: A mixed methods study protocol. J Adv Nurs 2017; 10.1111/jan.13400.

Kvale S . Interviews . Thousand Oaks (CA): Sage, 1996.

Spradley J . The Ethnographic Interview . New York: Holt, Rinehart and Winston, 1979.

Goodman C, Evans C . Focus Groups. In Gerrish K, Lathlean J (editors) The Research Process in Nursing . pp. 401–412. Oxford: Wiley Blackwell, 2015.

Shaha M, Wenzell J, Hill E . Planning and conducting focus group research with nurses. Nurse Res 2011; 18 : 77–87.

Wang G, Gao X, Edward C . Public perception of dental implants: a qualitative study. J Dent 2015; 43 : 798–805.

Bailey E . Contemporary views of dental practitioners' on patient safety. Br Dent J 2015; 219 : 535–540.

Abrams K, Gaiser T . Online Focus Groups. In Field N, Lee R, Blank G (editors) The Sage Handbook of Online Research Methods . pp. 435–450. London: Sage Publications, 2016.

Poynter R . The Handbook of Online and Social Media Research . West Sussex: John Wiley & Sons, 2010.

Kevern J, Webb C . Focus groups as a tool for critical social research in nurse education. Nurse Educ Today 2001; 21 : 323–333.

Kitzinger J, Barbour R . Introduction: The Challenge and Promise of Focus Groups. In Barbour R S K J (editor) Developing Focus Group Research . pp. 1–20. London: Sage Publications, 1999.

Krueger R, Casey M . Focus Groups: A Practical Guide for Applied Research. 4th ed. Thousand Oaks, California: SAGE; 2009.

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Gill, P., Baillie, J. Interviews and focus groups in qualitative research: an update for the digital age. Br Dent J 225 , 668–672 (2018). https://doi.org/10.1038/sj.bdj.2018.815

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Accepted : 02 July 2018

Published : 05 October 2018

Issue Date : 12 October 2018

DOI : https://doi.org/10.1038/sj.bdj.2018.815

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The Use of Closing Questions in Qualitative Research: Results of a Web-Based Survey

Timothy joseph sowicz.

The University of North Carolina at Greensboro School of Nursing, Greensboro, NC

Justine S. Sefcik

University of Pennsylvania School of Nursing, Philadelphia, PA

Helen L. Teng

Elliane irani.

Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH

Terri-Ann Kelly

Rutgers School of Nursing – Camden, Camden, NJ

Christine Bradway

Author Note

Justine S. Sefcik, Ph.D., RN , is Postdoctoral Fellow and Helen L. Teng, MSN, RN , is Doctoral Student and Christine Bradway, Ph.D., CRNP, FAAN, AGSF , is Associate Professor of Gerontological Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA.

Elliane Irani, Ph.D., RN , is Postdoctoral Fellow, Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH.

Terri-Ann Kelly, Ph.D., RN , is Assistant Professor, Rutgers School of Nursing – Camden, Camden, NJ.

Scarce and differing reasons for including closing questions in qualitative research exist, but how data generated from these questions are used remains uncertain.

The purpose of the study was to understand if and how researchers use closing questions in qualitative research; specifically, the research questions were: (a) “Why do qualitative researchers include or exclude closing questions during interviews?”; and (b) “How do qualitative researchers use data from closing questions?”

A qualitative descriptive design using a single, asynchronous, web-based, investigator-designed survey containing 14 items was used to collect data. Convenience and snowball sampling were used to recruit participants. Data were analyzed using descriptive statistics and qualitative content analysis. Codes were developed from the qualitative data. Subcategories were derived from similar codes, and these subcategories were further scrutinized and were used to create broad categories.

The number of respondents per question ranged from 76 to 99; most identified nursing and sociology as their academic disciplines, lived in the United States, and were involved in qualitative research for 1 to 10 years. Data, the interview, the interviewee , and the interviewer were broad categories to emerge as reasons for including closing questions. Only one respondent reported a reason for excluding closing questions. The uses of closing question data were described in four broad categories: analysis; data; the interview guide ; and inquiry .

Researchers frequently included closing questions in qualitative studies. The reasons for including these questions and how data are used varies and support for closing questions is limited in previously published literature. One unique reason, adding “new breath” to the interview, emerged. Study findings can aid qualitative researchers in deciding whether to include closing questions.

Qualitative researchers use various approaches to conclude interviews. The absence of standard procedures or rules contributes to methodological variability ( Brinkmann & Kvale, 2014 ). Some researchers terminate an interview by thanking participants and acknowledging their contributions ( Baumbusch, 2010 ; Whiting, 2008 ); others add closing questions. Limited and divergent accounts exist regarding researchers’ choice of executing closing questions, question format, and rationale for including these.

A closing question may allow research participants time to reflect, share additional information, and decompress; however, how this information informs the research is unclear. King and Horrocks (2010) suggest using closing questions to give more control to participants and ask if they want to share anything else or inquire about the research. Rationale for this approach is to minimize tension or anxiety from discussing personal and emotional experiences, and/or concerns about the research process. Similarly, Brinkmann and Kvale (2014) add a final debriefing stage to allow participants to process emotions and share further information. During debriefing, the interviewer may summarize the main points and ask participants to comment and provide feedback. The authors provide no guidance on how the additional information and feedback are used. In contrast, other authors use closing questions to signal the conclusion of the interview ( Castillo-Montoya, 2016 ; Wengraf, 2001 ). Although not considered primary research questions, reflective closing questions may add valuable information or raise additional issues for the researcher to consider ( Castillo-Montoya, 2016 ).

Few authors describe how they use or analyze data generated from closing questions. Krueger and Casey (2015) include three types of closing questions with focus groups, which they believe are critical for data analysis and directing future interviews. Participants are asked an all-things-considered question (e.g., “Of all the needs we discussed, which one is most important to you?”) allowing participants time to reflect, comment on critical areas of concern, and clarify their positions. Responses inform interpretation of conflicting comments and assign weight of importance. A summary question (e.g., “Is this an adequate summary?”) and then an insurance question (e.g., “Have we missed anything?”) are used for considering topic importance, and can inform modifications of interview guides. Lincoln and Guba (1985) describe terminating an interview by completing a member check where the interviewer summarizes what they believe they just learned, and the interviewee is given time to react and comment on the validity of the constructs made. All information learned, including additional thoughts sparked by the summary, is available for possible triangulation and further member checking as the study proceeds ( Lincoln & Guba, 1985 ).

Due to limited and variable literature regarding closing questions, the purpose of our study was to understand if and how researchers use closing questions during qualitative interviews. Specifically, our questions were: (a) “Why do qualitative researchers include or exclude closing questions during interviews?); and (b) “How do qualitative researchers use data from closing questions?”

Study Design

A qualitative descriptive design was utilized for this study. No a priori conceptual framework was used in this study; however, the study was informed by the axioms of the naturalistic paradigm as described by Lincoln and Guba (1985) . The [institution 1] and [institution 2; blinded for review] institutional review boards deemed this study exempt.

Participants

A convenience sample of researchers known to the authors as having engaged in qualitative research were recruited initially; snowball sampling was used to recruit additional participants. First, the corresponding author emailed 15 colleagues to describe the study and included a link to complete the web-based survey. Additionally, coauthors sent emails to 66 others, and these 81 (15 + 66) initial contacts were asked to forward the survey to others engaged in qualitative research. Given the recruitment strategy, it is unknown how many emails were sent inviting people to complete the survey; therefore, we are unable to calculate a response rate.

Measurements

A single, asynchronous, web-based, investigator-designed survey was used to collect data. Before launching the survey, coauthors pilot tested it to improve the questions’ structure and sequence. The final survey included 14 questions: Nine multiple-choice and five free text responses. Respondents were asked about themselves, their experiences with conducting qualitative research and, specifically, if and how they used closing questions during qualitative interviews. The survey was administered via SurveyMonkey® and was available from December 11, 2017 until January 8, 2018.

Data Analysis

Descriptive statistics were used to analyze data from the multiple-choice questions; however, the focus of this article is on the responses to two of the free text questions: (a) “Please tell us why you include or do not include closing questions in your interviews.”; and (b) “Please tell us how you use the data generated from closing questions.” Individual responses to these questions were analyzed using qualitative content analysis ( Graneheim & Lundman, 2004 ; Sandelowski, 1995 ). Individual codes that were similar in content and meaning were subcategorized. Subcategories were further scrutinized and placed into broader categories ( Morse, 2008 ). Table 1 provides an example of how similar codes were collapsed into subcategories, which were then collapsed into a category. Separate codebooks were created for each question given that the purpose of each differed (i.e., reasons for excluding/including closing questions and how data from them are used). Data were analyzed by the corresponding author and final categories were reviewed and approved by all authors. Techniques to establish trustworthiness included the development of a coding system, peer debriefing, and maintaining an audit trail of decisions related to analysis ( Abboud et al., 2017 ; Lincoln & Guba, 1985 ; Morse, 2015 ).

Example of Category Development

Respondents per question ranged from 76 to 99. Academic discipline/profession was reported by 99 respondents. Most identified with nursing (49%) and sociology (17%); 17% were not explicit (e.g., “social science” and “researcher”). Current country of residence varied; the United States was the most frequent answer (83%). Other reported locations were Canada (7%), the United Kingdom (2%), and Brazil, India, Ireland, Nepal, Nigeria, Peru, Switzerland, and Turkey (1% each). Years involved in qualitative research was reported by 96 respondents; 15 years was the most frequent (35%) followed by 6–10 years (27%), more than 15 years (25%), less than one year (7%), and 11–15 years (5%).

The frequency of including closing questions was reported by 95 respondents; 81% reported doing so “always”, 15% “sometimes”, and 4% “never”. The inclusion of closing questions by interview type varied among the 91 respondents to this question; 91% for semistructured interviews; 34% for structured interviews; and 29% for unstructured interviews (this question allowed respondents to choose all answers that apply).

Reasons for Excluding or Including Closing Questions

Free text answers from 85 participants regarding reasons for including closing questions during interviews were analyzed and four broad categories emerged: data; the interview; the interviewee; and the interviewer. Table 2 includes representative quotes from each of these categories. Only one respondent offered a reason for excluding closing questions: “I feel these kinds of closing questions are often unhelpful, as most will just respond ‘no’ or go on a tangent that is not necessarily related to your research questions.”

Reasons for Including Closing Questions

Respondents described using closing questions as a means of collecting data, including adding to existing data, uncovering new areas or topics to explore, and for modifying interview guides.

The Interview

Most responses in this category indicated that closing questions are included as a means for signaling the close of the interview. Additionally, respondents offered that these questions are a way of indicating the existence of the relationship between the interviewee and the interviewer. Notably, one respondent indicated, “i [ sic ] always include closing questions because they can give an [ sic ] new breath to the interview”, which contrasts most reasons for including them.

The Interviewee

Many respondents reported asking closing questions to acknowledge the interviewee as a person. These acknowledgments took many forms, including conferring respect and honoring participants, conveying that participants were heard, and that their experiences were valued. Closing questions were also noted to give interviewees “a feeling of agency” and voice as they expand on interview topics, particularly those most important to them.

Responses in this category moved beyond simply garnering interviewees’ replies to questions, but rather, provided opportunities for researchers to hear additional information free of interviewers’ assumptions and removed from their own research agenda. Such questions were also described as benefiting interviewees by providing an outlet for reconsidering or rethinking topics discussed during interviews, summarizing and finalizing thoughts, and gaining closure to the experience of being interviewed or of speaking about their experiences.

The Interviewer

This category concerns use of closing questions for the purpose of serving the interviewer. Closing questions provide them opportunities to obtain feedback for instrument development, clarify interviewees’ responses, and terminate the relationship. In addition, closing questions are used to ensure data needed for the research endeavor have been obtained, and to attain information to support an argument or stance related to the area being studied.

The Uses of Closing Question Data

In addition to understanding why closing questions are used, we were also interested in learning how respondents use the data. Free-text answers from 81 respondents were gathered and from these four broad categories emerged from these data: Analysis, data, the interview guide, and inquiry. Table 3 includes representative quotes from each of these categories.

Uses of Closing Question Data

Some respondents described using closing question data similarly to how they use all other study data, while others reported separate analysis of these questions. Respondents also described using data from closing questions in all phases of the analytic process, including generating codes and themes and for higher levels of analysis, such as data interpretation. Data also served as a source of reflection for researchers relative to what they are learning from the data and how they come to understand them.

Data are used as new information or to supplement and clarify other existing data, or, more generally, to add to the overall body of data. Some respondents noted they rarely or ever use these data, offering that closing questions generate little or no data, and that use is dependent on some other condition (e.g., if relevant to the purpose of the interview).

The Interview Guide

Some respondents reported using data to inform and modify interview guides, such as via addition of questions and prompts to be included in subsequent versions.

Finally, data are used to discover new areas for future inquiry. Examples include generating new research questions or components of future studies (e.g., informing the development of a survey).

To our knowledge this is the first study to describe why researchers include closing questions and how data from them are used. We found most respondents use closing questions; however, the rationale for inclusion and how the data are used varies. As with Castillo-Montoya’s (2016) suggestion, some respondents had a functional intention for the closing question: Signaling the end of the interview and validating the relationship between the interviewer and interviewee. Our study unearthed a previously unreported reason for including a closing question: Adding “an [ sic ] new breath” to the interview. This runs counter to ending an interview ( Wengraf, 2001 ) which is inherent in the name “closing” question.

Respondents shared they intended for the closing question to augment or expand what had been shared by the interviewee, striving for completeness in the data in case something pertinent was not captured previously in the interview. Echoing King and Horrocks (2010) , some respondents felt closing questions provide a space where the interviewee may have a stronger sense of agency and autonomy. The open-endedness of the questions does not impose the theoretical or philosophical lens that may have informed the interview guide, giving interviewees more control. Interestingly no respondents used closing questions as an opportunity for the interviewee to emotionally debrief from the interview as suggested by Brinkmann and Kvale (2014) .

Respondents included closing questions to generate data to inform future topics of inquiry and modify interview guides, and analyzed data produced by closing questions jointly and separately from the rest of the data. Closing question data augments existing data when analyzed jointly. Reflecting on Krueger and Casey’s (2015) and Lincoln and Guba’s (1985) use of the closing question, data analyzed separately from the rest of the data were treated as new information, supplemental, or used for triangulation. This strategy further strengthens the trustworthiness of the data and rigor of the study ( Lincoln & Guba, 1985 ). Limitations include convenience and snowball sampling and a design that did not allow us to ask follow-up or probing questions to further explore answers to free text response questions. Additionally, our survey was created by and for those whose primary language is English.

We found that researchers include closing questions in qualitative research, which is consistent with the limited existing literature and reinforces that valuable data can be collected via closing questions. We recommend building on our results to further the discussion regarding alternative views, usefulness of established criteria researchers use to guide closing question development and use, and as a process of sparking continued conversations about this commonly used component of data collection.

Acknowledgement

Research reported in this publication was supported by The Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System (Dr. Sowicz) and the National Institute of Nursing Research of the National Institutes of Health under Award Numbers T32NR015433 (Dr. Irani) and T32NR009356 (Dr. Sefcik). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Veterans Health Administration. The authors thank the peer reviewers for their thoughtful critique of previous versions of our article.

The authors have no conflicts of interest to report.

Ethical Conduct of Research : The VA Pittsburgh Healthcare System and The University of North Carolina at Greensboro institutional review boards deemed this study exempt.

Clinical Trial Registration : Not applicable.

Contributor Information

Timothy Joseph Sowicz, The University of North Carolina at Greensboro School of Nursing, Greensboro, NC.

Justine S. Sefcik, University of Pennsylvania School of Nursing, Philadelphia, PA.

Helen L. Teng, University of Pennsylvania School of Nursing, Philadelphia, PA.

Elliane Irani, Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, OH.

Terri-Ann Kelly, Rutgers School of Nursing – Camden, Camden, NJ.

Christine Bradway, University of Pennsylvania School of Nursing, Philadelphia, PA.

• Abboud S, Kim SK, Jacoby S, Mooney-Doyle K, Waite T, Froh E, . . . Kagan S (2017). Co-creation of a pedagogical space to support qualitative inquiry: An advanced qualitative collective . Nurse Education Today , 50 , 8–11. doi: 10.1016/j.nedt.2016.12.001 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Baumbusch J (2010). Semi-structured interviewing in practice-close research . Journal for Specialists in Pediatric Nursing , 15 , 255–258. doi: 10.1111/j.1744-6155.2010.00243.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Brinkmann S, & Kvale S (2014). Interviews: Learning the craft of qualitative research interviewing (3rd ed.). Thousand Oaks, CA: Sage Publications. [ Google Scholar ]
• Castillo-Montoya M (2016). Preparing for interview research: The interview protocol refinement framework . The Qualitative Report , 21 , 811–831. [ Google Scholar ]
• Graneheim UH, & Lundman B (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness . Nurse Education Today , 24 , 105–112. doi: 10.1016/j.nedt.2003.10.001 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• King N, & Horrocks C (2010). Interviews in qualitative research . Thousand Oaks, CA: Sage Publications. [ Google Scholar ]
• Krueger RA, & Casey MA (2015). Focus groups: A practical guide for applied research (5th ed.). Thousand Oaks, CA: Sage Publications. [ Google Scholar ]
• Lincoln YS, & Guba EG (1985). Naturalistic inquiry . Newbury Park, CA: Sage Publications. [ Google Scholar ]
• Morse JM (2008). Confusing categories and themes . Qualitative Health Research , 18 , 727–728. doi: 10.1177/1049732308314930 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Morse JM (2015). Critical analysis of strategies for determining rigor in qualitative inquiry . Qualitative Health Research , 25 , 1212–1222. doi: 10.1177/1049732315588501 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sandelowski M (1995). Sample size in qualitative research . Research in Nursing & Health , 18 , 179–183. doi: 10.1002/nur.4770180211 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wengraf T (2001). Qualitative research interviewing . London, UK: Sage Publications. [ Google Scholar ]
• Whiting LS (2008). Semi-structured interviews: Guidance for novice researchers . Nursing Standard , 22 , 35–41. [ PubMed ] [ Google Scholar ]

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Chapter 10: Qualitative Data Collection & Analysis Methods

10.5 Analysis of Qualitative Interview Data

Analysis of qualitative interview data typically begins with a set of transcripts of the interviews conducted. Obtaining said transcripts requires either having taken exceptionally good notes during an interview or, preferably, recorded the interview and then transcribed it. To transcribe an interview means to create a complete, written copy of the recorded interview by playing the recording back and typing in each word that is spoken on the recording, noting who spoke which words. In general, it is best to aim for a verbatim transcription, i.e., one that reports word for word exactly what was said in the recorded interview. If possible, it is also best to include nonverbal responses in the written transcription of an interview (if the interview is completed face-to-face, or some other form of visual contact is maintained, such as with Skype). Gestures made by respondents should be noted, as should the tone of voice and notes about when, where, and how spoken words may have been emphasized by respondents.

If you have the time, it is best to transcribe your interviews yourself. If the researcher who conducted the interviews transcribes them herself, that person will also be able to record associated nonverbal behaviors and interactions that may be relevant to analysis but that could not be picked up by audio recording. Interviewees may roll their eyes, wipe tears from their face, and even make obscene gestures that speak volumes about their feelings; however, such non-verbal gestures cannot be recorded, and being able to remember and record in writing these details as it relates to the transcribing of interviews is invaluable.

Overall, the goal of analysis is to reach some inferences, lessons, or conclusions by condensing large amounts of data into relatively smaller, more manageable bits of understandable information. Analysis of qualitative interview data often works inductively (Glaser & Strauss, 1967; Patton, 2001). To move from the specific observations an interviewer collects to identifying patterns across those observations, qualitative interviewers will often begin by reading through transcripts of their interviews and trying to identify codes. A code is a shorthand representation of some more complex set of issues or ideas. The process of identifying codes in one’s qualitative data is often referred to as coding . Coding involves identifying themes across interview data by reading and re-reading (and re-reading again) interview transcripts, until the researcher has a clear idea about what sorts of themes come up across the interviews. Coding helps to achieve the goal of data management and data reduction (Palys & Atchison, 2014, p. 304).

Coding can be inductive or deductive. Deductive coding is the approach used by research analysts who have a well-specified or pre-defined set of interests (Palys & Atchison, 2014, P. 304). The process of deductive coding begins with the analyst utilizing those specific or pre-defined interests to identify “relevant” passages, quotes, images, scenes, etc., to develop a set of preliminary codes (often referred to as descriptive coding ). From there, the analyst elaborates on these preliminary codes, making finer distinctions within each coding category (known as interpretative coding ). Pattern coding is another step an analyst might take as different associations become apparent. For example, if you are studying at-risk behaviours in youth, and you discover that the various behaviours have different characteristics and meanings depending upon the social context (e.g., school, family, work) in which the various behaviours occur, you have identified a pattern (Palys & Atchison, 2014, p. 304).

In contrast, inductive coding begins with the identification of general themes and ideas that emerge as the researcher reads through the data. This process is also referred to as open coding (Palys & Atchison, 2014, p. 305), because it will probably require multiple analyses. As you read through your transcripts, it is likely that you will begin to see some commonalities across the categories or themes that you’ve jotted down (Saylor Academy, 2012). The open coding process can go one of two ways: either the researcher elaborates on a category by making finer, and then even finer distinctions, or the researcher starts with a very specific descriptive category that is subsequently collapsed into another category (Palys & Atchison, 2014, p. 305). In other words, the development and elaboration of codes arise out of the material that is being examined.

The next step for the research analyst is to begin more specific coding, which is known as focused or axial coding . Focused coding involves collapsing or narrowing themes and categories identified in open coding by reading through the notes you made while conducting open coding, identifying themes or categories that seem to be related, and perhaps merging some. Then give each collapsed/merged theme or category a name (or code) and identify passages of data that fit each named category or theme. To identify passages of data that represent your emerging codes, you will need to read through your transcripts several times. You might also write up brief definitions or descriptions of each code. Defining codes is a way of giving meaning to your data, and developing a way to talk about your findings and what your data means (Saylor Academy, 2012).

As tedious and laborious as it might seem to read through hundreds of pages of transcripts multiple times, sometimes getting started with the coding process is actually the hardest part. If you find yourself struggling to identify themes at the open coding stage, ask yourself some questions about your data. The answers should give you a clue about what sorts of themes or categories you are reading (Saylor Academy, 2012). (Lofland and Lofland,1995, p. 2001) identify a set of questions that are useful when coding qualitative data. They suggest asking the following:

• Of what topic, unit, or aspect is this an instance?
• What question about a topic does this item of data suggest?
• What sort of answer to a question about a topic does this item of data suggest (i.e., what proposition is suggested)?

Asking yourself these questions about the passages of data that you are reading can help you begin to identify and name potential themes and categories.

Table 10.3 “ Interview coding” example is drawn from research undertaken by Saylor Academy (Saylor Academy, 2012) where she presents two codes that emerged from her inductive analysis of transcripts from her interviews with child-free adults. Table 10.3 also includes a brief description of each code and a few (of many) interview excerpts from which each code was developed.

Table 10.3 Interview coding

Just as quantitative researchers rely on the assistance of special computer programs designed to help sort through and analyze their data, so, do qualitative researchers. Where quantitative researchers have SPSS and MicroCase (and many others), qualitative researchers have programs such as NVivo ( http://www.qsrinternational.com ) and Atlasti ( http://www.atlasti.com ). These are programs specifically designed to assist qualitative researchers to organize, manage, sort, and analyze large amounts of qualitative data. The programs allow researchers to import interview transcripts contained in an electronic file and then label or code passages, cut and paste passages, search for various words or phrases, and organize complex interrelationships among passages and codes

Research Methods for the Social Sciences: An Introduction Copyright © 2020 by Valerie Sheppard is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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• Writing Tips

How to Write a Conclusion for a Research Paper

3-minute read

• 29th August 2023

If you’re writing a research paper, the conclusion is your opportunity to summarize your findings and leave a lasting impression on your readers. In this post, we’ll take you through how to write an effective conclusion for a research paper and how you can:

·   Reword your thesis statement

·   Highlight the significance of your research

·   Discuss limitations

·   Connect to the introduction

·   End with a thought-provoking statement

Rewording Your Thesis Statement

Begin your conclusion by restating your thesis statement in a way that is slightly different from the wording used in the introduction. Avoid presenting new information or evidence in your conclusion. Just summarize the main points and arguments of your essay and keep this part as concise as possible. Remember that you’ve already covered the in-depth analyses and investigations in the main body paragraphs of your essay, so it’s not necessary to restate these details in the conclusion.

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Highlighting the Significance of Your Research

The conclusion is a good place to emphasize the implications of your research . Avoid ambiguous or vague language such as “I think” or “maybe,” which could weaken your position. Clearly explain why your research is significant and how it contributes to the broader field of study.

Here’s an example from a (fictional) study on the impact of social media on mental health:

Discussing Limitations

Although it’s important to emphasize the significance of your study, you can also use the conclusion to briefly address any limitations you discovered while conducting your research, such as time constraints or a shortage of resources. Doing this demonstrates a balanced and honest approach to your research.

Connecting to the Introduction

In your conclusion, you can circle back to your introduction , perhaps by referring to a quote or anecdote you discussed earlier. If you end your paper on a similar note to how you began it, you will create a sense of cohesion for the reader and remind them of the meaning and significance of your research.

Ending With a Thought-Provoking Statement

Consider ending your paper with a thought-provoking and memorable statement that relates to the impact of your research questions or hypothesis. This statement can be a call to action, a philosophical question, or a prediction for the future (positive or negative). Here’s an example that uses the same topic as above (social media and mental health):

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How to write a strong conclusion for your research paper

Last updated

17 February 2024

Reviewed by

Writing a research paper is a chance to share your knowledge and hypothesis. It's an opportunity to demonstrate your many hours of research and prove your ability to write convincingly.

Ideally, by the end of your research paper, you'll have brought your readers on a journey to reach the conclusions you've pre-determined. However, if you don't stick the landing with a good conclusion, you'll risk losing your reader’s trust.

Writing a strong conclusion for your research paper involves a few important steps, including restating the thesis and summing up everything properly.

Find out what to include and what to avoid, so you can effectively demonstrate your understanding of the topic and prove your expertise.

• Why is a good conclusion important?

A good conclusion can cement your paper in the reader’s mind. Making a strong impression in your introduction can draw your readers in, but it's the conclusion that will inspire them.

• What to include in a research paper conclusion

There are a few specifics you should include in your research paper conclusion. Offer your readers some sense of urgency or consequence by pointing out why they should care about the topic you have covered. Discuss any common problems associated with your topic and provide suggestions as to how these problems can be solved or addressed.

The conclusion should include a restatement of your initial thesis. Thesis statements are strengthened after you’ve presented supporting evidence (as you will have done in the paper), so make a point to reintroduce it at the end.

Finally, recap the main points of your research paper, highlighting the key takeaways you want readers to remember. If you've made multiple points throughout the paper, refer to the ones with the strongest supporting evidence.

• Steps for writing a research paper conclusion

Many writers find the conclusion the most challenging part of any research project . By following these three steps, you'll be prepared to write a conclusion that is effective and concise.

• Step 1: Restate the problem

Always begin by restating the research problem in the conclusion of a research paper. This serves to remind the reader of your hypothesis and refresh them on the main point of the paper. 

When restating the problem, take care to avoid using exactly the same words you employed earlier in the paper.

• Step 2: Sum up the paper

After you've restated the problem, sum up the paper by revealing your overall findings. The method for this differs slightly, depending on whether you're crafting an argumentative paper or an empirical paper.

Argumentative paper: Restate your thesis and arguments

Argumentative papers involve introducing a thesis statement early on. In crafting the conclusion for an argumentative paper, always restate the thesis, outlining the way you've developed it throughout the entire paper.

It might be appropriate to mention any counterarguments in the conclusion, so you can demonstrate how your thesis is correct or how the data best supports your main points.

Empirical paper: Summarize research findings

Empirical papers break down a series of research questions. In your conclusion, discuss the findings your research revealed, including any information that surprised you.

Be clear about the conclusions you reached, and explain whether or not you expected to arrive at these particular ones.

• Step 3: Discuss the implications of your research

Argumentative papers and empirical papers also differ in this part of a research paper conclusion. Here are some tips on crafting conclusions for argumentative and empirical papers.

Argumentative paper: Powerful closing statement

In an argumentative paper, you'll have spent a great deal of time expressing the opinions you formed after doing a significant amount of research. Make a strong closing statement in your argumentative paper's conclusion to share the significance of your work.

You can outline the next steps through a bold call to action, or restate how powerful your ideas turned out to be.

Empirical paper: Directions for future research

Empirical papers are broader in scope. They usually cover a variety of aspects and can include several points of view.

To write a good conclusion for an empirical paper, suggest the type of research that could be done in the future, including methods for further investigation or outlining ways other researchers might proceed.

If you feel your research had any limitations, even if they were outside your control, you could mention these in your conclusion.

After you finish outlining your conclusion, ask someone to read it and offer feedback. In any research project you're especially close to, it can be hard to identify problem areas. Having a close friend or someone whose opinion you value read the research paper and provide honest feedback can be invaluable. Take note of any suggested edits and consider incorporating them into your paper if they make sense.

• Things to avoid in a research paper conclusion

Keep these aspects to avoid in mind as you're writing your conclusion and refer to them after you've created an outline.

Dry summary

Writing a memorable, succinct conclusion is arguably more important than a strong introduction. Take care to avoid just rephrasing your main points, and don't fall into the trap of repeating dry facts or citations.

You can provide a new perspective for your readers to think about or contextualize your research. Either way, make the conclusion vibrant and interesting, rather than a rote recitation of your research paper’s highlights.

Clichéd or generic phrasing

Your research paper conclusion should feel fresh and inspiring. Avoid generic phrases like "to sum up" or "in conclusion." These phrases tend to be overused, especially in an academic context and might turn your readers off.

The conclusion also isn't the time to introduce colloquial phrases or informal language. Retain a professional, confident tone consistent throughout your paper’s conclusion so it feels exciting and bold.

New data or evidence

While you should present strong data throughout your paper, the conclusion isn't the place to introduce new evidence. This is because readers are engaged in actively learning as they read through the body of your paper.

By the time they reach the conclusion, they will have formed an opinion one way or the other (hopefully in your favor!). Introducing new evidence in the conclusion will only serve to surprise or frustrate your reader.

Ignoring contradictory evidence

If your research reveals contradictory evidence, don't ignore it in the conclusion. This will damage your credibility as an expert and might even serve to highlight the contradictions.

Be as transparent as possible and admit to any shortcomings in your research, but don't dwell on them for too long.

Ambiguous or unclear resolutions

The point of a research paper conclusion is to provide closure and bring all your ideas together. You should wrap up any arguments you introduced in the paper and tie up any loose ends, while demonstrating why your research and data are strong.

Use direct language in your conclusion and avoid ambiguity. Even if some of the data and sources you cite are inconclusive or contradictory, note this in your conclusion to come across as confident and trustworthy.

• Examples of research paper conclusions

Your research paper should provide a compelling close to the paper as a whole, highlighting your research and hard work. While the conclusion should represent your unique style, these examples offer a starting point:

Ultimately, the data we examined all point to the same conclusion: Encouraging a good work-life balance improves employee productivity and benefits the company overall. The research suggests that when employees feel their personal lives are valued and respected by their employers, they are more likely to be productive when at work. In addition, company turnover tends to be reduced when employees have a balance between their personal and professional lives. While additional research is required to establish ways companies can support employees in creating a stronger work-life balance, it's clear the need is there.

Social media is a primary method of communication among young people. As we've seen in the data presented, most young people in high school use a variety of social media applications at least every hour, including Instagram and Facebook. While social media is an avenue for connection with peers, research increasingly suggests that social media use correlates with body image issues. Young girls with lower self-esteem tend to use social media more often than those who don't log onto social media apps every day. As new applications continue to gain popularity, and as more high school students are given smartphones, more research will be required to measure the effects of prolonged social media use.

What are the different kinds of research paper conclusions?

There are no formal types of research paper conclusions. Ultimately, the conclusion depends on the outline of your paper and the type of research you’re presenting. While some experts note that research papers can end with a new perspective or commentary, most papers should conclude with a combination of both. The most important aspect of a good research paper conclusion is that it accurately represents the body of the paper.

Can I present new arguments in my research paper conclusion?

Research paper conclusions are not the place to introduce new data or arguments. The body of your paper is where you should share research and insights, where the reader is actively absorbing the content. By the time a reader reaches the conclusion of the research paper, they should have formed their opinion. Introducing new arguments in the conclusion can take a reader by surprise, and not in a positive way. It might also serve to frustrate readers.

How long should a research paper conclusion be?

There's no set length for a research paper conclusion. However, it's a good idea not to run on too long, since conclusions are supposed to be succinct. A good rule of thumb is to keep your conclusion around 5 to 10 percent of the paper's total length. If your paper is 10 pages, try to keep your conclusion under one page.

What should I include in a research paper conclusion?

A good research paper conclusion should always include a sense of urgency, so the reader can see how and why the topic should matter to them. You can also note some recommended actions to help fix the problem and some obstacles they might encounter. A conclusion should also remind the reader of the thesis statement, along with the main points you covered in the paper. At the end of the conclusion, add a powerful closing statement that helps cement the paper in the mind of the reader.

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How to Write a Conclusion for Research Papers (with Examples)

The conclusion of a research paper is a crucial section that plays a significant role in the overall impact and effectiveness of your research paper. However, this is also the section that typically receives less attention compared to the introduction and the body of the paper. The conclusion serves to provide a concise summary of the key findings, their significance, their implications, and a sense of closure to the study. Discussing how can the findings be applied in real-world scenarios or inform policy, practice, or decision-making is especially valuable to practitioners and policymakers. The research paper conclusion also provides researchers with clear insights and valuable information for their own work, which they can then build on and contribute to the advancement of knowledge in the field.

The research paper conclusion should explain the significance of your findings within the broader context of your field. It restates how your results contribute to the existing body of knowledge and whether they confirm or challenge existing theories or hypotheses. Also, by identifying unanswered questions or areas requiring further investigation, your awareness of the broader research landscape can be demonstrated.

Remember to tailor the research paper conclusion to the specific needs and interests of your intended audience, which may include researchers, practitioners, policymakers, or a combination of these.

Table of Contents

What is a conclusion in a research paper, summarizing conclusion, editorial conclusion, externalizing conclusion, importance of a good research paper conclusion, how to write a conclusion for your research paper, research paper conclusion examples.

• How to write a research paper conclusion with Paperpal? 

Frequently Asked Questions

A conclusion in a research paper is the final section where you summarize and wrap up your research, presenting the key findings and insights derived from your study. The research paper conclusion is not the place to introduce new information or data that was not discussed in the main body of the paper. When working on how to conclude a research paper, remember to stick to summarizing and interpreting existing content. The research paper conclusion serves the following purposes: 1

• Warn readers of the possible consequences of not attending to the problem.
• Recommend specific course(s) of action.
• Restate key ideas to drive home the ultimate point of your research paper.
• Provide a “take-home” message that you want the readers to remember about your study.

Types of conclusions for research papers

In research papers, the conclusion provides closure to the reader. The type of research paper conclusion you choose depends on the nature of your study, your goals, and your target audience. I provide you with three common types of conclusions:

A summarizing conclusion is the most common type of conclusion in research papers. It involves summarizing the main points, reiterating the research question, and restating the significance of the findings. This common type of research paper conclusion is used across different disciplines.

An editorial conclusion is less common but can be used in research papers that are focused on proposing or advocating for a particular viewpoint or policy. It involves presenting a strong editorial or opinion based on the research findings and offering recommendations or calls to action.

An externalizing conclusion is a type of conclusion that extends the research beyond the scope of the paper by suggesting potential future research directions or discussing the broader implications of the findings. This type of conclusion is often used in more theoretical or exploratory research papers.

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The conclusion in a research paper serves several important purposes:

• Offers Implications and Recommendations : Your research paper conclusion is an excellent place to discuss the broader implications of your research and suggest potential areas for further study. It’s also an opportunity to offer practical recommendations based on your findings.
• Provides Closure : A good research paper conclusion provides a sense of closure to your paper. It should leave the reader with a feeling that they have reached the end of a well-structured and thought-provoking research project.
• Leaves a Lasting Impression : Writing a well-crafted research paper conclusion leaves a lasting impression on your readers. It’s your final opportunity to leave them with a new idea, a call to action, or a memorable quote.

Writing a strong conclusion for your research paper is essential to leave a lasting impression on your readers. Here’s a step-by-step process to help you create and know what to put in the conclusion of a research paper: 2

• Research Statement : Begin your research paper conclusion by restating your research statement. This reminds the reader of the main point you’ve been trying to prove throughout your paper. Keep it concise and clear.
• Key Points : Summarize the main arguments and key points you’ve made in your paper. Avoid introducing new information in the research paper conclusion. Instead, provide a concise overview of what you’ve discussed in the body of your paper.
• Address the Research Questions : If your research paper is based on specific research questions or hypotheses, briefly address whether you’ve answered them or achieved your research goals. Discuss the significance of your findings in this context.
• Significance : Highlight the importance of your research and its relevance in the broader context. Explain why your findings matter and how they contribute to the existing knowledge in your field.
• Implications : Explore the practical or theoretical implications of your research. How might your findings impact future research, policy, or real-world applications? Consider the “so what?” question.
• Future Research : Offer suggestions for future research in your area. What questions or aspects remain unanswered or warrant further investigation? This shows that your work opens the door for future exploration.
• Closing Thought : Conclude your research paper conclusion with a thought-provoking or memorable statement. This can leave a lasting impression on your readers and wrap up your paper effectively. Avoid introducing new information or arguments here.
• Proofread and Revise : Carefully proofread your conclusion for grammar, spelling, and clarity. Ensure that your ideas flow smoothly and that your conclusion is coherent and well-structured.

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Remember that a well-crafted research paper conclusion is a reflection of the strength of your research and your ability to communicate its significance effectively. It should leave a lasting impression on your readers and tie together all the threads of your paper. Now you know how to start the conclusion of a research paper and what elements to include to make it impactful, let’s look at a research paper conclusion sample.

How to write a research paper conclusion with Paperpal?

A research paper conclusion is not just a summary of your study, but a synthesis of the key findings that ties the research together and places it in a broader context. A research paper conclusion should be concise, typically around one paragraph in length. However, some complex topics may require a longer conclusion to ensure the reader is left with a clear understanding of the study’s significance. Paperpal, an AI writing assistant trusted by over 800,000 academics globally, can help you write a well-structured conclusion for your research paper. 

• Sign Up or Log In: Create a new Paperpal account or login with your details.  
• Navigate to Features : Once logged in, head over to the features’ side navigation pane. Click on Templates and you’ll find a suite of generative AI features to help you write better, faster.  
• Generate an outline: Under Templates, select ‘Outlines’. Choose ‘Research article’ as your document type.  
• Select your section: Since you’re focusing on the conclusion, select this section when prompted.  
• Choose your field of study: Identifying your field of study allows Paperpal to provide more targeted suggestions, ensuring the relevance of your conclusion to your specific area of research. 
• Provide a brief description of your study: Enter details about your research topic and findings. This information helps Paperpal generate a tailored outline that aligns with your paper’s content. 
• Generate the conclusion outline: After entering all necessary details, click on ‘generate’. Paperpal will then create a structured outline for your conclusion, to help you start writing and build upon the outline.  
• Write your conclusion: Use the generated outline to build your conclusion. The outline serves as a guide, ensuring you cover all critical aspects of a strong conclusion, from summarizing key findings to highlighting the research’s implications. 
• Refine and enhance: Paperpal’s ‘Make Academic’ feature can be particularly useful in the final stages. Select any paragraph of your conclusion and use this feature to elevate the academic tone, ensuring your writing is aligned to the academic journal standards. 

By following these steps, Paperpal not only simplifies the process of writing a research paper conclusion but also ensures it is impactful, concise, and aligned with academic standards. Sign up with Paperpal today and write your research paper conclusion 2x faster .  

The research paper conclusion is a crucial part of your paper as it provides the final opportunity to leave a strong impression on your readers. In the research paper conclusion, summarize the main points of your research paper by restating your research statement, highlighting the most important findings, addressing the research questions or objectives, explaining the broader context of the study, discussing the significance of your findings, providing recommendations if applicable, and emphasizing the takeaway message. The main purpose of the conclusion is to remind the reader of the main point or argument of your paper and to provide a clear and concise summary of the key findings and their implications. All these elements should feature on your list of what to put in the conclusion of a research paper to create a strong final statement for your work.

A strong conclusion is a critical component of a research paper, as it provides an opportunity to wrap up your arguments, reiterate your main points, and leave a lasting impression on your readers. Here are the key elements of a strong research paper conclusion: 1. Conciseness : A research paper conclusion should be concise and to the point. It should not introduce new information or ideas that were not discussed in the body of the paper. 2. Summarization : The research paper conclusion should be comprehensive enough to give the reader a clear understanding of the research’s main contributions. 3 . Relevance : Ensure that the information included in the research paper conclusion is directly relevant to the research paper’s main topic and objectives; avoid unnecessary details. 4 . Connection to the Introduction : A well-structured research paper conclusion often revisits the key points made in the introduction and shows how the research has addressed the initial questions or objectives. 5. Emphasis : Highlight the significance and implications of your research. Why is your study important? What are the broader implications or applications of your findings? 6 . Call to Action : Include a call to action or a recommendation for future research or action based on your findings.

The length of a research paper conclusion can vary depending on several factors, including the overall length of the paper, the complexity of the research, and the specific journal requirements. While there is no strict rule for the length of a conclusion, but it’s generally advisable to keep it relatively short. A typical research paper conclusion might be around 5-10% of the paper’s total length. For example, if your paper is 10 pages long, the conclusion might be roughly half a page to one page in length.

In general, you do not need to include citations in the research paper conclusion. Citations are typically reserved for the body of the paper to support your arguments and provide evidence for your claims. However, there may be some exceptions to this rule: 1. If you are drawing a direct quote or paraphrasing a specific source in your research paper conclusion, you should include a citation to give proper credit to the original author. 2. If your conclusion refers to or discusses specific research, data, or sources that are crucial to the overall argument, citations can be included to reinforce your conclusion’s validity.

The conclusion of a research paper serves several important purposes: 1. Summarize the Key Points 2. Reinforce the Main Argument 3. Provide Closure 4. Offer Insights or Implications 5. Engage the Reader. 6. Reflect on Limitations

Remember that the primary purpose of the research paper conclusion is to leave a lasting impression on the reader, reinforcing the key points and providing closure to your research. It’s often the last part of the paper that the reader will see, so it should be strong and well-crafted.

• Makar, G., Foltz, C., Lendner, M., & Vaccaro, A. R. (2018). How to write effective discussion and conclusion sections. Clinical spine surgery, 31(8), 345-346.
• Bunton, D. (2005). The structure of PhD conclusion chapters.  Journal of English for academic purposes ,  4 (3), 207-224.

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• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

• 9. The Conclusion
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

The conclusion is intended to help the reader understand why your research should matter to them after they have finished reading the paper. A conclusion is not merely a summary of the main topics covered or a re-statement of your research problem, but a synthesis of key points derived from the findings of your study and, if applicable, where you recommend new areas for future research. For most college-level research papers, two or three well-developed paragraphs is sufficient for a conclusion, although in some cases, more paragraphs may be required in describing the key findings and their significance.

Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University.

Importance of a Good Conclusion

A well-written conclusion provides you with important opportunities to demonstrate to the reader your understanding of the research problem. These include:

• Presenting the last word on the issues you raised in your paper . Just as the introduction gives a first impression to your reader, the conclusion offers a chance to leave a lasting impression. Do this, for example, by highlighting key findings in your analysis that advance new understanding about the research problem, that are unusual or unexpected, or that have important implications applied to practice.
• Summarizing your thoughts and conveying the larger significance of your study . The conclusion is an opportunity to succinctly re-emphasize  your answer to the "So What?" question by placing the study within the context of how your research advances past research about the topic.
• Identifying how a gap in the literature has been addressed . The conclusion can be where you describe how a previously identified gap in the literature [first identified in your literature review section] has been addressed by your research and why this contribution is significant.
• Demonstrating the importance of your ideas . Don't be shy. The conclusion offers an opportunity to elaborate on the impact and significance of your findings. This is particularly important if your study approached examining the research problem from an unusual or innovative perspective.
• Introducing possible new or expanded ways of thinking about the research problem . This does not refer to introducing new information [which should be avoided], but to offer new insight and creative approaches for framing or contextualizing the research problem based on the results of your study.

Bunton, David. “The Structure of PhD Conclusion Chapters.” Journal of English for Academic Purposes 4 (July 2005): 207–224; Conclusions. The Writing Center. University of North Carolina; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Conclusions. The Writing Lab and The OWL. Purdue University; Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Structure and Writing Style

I.  General Rules

The general function of your paper's conclusion is to restate the main argument . It reminds the reader of the strengths of your main argument(s) and reiterates the most important evidence supporting those argument(s). Do this by clearly summarizing the context, background, and necessity of pursuing the research problem you investigated in relation to an issue, controversy, or a gap found in the literature. However, make sure that your conclusion is not simply a repetitive summary of the findings. This reduces the impact of the argument(s) you have developed in your paper.

When writing the conclusion to your paper, follow these general rules:

• Present your conclusions in clear, concise language. Re-state the purpose of your study, then describe how your findings differ or support those of other studies and why [i.e., what were the unique, new, or crucial contributions your study made to the overall research about your topic?].
• Do not simply reiterate your findings or the discussion of your results. Provide a synthesis of arguments presented in the paper to show how these converge to address the research problem and the overall objectives of your study.
• Indicate opportunities for future research if you haven't already done so in the discussion section of your paper. Highlighting the need for further research provides the reader with evidence that you have an in-depth awareness of the research problem but that further investigations should take place beyond the scope of your investigation.

Consider the following points to help ensure your conclusion is presented well:

• If the argument or purpose of your paper is complex, you may need to summarize the argument for your reader.
• If, prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction or within a new context that emerges from the data [this is opposite of the introduction, which begins with general discussion of the context and ends with a detailed description of the research problem]. 

The conclusion also provides a place for you to persuasively and succinctly restate the research problem, given that the reader has now been presented with all the information about the topic . Depending on the discipline you are writing in, the concluding paragraph may contain your reflections on the evidence presented. However, the nature of being introspective about the research you have conducted will depend on the topic and whether your professor wants you to express your observations in this way. If asked to think introspectively about the topics, do not delve into idle speculation. Being introspective means looking within yourself as an author to try and understand an issue more deeply, not to guess at possible outcomes or make up scenarios not supported by the evidence.

II.  Developing a Compelling Conclusion

Although an effective conclusion needs to be clear and succinct, it does not need to be written passively or lack a compelling narrative. Strategies to help you move beyond merely summarizing the key points of your research paper may include any of the following:

• If your essay deals with a critical, contemporary problem, warn readers of the possible consequences of not attending to the problem proactively.
• Recommend a specific course or courses of action that, if adopted, could address a specific problem in practice or in the development of new knowledge leading to positive change.
• Cite a relevant quotation or expert opinion already noted in your paper in order to lend authority and support to the conclusion(s) you have reached [a good source would be from your literature review].
• Explain the consequences of your research in a way that elicits action or demonstrates urgency in seeking change.
• Restate a key statistic, fact, or visual image to emphasize the most important finding of your paper.
• If your discipline encourages personal reflection, illustrate your concluding point by drawing from your own life experiences.
• Return to an anecdote, an example, or a quotation that you presented in your introduction, but add further insight derived from the findings of your study; use your interpretation of results from your study to recast it in new or important ways.
• Provide a "take-home" message in the form of a succinct, declarative statement that you want the reader to remember about your study.

III. Problems to Avoid

Failure to be concise Your conclusion section should be concise and to the point. Conclusions that are too lengthy often have unnecessary information in them. The conclusion is not the place for details about your methodology or results. Although you should give a summary of what was learned from your research, this summary should be relatively brief, since the emphasis in the conclusion is on the implications, evaluations, insights, and other forms of analysis that you make. Strategies for writing concisely can be found here .

Failure to comment on larger, more significant issues In the introduction, your task was to move from the general [the field of study] to the specific [the research problem]. However, in the conclusion, your task is to move from a specific discussion [your research problem] back to a general discussion framed around the implications and significance of your findings [i.e., how your research contributes new understanding or fills an important gap in the literature]. In short, the conclusion is where you should place your research within a larger context [visualize your paper as an hourglass--start with a broad introduction and review of the literature, move to the specific analysis and discussion, conclude with a broad summary of the study's implications and significance].

Failure to reveal problems and negative results Negative aspects of the research process should never be ignored. These are problems, deficiencies, or challenges encountered during your study. They should be summarized as a way of qualifying your overall conclusions. If you encountered negative or unintended results [i.e., findings that are validated outside the research context in which they were generated], you must report them in the results section and discuss their implications in the discussion section of your paper. In the conclusion, use negative results as an opportunity to explain their possible significance and/or how they may form the basis for future research.

Failure to provide a clear summary of what was learned In order to be able to discuss how your research fits within your field of study [and possibly the world at large], you need to summarize briefly and succinctly how it contributes to new knowledge or a new understanding about the research problem. This element of your conclusion may be only a few sentences long.

Failure to match the objectives of your research Often research objectives in the social and behavioral sciences change while the research is being carried out. This is not a problem unless you forget to go back and refine the original objectives in your introduction. As these changes emerge they must be documented so that they accurately reflect what you were trying to accomplish in your research [not what you thought you might accomplish when you began].

Resist the urge to apologize If you've immersed yourself in studying the research problem, you presumably should know a good deal about it [perhaps even more than your professor!]. Nevertheless, by the time you have finished writing, you may be having some doubts about what you have produced. Repress those doubts! Don't undermine your authority as a researcher by saying something like, "This is just one approach to examining this problem; there may be other, much better approaches that...." The overall tone of your conclusion should convey confidence to the reader about the study's validity and realiability.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Concluding Paragraphs. College Writing Center at Meramec. St. Louis Community College; Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University; Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions. The Lab Report. University College Writing Centre. University of Toronto; Leibensperger, Summer. Draft Your Conclusion. Academic Center, the University of Houston-Victoria, 2003; Make Your Last Words Count. The Writer’s Handbook. Writing Center. University of Wisconsin Madison; Miquel, Fuster-Marquez and Carmen Gregori-Signes. “Chapter Six: ‘Last but Not Least:’ Writing the Conclusion of Your Paper.” In Writing an Applied Linguistics Thesis or Dissertation: A Guide to Presenting Empirical Research . John Bitchener, editor. (Basingstoke,UK: Palgrave Macmillan, 2010), pp. 93-105; Tips for Writing a Good Conclusion. Writing@CSU. Colorado State University; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Writing Conclusions. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Writing: Considering Structure and Organization. Institute for Writing Rhetoric. Dartmouth College.

Writing Tip

Don't Belabor the Obvious!

Avoid phrases like "in conclusion...," "in summary...," or "in closing...." These phrases can be useful, even welcome, in oral presentations. But readers can see by the tell-tale section heading and number of pages remaining that they are reaching the end of your paper. You'll irritate your readers if you belabor the obvious.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Another Writing Tip

New Insight, Not New Information!

Don't surprise the reader with new information in your conclusion that was never referenced anywhere else in the paper. This why the conclusion rarely has citations to sources. If you have new information to present, add it to the discussion or other appropriate section of the paper. Note that, although no new information is introduced, the conclusion, along with the discussion section, is where you offer your most "original" contributions in the paper; the conclusion is where you describe the value of your research, demonstrate that you understand the material that you’ve presented, and position your findings within the larger context of scholarship on the topic, including describing how your research contributes new insights to that scholarship.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Conclusions. The Writing Center. University of North Carolina.

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Chapter 21. Conclusion: The Value of Qualitative Research

Qualitative research is engaging research, in the best sense of the word.

A few of the meanings of engage = to attract or hold by influence or power; to hold the attention of; to induce to participate; to enter into contest with; to bring together or interlock; to deal with at length; to pledge oneself; to begin and carry on an enterprise; to take part or participate; to come together; engaged = to be actively involved in or committed; to greatly interest; to be embedded with. ( Merriam-Webster Unabridged Dictionary )

There really is no “cookbook” for conducting qualitative research. Each study is unique because the social world is rich and full of wonders, and those of us who are curious about it have our own position in that world and our own understandings and experiences we bring with us when we seek to explore it. And yet even though our reports may be subjective, we can do what we can to make them honest and intelligible to everyone else. Learning how to do that is learning how to be a qualitative researcher rather than simply an amateur observer. Helping you understand that and getting you ready for doing so have been the goal of this book.

According to Lareau ( 2021:36 ), excellent qualitative work must include all the following elements: a clear contribution to new knowledge, a succinct assessment of previous literature that shows the holes in the literature, a research question that can be answered with the data in hand, a breadth and depth in the data collection, a clear exposition of the results, a deep analysis that links the evidence to the interpretation, an acknowledgment of disconfirming evidence, a discussion that uses the case as a springboard to reflect on more general concerns, and a full discussion of implications for ideas and practices. The emphasis on rigor, the clear contribution to new knowledge, and the reflection on more general concerns place qualitative research within the “scientific” camp vis-à-vis the “humanistic inquiry” camp of pure description or ideographic approaches. The attention to previous literature and filling the holes in what we know about a phenomenon or case or situation set qualitative research apart from otherwise excellent journalism, which makes no pretensions of writing to or for a larger body of knowledge.

In the magnificently engaging untextbook Rocking Qualitative Social Science , Ashley Rubin ( 2021 ) notes, “Rigorous research does not have to be rigid” ( 3 ). I agree with her claim that there are many ways to get to the top of the mountain, and you can have fun doing so. An ardent rock climber, Rubin calls her approach the Dirtbagger approach, a way of climbing the mountain that is creative, flexible, and definitely outside proscribed methods. Here are eleven lessons offered by Rubin in paraphrase form with commentary and direct quotes noted:

• There is no right way to do qualitative social science, “and people should choose the approach that works for them, for the particular project at hand, given whatever constraints and opportunities are happening in their life at the time. ( 252 )”
• Disagreements about what is proper qualitative research are distracting and misleading.
• Even though research questions are very important, they can and most likely will change during data collection or even data analysis—don’t worry about this.
• Your findings will have a bigger impact if you’ve connected them to previous literature; this shows that you are part of the larger conversation. This “anchor” can be a policy issue or a theoretical debate in the literature, but it need not be either. Sometimes what we do is really novel (but rarely—so always poke around and check before proceeding as if you are inventing the wheel).
• Although there are some rules you really must follow when designing your study (e.g., how to obtain informed consent, defining a sample), unexpected things often happen in the course of data collection that make a mockery of your original plans. Be flexible.
• Sometimes you have chosen a topic for some reason you can’t yet articulate to yourself—the subject or site just calls to you in some way. That’s fine. But you will still need to justify your choice in some way (hint: see number 4 above).
• Pay close attention to your sample: “Think about what you are leaving out, what your data allow you to observe, and what you can do to fill in some of those blanks” (252).  And when you can’t fill them in, be honest about this when writing about the limitations of your study.
• Even if you are doing interviews, archival research, focus groups, or any other method of data collection that does not actually require “going into the field,” you can still approach your work as fieldwork. This means taking fieldnotes or memos about what you are observing and how you are reacting and processing those observations or interviews or interactions or documents. Remember that you yourself are the instrument of data collection, so keep a reflective eye on yourself throughout.
• Memo, memo, memo. There is no magic about how data become findings. It takes a lot of work, a lot of reflection, a lot of writing. Analytic memos are the helpful bridge between all that raw data and the presented findings.
• Rubin strongly rejects the idea that qualitative research cannot make causal claims. I would agree, but only to a point. We don’t make the kinds of predictive causal claims you see in quantitative research, and it can confuse you and lead you down some unpromising paths if you think you can. That said, qualitative research can help demonstrate the causal mechanisms by which something happens. Qualitative research is also helpful in exploring alternative explanations and counterfactuals. If you want to know more about qualitative research and causality, I encourage you to read chapter 10 of Rubin’s text.
• Some people are still skeptical about the value of qualitative research because they don’t understand the rigor required of it and confuse it with journalism or even fiction writing. You are just going to have to deal with this—maybe even people sitting on your committee are going to question your research. So be prepared to defend qualitative research by knowing the common misconceptions and criticisms and how to respond to them. We’ve talked a bit about these in chapter 20, and I also encourage you to read chapter 10 of Rubin’s text for more.

Hopefully, by the time you have reached the end of this book, you will have done a bit of your own qualitative research—maybe you’ve conducted an interview or practiced taking fieldnotes. You may have read some examples of excellent qualitative research and have (hopefully!) come to appreciate the value of this approach. This is a good time, then, to take a step back and think about the ways that qualitative research is valuable, distinct and different from both quantitative methods and humanistic (nonscientific) inquiry.

Researcher Note

Why do you employ qualitative research methods in your area of study?

Across all Western countries, we can observe a strong statistical relationship between young people’s educational attainment and their parent’s level of education. If you have at least one parent who went to university, your own chances of going to and graduating from university are much higher compared to not having university-educated parents. Why this happens is much less clear… This is where qualitative research becomes important: to help us get a clearer understanding of the dynamics that lead to this observed statistical relationship.

In my own research, I go a step further and look at young men and women who have crossed this barrier: they have become the first in their family to go to university. I am interested in finding out why and how first-in-family university students made it to university and how being at university is experienced. In-depth interviews allow me to learn about hopes, aspirations, fears, struggles, resilience and success. Interviews give participants an opportunity to tell their stories in their own words while also validating their experiences.

I often ask the young people I interview what being in my studies means to them. As one of my participants told me, it is good to know that “people like me are worth studying.” I cannot think of a better way to explain why qualitative research is important.

-Wolfgang Lehman, author of Education and Society: Canadian Perspectives

For me personally, the real value of the qualitative approach is that it helps me address the concerns I have about the social world—how people make sense of their lives, how they create strategies to deal with unfair circumstances or systems of oppression, and why they are motivated to act in some situations but not others. Surveys and other forms of large impersonal data collection simply do not allow me to get at these concerns. I appreciate other forms of research for other kinds of questions. This ecumenical approach has served me well in my own career as a sociologist—I’ve used surveys of students to help me describe classed pathways through college and into the workforce, supplemented by interviews and focus groups that help me explain and understand the patterns uncovered by quantitative methods ( Hurst 2019 ). My goal for this book has not been to convince you to become a qualitative researcher exclusively but rather to understand and appreciate its value under the right circumstances (e.g., with the right questions and concerns).

In the same way that we would not use a screwdriver to hammer a nail into the wall, we don’t want to misuse the tools we have at hand. Nor should we critique the screwdriver for its failure to do the hammer’s job. Qualitative research is not about generating predictions or demonstrating causality. We can never statistically generalize our findings from a small sample of people in a particular context to the world at large. But that doesn’t mean we can’t generate better understandings of how the world works, despite “small” samples. Excellent qualitative research does a great job describing (whether through “thick description” or illustrative quotes) a phenomenon, case, or setting and generates deeper insight into the social world through the development of new concepts or identification of patterns and relationships that were previously unknown to us. The two components—accurate description and theoretical insight—are generated together through the iterative process of data analysis, which itself is based on a solid foundation of data collection. And along the way, we can have some fun and meet some interesting people!

Supplement: Twenty Great (engaging, insightful) Books Based on Qualitative Research

Armstrong, Elizabeth A. and Laura T. Hamilton. 2015. Paying for the Party: How College Maintains Inequality . Cambridge: Harvard University Press.

Bourgois, Phillipe and Jeffrey Schonberg. 2009. Righteous Dopefiend . Berkeley, CA: University of California Press.

DiTomaso, Nancy. 2013. The American Non-dilemma: Racial Inequality without Racism . Thousand Oaks, CA; SAGE.

Ehrenreich, Barbara. 2010. Nickel and Dimed: On (Not) Getting By in America . New York: Metropolitan Books.

Fine, Gary Alan. 2018. Talking Art: The Culture of Practice and the Practice of Culture in MFA Education . Chicago: University of Chicago Press.

Ghodsee, Kristen Rogheh. 2011. Lost in Transition: Ethnographies of Everyday Life after Communism . Durham, NC: Duke University Press.

Gowan, Teresa. 2010. Hobos, Hustlers, and Backsliders: Homeless in San Francisco . Minneapolis: University of Minnesota Press.

Graeber, David. 2013. The Democracy Project: A History, a Crisis, a Movement . New York: Spiegel & Grau.

Grazian, David. 2015. American Zoo: A Sociological Safari . Princeton, NJ: Princeton University Press.

Hartigan, John. 1999. Racial Situations: Class Predicaments of Whiteness in Detroit . Princeton, N.J.: Princeton University Press.

Ho, Karen Zouwen. 2009. Liquidated: An Ethnography of Wall Street. Durham, NC: Duke University Press.

Hochschild, Arlie Russell. 2018. Strangers in Their Own Land: Anger and Mourning on the American Right . New York: New Press.

Lamont, Michèle. 1994. Money, Morals, and Manners: The Culture of the French and the American Upper-Middle Class . Chicago: University of Chicago Press.

Lareau, Annette. 2011. Unequal Childhoods: Class, Race, and Family Life. 2nd ed with an Update a Decade Later. Berkeley, CA: University of California Press.

Leondar-Wright, Betsy. 2014. Missing Class: Strengthening Social Movement Groups by Seeing Class Cultures . Ithaca, NY: ILR Press.

Macleod, Jay. 2008. Ain’t No Makin’ It: Aspirations and Attainment in a Low-Income Neighborhood . 3rd ed. New York: Routledge.

Newman, Katherine T. 2000. No Shame in My Game: The Working Poor in the Inner City . 3rd ed. New York: Vintage Press.

Sherman, Rachel. 2006. Class Acts: Service and Inequality in Luxury Hotels . Berkeley: University of California Press.

Streib, Jessi. 2015. The Power of the Past: Understanding Cross-Class Marriages . Oxford: Oxford University Press.

Stuber, Jenny M. 2011. Inside the College Gates: How Class and Culture Matter in Higher Education . Lanham, Md.: Lexington Books.

Introduction to Qualitative Research Methods Copyright © 2023 by Allison Hurst is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License , except where otherwise noted.

• Open access
• Published: 18 May 2024

Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration

• Michael J. Ward 1 , 2 , 3 , 4 ,
• Michael E. Matheny 1 , 4 , 5 , 6 ,
• Melissa D. Rubenstein 3 ,
• Kemberlee Bonnet 7 ,
• Chloe Dagostino 7 ,
• David G. Schlundt 7 ,
• Shilo Anders 4 , 8 ,
• Thomas Reese 4 &
• Amanda S. Mixon 1 , 9  

BMC Health Services Research volume  24 , Article number:  640 ( 2024 ) Cite this article

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Despite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration.

We conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process.

We conducted semi-structured interviews with 66 participants: clinicians ( N  = 25), stakeholders ( N  = 24), and Veterans ( N  = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal.

Conclusions

The diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.

Peer Review reports

Adverse drug events (ADEs) are the most common iatrogenic injury. [ 1 ] Efforts to reduce these events have primarily focused on the inpatient setting. However, the emergency department (ED), urgent care, and urgent primary care clinics are desirable targets for interventions to reduce ADEs because approximately 70% of all outpatient encounters occur in one of these settings. [ 2 ] Two of the most commonly prescribed drug classes during acute outpatient care visits that have frequent rates of potentially inappropriate prescribing include antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). [ 3 , 4 ]

An estimated 30% of all outpatient oral antibiotic prescriptions may be unnecessary. [ 5 , 6 ] The World Health Organization identified overuse of antibiotics and its resulting antimicrobial resistance as a global threat. [ 7 ] The Centers for Disease Control and Prevention (CDC) conservatively estimates that in the US there are nearly 3 million antibiotic-resistant infections that cause 48,000 deaths annually. [ 8 ] Antibiotics were the second most common source of adverse events with nearly one ADE resulting in an ED visit for every 100 prescriptions. [ 9 ] Inappropriate antibiotic prescriptions (e.g., antibiotic prescription for a viral infection) also contribute to resistance and iatrogenic infections such as C. difficile (antibiotic associated diarrhea) and Methicillin-resistant Staphylococcus aureus (MRSA) . [ 8 ] NSAID prescriptions, on the other hand, result in an ADE at more than twice the rate of antibiotics (2.2%), [ 10 ] are prescribed to patients at an already increased risk of potential ADEs, [ 4 , 11 ] and frequently interact with other medications. [ 12 ] Inappropriate NSAID prescriptions contribute to serious gastrointestinal, [ 13 ] renal, [ 14 ] and cardiovascular [ 15 , 16 ] ADEs such as gastrointestinal bleeding, acute kidney injury, and myocardial infarction or heart failure, respectively. Yet, the use of NSAIDs is ubiquitous; according to the CDC, between 2011 and 2014, 5% of the US population were prescribed an NSAID whereas an additional 2% take NSAIDs over the counter. [ 11 ]

Interventions to reduce inappropriate antibiotic prescribing commonly take the form of antimicrobial stewardship programs. However, no such national programs exist for NSAIDs, particularly in acute outpatient care settings. There is a substantial body of evidence supporting the evidence of such stewardship programs. [ 17 ] The CDC recognizes that such outpatient programs should consist of four core elements of antimicrobial stewardship, [ 18 ] including commitment, action for policy and practice, tracking and reporting, and education and expertise. However, the opportunities to extend antimicrobial stewardship in EDs are vast. Despite the effectiveness, there is a recognized need to understand which implementation strategies and how to implement multifaceted interventions. [ 19 ] Given the unique time-pressured environment of acute outpatient care settings, not all antimicrobial stewardship strategies work in these settings necessitating the development of approaches tailored to these environments. [ 19 , 20 ]

One particularly vulnerable population is within the Veterans Health Administration. With more than 9 million enrollees in the Veterans Health Administration, Veterans who receive care in Veteran Affairs (VA) hospitals and outpatient clinics may be particularly vulnerable to ADEs. Older Veterans have greater medical needs than younger patients, given their concomitant medical and mental health conditions as well as cognitive and social issues. Among Veterans seen in VA EDs and Urgent Care Clinics (UCCs), 50% are age 65 and older, [ 21 ] nearly three times the rate of non-VA emergency care settings (18%). [ 22 ] Inappropriate prescribing in ED and UCC settings is problematic with inappropriate antibiotic prescribing estimated to be higher than 40%. [ 23 ] In a sample of older Veterans discharged from VA ED and UCC settings, NSAIDs were found to be implicated in 77% of drug interactions. [ 24 ]

Learning from antimicrobial stewardship programs and applying to a broader base of prescribing in acute outpatient care settings, it is necessary to understand not only why potentially inappropriate prescribing remains a problem for antibiotics, but for medications (e.g., NSAIDs) which have received little stewardship focus previously. This understanding is essential to develop and implement interventions to reduce iatrogenic harm for vulnerable patients seen in unscheduled settings. In the setting of the Veterans Health Administration, we sought to use these two drug classes (antibiotics and NSAIDs) that have frequent rates of inappropriate prescribing in unscheduled outpatient care settings, to understand a diverse set of perspectives on why potentially inappropriate prescribing continues to occur.

Selection of participants

Participants were recruited from three groups in outpatient settings representing emergency care, urgent care, and urgent primary care in the VA: 1) Clinicians-VA clinicians such as physicians, advanced practice providers, and pharmacists 2) Stakeholders-VA and non-VA clinical operational and clinical content experts such as local and regional medical directors, national clinical, research, and administrative leadership in emergency care, primary care, and pharmacy including geriatrics; and 3) Veterans seeking unscheduled care for infectious or pain symptoms.

Clinicians and stakeholders were recruited using email, informational flyers, faculty/staff meetings, national conferences, and snowball sampling, when existing participants identify additional potential research subjects for recruitment. [ 25 ] Snowball sampling is useful for identifying and recruiting participants who may not be readily apparent to investigators and/or hard to reach. Clinician inclusion criteria consisted of: 1) at least 1 year of VA experience; and 2) ≥ 1 clinical shift in the last 30 days at any VA ED, urgent care, or primary care setting in which unscheduled visits occur. Veterans were recruited in-person at the VA by key study personnel. Inclusion criteria consisted of: 1) clinically stable as determined by the treating clinician; 2) 18 years or older; and 3) seeking care for infectious or pain symptoms in the local VA Tennessee Valley Healthcare System (TVHS). TVHS includes an ED at the Nashville campus with over 30,000 annual visits, urgent care clinic in Murfreesboro, TN with approximately 15,000 annual visits, and multiple primary care locations throughout the middle Tennessee region. This study was approved by the VA TVHS Institutional Review Board as minimal risk.

Data collection

Semi-structured interview guides (Supplemental Table 1) were developed using the Consolidated Framework for Implementation Research (CFIR) [ 26 ] and the Theory of Planned Behavior [ 27 , 28 ] to understand attitudes and beliefs as they relate to behaviors, and potential determinants of a future intervention. Interview guides were modified and finalized by conducting pilot interviews with three members of each participant group. Interview guides were tailored to each group of respondents and consisted of questions relating to: 1) determinants of potentially inappropriate prescribing; and 2) integration into practice (Table. 1 ). Clinicians were also asked about knowledge and awareness of evidence-based prescribing practices for antibiotics and NSAIDs. The interviewer asked follow-up questions to elicit clarity of responses and detail.

Each interview was conducted by a trained interviewer (MDR). Veteran interviews were conducted in-person while Veterans waited for clinical care so as not to disrupt clinical operations. Interviews with clinicians and stakeholders were scheduled virtually. All interviews (including in-person) were recorded and transcribed in a manner compliant with VA information security policies using Microsoft Teams (Redmond, WA). The audio-recorded interviews were transcribed and de-identified by a transcriptionist and stored securely behind the VA firewall using Microsoft Teams. Study personnel maintained a recording log on a password-protected server and each participant was assigned a unique participant ID number. Once 15 interviews were conducted per group, we planned to review interviews with the study team to discuss content, findings, and to decide collectively when thematic saturation was achieved, the point at which no new information was obtained. [ 29 ] If not achieved, we planned to conduct at least 2 additional interviews prior to group review for saturation. We estimated that approximately 20–25 interviews per group were needed to achieve thematic saturation.

Qualitative data coding and analysis was managed by the Vanderbilt University Qualitative Research Core. A hierarchical coding system (Supplemental Table 2) was developed and refined using an iterative inductive/deductive approach [ 30 , 31 , 32 ] guided by a combination of: 1) Consolidated Framework for Implementation Research (CFIR) [ 26 ]; 2) the Theory of Planned Behavior [ 27 , 28 ]; 3) interview guide questions; and 4) a preliminary review of the transcripts. Eighteen major categories (Supplemental Table 3) were identified and were further divided into subcategories, with some subcategories having additional levels of hierarchical division. Definitions and rules were written for the use of each of the coding categories. The process was iterative in that the coding system was both theoretically informed and derived from the qualitative data. The coding system was finalized after it was piloted by the coders. Data coding and analysis met the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. [ 33 ]

Four experienced qualitative coders were trained by independently coding two transcripts from each of the three participant categories. Coding was then compared, and any discrepancies resolved by reconciliation. After establishing reliability in using the coding system, the coders divided and independently coded the remaining transcripts in sequential order. Each statement was treated as a separate quote and could be assigned up to 21 different codes. Coded transcripts were combined and sorted by code.

Following thematic saturation, the frequency of each code was calculated to understand the distribution of quotes. Quotes were then cross-referenced with coding as a barrier to understand potential determinants of inappropriate prescribing. A thematic analysis of the barriers was conducted and presented in an iterative process with the research team of qualitative methodologists and clinicians to understand the nuances and refine the themes and subthemes from the coded transcripts. Transcripts, quotations, and codes were managed using Microsoft Excel and SPSS version 28.0.

We approached 132 individuals and 66 (50%) agreed to be interviewed. Participants included 25 clinicians, 24 stakeholders, and 17 Veterans whose demographic characteristics are presented in Table 2 . The clinicians were from 14 VA facilities throughout the US and 20 physicians, and five advanced practice providers. Of the clinicians, 21 (84%) worked in either an ED or urgent care while the remainder practiced in primary care. The 24 stakeholders included 13 (54%) clinical service chiefs or deputy chief (including medical directors), five (21%) national directors, and six (25%) experts in clinical content and methodology. The 17 Veterans interviewed included 15 (88%) who were seen for pain complaints.

Results are organized by the six thematic categories with several subthemes in each category. Themes and subthemes are presented in Table 3  and are visually represented in Fig.  1 . The six themes were: 1) perceived versus actual Veterans expectations about prescribing, 2) the influence of a time-pressured clinical environment on prescribing stewardship, 3) limited clinician knowledge, awareness, and willingness to use evidence-based care, 4) uncertainties about the Veteran condition at the time of the clinical encounter, 5) limited communication, and 6) technology barriers.

Visual representation of themes and subthemes from 66 clinician, stakeholder, and Veteran interviews

Theme 1: Perception that Veterans routinely expect a medication from their visit, despite clinical inappropriateness

According to clinicians, Veterans frequently expect to receive a prescription even when this decision conflicts with good clinical practice.

Certainly lots of people would say you know if you feel like you’re up against some strong expectations from the patients or caregivers or families around the utility of an antibiotic when it’s probably not indicated…In the emergency department the bias is to act and assume the worst and assume like the worst for the clinical trajectory for the patient rather than the reverse. [Clinician 49, Physician, ED]

In addition, stakeholders further stated that patient prescription expectations are quite influential and are likely shaped by Veterans’ prior experiences.

I think the patients, particularly for antibiotics, have strong feelings about whether they should or shouldn’t get something prescribed. [Stakeholder 34] You know I think the biggest challenge, I think, is adjusting patients’ expectations because you know they got better the last time they were doing an antibiotic. [Stakeholder 64]

Patient satisfaction and clinician workload may also influence the clinician’s prescription decision.

We have a lot of patients that come in with back pain or knee pain or something. We’ll get an x-ray and see there’s nothing actually wrong physically that can be identified on x-ray at least and you have to do something. Otherwise, patient satisfaction will dip, and patients leave angry. [Clinician 28, Physician, urgent care clinic] For some clinicians it’s just easier to prescribe an antibiotic when they know that’s the patient’s expectation and it shortens their in-room discussion and evaluation. [Clinician 55, Physician, ED]

Despite clinician perception, Veterans communicated that they did not necessarily expect a prescription and were instead focused on the clinical interaction and the clinician’s decision.

I’m not sure if they’ll give me [unintelligible] a prescription or what they’ll do. I don’t care as long as they stop the pain. [Patient 40, urgent care clinic] I don’t expect to [receive a prescription], but I mean whatever the doctor finds is wrong with me I will follow what he says. [Patient 31, ED]

Theme 2: Hectic clinical environments and unique practice conditions in unscheduled settings provide little time to focus on prescribing practices

Clinicians and stakeholders reported that the time-constrained clinical environment and need to move onto the next patient were major challenges to prescribing stewardship.

The number one reason is to get a patient out of your office or exam bay and move on to the next one. [Stakeholder 28] It takes a lot of time and you have to be very patient and understanding. So, you end up having to put a fair bit of emotional investment and intelligence into an encounter to not prescribe. [Stakeholder 1]

Stakeholders also noted that unique shift conditions and clinician perceptions that their patients were “different” might influence prescribing practices.

A common pushback was ‘well my patients are different.’ [Stakeholder 4] Providers who worked different types of shifts, so if you happened to work on a Monday when the clinics were open and had more adults from the clinics you were more likely to prescribe antibiotics than if you worked over night and had fewer patients. Providers who worked primarily holidays or your Friday prescribing pattern may be very different if you could get them into a primary care provider the next day. [Stakeholder 22]

Clinicians also reported that historical practices in the clinical environment practices may also contribute to inappropriate prescribing.

I came from working in the [outpatient] Clinic as a new grad and they’re very strict about prescribing only according to evidence-based practice. And then when I came here things are with other colleagues are a little more loose with that type of thing. It can be difficult because you start to adopt that practice to. [Clinician 61, Nurse Practitioner, ED]

Theme 3: Clinician knowledge, awareness, and willingness to use evidence-based care

Stakeholders felt that clinicians had a lack of knowledge about prescribing of NSAIDs and antibiotics.

Sometimes errors are a lack of knowledge or awareness of the need to maybe specifically dose for let’s say impaired kidney function or awareness of current up to date current antibiotic resistance patterns in the location that might inform a more tailored antibiotic choice for a given condition. [Stakeholder 37] NSAIDs are very commonly used in the emergency department for patients of all ages…the ED clinician is simply not being aware that for specific populations this is not recommended and again just doing routine practice for patients of all ages and not realizing that for older patients you actually probably should not be using NSAIDs. [Stakeholder 40]

Some clinicians may be unwilling to change their prescribing practices due to outright resistance, entrenched habits, or lack of interest in doing so.

It sounds silly but there’s always some opposition to people being mandated to do something. But there are some people who would look and go ‘okay we already have a handle on that so why do we need something else? I know who prescribes inappropriately and who doesn’t. Is this a requirement, am I evaluated on it? That would come from supervisors. Is this one more thing on my annual review?’ [Stakeholder 28] If people have entrenched habits that are difficult to change and are physicians are very individualistic people who think that they are right more often than the non-physician because of their expensive training and perception of professionalism. [Stakeholder 4]

Theme 4: Uncertainty about whether an adverse event will occur

Clinicians cited the challenge of understanding the entirety of a Veteran’s condition, potential drug-drug interactions, and existing comorbidities in knowing whether an NSAID prescription may result in an adverse event.

It’s oftentimes a judgement call if someone has renal function that’s right at the precipice of being too poor to merit getting NSAIDs that may potentially cause issues. [Clinician 43, Physician, inpatient and urgent care] It depends on what the harm is. So, for instance, you can’t always predict allergic reactions. Harm from the non-steroidals would be more if you didn’t pre-identify risk factors for harm. So, they have ulcer disease, they have kidney problems where a non-steroidal would not be appropriate for that patient. Or potential for a drug-drug interaction between that non-steroid and another medication in particular. [Clinician 16, Physician, ED]

Rather than be concerned about the adverse events resulting from the medication itself, stakeholders identified the uncertainty that clinicians experience about whether a Veteran may experience an adverse event from an infection if nothing is done. This uncertainty contributes to the prescription of an antibiotic.

My experience in working with providers at the VA over the years is that they worry more about the consequences of not treating an infection than about the consequences of the antibiotic itself. [Stakeholder 19] Sometimes folks like to practice conservatively and they’ll say even though I didn’t really see any hard evidence of a bacterial infection, the patient’s older and sicker and they didn’t want to risk it. [Stakeholder 16]

Theme 5: Limited communication during and after the clinical encounter

The role and type of communication about prescribing depended upon the respondent. Clinicians identified inadequate communication and coordination with the Veteran’s primary care physician during the clinical encounter.

I would like to have a little more communication with the primary doctors. They don’t seem to be super interested in talking to anyone in the emergency room about their patients… A lot of times you don’t get an answer from the primary doctor or you get I’m busy in clinic. You can just pick something or just do what you think is right. [Clinician 25, Physician, ED]

Alternatively, stakeholders identified post-encounter patient outcome and clinical performance feedback as potential barriers.

Physicians tend to think that they are doing their best for every individual patient and without getting patient by patient feedback there is a strong cognitive bias to think well there must have been some exception and reason that I did it in this setting. [Stakeholder 34] It’s really more their own awareness of like their clinical performance and how they’re doing. [Stakeholder 40]

Veterans, however, prioritized communication during the clinical encounter. They expressed the need for clear and informative communication with the clinician, and the need for the clinician to provide a rationale for the choice and medication-specific details along with a need to ask any questions.

I expect him to tell me why I’m taking it, what it should do, and probably the side effects. [Patient 25, ED] I’d like to have a better description of how to take it because I won’t remember all the time and sometimes what they put on the bottle is not quite as clear. [Patient 22, ED]

Veterans reported their desire for a simple way to learn about medication information. They provided feedback on the current approaches to educational materials about prescriptions.

Probably most pamphlets that people get they’re not going to pay attention to them. Websites can be overwhelming. [Patient 3, ED] Posters can be offsetting. If you’re sick, you’re not going to read them…if you’re sick you may glance at that poster and disregard it. So, you’re not really going to see it but if you give them something in the hand people will tend to look at it because it’s in their hand. [Patient 19, ED] It would be nice if labels or something just told me what I needed to know. You know take this exactly when and reminds me here’s why you’re taking it for and just real clear and not small letters. [Patient 7, ED]

Theme 6: Technology barriers limited the usefulness of clinical decision support for order checking and patient communication tools

Following the decision to prescribe a medication, clinicians complained that electronic health record pop-ups with clinical decision support warnings for potential safety concerns (e.g., drug-drug interactions) were both excessive and not useful in a busy clinical environment.

The more the pop ups, the more they get ignored. So, it’s finding that sweet spot right where you’re not constantly having to click out of something because you’re so busy. Particularly in our clinical setting where we have very limited amount of time to read the little monograph. Most of the time you click ‘no’ and off you go. (Clinician 16, Physician, ED) Some of these mechanisms like the EMR [electronic medical record] or pop-up decision-making windows really limit your time. If you know the guidelines appropriately and doing the right thing, even if you’re doing the right thing it takes you a long time to get through something. (Clinician 19, Physician, Primary care clinic)

For post-encounter communication that builds on Theme 5 about patient communication, patients reported finding using the VA patient portal (MyHealtheVet) challenging for post-event communication with their primary care physician and to review the medications they were prescribed.

I’ve got to get help to get onto MyHealtheVet but I would probably like to try and use that, but I haven’t been on it in quite some time. [Patient 22, ED] I tried it [MyHealtheVet] once and it’s just too complicated so I’m not going to deal with it. [Patient 37, Urgent care]

This work examined attitudes and perceptions of barriers to appropriate prescribing of antibiotics and NSAIDs in unscheduled outpatient care settings in the Veterans Health Administration. Expanding on prior qualitative work on antimicrobial stewardship programs, we also included an examination of NSAID prescribing, a medication class which has received little attention focused on prescribing stewardship. This work seeks to advance the understanding of fundamental problems underlying prescribing stewardship to facilitate interventions designed to improve not only the decision to prescribe antibiotics and NSAIDs, but enhances the safety checks once a decision to prescribe is made. Specifically, we identified six themes during these interviews: perceived versus actual Veteran expectations about prescribing, the influence of a time-pressured clinical environment on prescribing stewardship, limited clinician knowledge, awareness, and willingness to use evidence-based care, uncertainties about the Veteran condition at the time of the clinical encounter, limited communication, and technology barriers.

Sensitive to patient expectations, clinicians believed that Veterans would be dissatisfied if they did not receive an antibiotic prescription, [ 34 ] even though most patients presenting to the ED for upper respiratory tract infections do not expect antibiotics. [ 35 ] However, recent work by Staub et al. found that among patients with respiratory tract infections, receipt of an antibiotic was not independently associated with improved satisfaction. [ 36 ] Instead, they found that receipt of antibiotics had to match the patient’s expectations to affect patient satisfaction and recommended that clinicians communicate with their patients about prescribing expectations. This finding complements our results in the present study and the importance of communication about expectations is similarly important for NSAID prescribing as well.

A commitment to stewardship and modification of clinician behavior may be compromised by the time-pressured clinical environment, numerous potential drug interactions, comorbidities of a vulnerable Veteran population, and normative practices. The decision to prescribe medications such as antibiotics is a complex clinical decision and may be influenced by both clinical and non-clinical factors. [ 34 , 37 , 38 ] ED crowding, which occurs when the demand for services exceeds a system’s ability to provide care, [ 39 ] is a well-recognized manifestation of a chaotic clinical environment and is associated with detrimental effects on the hospital system and patient outcomes. [ 40 , 41 ] The likelihood that congestion and wait times will improve is unlikely as the COVID-19 pandemic has exacerbated the already existing crowding and boarding crisis in EDs. [ 42 , 43 ]

Another theme was the uncertainty in the anticipation of adverse events that was exacerbated by the lack of a feedback loop. Feedback on clinical care processes and patient outcomes is uncommonly provided in emergency care settings, [ 44 ] yet may provide an opportunity to change clinician behavior, particularly for antimicrobial stewardship. [ 45 ] However, the frequent use of ineffective feedback strategies [ 46 ] compromises the ability to implement effective feedback interventions; feedback must be specific [ 47 ] and address the Intention-to-Action gap [ 48 ] by including co-interventions to address recipient characteristics (i.e., beliefs and capabilities) and context to maximize impact. Without these, feedback may be ineffective.

An additional barrier identified from this work is the limited communication with primary care following discharge. A 2017 National Quality Forum report on ED care transitions [ 49 ] recommended that EDs and their supporting hospital systems should expand infrastructure and enhance health information technology to support care transitions as Veterans may not understand discharge instructions, may not receive post-ED or urgent care, [ 50 , 51 , 52 ] or may not receive a newly prescribed medication. [ 24 ] While there are existing mechanisms to communicate between the ED and primary care teams such as notifications when a Veteran presents to the ED and when an emergency clinician copies a primary care physician on a note, these mechanisms are insufficient to address care transition gaps and are variable in best practice use. To address this variability, the VA ED PACT Tool was developed using best practices (standardized processes, "closed-loop" communication, embedding into workflow) to facilitate and standardize communication between VA EDs and follow-up care clinicians. [ 53 ] While the ED PACT Tool is implemented at the Greater Los Angeles VA and can create a care coordination order upon ED discharge, its use is not yet widely adopted throughout the VA.

In the final theme about technology barriers, once the decision has been made to prescribe a medication, existing electronic tools that are key components of existing stewardship interventions designed to curtail potentially inappropriate prescriptions may be compromised by their lack of usability. For example, clinician and stakeholder interview respondents described how usability concerns were exacerbated in a time-pressured clinical environment (e.g., electronic health record clinical decision support tools). Clinical decision support is an effective tool to improve healthcare process measures in a diverse group of clinical environments; [ 54 ] however, usability remains a barrier when alerts must be frequently overridden. [ 55 , 56 ] Alert fatigue, as expressed in our interviews for order checking and recognized within the VA’s EHR, [ 57 , 58 ] may contribute to excessive overrides reducing the benefit of clinical decision support, [ 56 , 59 ] there was a notable lack of discussion about the decision to initiate appropriate prescriptions, which is a key action of the CDC’s outpatient antibiotic stewardship campaign. [ 18 ] Thus, a potentially more effective, albeit challenging approach, is to “nudge” clinicians towards appropriate prescribing and away from the initial decision to prescribe (e.g., inappropriate antibiotic prescribing for viral upper respiratory tract infections) with either default order sets for symptom management or to enhance prescription decisions through reminders about potential contraindications to specific indications (e.g., high risk comorbidities). Beyond EHR-based solutions that might change clinician behavior, the CDC’s outpatient antibiotic stewardship program provides a framework to change the normative practices around inappropriate prescribing and includes a commitment to appropriate prescribing, action for policy and change, tracking and reporting, and education and expertise. [ 18 ]

Another technical barrier faces patients through patient-facing electronic tools such as the VA’s MyHealtheVet portal, which was developed to enhance patient communication following care transitions and to allow Veterans to review their medications and to communicate with their primary care clinical team. Patient portals can be an effective tool for medication adherence [ 60 ] and offer promise to provide patient education [ 61 ] following a clinical encounter. However, they are similarly limited by usability concerns, representing an adoption barrier to broader Veteran use after unscheduled outpatient care visits [ 62 ], particularly in an older patient population.

These interviews further underscored that lack of usability of clinical decision support for order checking that arises from ineffective design and is a key barrier preventing health information technology from reaching its promise of improving patient safety. [ 63 ] A common and recognized reason for these design challenges include the failure to place the user (i.e., acute care clinician) at the center of the design process resulting in underutilization, workarounds, [ 64 ] and unintended consequences, [ 65 ] all of which diminish patient safety practices and fail to change clinician behavior (i.e., prescribing). Complex adaptive systems work best when the relative strengths of humans (e.g., context sensitivity, situation specificity) are properly integrated with the information processing power of computerized systems. [ 66 ] One potential approach to address usability concerns is through the integration of user-centered design into technology design represents an opportunity to design more clinician- and patient-centric systems of care to advance prescribing stewardship interventions that may have lacked broader adoption previously. As antimicrobial stewardship and additional prescribing stewardship efforts focus on time-pressured environments where usability is essential to adoption, taking a user-centered design approach to not only the development of electronic tools but also in addressing the identified barriers in prescribing represents a promising approach to enhance the quality of prescribing.

Limitations

The study findings should be considered in light of its limitations. First, the setting for this work was the Veterans Health Administration, the largest integrated health system in the US. Also, while we focused on the stewardship of two drug classes, there are numerous additional drug classes that are prescribed in these settings. Studies in other settings or on other drug classes may not generalize to other settings and drug classes. Second, while clinicians and stakeholder perspectives included diverse, national representation, the Veterans interviewed were local to the Tennessee Valley Healthcare System. Given the concurrent COVID-19 pandemic at the time of enrollment, most of the Veterans were seen for pain-related complaints, and only two infectious-related complaints were included. However, we also asked them about antibiotic prescribing. Clinician and stakeholder narratives may not completely reflect their practice patterns as their responses could be influenced by social desirability bias. Third, responses may be subject to recall bias and may influence the data collected. Finally, the themes and subthemes identified may overlap and have potential interactions. While we used an iterative process to identify discrete themes and subthemes, prescription decisions represent a complex decision process that are influenced by numerous patient and contextual factors and may not be completely independent.

Despite numerous interventions to improve the quality of prescribing, the appropriate prescription of antibiotics and NSAIDs in unscheduled outpatient care settings remains a challenge. Using the Veterans Health Administration, this study found that challenges to high quality prescribing include perceived Veteran expectations about receipt of medications, a hectic clinical environment deprioritizing stewardship, limited clinician knowledge, awareness, and willingness to use evidence-based care, uncertainty about the potential for adverse events, limited communication, and technology barriers. Findings from these interviews suggest that interventions should consider the detrimental impact of high workload on prescribing stewardship, clinician workflow, the initial decision to prescribe medications, and incorporate end-users into the intervention design process. Doing so is a promising approach to enhance adoption of high quality prescribing practices in order to improve the quality and patient outcomes from NSAID and antibiotic prescribing.

Availability of data and materials

De-identified datasets used and/or analysed during the current study will be made available from the corresponding author on reasonable request.

Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–384.

Article   CAS   PubMed   Google Scholar  

Pitts SR, Carrier ER, Rich EC, Kellermann AL. Where Americans get acute care: increasingly, it’s not at their doctor’s office. Health Aff (Millwood). 2010;29(9):1620–9.

Article   PubMed   Google Scholar  

Palms DL, Hicks LA, Bartoces M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. Jama Intern Med. 2018;178(9):1267–9.

Article   PubMed   PubMed Central   Google Scholar  

Davis JS, Lee HY, Kim J, et al. Use of non-steroidal anti-inflammatory drugs in US adults: changes over time and by demographic. Open Heart. 2017;4(1):e000550.

Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315(17):1864–73.

Shively NR, Buehrle DJ, Clancy CJ, Decker BK. Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System. Antimicrob Agents Chemother. 2018;62(8):e00337–18. https://doi.org/10.1128/AAC.00337-18 .  https://pubmed.ncbi.nlm.nih.gov/29967028/ .

World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report: 2022. 2022.

Centers for Disease Control and Prevention. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta: U.S. Department of Health and Human Services, CDC; 2022.

Google Scholar  

Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US emergency department visits for outpatient adverse drug events, 2013–2014. JAMA. 2016;316(20):2115–25.

Fassio V, Aspinall SL, Zhao X, et al. Trends in opioid and nonsteroidal anti-inflammatory use and adverse events. Am J Manag Care. 2018;24(3):e61–72.

PubMed   Google Scholar  

Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. http://www.cdc.gov/ckd . Accessed 21 March 2023.

Cahir C, Fahey T, Teeling M, Teljeur C, Feely J, Bennett K. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol. 2010;69(5):543–52.

Gabriel SE, Jaakkimainen L, Bombardier C. Risk for Serious Gastrointestinal Complications Related to Use of Nonsteroidal Antiinflammatory Drugs - a Metaanalysis. Ann Intern Med. 1991;115(10):787–96.

Zhang X, Donnan PT, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. 2017;18(1):256.

McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011;8(9): e1001098.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Holt A, Strange JE, Nouhravesh N, et al. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2023;81(15):1459–70.

Davey P, Marwick CA, Scott CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2(2):CD003543.

Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep. 2016;65(6):1–12.

May L, Martin Quiros A, Ten Oever J, Hoogerwerf J, Schoffelen T, Schouten J. Antimicrobial stewardship in the emergency department: characteristics and evidence for effectiveness of interventions. Clin Microbiol Infect. 2021;27(2):204–9.

May L, Cosgrove S, L'Archeveque M, et al. A call to action for antimicrobial stewardship in the emergency department: approaches and strategies. Ann Emerg Med. 2013;62(1):69–77 e62.

Veterans Health Administration Emergency Medicine Management Tool. EDIS GeriatricsAgeReport v3.

Cairns C KK, Santo L. National Hospital Ambulatory Medical Care Survey: 2020 emergency department summary tables. NHAMCS Factsheets - EDs Web site. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2020-nhamcs-ed-web-tables-508.pdf . Accessed 20 Dec 2022.

Lowery JL, Alexander B, Nair R, Heintz BH, Livorsi DJ. Evaluation of antibiotic prescribing in emergency departments and urgent care centers across the Veterans’ Health Administration. Infect Control Hosp Epidemiol. 2021;42(6):694–701.

Hastings SN, Sloane RJ, Goldberg KC, Oddone EZ, Schmader KE. The quality of pharmacotherapy in older veterans discharged from the emergency department or urgent care clinic. J Am Geriatr Soc. 2007;55(9):1339–48.

Goodman LA. Snowball sampling. The annals of mathematical statistics. 1961. pp. 148–170.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211.

Article   Google Scholar  

Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011;26(9):1113–27.  https://doi.org/10.1080/08870446.2011.613995 .  https://www.tandfonline.com/doi/full/10.1080/08870446.2011.613995 .

Morse JM. The significance of saturation. Qual Health Res. 1995;5(2):147–9.

Azungah T. Qualitative research: deductive and inductive approaches to data analysis. Qual Res J. 2018;18(4):383–400.

Tjora A. Qualitative research as stepwise-deductive induction. Routledge; 2018.  https://www.routledge.com/Qualitative-Research-as-Stepwise-Deductive-Induction/Tjora/p/book/9781138304499 .

Fereday J, Muir-Cochrane E. Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80–92.

Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.

Patel A, Pfoh ER, Misra Hebert AD, et al. Attitudes of High Versus Low Antibiotic Prescribers in the Management of Upper Respiratory Tract Infections: a Mixed Methods Study. J Gen Intern Med. 2020;35(4):1182–8.

May L, Gudger G, Armstrong P, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol. 2014;35(9):1114–25.

Staub MB, Pellegrino R, Gettler E, et al. Association of antibiotics with veteran visit satisfaction and antibiotic expectations for upper respiratory tract infections. Antimicrob Steward Healthc Epidemiol. 2022;2(1): e100.

Schroeck JL, Ruh CA, Sellick JA Jr, Ott MC, Mattappallil A, Mergenhagen KA. Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother. 2015;59(7):3848–52.

Hruza HR, Velasquez T, Madaras-Kelly KJ, Fleming-Dutra KE, Samore MH, Butler JM. Evaluation of clinicians’ knowledge, attitudes, and planned behaviors related to an intervention to improve acute respiratory infection management. Infect Control Hosp Epidemiol. 2020;41(6):672–9.

American College of Emergency Physicians Policy Statement. Crowding. https://www.acep.org/globalassets/new-pdfs/policy-statements/crowding.pdf . Published 2019. Accessed 11 Oct 2023.

Bernstein SL, Aronsky D, Duseja R, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1–10.

Rasouli HR, Esfahani AA, Nobakht M, et al. Outcomes of crowding in emergency departments; a systematic review. Arch Acad Emerg Med. 2019;7(1):e52.

PubMed   PubMed Central   Google Scholar  

Janke AT, Melnick ER, Venkatesh AK. Monthly Rates of Patients Who Left Before Accessing Care in US Emergency Departments, 2017–2021. JAMA Netw Open. 2022;5(9): e2233708.

Janke AT, Melnick ER, Venkatesh AK. Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic. JAMA Netw Open. 2022;5(9): e2233964.

Lavoie CF, Plint AC, Clifford TJ, Gaboury I. “I never hear what happens, even if they die”: a survey of emergency physicians about outcome feedback. CJEM. 2009;11(6):523–8.

Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259. https://doi.org/10.1002/14651858.CD000259.pub3 .

Hysong SJ, SoRelle R, Hughes AM. Prevalence of Effective Audit-and-Feedback Practices in Primary Care Settings: A Qualitative Examination Within Veterans Health Administration. Hum Factors. 2022;64(1):99–108.

Presseau J, McCleary N, Lorencatto F, Patey AM, Grimshaw JM, Francis JJ. Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implement Sci. 2019;14(1):102.

Desveaux L, Ivers NM, Devotta K, Ramji N, Weyman K, Kiran T. Unpacking the intention to action gap: a qualitative study understanding how physicians engage with audit and feedback. Implement Sci. 2021;16(1):19.

National Quality Forum. Emergency Department Transitions of Care: A Quality Measurement Framework—Final Report: DHHS contract HHSM‐500–2012–000091, Task Order HHSM‐500‐T0025. Washington, DC: National Quality Forum; 2017.

Kyriacou DN, Handel D, Stein AC, Nelson RR. Brief report: factors affecting outpatient follow-up compliance of emergency department patients. J Gen Intern Med. 2005;20(10):938–42.

Vukmir RB, Kremen R, Ellis GL, DeHart DA, Plewa MC, Menegazzi J. Compliance with emergency department referral: the effect of computerized discharge instructions. Ann Emerg Med. 1993;22(5):819–23.

Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Ann Emerg Med. 2009;53(4):454–461 e415.

Cordasco KM, Saifu HN, Song HS, et al. The ED-PACT Tool Initiative: Communicating Veterans’ Care Needs After Emergency Department Visits. J Healthc Qual. 2020;42(3):157–65.

Bright TJ, Wong A, Dhurjati R, et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med. 2012;157(1):29–43.

Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163(21):2625–31.

van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138–47.

Shah T, Patel-Teague S, Kroupa L, Meyer AND, Singh H. Impact of a national QI programme on reducing electronic health record notifications to clinicians. BMJ Qual Saf. 2019;28(1):10–4.

Lin CP, Payne TH, Nichol WP, Hoey PJ, Anderson CL, Gennari JH. Evaluating clinical decision support systems: monitoring CPOE order check override rates in the Department of Veterans Affairs’ Computerized Patient Record System. J Am Med Inform Assoc. 2008;15(5):620–6.

Middleton B, Bloomrosen M, Dente MA, et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc. 2013;20(e1):e2-8.

Han HR, Gleason KT, Sun CA, et al. Using Patient Portals to Improve Patient Outcomes: Systematic Review. JMIR Hum Factors. 2019;6(4): e15038.

Johnson AM, Brimhall AS, Johnson ET, et al. A systematic review of the effectiveness of patient education through patient portals. JAMIA Open. 2023;6(1):ooac085.

Lazard AJ, Watkins I, Mackert MS, Xie B, Stephens KK, Shalev H. Design simplicity influences patient portal use: the role of aesthetic evaluations for technology acceptance. J Am Med Inform Assoc. 2016;23(e1):e157-161.

IOM. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, DC: NAP;2012.

Koppel R, Wetterneck T, Telles JL, Karsh BT. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc. 2008;15(4):408–23.

Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2007;14(4):415–23.

Hollnagel E, Woods D. Joint Cognitive Systems: Foundations of Cognitive Systems Engineering. Boca Raton: CRC Press; 2006.

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Acknowledgements

This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (I01HX003057). The content is solely the responsibility of the authors and does not necessarily represent the official views of the VA.

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Conceptualization: MJW, ASM, MEM, DS, SA. Methodology: MJW, ASM, MEM, DS, KB, SA, TR. Formal analysis: KB, DS, CD, MJW. Investigation: MJW, MDR, DS. Resources: MJW, MEM. Writing—Original Draft. Preparation: MJW, ASM, KB, MDR. Writing—Review & Editing: All investigators. Supervision: MJW, ASM, MEM. Funding acquisition: MJW, MEM.

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Ward, M.J., Matheny, M.E., Rubenstein, M.D. et al. Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration. BMC Health Serv Res 24 , 640 (2024). https://doi.org/10.1186/s12913-024-11082-0

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4]  Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I.     Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a.     US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b.     Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole . Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus. [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF.  Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c.     Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d.     Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e.     Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45]  Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II.     Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III.     A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders.  This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV.     Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

[1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk ; Kimmelman, J., Hyun, I., Benvenisty, N.  et al.  Policy: Global standards for stem-cell research.  Nature   533 , 311–313 (2016). https://doi.org/10.1038/533311a

[4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk

[5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources:

Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research.  The New England journal of medicine ,  351 (3), 207–209. https://doi.org/10.1056/NEJMp048145 ; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos . The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos ; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy , 38 (2/3), 264–284. http://www.jstor.org/stable/24439776 ; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells.  The New England journal of medicine ,  351 (3), 209–211. https://doi.org/10.1056/NEJMp048147 ; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality.  Bosnian journal of basic medical sciences ,  4 (1), 5–14. https://doi.org/10.17305/bjbms.2004.3453

[6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review.  Restorative neurology and neuroscience ,  28 (4), 589–603. https://doi.org/10.3233/RNN-2010-0543

[7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics . Oxford University Press.

[8] Sherley v. Sebelius , 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf

[9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109 th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text ; Bush, G. W. (2006, July 19). Message to the House of Representatives . National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html

[10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells . National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells

[11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells.  Social Research ,  73 (3), 819–834. http://www.jstor.org/stable/40971854

[12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics . 22. 10.1186/s12910-021-00678-4.

[13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics , 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight , 49 (4).

[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics , 22 (2), 112–122. https://doi.org/10.1111/dewb.12324

[15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324

[16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa.  Stem Cell Res Ther   4 , 54 (2013). https://doi.org/10.1186/scrt204 ; Pew Research Center. (2014, May 1). Public health a major priority in African nations . Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/

[17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024 . National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf

[18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80 , see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia . UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html

[20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries.  Middle East Fertil Soc J   24 , 8 (2020). https://doi.org/10.1186/s43043-019-0011-0 ; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics , 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247

[23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction.  Frontiers in pharmacology ,  13 , 1013740. https://doi.org/10.3389/fphar.2022.1013740

[25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech.

[26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine , 12 (6), 647–656. https://doi.org/10.2217/rme-2017-0035

[29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[30] Chen, H., Wei, T., Wang, H.  et al.  Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017.  BMC Public Health   22 , 434 (2022). https://doi.org/10.1186/s12889-022-12839-0

[31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan.  Curr Stem Cell Rep   1 , 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6

[32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production . NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production

[33] Park, S. (2012). South Korea steps up stem-cell work.  Nature . https://doi.org/10.1038/nature.2012.10565

[34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned.  Accountability in research ,  13 (1), 101–109. https://doi.org/10.1080/08989620600634193 .

[35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

[36] Association for the Advancement of Blood and Biotherapies.  https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia

[37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia.  BMC medical ethics ,  21 (1), 35. https://doi.org/10.1186/s12910-020-00482-6

[38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics , 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

[39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France.  Biotechnology Law Report ,  32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ...  Revista do Colegio Brasileiro de Cirurgioes ,  41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe   

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights.  Cultura (Iasi, Romania) ,  14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent?  Research Ethics ,  13 (1), 23-41.  https://doi.org/10.1177/1747016116650235

[52] The Qur'an  (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52.  https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation.  Journal of Religion and Health ,  30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law).  Journal of assisted reproduction and genetics ,  25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

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Epistemic Goals and Practices in Biology Curriculum—the Philippines and Japan

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• Denis Dyvee Errabo   ORCID: orcid.org/0000-0002-4084-5142 1 , 2 , 3 ,
• Keigo Fujinami 2   na1 &
• Tetsuo Isozaki 2   na1  

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Despite cultural differences, the Philippines–Japan partnership is developing an intentional teaching curriculum with parallel standards. However, disparities among their respective educational systems have prompted inequalities. As education plays a critical role in collaboration, we explored the Epistemic Goals (EGs) and Epistemic Practices (EPs) in the biology curriculum, with the research question: How do the epistemic goals and practices of the biology curriculum transmit knowledge and skills in the Philippines and Japan? Using an ethnographic design, we conducted two iterative explorations of EGs and EPs. First, we examined the curriculum policy to determine its EGs. Using the A-B-C-D protocol, we employed discourse analysis to evaluate knowledge and skills in the biology grade-level standards. Second, we examined the articulation of goals in classroom teaching practices. We conducted classroom immersion and observed classes to determine EPs and supported our observations through interviews, synthesizing the data using inductive content analysis. Our findings revealed that the Philippines’ EGs were to transmit factual knowledge enhanced by basic science skills, and their EPs were audio-visual materials, gamified instructions, guided inquiry, posing questions, and learning-by-doing. In comparison, Japan’s EGs were to provide a solid foundation of theoretical and metacognitive knowledge, integrated science skills, and positive attitudes. Its EPs involved cultivating lasting learning, observation, investigation, experimentation, collaborative discussion, and reflective thinking. Our study makes a meaningful contribution by shedding light on crucial ideologies and cultural identities embedded in Biology curricula and teaching traditions.

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Introduction

The cultural and educational connections within the Philippines-Japan collaboration establish the basis for developing long-lasting relationships between individuals. Despite cultural differences, both countries continue to develop an intentional teaching curriculum with parallel standards. According to Joseph ( 2010 ), the most effective way to demonstrate cultural ideology is through school curriculum. The term "curriculum" refers to different areas of education, such as the content taught in schools, learning methods, teacher approaches, and student progress assessment (Schiro, 2013 ). Understanding the basic components of an effective curriculum is critical to academic achievement.

Improving the Philippines’ curriculum is a significant and urgent matter given the considerable challenges they face in academic achievement. According to the Program for International Student Assessment (Organization for Economic Co-operation and Development, 2023 ), Filipino students exhibit relatively lower levels of achievement in critical academic domains such as science, mathematics, and reading (OECD, 2023 ). In contrast, the educational system in Japan is highly regarded for its exceptional quality and performance, consistently achieving top ranks among global academic systems. The 2022 PISA assessment shows that Japanese students consistently demonstrate superior performance compared with the average in their respective subject areas (OECD, 2023 ).

The disparities in outcomes and rankings between the education systems in Japan and the Philippines prompt an intriguing inquiry: what distinguishes Japanese education and how can we draw insights from its curricular practices to enhance the quality of education in the Philippines? This inquiry is of utmost importance as we aim to improve the educational outcomes and opportunities for Filipino students through an effective, quality curriculum. Moreover, it is essential to acknowledge the substantial research gap in curriculum studies regarding curricular benchmarks. This gap provides a valuable opportunity to gain insight into the unique educational system strategies.

Background of the Study

Examining the Epistemic Goals (EGs) and Epistemic Practices (EPs) of the biology curricula requires fundamental inquiries regarding the Nature of Science (NoS), the methodologies scientists employ in knowledge acquisition, and the scientific frameworks of understanding. Brock and Park ( 2022 ) argue that there has been a longstanding emphasis in science education on comprehending the NoS and the processes and undertakings of knowledge production. These essential elements are integrated as important learning goals in global science education curricula and policy documents (Leden & Hansson, 2019 ; Olson, 2018 ; Park et al., 2020 ).

EGs play a crucial role in establishing the fundamental and structural knowledge framework, including the required skills and attitudes. It encompasses the essential cognitive abilities that are pivotal for comprehension, academic engagement, and learning. It represents knowledge seeking, comprehension, and construction, particularly within the framework of the NoS (Chinn et al., 2011 ). Similarly, EGs enable individuals to explore their own beliefs about knowledge, as emphasized by Cho et al. ( 2011 ), with a significant influence on how individuals develop epistemic values and academic achievement. This includes improving advanced literacy skills, making informed decisions, and promoting a lifelong dedication to continuous learning.

Similarly, McDevitt et al. ( 1994 ) discuss how EPs involve various personal inquiry methods. The practices discussed by Hofer ( 2001 ) relate to the personal justification of knowledge acquisition. Personal justification of epistemic beliefs occurs through reliable processes when individual and social practices are considered within the epistemological framework (Chinn et al., 2011 ). According to Goldman ( 1999 ), considerable research has been dedicated to studying reliable belief formation processes, particularly concerning specific practices within scientific inquiry, arguing that practices, as opposed to errors and ignorance, have a relatively positive effect on knowledge. Furthermore, utilizing EPs include exploring external sources of information and engaging in active cognitive construction processes, as elucidated by Muis and Franco ( 2009 ). Hence, scientific inquiry is developed as a core emphasis to raise awareness, cultivate independent thinking skills, question assumptions, and make informed judgments.

Theoretical Framework

This study anchors its theoretical framework in the earlier work of Berland et al. ( 2016 ) on Epistemologies in Practice (EIP). Two epistemic folds define this framework.

First, the EIP defines epistemic goals for student knowledge acquisition, referring to the NoS as a means of understanding scientific development (Lederman, 2002 ). It entails an epistemological investigation of the fundamental features of reality such as the essence of truth, the process of justification, and the distinction between knowledge as a manifestation of capabilities and as a collection of factual information (Knight et al., 2014 ).

Moreover, defining goals is intimately connected to the epistemic dimensions; hence, this study examines how students use epistemic considerations when constructing scientific knowledge. This approach offers an analytical lens for understanding student involvement in scientific practices, which is vital to classroom and learning engagement. Berland et al. ( 2016 ) conducted a study identifying four noteworthy epistemic considerations: nature , generality , justification , and audience .

Nature  explores an extensive range of knowledge. Fundamental to this consideration is the nature of knowledge (knowledge is) and that of knowing (knowledge acquisition) (Lederman, 2007 ; Schiefer et al., 2022 ). Generality  delves into complex interconnections, forming an understanding using scientific concepts and facts. For instance, a phenomenon of interest can be comprehensively understood and explained within the scientific community by examining specific contexts and conditions utilizing scientific theories (Lewis & Belanger, 2015 ). Hence, this act of knowledge generation is crucial to thoroughly comprehending observed events and phenomena (Beeth & Hewson, 1999 ).

Next,  justification  underscores the necessity for logical reasoning to substantiate our conceptual comprehension. It is the systematic process that employs factual information and evidence, particularly that obtained from experiments, to substantiate assertions (Peffer & Ramezani, 2019 ). This practice links evidence with knowledge to assess essential claims and facilitates meaningful discussion (McNeill et al., 2006 ; Osborne et al., 2004 ). Finally, the  audience  dimension orients students' knowledge and the usefulness of their understanding (Berland et al., 2016 ). It is also relevant regarding how students perceive and derive meaning from the material, and how they develop a comprehensive understanding of it (Berland & Reiser, 2009 ; Paretti, 2009 ). The combined impact of these epistemic factors intricately shapes and defines the goals that guide the pursuit of epistemic knowledge.

Second, EIP includes essential practices in the classroom and learning community. In addition to acquiring discipline-specific knowledge, Peffer and Ramezani ( 2019 ) argue that demonstrating proficiency in scientific methodologies leads to developing a sophisticated epistemological understanding of concepts relevant to the NoS and scientific knowledge. Since the NoS is an essential element of inquiry in practice, epistemology and the NoS are inextricably linked (Deng et al., 2011 ). By exploring the NoS, we can gain insight into the fundamental elements that define scientific investigation, including its fundamental principles, underlying assumptions, and the methodologies of scientific pursuit.

According to Greene et al. ( 2016 ), NoS can be used interchangeably with concepts such as personal epistemology and epistemic cognition, which explore how individuals conceptualize knowledge. Personal epistemology reflects epistemological beliefs, reflective judgments, ways of knowing, and reflection (Hofer, 2001 ), whereas epistemic cognition is the examination of knowledge, particularly the evaluation of the essential components of justification and related concepts of objectivity, subjectivity, rationality, and truth (Moshman, 2014 ).

Furthermore, Lederman et al. ( 2002 ), referred NoS to the epistemology and sociology of science – understanding science as a way of knowing, and the values and beliefs inherent in scientific knowledge and its development. It encompasses various philosophical presuppositions, including values, development, conceptual inventions, consensus-building in the scientific community, and distinguishing scientific knowledge (Lederman, 1992 ; Smith & Wenk, 2006 ; Tsai, 2007 ). The close connection between an individual's cognitive framework and the philosophical foundations of the NoS becomes evident when we recognize that these concepts have a shared identity.

Research Question

In this study we analyzed the EGs and EPs in the Biology curriculum. Specifically, we address the question: How do the epistemic goals and practices of the Biology curriculum transmit knowledge and skills in the Philippines and Japan?

Research Design

We employed an ethnography design to examine the EGs and EPs of the biology curricula. Ethnography comprehensively explores the historical, cultural, and political aspects of knowledge evident in the educational traditions and practices of the countries under study (Hout, 2004 ). It involves systematically observing individuals, locations, concepts, written records, and behaviors (Savage, 2000 ) to document routine occurrences and identify opportunities for improvement (Dixon-Woods et al., 2019 ).

Research Strategies

We investigated two iterative cases of EGs and EPs. First, to determine the framework guiding the scope and implementation of EGs, we examined the Biology Grade Level Standards (BGLSs). In this context, EGs refer to the instructions’ specific statements and purposes that outline what students are expected to learn as they interact with the curriculum (Orr et al., 2022 ; Print, 1993 ).

According to Plowright ( 2011 ), the standards within a curriculum serve as its policies. A curriculum is inherently governed by the power and knowledge structures that stem from and circulate within sociocultural and political domains (Ball et al., 2012 ). As an artifact, it embodies culture, design, and learning (Hodder, 2000 ) and is associated with socio-material factors, discursive frameworks, policies, and performativity frameworks (Horan et al., 2014 ; Kalantzis & Cope, 2020 ; Maguire et al., 2011 ).

Second, we engaged in classroom immersion for observational (teaching) research (Sheal, 1989 ) to investigate the EPs. Teaching observation is an unbiased measure that allows us to gain a thorough, firsthand understanding of teaching practice (Desimone, 2009 ). Being physically present in the learning environment provides a unique opportunity to directly observe the teaching methods and strategies in real-time, including their application and usefulness (Granström et al., 2023 ). In addition to helping us identify opportunities for unique learning practices and ways to improve education (Sullivan et al., 2012 ), it provided a better understanding and appreciation of each country's cultural and pedagogical intricacies.

Data Collection and Gathering Procedures

This longitudinal study is part of an ongoing two-year community inquiry project. Our ongoing immersion began in the last quarter of 2022. The first iteration of the case focuses on the documented policies based on the BGLS. Policy materials were obtained from the websites of the Philippines Department of Education (DepEd) and the Ministry of Education, Culture, Sports, Science, and Technology (MEXT) ( 2006 ) in Japan. In the Philippines, science education goals are carefully designed with each grade level having its own standards that differentiate biology from other specialized areas of science, such as earth science, chemistry, and physics. The curriculum goals are divided into objectives customized for each grade level, thus ensuring a smooth and logical learning progression.

In contrast, science education in Japan follows a standardized set of overarching objectives that cover essential scientific concepts such as energy, particles (matter), life, and the earth. These objectives are outlined in the study course and provide a comprehensive framework that includes a range of knowledge, skills, and attitudes. The framework clearly outlines the overall objectives, making it possible to identify those specific to different scientific concepts.

The collected BGLSs were analyzed in the subsequent stages below.

Curriculum Matching and Mapping

Table 1 shows the curriculum matching results for both countries. DepEd and MEXT developed, implemented, and monitored the goals of the biology curriculum at the elementary (grades (G) 3–6), junior high (G7–G10), and lower secondary (G7–G9) levels. Employing Hale’s ( 2007 ) curriculum mapping protocol, to map EGs in the BGLS. Essential mapping was used to ascertain specific competencies, including detailed knowledge and abilities that students are expected to acquire.

Syntactic Analysis and Transformation

We expound upon these goals by examining their syntax. Syntax is a methodological analysis of the structure of sentences or statements (Foorman et al., 2016 ), including aspects such as word order, and structure. First, we investigated the verb-content-context and transformed it into Anderson and Krathwohl’s ( 2001 ) A-B-C-D protocol. As shown in Table  2 , a sample goal is divided into four distinct components.

Component A pertains to the intended audience , typically comprising students; component B relates to expected behavior or cognitive faculties component C pertains to the conditions necessary to demonstrate capabilities, and component D relates to the degree to which a behavior must be performed.

Classroom Immersion and Teaching Observation

We coordinated the immersion and teaching observation (IATO) with Philippine and Japanese school administrators. We were granted permission to conduct observations at three schools in Japan and two in the Philippines between January and December 2023. In August 2023, we conducted teaching observations in three classrooms in the Philippines. We further observed ten classrooms, which were predominantly held between November and December in Japan. Our observations encompass various aspects such as imparting subject knowledge, fostering skills, critical thinking abilities, and instilling specific values. Inside the classrooms, we were able to capture photographs and take detailed field notes, which allowed us to thoroughly document the interactions within each dynamic learning environment. By engaging in visual and observational documentation, we created a thorough record of the EPs. For ethical considerations, we deliberately chose not to incorporate any photographs of the students in this manuscript.

Interviews and Focus Group Discussions

After completing IATO, we conducted interviews with the educators to clarify the EPs. This dialogue dramatically improved our understanding of the factors influencing pedagogical decision-making by facilitating the exchange of ideas and perspectives. It also provided valuable context, enhancing our observations and enriching the quality of the observational data collected.

Data Analysis

Using discourse analysis (DA) and curriculum coding, we examined the explicit words that indicate EGs (knowledge and skills), which go beyond signs and signifiers by becoming “practices that methodically produce the objects of which they speak” (Foucault, 1972 , p. 49) at the expense of meaning formation (Khan & MacEachen, 2021 ).

We analyzed EGs based on the explicit BGLSs in the form of knowledge-using behavior and condition . Behavior referred to the knowledge dimension, and condition referred to content (scope of knowledge). To establish a connection between behavior and the cognitive domain, it is imperative to systematically categorize and classify individual cognitive verbs or processes based on their unique characteristics and underlying theoretical frameworks. This allows the development of personalized knowledge about cognitive tasks while contributing to a more organized understanding of cognitive functioning. Using Bloom’s Taxonomy of Objectives as revised by Anderson and Krathwohl ( 2001 ), we coded each behavior against the cognitive domains. Each cognitive domain uses active verbs arranged hierarchically. The first aspect is remembering , which facilitates quick recall (i.e., recognition). The second aspect is understanding , which allows one to make sense of knowledge/information (i.e., description). The third aspect is applying , which is a demonstration method/procedure (i.e., classification). The fourth aspect is analyzing , which enables breaking down the structure of one’s understanding into parts and pieces of information (i.e., differentiation). The fifth aspect is evaluating , which entails making use of one’s judgment based on parameters such as conditions (i.e., conclusion). Finally, the sixth aspect is creating , which involves putting together pieces of information to create cohesive and holistic knowledge (i.e., development).

Table 3 presents the coding of EGs using knowledge types. First, with the verb describe , we classified a wide range of behaviors from focus and recall to perception and processing to problem-solving and decision-making and compared and categorized the respective verbs based on characteristics derived from cognitive traits. In this context, the term be describes the understanding of information by employing the knowledge of principles. After determining behaviors using verbs, we further classified them into Anderson and Krathwohl’s ( 2001 ) types of knowledge (ToK). Each behavior is determined using the following: (1) familiarity with concepts, which necessitates acquiring factual knowledge (fk) , specifically knowledge of revealed facts; (2) conceptual knowledge (ck) encompassing the comprehension of ideas, associations, and operations; (3) procedural knowledge (pk), pertaining to the investigation methodology and knowledge acquisition within scientific inquiry; and (4) meta-cognitive knowledge (mck) , which denotes a more advanced level of comprehension pertaining to an individual’s understanding of cognition, self-awareness, and self-regulation. In Table 3 , remembering falls under fk , illustrating the knowledge of details/elements .

Similarly, we assessed EGs based on explicit standards in the form of practical skills (PSs) using condition and degree categories. Condition revealed the scope of knowledge and the degree of skill development. We examined the degree by selecting skills based on Gott and Duggan’s ( 1995 ) classification. These PSs were classified according to Finley ( 1983 ) Science skills . The first is Basic Science skills (BSs) , which cover fundamental scientific processes, including observation, classification, measurement, prediction, inference-making, and communication. Second, Integrated Science skills (ISs) are composites (two or more BSs) with fundamental scientific process competencies. Integrated science skills are uniformly identified as a control variable combined with interpreting, hypothesizing, and experimenting to form a cohesive approach.

Table 4 presents the coding of conditions and degrees. We underlined PSs (i.e., investigating) for ease of identification. Each skill is coded according to its degree of development. Finally, we classified the underlying skills as ISs .

Furthermore, we analyzed IATO data using inductive content analysis (ICA). ICA is a social inquiry method grounded in epistemology that depicts the reality of practice. For example, by examining learning delivery, one can identify replicable and valid strategies that can be used to draw inferences from the data (Krippendorff, 2019 ). We utilized Marying's ( 2000 ) ICA protocol to effectively organize, refine, and establish significant categories in teaching practice, ensuring that our observations and field notes were aligned.

Epistemic Goals and Practices – the Philippines

Table 5 presents the EGs and ToK in the Philippines context, utilizing behavior and condition . Regarding behavior , the data revealed a wide range of knowledge, primarily encompassing the domains of remembering and understanding. This trend indicates that the EGs emphasize acquiring crucial and foundational knowledge to develop fk , namely the specific details, elements, and principles of biology. Furthermore, this trend was consistently evident in G3, G4, G7, G8, and G9. However, we found variations in knowledge offerings for G5, G6, and G9. Higher order behavior incorporates mck in G5. This approach involves generating and cultivating strategic knowledge about health-promotion and hygienic practices. During G6, ck was presented to deliver life science principles, whereas during G9, more profound pk was presented. During G9, students were involved in the knowledge acquisition of scientific inquiry.

The condition suggests a progression of goals from elementary to junior high school. Fundamental principles of biology, such as the components and functions of living organisms, are systematically introduced in the early stages of education. For instance, as students progressed to higher grades, they were presented with more advanced concepts related to the organization and functioning of the human body.

Table 6 shows the degree-related goals and PSs in the Philippines. The data indicates that most elementary-level skills (G3–G6) involved classification, investigation, and communication. The acquisition of proficiency in classification and communication skills are imperative for developing a solid foundation for scientific literacy, commonly known as BSs . This investigation enabled a comprehensive scientific inquiry encompassing extensive processes. Investigative skills in G5 and advancements in classification improve the exploration and comprehension of biological phenomena, a combination of skills commonly referred to as ISs .

Additionally, we acknowledge the skills alignment with the proficiencies exhibited in junior high school. Where the use of condition and degree in the syntax did not effectively express practical skills, we resorted to observing behavior as an indicator of the skill dimension. Both the G7 and G8 levels of the curriculum employed the term recognize . In contrast, at the G9 level, the term familiar was used, implying the incorporation of students’ sensory abilities, such as sight or visual perception. These BSs enable students to cultivate their power of observation.

During our IATO, we identified recurring themes to indicate the EPs in the Philippines.

Audio-Visual Materials

We frequently noticed how adept educators were in using audio-visual materials (AVM) to leverage their instruction. Strategically integrating AVM materials led to more engaging and interactive multimedia content for students while stimulating their auditory and visual faculties. Interestingly, we found that the use of AVM also encourages inclusivity within the classroom. By supporting diverse learning preferences, AVM fostered wider understanding, retention, and promoted significant learning experiences.

Gamified Instruction

Several students actively participated in thrilling learning experiences. We observed a gamified strategy that effectively utilized game elements to optimize student engagement. Teachers incorporated gamified experiences, including quick recall sessions, critical thinking exercises, and formative assessments. The interactive nature of gamified experiences captured students’ attention, transforming ordinary learning activities into intellectually stimulating tasks. Therefore, sparked greater motivation, and consistent engagement.

Guided Inquiry

Students demonstrated scientific exploration consistent along with the structured guidance by their teachers. Curiosity prompted students to ask scientific questions and uncover practical solutions. This increased their interest and understanding to learning, while honing important abilities such as inquiry, critical thinking, and decision-making.

Posing Questions

We observed the art of posing thought-provoking questions. Posing questions tapped into students' inherent curiosity while stimulating their interest and motivation. Teachers often asked questions to probe student understanding and ask critical questions. Students learned self-regulation, critical inquiry, and advanced learning while providing relevant, accurate, and thorough knowledge through this guided process.

Learning-By-Doing

We witnessed a learning experience in which the students were active participants. They were engaged in dynamic discussions that provided them with first-hand encounters toward understanding. During this period, students actively engaged in observing phenomena and scientific processes. Through hands-on experiences, engaged learners assume responsibility for their own understanding. They skillfully implement acquired knowledge while effectively connecting theoretical ideas to real-life situations.

Epistemic Goals and Practices – Japan

Table 7 presents the EGs and ToK by incorporating behavior and condition . Japan has a standardized overall objective (goals) from elementary to lower secondary/junior high schools. The objective is to construct a layer: in elementary school science, each grade’s objectives fall under the subject’s overall objectives and that of lower secondary school science. Under the “objectives of science as a subject,” the first (energy and particles) and second (life and earth) fields have their own objectives, and each unit of the two fields has objectives based on the upper levels. This classification includes knowledge, abilities, and attitudes. We observed a comparable classification between the elementary and lower secondary levels. Within this categorization, there is remarkable uniformity in behavior, which illustrates the knowledge pattern. Students acquire knowledge, abilities, and attributes through higher cognitive learning, specifically in the form of creation. Each form of mck then contributes to the development of strategic knowledge, knowledge of cognitive tasks, and self-knowledge from G3–G9.

This condition entails a deeper understanding of living things, the structure of movement, the continuity of life, and the structure and function of the body. Various biology concepts facilitate scientific inquiry with the objective of advancing the understanding and acquisition of metacognitive knowledge. These objectives were designed to enhance proficiency in employing scientific methods, specifically in conducting scientific inquiry into natural objects, experiencing objects, and understanding phenomena. Furthermore, the process of developing student understanding is facilitated by their direct engagement with objects and phenomena, while honing their attitudes toward scientific inquiry.

Table 8 shows the degree-related EGs and PSs in Japan. The goals consist of knowledge, abilities, and attitude, and demonstrate the consistency of learning development across the elementary and lower secondary school levels. Irrespective of the concept being considered, skill development follows a standardized approach from G3 to G9. PSs are uniform across various learning domains, like all knowledge derived from active demonstration, including observations, experiments, and other scientific activities. Similarly, we noted that student abilities were centered around a repetitive mode of inquiry. The students employ and hone their skills to enhance their comprehension of biological principles. Furthermore, cultivating a positive attitude toward nature, life, and the environment requires consistent practice and refining one’s abilities. By employing observation, experimentation, and other practical work, students cultivate a positive disposition toward scientific inquiry and conducting scientific inquiries.

Our IATO in different schools, helped us determine recurring themes to indicate the EPs in Japan.

Cultivating Lasting Learning

Japanese teachers cultivate lasting learning. They began their lessons by writing the learning goals which are grounded on shared responsibility, to develop a sense of direction and purpose. They introduce real-world problems that allow students to connect their prior understanding. During active learning activities, the teachers gathered students’ observations and methodically arranged them on classroom boards. Such visual representations served as a valuable reference for ongoing discussions, reflection, and knowledge construction. It depicted patterns and variation that can elicit further scientific inquiries. Similarly, it promotes data-driven practice towards generating conclusions and generalizations. This approach bolstered students' capacity for analysis and cultivated a more profound comprehension of biology.

Observation, Investigation, and Experimentation

We observed learners utilizing their senses to examine organisms. They engaged in direct interactions under meticulously replicated conditions in the classroom or laboratory. They participated in a wide range of scientific activities and performed experiments. They diligently adhered to scientific methodologies and precisely recorded their discoveries to enhance understanding of diverse scientific phenomena and processes through practical activities.

Collaborative Discussion

All classes were encouraged to participate in micro-discussions. This allowed the students to ask questions, seek clarification, and enhance their understanding in a smaller and supportive environment. It was crucial for students with advanced understanding to take the lead and facilitate the discussion. Collaborative discussions were instrumental to learning from peers and affirming understanding, while expressing their thoughts and beliefs leading to collective empowerment and collaborative learning.

Reflective Thinking

The classes were adept in reflective thinking. This method encouraged students to carefully review what they had learned and evaluate if their present experiences met the learning objectives. Teachers designed purposeful queries to prompt reflection. While the students were provided ample time to ponder and participate in creating a tranquil environment for introspection.

Epistemic Goals – the Philippines and Japan

In the Philippines, EGs focus on transmitting fk . Both fk and ck are crucial for cognitive proficiency advancement (Schraw, 2006 ) and for helping students perform better in school (Idrus et al., 2022 ). Having a solid foundation of fk is essential for comprehending biological concepts. Thus, these goals aid in the development of critical thinking skills and enhancing students’ self-confidence. Moreover, this knowledge helps individuals navigate their surroundings, make informed choices, and contribute to a knowledgeable and enlightened society. Fk leverages ck , in contrast to the mere acquisition of information; fostering critical thinking skills and facilitating the transfer of learning, adaptability, and effective problem-solving.

The Philippines’ EGs mainly involve transmitting scientific skills essential for establishing scientific literacy and active participation in scientific investigations. Individuals with such skills can confidently observe, communicate, measure, hypothesize, analyze data, solve issues, and navigate the life sciences. Improving and refining these skills increases scientific comprehension and builds crucial life skills such as critical thinking, problem-solving, and communication.

In contrast, EGs in Japan center on transmitting mck , which is critical for cognitive development and learning. This knowledge can govern and regulate all aspects of knowledge or processes and can be applied to any cognitive pursuit, including learning (Flavell, 1979 ). This enables individuals to control their learning, adjust their strategies, participate in metacognitive processes, and apply their knowledge to new situations.

Japan’s EGs transmit highly integrated skills that provide a comprehensive and interdisciplinary approach to scientific inquiry. Such skills foster a holistic comprehension of broader issues and the cultivation of analytical and reasoning abilities, ideation, and advanced learning. Padilla ( 1990 ) posits that acquiring expertise is imperative for the development, experimentation, and execution of scientific research. Acquiring integrated scientific processing skills enables individuals to proficiently address complex challenges, contribute meaningfully to scientific advancement, and have a considerable impact on their understanding of biology.

Epistemic Practices – the Philippines and Japan

Epistemic practices in the Philippines capitalize on timely and relevant learner-centered pedagogy. The strategic integration of AVM resulted in an engaging and interactive classroom. AVM are designed to cater to diverse learning styles and stimulate learners’ auditory and visual faculties. AVM or multimedia inside the classroom consists of more than one medium aided by technology (Kapi et al., 2017 ; Abdulrahaman et al., 2020 ) and is used to improve understanding (Guan et al., 2018 ). Shaojie et al. ( 2022 ) found that AVM input can enrich learners' understanding of the content and motivate them to actively participate in listening comprehension activities by providing more authentic language input that is richer in multimodal cultural and situational contexts. Moreover, AVM promotes inclusivity by accommodating diverse learning preferences and enhancing comprehension and retention. This drives students’ eagerness to learn, while simplifying and adding excitement to the learning process (Rasul et al., 2011 ). AVM found to enhance student motivation and engagement (Dichev & Dicheva, 2017 ), as well as improve positive learning outcomes (Zainuddin, 2023 ), thus positively impacting student focus and concentration. Integrating gamified elements proved effective in capturing students' attention and foster a higher level of engagement.

It was also evident that the students exhibited a proactive and experiential approach toward scientific exploration. According to Kong ( 2021 ), this educational phenomenon promotes engagement and eventually leads to classroom success. The students demonstrated genuine and inherent curiosity and displayed a sincere interest in biology. Wang et al. ( 2022 ) argue that inquiries and epistemological beliefs form the foundation of scientific literacy. The teachers' adept organization and support effectively nurtured this curiosity. Students’ inherent inquisitiveness, under the guidance of the teacher's intentional mentorship, fostered an atmosphere conducive to purposeful inquiry and thus a heightened comprehension of biology. Based on Lin et al. ( 2011 ) and Jack et al. ( 2014 ), advancing toward scientific understanding and the application of scientific knowledge promotes interest in learning science.

Finally, educators' ability to pose thought-provoking questions has become important in the classroom. Each teacher's inquiries shaped classroom dynamics and fostered students' curiosity, critical thinking, and academic growth (Salmon & Barrera, 2021 ). Hilsdon ( 2010 ) states that insightful inquiries can lead to critical thinking by efficiently probing comprehension. Students actively participate in dynamic discussions and take responsibility for their learning.

Conversely, EPs in Japan use advanced methods to create a highly engaged and learning environment, outperforming traditional education. Teacher techniques included collaborative conversations, reflective thinking, and strategic use of thought-provoking questions throughout our classroom visits. This fostered active participation that encouraged students to critically engage and reflect on their learning. Higher-order thinking skills are essential for conceptual and disciplinary understanding (Heron & Palfreyman, 2023 ). These skills enable students to examine, synthesize, and evaluate information beyond fundamental knowledge.

Barlow et al. ( 2020 ) noted that in extensive research, empirical evidence is consistent, indicating that students who actively engage with learning materials and participate in the educational process demonstrate increased levels of engagement and achieve significantly greater learning outcomes. Similarly, Wang et al. ( 2022 ) argue that metacognitive skills help students learn and perform better. Furthermore, metacognition, or higher learning, also prepares learners for higher education (Stanton et al., 2021 ).

Reflective breaks were thoughtfully included in classroom immersion. Teachers set aside times for students to reflect. It reflects Japan's educational philosophy, which emphasizes learning, internalizing, and synthesizing knowledge to improve metacognition (Hanya et al., 2014 ). Kolb ( 1984 ) successfully linked reflection to experiential learning. The Japanese way of active learning transfer incorporates collaborative discussion and reflective dialogue. Dewey ( 1993 ) argues that reflective thinking examines beliefs, requiring careful examination of reporting, relating, reasoning, and reconstructing knowledge (Ryan, 2013 ).

We conducted ethnographic research examining two iterative cases of EGs and EPs of biology curriculum in the Philippines and Japan. We analyzed how these curricula effectively transmit valuable knowledge and skills. We found that the EGs in the Philippines were primarily grounded in disseminating factual knowledge with a specific emphasis on enhancing health and environmental awareness. Knowledge acquisition transitions from factual to conceptual as students progress to junior high school. EGs emphasize the utilization of basic science skills , particularly for exploring and comprehending various biological concepts. Alternatively, EPs prioritize learner-centered approaches that are both timely and relevant. These EPs include using AVM, gamified instruction, guided inquiry, thought-provoking questions, and hands-on learning experience.

However, EGs in Japan differed, focusing on a reliable means of imparting meta-cognitive knowledge . Students are equipped with problem-solving abilities and empowered to acquire integrated science skills to effectively engage in scientific inquiry. Implementing EPs fosters a sustainable learning environment and cultivates lasting learning, observation, investigation, experimentation, collaborative discussion, and reflective thinking.

Our findings shed light on the distinct and prioritized elements of biology standards and its EGs and EPs, making it a valuable addition to the current body of literature. Examining the realm of curriculum can improve comprehension, spark significant conversations, and enable informed decisions across cultures and borders. This research invites educators, policymakers, and stakeholders to embrace varied educational approaches to build a global community exploring knowledge and skills across national lines.

Limitations and Implications

The scope of this study is limited to a DA of the EGs and an ICA of the EPs. Our study provides insights into the development of policies and interventions that can address gaps in EGs and Eps. They can be used as a foundation for improving the biology curriculum in line with educational objectives and societal needs. Educators can also derive advantages from the findings of this study by engaging in professional development programs specifically designed to equip them with the essential skills and knowledge required to effectively implement learner-centric methodologies and integrate innovative teaching practices seamlessly. In addition, this study's cross-cultural benchmarks provide the potential for collaborative initiatives among educational institutions. Gaining insight into both commonalities and distinctions in EGs and EPs can foster cooperative endeavors aimed at improving global educational benchmarks.

Data Availability

The data have been made accessible in the results.

Abdulrahaman, M. D., Faruk, N., Oloyede, A. A., Surajudeen-Bakinde, N. T., Olawoyin, L. A., Mejabi, O. V., Imam Fulani, Y. O., Fahm, A. O., & Azeez, A. L. (2020). Multimedia tools in the teaching andlearningprocesses: A systematic review. Heliyon, 6 (11), e05312. https://doi.org/10.1016/j.heliyon.2020.e05312

Article   Google Scholar  

Anderson, L. W., & Krathwohl, D. R. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives . Longman.

Google Scholar  

Ball, S. J., Maguire, M., & Braun, A. (2012). How schools do policy: Policy enactment in secondary schools . Routledge.

Barlow, A., Brown, S., Lutz, B., et al. (2020). Development of the Student Course Cognitive Engagement Instrument (SCCEI) for college engineering courses. International Journal of STEM Education, 7 (1), 22. https://doi.org/10.1186/s40594-020-00220-9

Beeth, M. E., & Hewson, P. W. (1999). Learning goals in an exemplary science teacher’s practice: Cognitive and social factors in teaching for conceptual change. Science Education, 83 , 738–760.

Berland, L. K., & Reiser, B. J. (2009). Making sense of argumentation and explanation. Science Education, 93 (1), 26–55.

Berland, L. K., Schwarz, C. V., Krist, C., Kenyon, L., Lo, A. S., & Reiser, B. J. (2016). Epistemologies in practice: Making scientific practices meaningful for students. Journal of Research in Science Teaching, 53 (7), 1082–1112. https://doi.org/10.1002/tea.21257

Brock, R., & Park, W. (2022). Distinguishing Nature of Science Beliefs, Knowledge, and Understandings. Science & Education. Advance Online Publication. https://doi.org/10.1007/s11191-022-00368-6

Chinn, C. A., Buckland, L. A., & Samarapungavan, A. (2011). Expanding the dimensions of epistemic cognition: Arguments from philosophy and psychology. Educational Psychologist, 46 (3), 141–167. https://doi.org/10.1080/00461520.2011.587722

Cho, M. H., Lankford, D. M., & Wescott, D. J. (2011). Exploring the relationships among epistemological beliefs, nature of science, and conceptual change in the learning of evolutionary theory. Evolution: Education and Outreach , 4(3), 313–322. https://doi.org/10.1007/s12052-011-0324-7

Deng, F., Chen, D. T., Tsai, C. C., & Chai, C. S. (2011). Students’ views of the nature of science: A critical review of research. Science Education, 95 , 961–999.

Department of Education (DepEd) (n.d.). Executive report . https://www.deped.gov.ph/2022/06/02/deped-to-launch-basic-educationdevelopment-plan-2030-as-strategic-roadmap-for-basic-education/

Desimone, L. M. (2009). Improving impact studies of teachers’ professional development: Toward better conceptualizations and measures. Educational Researcher , 38 (3), 181–199. https://www.jstor.org/stable/20532527

Dewey, J. (1993). How we think: A restatement of the relation of reflective thinking to the educativeprocess . D. C. Heath.

Dichev, C., & Dicheva, D. (2017). Gamifying education: What is known, what is believed and what remains uncertain: A critical review. International Journal of Educational Technology in Higher Education, 14 , 9. https://doi.org/10.1186/s41239-017-0042-5

Dixon-Woods, M., Campbell, A., Aveling, E. L., & Martin, G. (2019). An ethnographic study of improving data collection and completeness in large-scale data exercises. Wellcome Open Research , 4 , 203. https://doi.org/10.12688/wellcomeopenres.14993.1

Finley, F. N. (1983). Science processes. Journal of Research in Science Teaching, 20 (1), 47–54. https://doi.org/10.1002/tea.3660200105

Flavell, J. H. (1979). Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry. American Psychologist, 34 (10), 906–911. https://doi.org/10.1037/0003-066X.34.10.906

Foorman, B., Beyler, N., Borradaile, K., Coyne, M., Denton, C. A., Dimino, J., Furgeson, J., Hayes, L., Henke, J., Justice, L., Keating, B., Lewis, W., Sattar, S., Streke, A., Wagner, R., & Wissel, S. (2016). Foundational skills to support reading for understanding in kindergarten through 3rd grade (NCEE 2016–4008). National Center for Education Evaluation and Regional Assistance (NCEE), Institute of Education Sciences, U.S. Department of Education.

Foucault, M. (1972). The archaeology of knowledge (A. M. S. Smith, Trans.). Pantheon Books.

Goldman, A. I. (1999). Knowledge in a social world . Oxford University Press.

Book   Google Scholar  

Gott, R., & Duggan, S. (1995). Investigative work in the science curriculum . Open University Press.

Granström, M., Kikas, E., & Eisenschmidt, E. (2023). Classroom observations: How do teachers teachlearning strategies? Frontiers in Education, 8 , 1119519. https://doi.org/10.3389/feduc.2023.1119519

Greene, J. A., Sandoval, W. A., & Bråten, I. (2016). Handbook of epistemic cognition . Routledge Ltd. https://doi.org/10.4324/9781315795225

Guan, N., Song, J., & Li, D. (2018). On the advantages of computer multimedia-aided English teaching. Procedia Computer Science, 131 , 727–732. https://doi.org/10.1016/j.procs.2018.04.126

Hale, J. A. (2007). Guide to curriculum mapping: Planning, implementing, and sustaining the process . Sage.

Hanya, M., Yonei, H., Kurono, S., & Kamei, H. (2014). Development of reflective thinking in pharmacy students to improve their communication with patients through a process of role-playing, videoreviews, and transcript creation. Currents in Pharmacy Teaching and Learning, 6 (1), 122–129.

Heron, M., & Palfreyman, D. M. (2023). Exploring higher-order thinking in higher education seminar talk. College Teaching, 71 (4), 252–259. https://doi.org/10.1080/87567555.2021.2018397

Hilsdon, J. (2010). Critical thinking . Learning development with Plymouth University. Retrieved from http://www.plymouth.ac.uk/learn

Hodder, I. (2000). The interpretation of documents and material culture. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2 nd ed., pp. 703–715). Sage.

Hofer, B. K. (2001). Personal epistemology research: Implications for learning and teaching. EducationalPsychology Review, 13 , 353–383.

Horan, C., Finch, J., & Reid, E. (2014). The performativity of objects: The sociomaterial role of imaginal others [Conference presentation]. European Group for Organisation Studies (EGOS) Conference, Rotterdam, Netherlands.

Hout, S. (2004). Ethnography: Understanding occupation through an examination of culture. In S. Naylor & M. Stanley (Eds.), Qualitative research methodologies for occupational science and therapy (pp. 84–101). Taylor & Francis.

Idrus, H., Rahim, S. S. A., & Zulnaidi, H. (2022). Conceptual knowledge in area measurement for primary school students: A systematic review. STEM Education, 2 (1), 47–58. https://doi.org/10.3934/steme.2022003

Jack, B. M., Lin, H.-S., & Yore, L. D. (2014). The synergistic effect of affective factors on student learning outcomes. Journal of Research in Science Teaching, 51 (8), 1084–1101. https://doi.org/10.1002/tea.21153

Joseph, P. B. (Ed.). (2010). Cultures of curriculum (2nd ed.). Routledge.

Kalantzis, M., & Cope, B. (2020). Learning by design glossary: Artefacts . http://newlearningonline.com/learning-by-design/glossary/artefact

Kapi, A. Y., Osman, N., Ramli, R. Z., & Taib, J. M. (2017). Multimedia education tools for effective teaching and learning. Journal of Telecommunication, Electronic and Computer Engineering, 9 (2–8), 143–146.

Khan, T. H., & MacEachen, E. (2021). Foucauldian discourse analysis: Moving beyond a social constructionist analytic. International Journal of Qualitative Methods , 20 . https://doi.org/10.1177/16094069211018009

Knight, S., Buckingham Shum, S., & Littleton, K. (2014). Epistemology, assessment, pedagogy: Where learning meets analytics in the middle space. Journal of Learning Analytics , 1 (2), 23–47. https://doi.org/10.18608/jla.2014.12.3 .

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development (Vol. 1). Prentice-Hall.

Kong, Y. (2021). The Role of Experiential Learning on Students’ Motivation and Classroom Engagement. Frontiers in Psychology, 12 , 771272. https://doi.org/10.3389/fpsyg.2021.771272

Krippendorff, K. (2019). Analytical constructs. In Content Analysis: An Introduction to Its Methodology (Fourth Edition ed., pp. 178–194). SAGE Publications, Inc., https://doi.org/10.4135/9781071878781

Leden, L., & Hansson, L. (2019). Nature of science progression in school year 1–9: A case study of teachers’ suggestions and rationales. Research in Science Education, 49 (2), 591–611. https://doi.org/10.1007/s11165-017-9628-0

Lederman, N. G. (1992). Students’ and teachers’ conceptions of the nature of science: A review of the research. Journal of Research in Science Teaching, 29 (4), 331–359.

Lederman, N. G. (2002). The state of science education: Subject matter without context. Electronic Journal of Science Education , 3 (2). Retrieved from http://unr.edu/homepage/jcannon/ejse/ejse.html

Lederman, N. G. (2007). Nature of science: Past, present, and future. In S. K. Abell & N. G. Lederman (Eds.), Handbook of research on science education (pp. 831–879). Lawrence Erlbaum Associates.

Lederman, N. G., Abd-El-Khalick, F., Bell, R. L., & Schwartz, R. S. (2002). Views of nature of science questionnaire: Toward valid and meaningful assessment of learners’ conceptions of nature of science. Journal of Research in Science Teaching, 39 (6), 497–521.

Lewis, C. T., & Belanger, C. (2015). The generality of scientific models: A measure theoretic approach. Synthese, 192 , 269–285. https://doi.org/10.1007/s11229-014-0567-2

Lin, H. S., Hong, Z. R., Chen, C. C., & Chou, C. H. (2011). The effect of integrating aesthetic understanding in reflective inquiry activities. International Journal of Science Education, 33 (9), 1199–1217. https://doi.org/10.1080/09500693.2010.504788

Maguire, M., Hoskins, K., & Ball, S. J. (2011). Policy discourses in school texts. Discourse: Studies in the Cultural Politics of Education, 32 (4), 597–609.

Mayring, P. (2000). Qualitative content analysis [28 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 1 (2), Article 20. http://nbn-resolving.de/urn:nbn:de:0114fqs0002204

McDevitt, T. M., Sheehan, E. P., Cooney, J. B., & Smith, H. V. (1994). Conceptions of listening, learning processes, and epistemologies held by American, Irish, and Australian university students. Learning & Individual Differences, 6 , 231–256.

McNeill, K. L., Lizotte, D. J., Krajcik, J., & Marx, R. W. (2006). Supporting students’ construction of scientific explanations by fading scaffolds in instructional materials. The Journal of the Learning Sciences, 15 (2), 153–191.

Ministry of Education, Culture, Sports, Science and Technology. (2006). Basic Act on Education . https://www.mext.go.jp/en/policy/education/lawandplan/title01/detail01/1373798.htm

Moshman, D. (2014). Epistemic domains of reasoning. In H. Markovits (Ed.), The developmental psychology of reasoning and decision-making (pp. 115–129). Psychology Press.

Muis, K. R., & Franco, G. M. (2009). Epistemic beliefs: Setting the standards for self-regulated learning. Contemporary Educational Psychology, 34 , 306–318.

Olson, J. K. (2018). The inclusion of the nature of science in nine recent international science education standards documents. Science & Education, 27 (7), 637–660.

Organization for Economic Co-operation and Development. (2023). PISA 2022 results (Volume I): The state of learning and equity in education . OECD Publishing. https://doi.org/10.1787/53f23881-en

Orr, R. B., Csikari, M. M., Freeman, S., & Rodriguez, M. C. (2022). Writing and using learning objectives. CBE Life Sciences Education , 21 (3), fe3. https://doi.org/10.1187/cbe.22-04-0073

Osborne, J. F., Erduran, S., & Simon, S. (2004). Enhancing the quality of argumentation in school science. Journal of Research in Science Teaching, 41 (10), 994–1020.

Padilla, M. J. (1990). The science process skills . National Association for Research in Science Teaching (NARST)

Paretti, M. (2009). When the teacher is the audience: Assignment design and assessment in the absence of “real” readers. In M. Weiser, B. Fehler, & A. Gonzalez (Eds.), Engaging audience: Writing in an age of new literacies. National Council of Teachers of English.

Park, W., Wu, J. Y., & Erduran, S. (2020). The nature of STEM disciplines in the science education standards documents from the USA, Korea, and Taiwan. Science & Education, 29 (4), 899–927.

Peffer, M. E., & Ramezani, N. (2019). Assessing epistemological beliefs of experts and novices via practices in authentic science inquiry. International Journal of STEM Education, 6 (1), 3. https://doi.org/10.1186/s40594-018-0157-9

Plowright, D. (2011). Using mixed methods: Frameworks for an integrated methodology . Sage.

Print, M. (1993). Curriculum development and design (2nd ed.). Routledge.

Rasul, S., Bukhsh, Q., & Batool, S. (2011). A study to analyze the effectiveness of audio visual aids in teaching learning process at Uvniversity level. Procedia Social and Behavioral Sciences, 28 , 78–81. https://doi.org/10.1016/j.sbspro.2011.11.016

Ryan, M. (2013). The pedagogical balancing act: Teaching reflection in higher education. Teaching in Higher Education, 18 (2), 144–151.

Salmon, A. K., & Barrera, M. X. (2021). Intentional questioning to promote thinking and learning. Thinking Skills and Creativity, 40 , 100822. https://doi.org/10.1016/j.tsc.2021.100822

Savage, J. (2000). Ethnography and health care. BMJ (Clinical Research Ed), 321 (7273), 1400–1402. https://doi.org/10.1136/bmj.321.7273.1400

Schiefer, J., Edelsbrunner, P. A., Bernholt, A., et al. (2022). Epistemic beliefs in science—a systematic integration of evidence from multiple studies. Educational Psychology Review, 34 (4), 1541–1575. https://doi.org/10.1007/s10648-022-09661-w

Schiro, M. (2013). Curriculum theory. Conflicting visions and enduring concerns (2nd ed.). Sage.

Schraw, G. (2006). Knowledge: Structures and processes. In P. A. Alexander & P. H. Winne (Eds.), Handbook of educational psychology (pp. 245–263). Lawrence Erlbaum.

Shaojie, T., Samad, A. A., & Ismail, L. (2022). Systematic literature review on audio-visual multimodal input in listening comprehension. Frontiers in Psychology, 13 , 980133. https://doi.org/10.3389/fpsyg.2022.980133

Sheal, P. (1989). Classroom observation: Training the observers. ELT Journal, 43 (2), 92–104. https://doi.org/10.1093/elt/43.2.92

Smith, C. L., & Wenk, L. (2006). Relations among three aspects of first-year college students’ epistemologies of science. Journal of Research in Science Teaching, 43 (8), 747–785.

Stanton, J. D., Sebesta, A. J., & Dunlosky, J. (2021). Fostering metacognition to support student learning and performance. CBE Life Sciences Education , 20(2), fe3. https://doi.org/10.1187/cbe.20-12-0289 .

Sullivan, P. B., Buckle, A., Nicky, G., et al. (2012). Peer observation of teaching as a faculty development tool. BMC Medical Education, 12 , 26. https://doi.org/10.1186/1472-6920-12-26

Tsai, C. C. (2007). Teachers’ scientific epistemological views: The coherence with instruction and students’ views. Science Education, 91 (2), 222–243. https://doi.org/10.1002/sce.20175

Wang, H. H., Hong, Z. R., & She, H. C. (2022). The role of structured inquiry, open inquiry, and epistemological beliefs in developing secondary students’ scientific and mathematical literacies. International Journal of STEM Education, 9 , 14. https://doi.org/10.1186/s40594-022-00329-z

Zainuddin, Z. (2023). Integrating ease of use and affordable gamification-based instruction into a remote learning environment . Advance online publication. https://doi.org/10.1007/s12564-023-09832-6

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Open Access funding provided by Hiroshima University. This research was financially supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI program under Grant Number 22KF0274.

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Keigo Fujinami and Tetsuo Isozaki contributed equally to this work.

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International Research Fellow, Japan Society for the Promotion of Science Postdoctoral Fellowship (Standard), Tokyo, Japan

Denis Dyvee Errabo

Graduate School of Humanities and Social Science, Hiroshima University, Hiroshima, Japan

Denis Dyvee Errabo, Keigo Fujinami & Tetsuo Isozaki

Department of Science Education, Bro. Andrew Gonzales FSC College of Education, De La Salle University, Manila, Philippines

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Errabo, D.D., Fujinami, K. & Isozaki, T. Epistemic Goals and Practices in Biology Curriculum—the Philippines and Japan. Res Sci Educ (2024). https://doi.org/10.1007/s11165-024-10170-9

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5 common mistakes to avoid in user research in Product Management

User research in product management is really important. But sometimes people make mistakes that can mess it up. Like not setting clear goals for the research, using the wrong methods, picking the wrong people to ask questions, not asking the right questions, and forgetting to look at the data properly. These mistakes can make the research not very useful. But if we avoid them, we can learn a lot about what users want and make better products that they’ll like more.

5 Common Mistakes to Avoid in User Research in Product Management

Here are the 5 Common Mistakes that can be Avoid in User Research in Product Management:

Mistake 1: Not defining a clear research goal

When we don’t have a clear research goal, it means we’re starting user research without knowing exactly what we want to find out. This mistake can waste time and effort because we might end up collecting information that doesn’t help us. Without a clear goal, we might ask the wrong questions or get data that doesn’t give us useful insights for our product. To avoid this, it’s important to take the time to decide what we want to learn from our research. This means figuring out the main questions we need answers to or setting specific goals for what we want to achieve. By doing this, we can make sure our research is focused and helpful for making decisions about our product.

Mistake 2: Not choosing the right research method

This mistake means using a research method that doesn’t fit what we’re trying to learn. This can lead to incomplete or wrong information, which makes it hard to make good decisions about our product. Different research methods, like talking to people, asking questions, or watching how they use things, have different strengths and weaknesses. If we pick the wrong one, we might waste time and money without getting useful data. To avoid this, we need to think about what we want to learn, the kind of information we need, and who we’re trying to learn from. By picking the best method for our goals, we can make sure we get the right information to help us improve our product.

Mistake 3: Not recruiting the right participants

This mistake happens when we choose the wrong people for our research. When we don’t recruit the right participants, we miss out on getting insights that truly represent our target users. This can lead to decisions about our product that don’t match what our users want or need. Whether it’s because we pick people who aren’t like our typical users or we forget to include important groups like older adults or students, it means we’re not getting the full picture. To avoid this, we need to think carefully about who we want to include in our research and make sure they’re a good match for our target audience. By recruiting the right participants, we can get the information we need to make our product better for the people who will use it.

Mistake 4: Not asking the right questions

This mistake happens when we don’t ask the questions that will give us the information we need. When we don’t ask the right questions, we miss out on getting important insights that could help us make better decisions about our product. This can lead to us making choices that don’t match what our users want or need. Whether it’s because our questions are too vague, or leading, or we forget to ask about important things, it means we’re not getting the whole story. To avoid this, we need to think carefully about what we want to know and make sure our questions will give us the answers we’re looking for. By asking the right questions, we can get the information we need to make our product better for our users.

Mistake 5: Not analyzing and synthesizing the data

This mistake happens when we gather data from our research but don’t take the time to carefully look at it and put it together to find important things. When we don’t analyze and synthesize the data, we miss out on understanding what it’s telling us about our users and our product. This can lead to us making decisions without all the information we need or missing chances to make our product better. Whether it’s because we’re busy, don’t know how to do it, or just forget, not analyzing and synthesizing the data means we’re not using it to help us improve our product. To avoid this, we need to take the time to carefully look at the data we’ve collected and think about what it means for our product. By doing this, we can make better decisions and create products that work well for our users.

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In conclusion, good user research is important for making products that people like. By avoiding common mistakes like not setting clear research goals, picking the right research methods, choosing the right people for our research, asking the right questions, and looking carefully at the data, we can make sure our products meet users’ needs. When we focus on what users want and keep improving our research, we can create products that work well and make users happy. So, by putting effort into user research, we can make better decisions and build successful products.

FAQs: 5 Common Mistakes to Avoid in User Research in Product Management

Why is user research important in product management.

User research helps us figure out what users need and want, making sure our products actually solve their problems and meet their expectations.

How often should we do user research?

It’s best to keep doing user research regularly, all through making the product. This way, we stay updated on what users want and need.

In what ways can we do user research?

We can talk to users, ask them questions, watch how they use things, and even have them try out our product and give feedback. All these ways help us understand what users want.

What do we do with the feedback from user research?

We carefully listen to what users say and use their feedback to improve our product. This helps us make something that users really like.

How can we make sure our user research works well?

To do good user research, we talk to lots of different users, ask questions that let them share their thoughts freely, and pay attention to what they actually do. And we keep learning and improving how we do research.

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