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Peer Review and Primary Literature: An Introduction: Is it Primary Research? How Do I Know?

• Scholarly Journal vs. Magazine
• Peer Review: What is it?
• Finding Peer-Reviewed Articles
• Primary Journal Literature
• Is it Primary Research? How Do I Know?

Components of a Primary Research Study

As indicated on a previous page, Peer-Reviewed Journals also include non -primary content. Simply limiting your search results in a database to "peer-reviewed" will not retrieve a list of only primary research studies.

Learn to recognize the parts of a primary research study. Terminology will vary slightly from discipline to discipline and from journal to journal.  However, there are common components to most research studies.

When you run a search, find a promising article in your results list and then look at the record for that item (usually by clicking on the title). The full database record for an item usually includes an abstract or summary--sometimes prepared by the journal or database, but often written by the author(s) themselves. This will usually give a clear indication of whether the article is a primary study.  For example, here is a full database record from a search for family violence and support in SocINDEX with Full Text :

Although the abstract often tells the story, you will need to read the article to know for sure. Besides scanning the Abstract or Summary, look for the following components: (I am only capturing small article segments for illustration.)

Look for the words METHOD or METHODOLOGY . The authors should explain how they conducted their research.

NOTE: Different Journals and Disciplines will use different terms to mean similar things. If instead of " Method " or " Methodology " you see a heading that says " Research Design " or " Data Collection ," you have a similar indicator that the scholar-authors have done original research.

Look for the section called RESULTS . This details what the author(s) found out after conducting their research.

Charts , Tables , Graphs , Maps and other displays help to summarize and present the findings of the research.

A Discussion indicates the significance of findings, acknowledges limitations of the research study, and suggests further research.

References , a Bibliography or List of Works Cited indicates a literature review and shows other studies and works that were consulted. USE THIS PART OF THE STUDY! If you find one or two good recent studies, you can identify some important earlier studies simply by going through the bibliographies of those articles.

A FINAL NOTE:  If you are ever unclear about whether a particular article is appropriate to use in your paper, it is best to show that article to your professor and discuss it with them.  The professor is the final judge since they will be assigning your grade.

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Peer-review and primary research.

• Getting Started With Peer-Reviewed Literature

Primary Research

Identifying a primary research article.

• Finding Peer-Reviewed Journal Articles
• Finding Randomized Controlled Trials (RCTs)
• Evaluating Scholarly Articles
• Google Scholar
• Tips for Reading Journal Articles

STEM Librarian

Primary research or a primary study refers to a research article that is an author’s original research that is almost always published in a peer-reviewed journal. A primary study reports on the details, methods and results of a research study. These articles often have a standard structure of a format called IMRAD, referring to sections of an article: Introduction, Methods, Results and Discussion. Primary research studies will start with a review of the previous literature, however, the rest of the article will focus on the authors’ original research. Literature reviews can be published in peer-reviewed journals, however, they are not primary research.

Primary studies are part of primary sources but should not be mistaken for primary documents. Primary documents are usually original sources such as a letter, a diary, a speech or an autobiography. They are a first person view of an event or a period. Typically, if you are a Humanities major, you will be asked to find primary documents for your paper however, if you are in Social Sciences or the Sciences you are most likely going to be asked to find primary research studies. If you are unsure, ask your professor or a librarian for help.

A primary research or study is an empirical research that is published in peer-reviewed journals. Some ways of recognizing whether an article is a primary research article when searching a database:

1. The abstract includes a research question or a hypothesis,  methods and results.

2. Studies can have tables and charts representing data findings.

3. The article includes a section for "methods” or “methodology” and "results".

4. Discussion section indicates findings and discusses limitations of the research study, and suggests further research.

5. Check the reference section because it will refer you to the studies and works that were consulted. You can use this section to find other studies on that particular topic.

The following are not to be confused with primary research articles:

- Literature reviews

- Meta-analyses or systematic reviews (these studies make conclusions based on research on many other studies)

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Primary Research

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Note:  This page offers a brief primer on primary research. For more information, see our dedicated set of pages on this topic .

Research isn't limited to finding published material on the Internet or at the library. Many topics you choose to write on may not already have been covered by an abundance of sources and hence may require a different kind of approach to conducting research. This approach involves collecting information directly from the world around you and can include interviews, observations, surveys, and experiments. These strategies are collectively called  primary research.

For example, if you are writing about a problem specific to your school or local community, you may need to conduct primary research. You may be able to find  secondary sources  (such as those found at the library or online) on the more general topic you are pursuing, but may not find specifics on your school or town. To supplement this lack of sources, you can collect data on your own.

For example, Briel wants to research a proposed smoking ban in public establishments in Lafayette, Indiana. Briel begins by going to the library and then searching online. She finds information related to smoking bans in other cities around the United States, but only a few limited articles from the local newspaper on the ban proposed in Lafayette. To supplement this information, she decides to survey twenty local residents to learn what they think of the proposed smoking ban. She also decides to interview two local business owners to learn how they think the ban may affect their businesses. Finally, Briel attends and observes a town hall meeting where the potential ban is discussed.

Many different types of primary research exist. Some common types used in writing classes and beyond include:

• Interviews:  A conversation between two or more people in which one person (the interviewer) asks a series of questions to another person or persons (the interviewee). See also our page on interviewing .
• Surveys and questionnaires:  A process of gathering specific information from people in a systematic way with a set series of questions. Survey questions usually have pre-specified or short responses. See also our introduction to writing surveys .
• Observations:  Careful viewing and documenting of the world around you. See also our page on performing observations .

Primary Research Articles

• Library vs. Google
• Background Reading
• Keyword Searching
• Evaluating Sources
• Citing Sources
• Need more help?

How Can I Find Primary Research Articles?

Many of the recommended databases in this subject guide contain primary research articles (also known as empirical articles or research studies). Search in databases like ScienceDirect  and MEDLINE .

Primary Research Articles: How Will I Know One When I See One?

Primary research articles  to conduct and publish an experiment or research study, an author or team of authors designs an experiment, gathers data, then analyzes the data and discusses the results of the experiment. a published experiment or research study will therefore  look  very different from other types of articles (newspaper stories, magazine articles, essays, etc.) found in our library databases. the following guidelines will help you recognize a primary research article, written by the researchers themselves and published in a scholarly journal., structure of a primary research article typically, a primary research article has the following sections:.

• The author summarizes her article
• The author discusses the general background of her research topic; often, she will present a literature review, that is, summarize what other experts have written on this particular research topic
• The author describes the study she designed and conducted
• The author presents the data she gathered during her experiment
• The author offers ideas about the importance and implications of her research findings, and speculates on future directions that similar research might take
• The author gives a References list of sources she used in her paper

The structure of the article will often be clearly shown with headings: Introduction, Method, Results, Discussion.

A primary research article will almost always contains statistics, numerical data presented in tables. Also, primary research articles are written in very formal, very technical language.

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13.1 Formatting a Research Paper

Learning objectives.

• Identify the major components of a research paper written using American Psychological Association (APA) style.
• Apply general APA style and formatting conventions in a research paper.

In this chapter, you will learn how to use APA style , the documentation and formatting style followed by the American Psychological Association, as well as MLA style , from the Modern Language Association. There are a few major formatting styles used in academic texts, including AMA, Chicago, and Turabian:

• AMA (American Medical Association) for medicine, health, and biological sciences
• APA (American Psychological Association) for education, psychology, and the social sciences
• Chicago—a common style used in everyday publications like magazines, newspapers, and books
• MLA (Modern Language Association) for English, literature, arts, and humanities
• Turabian—another common style designed for its universal application across all subjects and disciplines

While all the formatting and citation styles have their own use and applications, in this chapter we focus our attention on the two styles you are most likely to use in your academic studies: APA and MLA.

If you find that the rules of proper source documentation are difficult to keep straight, you are not alone. Writing a good research paper is, in and of itself, a major intellectual challenge. Having to follow detailed citation and formatting guidelines as well may seem like just one more task to add to an already-too-long list of requirements.

Following these guidelines, however, serves several important purposes. First, it signals to your readers that your paper should be taken seriously as a student’s contribution to a given academic or professional field; it is the literary equivalent of wearing a tailored suit to a job interview. Second, it shows that you respect other people’s work enough to give them proper credit for it. Finally, it helps your reader find additional materials if he or she wishes to learn more about your topic.

Furthermore, producing a letter-perfect APA-style paper need not be burdensome. Yes, it requires careful attention to detail. However, you can simplify the process if you keep these broad guidelines in mind:

• Work ahead whenever you can. Chapter 11 “Writing from Research: What Will I Learn?” includes tips for keeping track of your sources early in the research process, which will save time later on.
• Get it right the first time. Apply APA guidelines as you write, so you will not have much to correct during the editing stage. Again, putting in a little extra time early on can save time later.
• Use the resources available to you. In addition to the guidelines provided in this chapter, you may wish to consult the APA website at http://www.apa.org or the Purdue University Online Writing lab at http://owl.english.purdue.edu , which regularly updates its online style guidelines.

General Formatting Guidelines

This chapter provides detailed guidelines for using the citation and formatting conventions developed by the American Psychological Association, or APA. Writers in disciplines as diverse as astrophysics, biology, psychology, and education follow APA style. The major components of a paper written in APA style are listed in the following box.

These are the major components of an APA-style paper:

Body, which includes the following:

• Headings and, if necessary, subheadings to organize the content
• In-text citations of research sources
• References page

All these components must be saved in one document, not as separate documents.

The title page of your paper includes the following information:

• Title of the paper
• Author’s name
• Name of the institution with which the author is affiliated
• Header at the top of the page with the paper title (in capital letters) and the page number (If the title is lengthy, you may use a shortened form of it in the header.)

List the first three elements in the order given in the previous list, centered about one third of the way down from the top of the page. Use the headers and footers tool of your word-processing program to add the header, with the title text at the left and the page number in the upper-right corner. Your title page should look like the following example.

The next page of your paper provides an abstract , or brief summary of your findings. An abstract does not need to be provided in every paper, but an abstract should be used in papers that include a hypothesis. A good abstract is concise—about one hundred fifty to two hundred fifty words—and is written in an objective, impersonal style. Your writing voice will not be as apparent here as in the body of your paper. When writing the abstract, take a just-the-facts approach, and summarize your research question and your findings in a few sentences.

In Chapter 12 “Writing a Research Paper” , you read a paper written by a student named Jorge, who researched the effectiveness of low-carbohydrate diets. Read Jorge’s abstract. Note how it sums up the major ideas in his paper without going into excessive detail.

Write an abstract summarizing your paper. Briefly introduce the topic, state your findings, and sum up what conclusions you can draw from your research. Use the word count feature of your word-processing program to make sure your abstract does not exceed one hundred fifty words.

Depending on your field of study, you may sometimes write research papers that present extensive primary research, such as your own experiment or survey. In your abstract, summarize your research question and your findings, and briefly indicate how your study relates to prior research in the field.

Margins, Pagination, and Headings

APA style requirements also address specific formatting concerns, such as margins, pagination, and heading styles, within the body of the paper. Review the following APA guidelines.

Use these general guidelines to format the paper:

• Set the top, bottom, and side margins of your paper at 1 inch.
• Use double-spaced text throughout your paper.
• Use a standard font, such as Times New Roman or Arial, in a legible size (10- to 12-point).
• Use continuous pagination throughout the paper, including the title page and the references section. Page numbers appear flush right within your header.
• Section headings and subsection headings within the body of your paper use different types of formatting depending on the level of information you are presenting. Additional details from Jorge’s paper are provided.

Begin formatting the final draft of your paper according to APA guidelines. You may work with an existing document or set up a new document if you choose. Include the following:

• Your title page
• The abstract you created in Note 13.8 “Exercise 1”
• Correct headers and page numbers for your title page and abstract

APA style uses section headings to organize information, making it easy for the reader to follow the writer’s train of thought and to know immediately what major topics are covered. Depending on the length and complexity of the paper, its major sections may also be divided into subsections, sub-subsections, and so on. These smaller sections, in turn, use different heading styles to indicate different levels of information. In essence, you are using headings to create a hierarchy of information.

The following heading styles used in APA formatting are listed in order of greatest to least importance:

• Section headings use centered, boldface type. Headings use title case, with important words in the heading capitalized.
• Subsection headings use left-aligned, boldface type. Headings use title case.
• The third level uses left-aligned, indented, boldface type. Headings use a capital letter only for the first word, and they end in a period.
• The fourth level follows the same style used for the previous level, but the headings are boldfaced and italicized.
• The fifth level follows the same style used for the previous level, but the headings are italicized and not boldfaced.

Visually, the hierarchy of information is organized as indicated in Table 13.1 “Section Headings” .

Table 13.1 Section Headings

A college research paper may not use all the heading levels shown in Table 13.1 “Section Headings” , but you are likely to encounter them in academic journal articles that use APA style. For a brief paper, you may find that level 1 headings suffice. Longer or more complex papers may need level 2 headings or other lower-level headings to organize information clearly. Use your outline to craft your major section headings and determine whether any subtopics are substantial enough to require additional levels of headings.

Working with the document you developed in Note 13.11 “Exercise 2” , begin setting up the heading structure of the final draft of your research paper according to APA guidelines. Include your title and at least two to three major section headings, and follow the formatting guidelines provided above. If your major sections should be broken into subsections, add those headings as well. Use your outline to help you.

Because Jorge used only level 1 headings, his Exercise 3 would look like the following:

Citation Guidelines

In-text citations.

Throughout the body of your paper, include a citation whenever you quote or paraphrase material from your research sources. As you learned in Chapter 11 “Writing from Research: What Will I Learn?” , the purpose of citations is twofold: to give credit to others for their ideas and to allow your reader to follow up and learn more about the topic if desired. Your in-text citations provide basic information about your source; each source you cite will have a longer entry in the references section that provides more detailed information.

In-text citations must provide the name of the author or authors and the year the source was published. (When a given source does not list an individual author, you may provide the source title or the name of the organization that published the material instead.) When directly quoting a source, it is also required that you include the page number where the quote appears in your citation.

This information may be included within the sentence or in a parenthetical reference at the end of the sentence, as in these examples.

Epstein (2010) points out that “junk food cannot be considered addictive in the same way that we think of psychoactive drugs as addictive” (p. 137).

Here, the writer names the source author when introducing the quote and provides the publication date in parentheses after the author’s name. The page number appears in parentheses after the closing quotation marks and before the period that ends the sentence.

Addiction researchers caution that “junk food cannot be considered addictive in the same way that we think of psychoactive drugs as addictive” (Epstein, 2010, p. 137).

Here, the writer provides a parenthetical citation at the end of the sentence that includes the author’s name, the year of publication, and the page number separated by commas. Again, the parenthetical citation is placed after the closing quotation marks and before the period at the end of the sentence.

As noted in the book Junk Food, Junk Science (Epstein, 2010, p. 137), “junk food cannot be considered addictive in the same way that we think of psychoactive drugs as addictive.”

Here, the writer chose to mention the source title in the sentence (an optional piece of information to include) and followed the title with a parenthetical citation. Note that the parenthetical citation is placed before the comma that signals the end of the introductory phrase.

David Epstein’s book Junk Food, Junk Science (2010) pointed out that “junk food cannot be considered addictive in the same way that we think of psychoactive drugs as addictive” (p. 137).

Another variation is to introduce the author and the source title in your sentence and include the publication date and page number in parentheses within the sentence or at the end of the sentence. As long as you have included the essential information, you can choose the option that works best for that particular sentence and source.

Citing a book with a single author is usually a straightforward task. Of course, your research may require that you cite many other types of sources, such as books or articles with more than one author or sources with no individual author listed. You may also need to cite sources available in both print and online and nonprint sources, such as websites and personal interviews. Chapter 13 “APA and MLA Documentation and Formatting” , Section 13.2 “Citing and Referencing Techniques” and Section 13.3 “Creating a References Section” provide extensive guidelines for citing a variety of source types.

Writing at Work

APA is just one of several different styles with its own guidelines for documentation, formatting, and language usage. Depending on your field of interest, you may be exposed to additional styles, such as the following:

• MLA style. Determined by the Modern Languages Association and used for papers in literature, languages, and other disciplines in the humanities.
• Chicago style. Outlined in the Chicago Manual of Style and sometimes used for papers in the humanities and the sciences; many professional organizations use this style for publications as well.
• Associated Press (AP) style. Used by professional journalists.

References List

The brief citations included in the body of your paper correspond to the more detailed citations provided at the end of the paper in the references section. In-text citations provide basic information—the author’s name, the publication date, and the page number if necessary—while the references section provides more extensive bibliographical information. Again, this information allows your reader to follow up on the sources you cited and do additional reading about the topic if desired.

The specific format of entries in the list of references varies slightly for different source types, but the entries generally include the following information:

• The name(s) of the author(s) or institution that wrote the source
• The year of publication and, where applicable, the exact date of publication
• The full title of the source
• For books, the city of publication
• For articles or essays, the name of the periodical or book in which the article or essay appears
• For magazine and journal articles, the volume number, issue number, and pages where the article appears
• For sources on the web, the URL where the source is located

The references page is double spaced and lists entries in alphabetical order by the author’s last name. If an entry continues for more than one line, the second line and each subsequent line are indented five spaces. Review the following example. ( Chapter 13 “APA and MLA Documentation and Formatting” , Section 13.3 “Creating a References Section” provides extensive guidelines for formatting reference entries for different types of sources.)

In APA style, book and article titles are formatted in sentence case, not title case. Sentence case means that only the first word is capitalized, along with any proper nouns.

Key Takeaways

• Following proper citation and formatting guidelines helps writers ensure that their work will be taken seriously, give proper credit to other authors for their work, and provide valuable information to readers.
• Working ahead and taking care to cite sources correctly the first time are ways writers can save time during the editing stage of writing a research paper.
• APA papers usually include an abstract that concisely summarizes the paper.
• APA papers use a specific headings structure to provide a clear hierarchy of information.
• In APA papers, in-text citations usually include the name(s) of the author(s) and the year of publication.
• In-text citations correspond to entries in the references section, which provide detailed bibliographical information about a source.

Writing for Success Copyright © 2015 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Understanding research and critical appraisal

• Introduction
• Secondary research

What is primary research?

Quantitative research study designs, qualitative research study designs, mixed methods research study designs.

• Critical appraisal of research papers
• Useful terminology
• Further reading and helpful resources

Primary research articles provide a report of individual, original research studies, which constitute the majority of articles published in peer-reviewed journals. All primary research studies are conducted according to a specified methodology, which will be partly determined by the aims and objectives of the research.

The following sections offer brief summaries of some of the common quantitative, qualitative, and mixed-methods study designs you may encounter. 

Randomised Controlled Trial

A randomised controlled trial (RCT) is a study where participants are randomly allocated to two or more groups. One group receives the treatment that is being tested by the study (treatment or experimental group), and the other group(s) receive an alternative, which is often the current standard treatment or a placebo (control or comparison group). The nature of the control used should always be specified.

An RCT is a good study choice for determining the effectiveness of an intervention or treatment, or for comparing the relative effectiveness of different interventions or treatments. If well implemented, the randomisation of participants in RCTs should ensure that the groups differ only in their exposure to treatment, and that differences in outcomes between the groups are probably attributable to the treatment being studied.

In crossover randomised controlled trials, participants receive all of the treatments and controls being tested in a random order. This means that participants receive one treatment, the effect of which is measured, and then "cross over" into the other treatment group, where the effect of the second treatment (or control) is measured.

RCTs are generally considered to be the most rigorous experimental study design, as the randomisation of participants helps to minimise confounding and other sources of bias.

Cohort study

A cohort study identifies a group of people and follows them over a period of time to see who develops the outcome of interest to the study. This type of study is normally used to look at the effect of suspected risk factors that cannot be controlled experimentally – for example, the effect of smoking on lung cancer.

Also sometimes called longitudinal studies, cohort studies can be either prospective, that is, exposure factors are identified at the beginning of a study and the study population is followed into the future, or retrospective, that is, medical records for the study population are used to identify past exposure factors.

Cohort studies are useful in answering questions about disease causation or progression, or studying the effects of harmful exposures.

Cohort studies are generally considered to be the most reliable observational study design. They are not as reliable as RCTs, as the study groups may differ in ways other than the variable being studied.

Other problems with cohort studies are that they require a large sample size, are inefficient for rare outcomes, and can take long periods of time.

Case-Control Study

A case-control study compares a group of people with a disease or condition, against a control population without the disease or condition, in order to investigate the causes of particular outcomes. The study looks back at the two groups over time to see which risk factors for the disease or condition they have been exposed to.

Case-control studies can be useful in identifying which risk factors may predict a disease, or how a disease progresses over time. They can be especially useful for investigating the causes of rare outcomes.

Case-control studies can be done quickly, and do not require large groups of subjects. However, their reliance on retrospective data which may be incomplete or unreliable (owing to subject ability to accurately recall information such as the appearance of a symptom) can be a difficulty.

Cross-Sectional Study

A cross-sectional study collects data from the study population at one point in time, and considers the relationships between characteristics. Also  sometimes called surveys or prevalence studies.

Cross-sectional studies are generally used to study the prevalence of a risk factor, disease or outcome in a chosen population.

Because cross-sectional studies do not look at trends or changes over time, they cannot establish cause and effect between exposures and outcomes.

Case Series / Case Reports

A case series is a descriptive study of a group of people, who have either received the same treatment or have the same disease, in order to identify characteristics or outcomes in a particular group of people.

Case series are useful for studying rare diseases or adverse outcomes, for illustrating particular aspects of a condition, identifying treatment approaches, and for generating hypotheses for further study.

A case report provides a study of an individual, rather than a group.

Case series and case reports have no comparative control groups, and are prone to bias and chance association.

Expert opinion

Expert opinion draws upon the clinical experience and recommendations of those with established expertise on a topic.

Grounded theory

Grounded theory studies aim to generate theory in order to explain social processes, interactions or issues. This explanatory theory is grounded in, and generated from, the research participant data collected.

Research data typically takes the form of interviews, observations or documents. Data is analysed as it is collected, and is coded and organised into categories which inform the further collection of data, and the construction of theory. This cycle helps to refine the theory, which evolves as more data is gathered.

Phenomenology

A phenomenological study aims to describe the meaning(s) of the lived experience of a phenomenon. Research participants will have some common experience of the phenomenon under examination, but will differ in their precise individual experience, and in other personal or social characteristics.

Research data is typically in the form of observations, interviews or written records, and its analysis sets out to identify common themes in the participants' experience, while also highlighting variations and unique themes.

Ethnography

Ethnography is the study of a specific culture or cultural group, where the researcher seeks an insider perspective by placing themselves as a participant observer within the group under study.

Data is typically formed of observations, interviews and conversation. Ethnography aims to offer direct insight into the lives and the experiences of the group or the culture under study, examining its beliefs, values, practices and behaviours.

A case study offers a detailed description of the experience of an individual, a family, a community or an organisation, often with the aim of highlighting a particular issue. Research data may include documents, interviews and observations.

Content analysis

Content analysis is used to explore the occurrence, meanings and relationships of words, themes or concepts within a set of textual data. Research data might be drawn from any type of written document(s). Data is coded and categorised, with the aim of revealing and examining the patterns and the intentions of language use within the data set.

Narrative inquiry

A narrative inquiry offers in depth detail of a situation or experience from the perspective of an individual or small groups. Research data usually consists of interviews or recordings, which is presented as a structured, chronological narrative. Narrative inquiry studies often seek to give voice to individuals or populations whose perspective is less well established, or not commonly sought.

Action research

Action research is a form of research, commonly used with groups, where the participants take a more active, collaborative role in producing the research. Studies incorporate the lived experiences of the individuals, groups or communities under study, drawing on data which might include observation, interviews, questionnaires or workshops.

Action research is generally aimed at changing or improving a particular context, or a specific practice, alongside the generation of theory.

Explanatory sequential design

In an explanatory sequential study, emphasis is given to the collection and analysis of quantitative data, which occurs during the first phase of the study. The results of this quantitative phase inform the subsequent collection of qualitative data in the next phase.

Analysis of the resultant qualitative data is then used to 'explain' the quantitative results, usually serving to contextualise these, or to otherwise enhance or enrich the initial findings.

Exploratory sequential design

In an exploratory sequential study, the opposite sequence to that outlined above is used. In this case, qualitative data is emphasised, with this being collected and analysed during the first phase of the study. The results of this qualitative phase inform the subsequent collection of quantitative data in the next phase.

The quantitative data can then be used to define or to generalise the qualitative results, or to test these results on the basis of theory emerging from the initial findings.

Convergent design

In a convergent study, qualitative and quantitative data sets are collected and analysed simultaneously and independently of one another.

Results from analysis of both sets of data are brought together to provide one overall interpretation; this combination of data types can be handled in various ways, but the objective is always to provide a fuller understanding of the phenomena under study. Equal emphasis is given to both qualitative and quantitative data in a convergent study.

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What Is a Primary Source?

Glossary of Grammatical and Rhetorical Terms - Definition and Examples

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• B.A., English, State University of New York

In research and academics, a primary source refers to information collected from sources that witnessed or experienced an event firsthand. These can be historical documents , literary texts, artistic works, experiments, journal entries, surveys, and interviews. A primary source, which is very different from a secondary source , is also called primary data.

The Library of Congress defines primary sources as "the raw materials of history—original documents and objects which were created at the time under study," in contrast to secondary sources , which are "accounts or interpretations of events created by someone without firsthand experience," ("Using Primary Sources").

Secondary sources are often meant to describe or analyze a primary source and do not give firsthand accounts; primary sources tend to provide more accurate depictions of history but are much harder to come by.

Characteristics of Primary Sources

There are a couple of factors that can qualify an artifact as a primary source. The chief characteristics of a primary source, according to Natalie Sproull, are: "(1) [B]eing present during the experience, event or time and (2) consequently being close in time with the data. This does not mean that data from primary sources are always the best data."

Sproull then goes on to remind readers that primary sources are not always more reliable than secondary sources. "Data from human sources are subject to many types of distortion because of such factors as selective recall, selective perceptions, and purposeful or nonpurposeful omission or addition of information. Thus data from primary sources are not necessarily accurate data even though they come from firsthand sources," (Sproull 1988).

Original Sources

Primary sources are often called original sources, but this is not the most accurate description because you're not always going to be dealing with original copies of primary artifacts. For this reason, "primary sources" and "original sources" should be considered separate. Here's what the authors of "Undertaking Historical Research in Literacy," from Handbook of Reading Research , have to say about this:

"The distinction also needs to be made between primary and original sources . It is by no means always necessary, and all too often it is not possible, to deal only with original sources. Printed copies of original sources, provided they have been undertaken with scrupulous care (such as the published letters of the Founding Fathers), are usually an acceptable substitute for their handwritten originals." (E. J. Monaghan and D. K. Hartman, "Undertaking Historical Research in Literacy," in Handbook of Reading Research , ed. by P. D. Pearson et al. Erlbaum, 2000)

When to Use Primary Sources

Primary sources tend to be most useful toward the beginning of your research into a topic and at the end of a claim as evidence, as Wayne Booth et al. explain in the following passage. "[Primary sources] provide the 'raw data' that you use first to test the working hypothesis and then as evidence to support your claim . In history, for example, primary sources include documents from the period or person you are studying, objects, maps, even clothing; in literature or philosophy, your main primary source is usually the text you are studying, and your data are the words on the page. In such fields, you can rarely write a research paper  without using primary sources," (Booth et al. 2008).

When to Use Secondary Sources

There is certainly a time and place for secondary sources and many situations in which these point to relevant primary sources. Secondary sources are an excellent place to start. Alison Hoagland and Gray Fitzsimmons write: "By identifying basic facts, such as year of construction, secondary sources can point the researcher to the best primary sources , such as the right tax books. In addition, a careful reading of the bibliography in a secondary source can reveal important sources the researcher might otherwise have missed," (Hoagland and Fitzsimmons 2004).

Finding and Accessing Primary Sources

As you might expect, primary sources can prove difficult to find. To find the best ones, take advantage of resources such as libraries and historical societies. "This one is entirely dependent on the assignment given and your local resources; but when included, always emphasize quality. ... Keep in mind that there are many institutions such as the Library of Congress that make primary source material freely available on the Web," (Kitchens 2012).

Methods of Collecting Primary Data

Sometimes in your research, you'll run into the problem of not being able to track down primary sources at all. When this happens, you'll want to know how to collect your own primary data; Dan O'Hair et all tell you how: "If the information you need is unavailable or hasn't yet been gathered, you'll have to gather it yourself. Four basic methods of collecting primary data are field research, content analysis, survey research, and experiments. Other methods of gathering primary data include historical research, analysis of existing statistics, ... and various forms of direct observation," (O'Hair et al. 2001).

• Booth, Wayne C., et al. The Craft of Research . 3rd ed., University of Chicago Press, 2008.
• Hoagland, Alison, and Gray Fitzsimmons. "History."  Recording Historic Structures. 2nd. ed., John Wiley & Sons, 2004.
• Kitchens, Joel D. Librarians, Historians, and New Opportunities for Discourse: A Guide for Clio's Helpers . ABC-CLIO, 2012.
• Monaghan, E. Jennifer, and Douglas K. Hartman. "Undertaking Historical Research in Literacy." Handbook of Reading Research. Lawrence Erlbaum Associates, 2002.
• O'Hair, Dan, et al. Business Communication: A Framework for Success . South-Western College Pub., 2001.
• Sproull, Natalie L. Handbook of Research Methods: A Guide for Practitioners and Students in the Social Sciences. 2nd ed. Scarecrow Press, 1988.
• "Using Primary Sources." Library of Congress .
• Secondary Sources in Research
• Primary and Secondary Sources in History
• How to Prove Your Family Tree Connections
• Research in Essays and Reports
• Five Steps to Verifying Online Genealogy Sources
• Pros and Cons of Secondary Data Analysis
• Understanding Secondary Data and How to Use It in Research
• Documentation in Reports and Research Papers
• What Is a Research Paper?
• 6 Skills Students Need to Succeed in Social Studies Classes
• How to Use Libraries and Archives for Research
• How to Cite Genealogy Sources
• Definition and Examples of Quotation in English Grammar
• Glossary of Historical Terms
• How to Determine a Reliable Source on the Internet
• Fashion Throughout History

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Primary Research: What It Is, Purpose & Methods + Examples

As we continue exploring the exciting research world, we’ll come across two primary and secondary data approaches. This article will focus on primary research – what it is, how it’s done, and why it’s essential. 

We’ll discuss the methods used to gather first-hand data and examples of how it’s applied in various fields. Get ready to discover how this research can be used to solve research problems , answer questions, and drive innovation.

What is Primary Research: Definition

Primary research is a methodology researchers use to collect data directly rather than depending on data collected from previously done research. Technically, they “own” the data. Primary research is solely carried out to address a certain problem, which requires in-depth analysis .

There are two forms of research:

• Primary Research
• Secondary Research

Businesses or organizations can conduct primary research or employ a third party to conduct research. One major advantage of primary research is this type of research is “pinpointed.” Research only focuses on a specific issue or problem and on obtaining related solutions.

For example, a brand is about to launch a new mobile phone model and wants to research the looks and features they will soon introduce. 

Organizations can select a qualified sample of respondents closely resembling the population and conduct primary research with them to know their opinions. Based on this research, the brand can now think of probable solutions to make necessary changes in the looks and features of the mobile phone.

Primary Research Methods with Examples

In this technology-driven world, meaningful data is more valuable than gold. Organizations or businesses need highly validated data to make informed decisions. This is the very reason why many companies are proactive in gathering their own data so that the authenticity of data is maintained and they get first-hand data without any alterations.

Here are some of the primary research methods organizations or businesses use to collect data:

1. Interviews (telephonic or face-to-face)

Conducting interviews is a qualitative research method to collect data and has been a popular method for ages. These interviews can be conducted in person (face-to-face) or over the telephone. Interviews are an open-ended method that involves dialogues or interaction between the interviewer (researcher) and the interviewee (respondent).

Conducting a face-to-face interview method is said to generate a better response from respondents as it is a more personal approach. However, the success of face-to-face interviews depends heavily on the researcher’s ability to ask questions and his/her experience related to conducting such interviews in the past. The types of questions that are used in this type of research are mostly open-ended questions . These questions help to gain in-depth insights into the opinions and perceptions of respondents.

Personal interviews usually last up to 30 minutes or even longer, depending on the subject of research. If a researcher is running short of time conducting telephonic interviews can also be helpful to collect data.

2. Online surveys

Once conducted with pen and paper, surveys have come a long way since then. Today, most researchers use online surveys to send to respondents to gather information from them. Online surveys are convenient and can be sent by email or can be filled out online. These can be accessed on handheld devices like smartphones, tablets, iPads, and similar devices.

Once a survey is deployed, a certain amount of stipulated time is given to respondents to answer survey questions and send them back to the researcher. In order to get maximum information from respondents, surveys should have a good mix of open-ended questions and close-ended questions . The survey should not be lengthy. Respondents lose interest and tend to leave it half-done.

It is a good practice to reward respondents for successfully filling out surveys for their time and efforts and valuable information. Most organizations or businesses usually give away gift cards from reputed brands that respondents can redeem later.

3. Focus groups

This popular research technique is used to collect data from a small group of people, usually restricted to 6-10. Focus group brings together people who are experts in the subject matter for which research is being conducted.

Focus group has a moderator who stimulates discussions among the members to get greater insights. Organizations and businesses can make use of this method, especially to identify niche markets to learn about a specific group of consumers.

4. Observations

In this primary research method, there is no direct interaction between the researcher and the person/consumer being observed. The researcher observes the reactions of a subject and makes notes.

Trained observers or cameras are used to record reactions. Observations are noted in a predetermined situation. For example, a bakery brand wants to know how people react to its new biscuits, observes notes on consumers’ first reactions, and evaluates collective data to draw inferences .

Primary Research vs Secondary Research – The Differences

Primary and secondary research are two distinct approaches to gathering information, each with its own characteristics and advantages. 

While primary research involves conducting surveys to gather firsthand data from potential customers, secondary market research is utilized to analyze existing industry reports and competitor data, providing valuable context and benchmarks for the survey findings.

Find out more details about the differences: 

1. Definition

• Primary Research: Involves the direct collection of original data specifically for the research project at hand. Examples include surveys, interviews, observations, and experiments.
• Secondary Research: Involves analyzing and interpreting existing data, literature, or information. This can include sources like books, articles, databases, and reports.

2. Data Source

• Primary Research: Data is collected directly from individuals, experiments, or observations.
• Secondary Research: Data is gathered from already existing sources.

3. Time and Cost

• Primary Research: Often time-consuming and can be costly due to the need for designing and implementing research instruments and collecting new data.
• Secondary Research: Generally more time and cost-effective, as it relies on readily available data.

4. Customization

• Primary Research: Provides tailored and specific information, allowing researchers to address unique research questions.
• Secondary Research: Offers information that is pre-existing and may not be as customized to the specific needs of the researcher.
• Primary Research: Researchers have control over the research process, including study design, data collection methods , and participant selection.
• Secondary Research: Limited control, as researchers rely on data collected by others.

6. Originality

• Primary Research: Generates original data that hasn’t been analyzed before.
• Secondary Research: Involves the analysis of data that has been previously collected and analyzed.

7. Relevance and Timeliness

• Primary Research: Often provides more up-to-date and relevant data or information.
• Secondary Research: This may involve data that is outdated, but it can still be valuable for historical context or broad trends.

Advantages of Primary Research

Primary research has several advantages over other research methods, making it an indispensable tool for anyone seeking to understand their target market, improve their products or services, and stay ahead of the competition. So let’s dive in and explore the many benefits of primary research.

• One of the most important advantages is data collected is first-hand and accurate. In other words, there is no dilution of data. Also, this research method can be customized to suit organizations’ or businesses’ personal requirements and needs .
• I t focuses mainly on the problem at hand, which means entire attention is directed to finding probable solutions to a pinpointed subject matter. Primary research allows researchers to go in-depth about a matter and study all foreseeable options.
• Data collected can be controlled. I T gives a means to control how data is collected and used. It’s up to the discretion of businesses or organizations who are collecting data how to best make use of data to get meaningful research insights.
• I t is a time-tested method, therefore, one can rely on the results that are obtained from conducting this type of research.

Disadvantages of Primary Research

While primary research is a powerful tool for gathering unique and firsthand data, it also has its limitations. As we explore the drawbacks, we’ll gain a deeper understanding of when primary research may not be the best option and how to work around its challenges.

• One of the major disadvantages of primary research is it can be quite expensive to conduct. One may be required to spend a huge sum of money depending on the setup or primary research method used. Not all businesses or organizations may be able to spend a considerable amount of money.
• This type of research can be time-consuming. Conducting interviews and sending and receiving online surveys can be quite an exhaustive process and require investing time and patience for the process to work. Moreover, evaluating results and applying the findings to improve a product or service will need additional time.
• Sometimes, just using one primary research method may not be enough. In such cases, the use of more than one method is required, and this might increase both the time required to conduct research and the cost associated with it.

Every research is conducted with a purpose. Primary research is conducted by organizations or businesses to stay informed of the ever-changing market conditions and consumer perception. Excellent customer satisfaction (CSAT) has become a key goal and objective of many organizations.

A customer-centric organization knows the importance of providing exceptional products and services to its customers to increase customer loyalty and decrease customer churn. Organizations collect data and analyze it by conducting primary research to draw highly evaluated results and conclusions. Using this information, organizations are able to make informed decisions based on real data-oriented insights.

QuestionPro is a comprehensive survey platform that can be used to conduct primary research. Users can create custom surveys and distribute them to their target audience , whether it be through email, social media, or a website.

QuestionPro also offers advanced features such as skip logic, branching, and data analysis tools, making collecting and analyzing data easier. With QuestionPro, you can gather valuable insights and make informed decisions based on the results of your primary research. Start today for free!

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Writing Research Papers

• Research Paper Structure

Whether you are writing a B.S. Degree Research Paper or completing a research report for a Psychology course, it is highly likely that you will need to organize your research paper in accordance with American Psychological Association (APA) guidelines.  Here we discuss the structure of research papers according to APA style.

Major Sections of a Research Paper in APA Style

A complete research paper in APA style that is reporting on experimental research will typically contain a Title page, Abstract, Introduction, Methods, Results, Discussion, and References sections. 1  Many will also contain Figures and Tables and some will have an Appendix or Appendices.  These sections are detailed as follows (for a more in-depth guide, please refer to " How to Write a Research Paper in APA Style ”, a comprehensive guide developed by Prof. Emma Geller). 2

What is this paper called and who wrote it? – the first page of the paper; this includes the name of the paper, a “running head”, authors, and institutional affiliation of the authors.  The institutional affiliation is usually listed in an Author Note that is placed towards the bottom of the title page.  In some cases, the Author Note also contains an acknowledgment of any funding support and of any individuals that assisted with the research project.

One-paragraph summary of the entire study – typically no more than 250 words in length (and in many cases it is well shorter than that), the Abstract provides an overview of the study.

Introduction

What is the topic and why is it worth studying? – the first major section of text in the paper, the Introduction commonly describes the topic under investigation, summarizes or discusses relevant prior research (for related details, please see the Writing Literature Reviews section of this website), identifies unresolved issues that the current research will address, and provides an overview of the research that is to be described in greater detail in the sections to follow.

What did you do? – a section which details how the research was performed.  It typically features a description of the participants/subjects that were involved, the study design, the materials that were used, and the study procedure.  If there were multiple experiments, then each experiment may require a separate Methods section.  A rule of thumb is that the Methods section should be sufficiently detailed for another researcher to duplicate your research.

What did you find? – a section which describes the data that was collected and the results of any statistical tests that were performed.  It may also be prefaced by a description of the analysis procedure that was used. If there were multiple experiments, then each experiment may require a separate Results section.

What is the significance of your results? – the final major section of text in the paper.  The Discussion commonly features a summary of the results that were obtained in the study, describes how those results address the topic under investigation and/or the issues that the research was designed to address, and may expand upon the implications of those findings.  Limitations and directions for future research are also commonly addressed.

List of articles and any books cited – an alphabetized list of the sources that are cited in the paper (by last name of the first author of each source).  Each reference should follow specific APA guidelines regarding author names, dates, article titles, journal titles, journal volume numbers, page numbers, book publishers, publisher locations, websites, and so on (for more information, please see the Citing References in APA Style page of this website).

Tables and Figures

Graphs and data (optional in some cases) – depending on the type of research being performed, there may be Tables and/or Figures (however, in some cases, there may be neither).  In APA style, each Table and each Figure is placed on a separate page and all Tables and Figures are included after the References.   Tables are included first, followed by Figures.   However, for some journals and undergraduate research papers (such as the B.S. Research Paper or Honors Thesis), Tables and Figures may be embedded in the text (depending on the instructor’s or editor’s policies; for more details, see "Deviations from APA Style" below).

Supplementary information (optional) – in some cases, additional information that is not critical to understanding the research paper, such as a list of experiment stimuli, details of a secondary analysis, or programming code, is provided.  This is often placed in an Appendix.

Variations of Research Papers in APA Style

Although the major sections described above are common to most research papers written in APA style, there are variations on that pattern.  These variations include: 

• Literature reviews – when a paper is reviewing prior published research and not presenting new empirical research itself (such as in a review article, and particularly a qualitative review), then the authors may forgo any Methods and Results sections. Instead, there is a different structure such as an Introduction section followed by sections for each of the different aspects of the body of research being reviewed, and then perhaps a Discussion section. 
• Multi-experiment papers – when there are multiple experiments, it is common to follow the Introduction with an Experiment 1 section, itself containing Methods, Results, and Discussion subsections. Then there is an Experiment 2 section with a similar structure, an Experiment 3 section with a similar structure, and so on until all experiments are covered.  Towards the end of the paper there is a General Discussion section followed by References.  Additionally, in multi-experiment papers, it is common for the Results and Discussion subsections for individual experiments to be combined into single “Results and Discussion” sections.

Departures from APA Style

In some cases, official APA style might not be followed (however, be sure to check with your editor, instructor, or other sources before deviating from standards of the Publication Manual of the American Psychological Association).  Such deviations may include:

• Placement of Tables and Figures  – in some cases, to make reading through the paper easier, Tables and/or Figures are embedded in the text (for example, having a bar graph placed in the relevant Results section). The embedding of Tables and/or Figures in the text is one of the most common deviations from APA style (and is commonly allowed in B.S. Degree Research Papers and Honors Theses; however you should check with your instructor, supervisor, or editor first). 
• Incomplete research – sometimes a B.S. Degree Research Paper in this department is written about research that is currently being planned or is in progress. In those circumstances, sometimes only an Introduction and Methods section, followed by References, is included (that is, in cases where the research itself has not formally begun).  In other cases, preliminary results are presented and noted as such in the Results section (such as in cases where the study is underway but not complete), and the Discussion section includes caveats about the in-progress nature of the research.  Again, you should check with your instructor, supervisor, or editor first.
• Class assignments – in some classes in this department, an assignment must be written in APA style but is not exactly a traditional research paper (for instance, a student asked to write about an article that they read, and to write that report in APA style). In that case, the structure of the paper might approximate the typical sections of a research paper in APA style, but not entirely.  You should check with your instructor for further guidelines.

Workshops and Downloadable Resources

• For in-person discussion of the process of writing research papers, please consider attending this department’s “Writing Research Papers” workshop (for dates and times, please check the undergraduate workshops calendar).

Downloadable Resources

• How to Write APA Style Research Papers (a comprehensive guide) [ PDF ]
• Tips for Writing APA Style Research Papers (a brief summary) [ PDF ]
• Example APA Style Research Paper (for B.S. Degree – empirical research) [ PDF ]
• Example APA Style Research Paper (for B.S. Degree – literature review) [ PDF ]

Further Resources

How-To Videos     

• Writing Research Paper Videos

APA Journal Article Reporting Guidelines

• Appelbaum, M., Cooper, H., Kline, R. B., Mayo-Wilson, E., Nezu, A. M., & Rao, S. M. (2018). Journal article reporting standards for quantitative research in psychology: The APA Publications and Communications Board task force report . American Psychologist , 73 (1), 3.
• Levitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Suárez-Orozco, C. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report . American Psychologist , 73 (1), 26.  

External Resources

• Formatting APA Style Papers in Microsoft Word
• How to Write an APA Style Research Paper from Hamilton University
• WikiHow Guide to Writing APA Research Papers
• Sample APA Formatted Paper with Comments
• Sample APA Formatted Paper
• Tips for Writing a Paper in APA Style

1 VandenBos, G. R. (Ed). (2010). Publication manual of the American Psychological Association (6th ed.) (pp. 41-60).  Washington, DC: American Psychological Association.

2 geller, e. (2018).  how to write an apa-style research report . [instructional materials]. , prepared by s. c. pan for ucsd psychology.

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• Academic Integrity and Avoiding Plagiarism
• Writing Research Papers Videos

Everything you need to know about primary research

Last updated

28 February 2023

Reviewed by

Miroslav Damyanov

They might search existing research to find the data they need—a technique known as secondary research .

Alternatively, they might prefer to seek out the data they need independently. This is known as primary research.

Analyze your primary research

Bring your primary research together inside Dovetail and uncover actionable insights

• What is primary research?

During primary research, the researcher collects the information and data for a specific sample directly.

Types of primary research

Primary research can take several forms, depending on the type of information studied. Here are the four main types of primary research:

Observations

Focus groups

When conducting primary research, you can collect qualitative or quantitative data (or both).

Qualitative primary data collection provides a vast array of feedback or information about products and services. However, it may need to be interpreted before it is used to make important business decisions.

Quantitative primary data collection , on the other hand, involves looking at the numbers related to a specific product or service.

• What types of projects can benefit from primary research?

Data obtained from primary research may be more accurate than if it were obtained from previous data samples.

Primary research may be used for

Salary guides

Industry benchmarks

Government reports

Any information based on the current state of the target, including statistics related to current information

Scientific studies

Current market research

Crafting user-friendly products

Primary research can also be used to capture any type of sentiment that cannot be represented statistically, verbally, or through transcription. This may include tone of voice, for example. The researcher might want to find out if the subject sounds hesitant, uncertain, or unhappy.

• Methods for conducting primary research

Your methods for conducting primary research may vary based on the information you’re looking for and how you prefer to interact with your target market.

Surveys are a method to obtain direct information and feedback from the target audience. Depending on the target market’s specific needs, they can be conducted over the phone, online, or face-to-face.

Observation

In some cases, primary research will involve watching the behaviors of consumers or members of the target audience.

Communication with members of the target audience who can share direct information and feedback about products and services.

Test marketing

Explore customer response to a product or marketing campaign before a wider release.

Competitor visits

Competitor visits allow you to check out what competitors have to offer to get a better feel for how they interact with their target markets. This approach can help you better understand what the market might be looking for.

This involves bringing a group of people together to discuss a specific product or need within the industry. This approach could help provide essential insights into the needs of that market.

Usability testing

Usability testing allows you to evaluate a product’s usability when you launch a live prototype. You might recruit representative users to perform tasks while you observe, ask questions, and take notes on how they use your product.

• When to conduct primary research

Primary research is needed when you want first-hand information about your product, service, or target market. There are several circumstances where primary research may be the best strategy for getting the information you need.

You might use it to:

Understand pricing information, including what price points customers are likely to purchase at. 

Get insight into your sales process. For example, you might look at screenshots of a sales demo, listen to audio recordings of the sales process, or evaluate key details and descriptions. 

Learn about problems your consumers might be having and how your business can solve them.

Gauge how a company feels about its competitors. For example, you might want to ask an e-tailer if they plan to offer free shipping to compete with Amazon, Walmart, and other major retailers.

• How to get started with primary research

Step one: Define the problem you’re trying to answer. Clearly identify what you want to know and why it’s important. Does the customer want you to perform the “usual?” This is often the case if they are new, inexperienced, or simply too busy and want to have the task taken care of.

Step two: Determine the best method for getting those answers. Do you need quantitative data , which can be measured in multiple-choice surveys? Or do you need more detailed qualitative data , which may require focus groups or interviews?

Step three: Select your target. Where will you conduct your primary research? You may already have a focus group available; for example, a social media group where people already gather to discuss your brand.

Step four: Compile your questions or define your method. Clearly set out what information you need and how you plan to gather it.

Step five: Research!

• Advantages of primary research

Primary research offers a number of potential advantages. Most importantly, it offers you information that you can’t get elsewhere.

It provides you with direct information from consumers who are already members of your target market or using your products.

You are able to get feedback directly from your target audience, which can allow you to immediately improve products or services and provide better support to your target market.

Primary data is current. Secondary sources may contain outdated data.

Primary data is reliable. You will know what methods you used and how the data relates to your research because you collected it yourself.

• Disadvantages of primary research

You might decide primary research isn’t the best option for your research project when you consider the disadvantages.

Primary research can be time-consuming. You will have to put in the time to collect data yourself, meaning the research may take longer to complete.

Primary research may be more expensive to conduct if it involves face-to-face interactions with your target audience, subscriptions for insight platforms, or participant remuneration.

The people you engage with for your research may feel disrupted by information-gathering methods, so you may not be able to use the same focus group every time you conduct that research.

It can be difficult to gather accurate information from a small group of people, especially if you deliberately select a focus group made up of existing customers. 

You may have a hard time accessing people who are not already members of your customer base.

Biased surveys can be a challenge. Researchers may, for example, inadvertently structure questions to encourage participants to respond in a particular way. Questions may also be too confusing or complex for participants to answer accurately.

Despite the researcher’s best efforts, participants don’t always take studies seriously. They may provide inaccurate or irrelevant answers to survey questions, significantly impacting any conclusions you reach. Therefore, researchers must take extra caution when examining results.

Conducting primary research can help you get a closer look at what is really going on with your target market and how they are using your product. That research can then inform your efforts to improve your services and products.

What is primary research, and why is it important?

Primary research is a research method that allows researchers to directly collect information for their use. It can provide more accurate insights into the target audience and market information companies really need.

What are primary research sources?

Primary research sources may include surveys, interviews, visits to competitors, or focus groups.

What is the best method of primary research?

The best method of primary research depends on the type of information you are gathering. If you need qualitative information, you may want to hold focus groups or interviews. On the other hand, if you need quantitative data, you may benefit from conducting surveys with your target audience.

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Writing the title and abstract for a research paper: Being concise, precise, and meticulous is the key

Milind s. tullu.

Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India

This article deals with formulating a suitable title and an appropriate abstract for an original research paper. The “title” and the “abstract” are the “initial impressions” of a research article, and hence they need to be drafted correctly, accurately, carefully, and meticulously. Often both of these are drafted after the full manuscript is ready. Most readers read only the title and the abstract of a research paper and very few will go on to read the full paper. The title and the abstract are the most important parts of a research paper and should be pleasant to read. The “title” should be descriptive, direct, accurate, appropriate, interesting, concise, precise, unique, and should not be misleading. The “abstract” needs to be simple, specific, clear, unbiased, honest, concise, precise, stand-alone, complete, scholarly, (preferably) structured, and should not be misrepresentative. The abstract should be consistent with the main text of the paper, especially after a revision is made to the paper and should include the key message prominently. It is very important to include the most important words and terms (the “keywords”) in the title and the abstract for appropriate indexing purpose and for retrieval from the search engines and scientific databases. Such keywords should be listed after the abstract. One must adhere to the instructions laid down by the target journal with regard to the style and number of words permitted for the title and the abstract.

Introduction

This article deals with drafting a suitable “title” and an appropriate “abstract” for an original research paper. Because the “title” and the “abstract” are the “initial impressions” or the “face” of a research article, they need to be drafted correctly, accurately, carefully, meticulously, and consume time and energy.[ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ] Often, these are drafted after the complete manuscript draft is ready.[ 2 , 3 , 4 , 5 , 9 , 10 , 11 ] Most readers will read only the title and the abstract of a published research paper, and very few “interested ones” (especially, if the paper is of use to them) will go on to read the full paper.[ 1 , 2 ] One must remember to adhere to the instructions laid down by the “target journal” (the journal for which the author is writing) regarding the style and number of words permitted for the title and the abstract.[ 2 , 4 , 5 , 7 , 8 , 9 , 12 ] Both the title and the abstract are the most important parts of a research paper – for editors (to decide whether to process the paper for further review), for reviewers (to get an initial impression of the paper), and for the readers (as these may be the only parts of the paper available freely and hence, read widely).[ 4 , 8 , 12 ] It may be worth for the novice author to browse through titles and abstracts of several prominent journals (and their target journal as well) to learn more about the wording and styles of the titles and abstracts, as well as the aims and scope of the particular journal.[ 5 , 7 , 9 , 13 ]

The details of the title are discussed under the subheadings of importance, types, drafting, and checklist.

Importance of the title

When a reader browses through the table of contents of a journal issue (hard copy or on website), the title is the “ first detail” or “face” of the paper that is read.[ 2 , 3 , 4 , 5 , 6 , 13 ] Hence, it needs to be simple, direct, accurate, appropriate, specific, functional, interesting, attractive/appealing, concise/brief, precise/focused, unambiguous, memorable, captivating, informative (enough to encourage the reader to read further), unique, catchy, and it should not be misleading.[ 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 ] It should have “just enough details” to arouse the interest and curiosity of the reader so that the reader then goes ahead with studying the abstract and then (if still interested) the full paper.[ 1 , 2 , 4 , 13 ] Journal websites, electronic databases, and search engines use the words in the title and abstract (the “keywords”) to retrieve a particular paper during a search; hence, the importance of these words in accessing the paper by the readers has been emphasized.[ 3 , 4 , 5 , 6 , 12 , 14 ] Such important words (or keywords) should be arranged in appropriate order of importance as per the context of the paper and should be placed at the beginning of the title (rather than the later part of the title, as some search engines like Google may just display only the first six to seven words of the title).[ 3 , 5 , 12 ] Whimsical, amusing, or clever titles, though initially appealing, may be missed or misread by the busy reader and very short titles may miss the essential scientific words (the “keywords”) used by the indexing agencies to catch and categorize the paper.[ 1 , 3 , 4 , 9 ] Also, amusing or hilarious titles may be taken less seriously by the readers and may be cited less often.[ 4 , 15 ] An excessively long or complicated title may put off the readers.[ 3 , 9 ] It may be a good idea to draft the title after the main body of the text and the abstract are drafted.[ 2 , 3 , 4 , 5 ]

Types of titles

Titles can be descriptive, declarative, or interrogative. They can also be classified as nominal, compound, or full-sentence titles.

Descriptive or neutral title

This has the essential elements of the research theme, that is, the patients/subjects, design, interventions, comparisons/control, and outcome, but does not reveal the main result or the conclusion.[ 3 , 4 , 12 , 16 ] Such a title allows the reader to interpret the findings of the research paper in an impartial manner and with an open mind.[ 3 ] These titles also give complete information about the contents of the article, have several keywords (thus increasing the visibility of the article in search engines), and have increased chances of being read and (then) being cited as well.[ 4 ] Hence, such descriptive titles giving a glimpse of the paper are generally preferred.[ 4 , 16 ]

Declarative title

This title states the main finding of the study in the title itself; it reduces the curiosity of the reader, may point toward a bias on the part of the author, and hence is best avoided.[ 3 , 4 , 12 , 16 ]

Interrogative title

This is the one which has a query or the research question in the title.[ 3 , 4 , 16 ] Though a query in the title has the ability to sensationalize the topic, and has more downloads (but less citations), it can be distracting to the reader and is again best avoided for a research article (but can, at times, be used for a review article).[ 3 , 6 , 16 , 17 ]

From a sentence construct point of view, titles may be nominal (capturing only the main theme of the study), compound (with subtitles to provide additional relevant information such as context, design, location/country, temporal aspect, sample size, importance, and a provocative or a literary; for example, see the title of this review), or full-sentence titles (which are longer and indicate an added degree of certainty of the results).[ 4 , 6 , 9 , 16 ] Any of these constructs may be used depending on the type of article, the key message, and the author's preference or judgement.[ 4 ]

Drafting a suitable title

A stepwise process can be followed to draft the appropriate title. The author should describe the paper in about three sentences, avoiding the results and ensuring that these sentences contain important scientific words/keywords that describe the main contents and subject of the paper.[ 1 , 4 , 6 , 12 ] Then the author should join the sentences to form a single sentence, shorten the length (by removing redundant words or adjectives or phrases), and finally edit the title (thus drafted) to make it more accurate, concise (about 10–15 words), and precise.[ 1 , 3 , 4 , 5 , 9 ] Some journals require that the study design be included in the title, and this may be placed (using a colon) after the primary title.[ 2 , 3 , 4 , 14 ] The title should try to incorporate the Patients, Interventions, Comparisons and Outcome (PICO).[ 3 ] The place of the study may be included in the title (if absolutely necessary), that is, if the patient characteristics (such as study population, socioeconomic conditions, or cultural practices) are expected to vary as per the country (or the place of the study) and have a bearing on the possible outcomes.[ 3 , 6 ] Lengthy titles can be boring and appear unfocused, whereas very short titles may not be representative of the contents of the article; hence, optimum length is required to ensure that the title explains the main theme and content of the manuscript.[ 4 , 5 , 9 ] Abbreviations (except the standard or commonly interpreted ones such as HIV, AIDS, DNA, RNA, CDC, FDA, ECG, and EEG) or acronyms should be avoided in the title, as a reader not familiar with them may skip such an article and nonstandard abbreviations may create problems in indexing the article.[ 3 , 4 , 5 , 6 , 9 , 12 ] Also, too much of technical jargon or chemical formulas in the title may confuse the readers and the article may be skipped by them.[ 4 , 9 ] Numerical values of various parameters (stating study period or sample size) should also be avoided in the titles (unless deemed extremely essential).[ 4 ] It may be worthwhile to take an opinion from a impartial colleague before finalizing the title.[ 4 , 5 , 6 ] Thus, multiple factors (which are, at times, a bit conflicting or contrasting) need to be considered while formulating a title, and hence this should not be done in a hurry.[ 4 , 6 ] Many journals ask the authors to draft a “short title” or “running head” or “running title” for printing in the header or footer of the printed paper.[ 3 , 12 ] This is an abridged version of the main title of up to 40–50 characters, may have standard abbreviations, and helps the reader to navigate through the paper.[ 3 , 12 , 14 ]

Checklist for a good title

Table 1 gives a checklist/useful tips for drafting a good title for a research paper.[ 1 , 2 , 3 , 4 , 5 , 6 , 12 ] Table 2 presents some of the titles used by the author of this article in his earlier research papers, and the appropriateness of the titles has been commented upon. As an individual exercise, the reader may try to improvise upon the titles (further) after reading the corresponding abstract and full paper.

Checklist/useful tips for drafting a good title for a research paper

Some titles used by author of this article in his earlier publications and remark/comment on their appropriateness

The Abstract

The details of the abstract are discussed under the subheadings of importance, types, drafting, and checklist.

Importance of the abstract

The abstract is a summary or synopsis of the full research paper and also needs to have similar characteristics like the title. It needs to be simple, direct, specific, functional, clear, unbiased, honest, concise, precise, self-sufficient, complete, comprehensive, scholarly, balanced, and should not be misleading.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 13 , 17 ] Writing an abstract is to extract and summarize (AB – absolutely, STR – straightforward, ACT – actual data presentation and interpretation).[ 17 ] The title and abstracts are the only sections of the research paper that are often freely available to the readers on the journal websites, search engines, and in many abstracting agencies/databases, whereas the full paper may attract a payment per view or a fee for downloading the pdf copy.[ 1 , 2 , 3 , 7 , 8 , 10 , 11 , 13 , 14 ] The abstract is an independent and stand-alone (that is, well understood without reading the full paper) section of the manuscript and is used by the editor to decide the fate of the article and to choose appropriate reviewers.[ 2 , 7 , 10 , 12 , 13 ] Even the reviewers are initially supplied only with the title and the abstract before they agree to review the full manuscript.[ 7 , 13 ] This is the second most commonly read part of the manuscript, and therefore it should reflect the contents of the main text of the paper accurately and thus act as a “real trailer” of the full article.[ 2 , 7 , 11 ] The readers will go through the full paper only if they find the abstract interesting and relevant to their practice; else they may skip the paper if the abstract is unimpressive.[ 7 , 8 , 9 , 10 , 13 ] The abstract needs to highlight the selling point of the manuscript and succeed in luring the reader to read the complete paper.[ 3 , 7 ] The title and the abstract should be constructed using keywords (key terms/important words) from all the sections of the main text.[ 12 ] Abstracts are also used for submitting research papers to a conference for consideration for presentation (as oral paper or poster).[ 9 , 13 , 17 ] Grammatical and typographic errors reflect poorly on the quality of the abstract, may indicate carelessness/casual attitude on part of the author, and hence should be avoided at all times.[ 9 ]

Types of abstracts

The abstracts can be structured or unstructured. They can also be classified as descriptive or informative abstracts.

Structured and unstructured abstracts

Structured abstracts are followed by most journals, are more informative, and include specific subheadings/subsections under which the abstract needs to be composed.[ 1 , 7 , 8 , 9 , 10 , 11 , 13 , 17 , 18 ] These subheadings usually include context/background, objectives, design, setting, participants, interventions, main outcome measures, results, and conclusions.[ 1 ] Some journals stick to the standard IMRAD format for the structure of the abstracts, and the subheadings would include Introduction/Background, Methods, Results, And (instead of Discussion) the Conclusion/s.[ 1 , 2 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 17 , 18 ] Structured abstracts are more elaborate, informative, easy to read, recall, and peer-review, and hence are preferred; however, they consume more space and can have same limitations as an unstructured abstract.[ 7 , 9 , 18 ] The structured abstracts are (possibly) better understood by the reviewers and readers. Anyway, the choice of the type of the abstract and the subheadings of a structured abstract depend on the particular journal style and is not left to the author's wish.[ 7 , 10 , 12 ] Separate subheadings may be necessary for reporting meta-analysis, educational research, quality improvement work, review, or case study.[ 1 ] Clinical trial abstracts need to include the essential items mentioned in the CONSORT (Consolidated Standards Of Reporting Trials) guidelines.[ 7 , 9 , 14 , 19 ] Similar guidelines exist for various other types of studies, including observational studies and for studies of diagnostic accuracy.[ 20 , 21 ] A useful resource for the above guidelines is available at www.equator-network.org (Enhancing the QUAlity and Transparency Of health Research). Unstructured (or non-structured) abstracts are free-flowing, do not have predefined subheadings, and are commonly used for papers that (usually) do not describe original research.[ 1 , 7 , 9 , 10 ]

The four-point structured abstract: This has the following elements which need to be properly balanced with regard to the content/matter under each subheading:[ 9 ]

Background and/or Objectives: This states why the work was undertaken and is usually written in just a couple of sentences.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 ] The hypothesis/study question and the major objectives are also stated under this subheading.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 ]

Methods: This subsection is the longest, states what was done, and gives essential details of the study design, setting, participants, blinding, sample size, sampling method, intervention/s, duration and follow-up, research instruments, main outcome measures, parameters evaluated, and how the outcomes were assessed or analyzed.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

Results/Observations/Findings: This subheading states what was found, is longer, is difficult to draft, and needs to mention important details including the number of study participants, results of analysis (of primary and secondary objectives), and include actual data (numbers, mean, median, standard deviation, “P” values, 95% confidence intervals, effect sizes, relative risks, odds ratio, etc.).[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

Conclusions: The take-home message (the “so what” of the paper) and other significant/important findings should be stated here, considering the interpretation of the research question/hypothesis and results put together (without overinterpreting the findings) and may also include the author's views on the implications of the study.[ 3 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 ]

The eight-point structured abstract: This has the following eight subheadings – Objectives, Study Design, Study Setting, Participants/Patients, Methods/Intervention, Outcome Measures, Results, and Conclusions.[ 3 , 9 , 18 ] The instructions to authors given by the particular journal state whether they use the four- or eight-point abstract or variants thereof.[ 3 , 14 ]

Descriptive and Informative abstracts

Descriptive abstracts are short (75–150 words), only portray what the paper contains without providing any more details; the reader has to read the full paper to know about its contents and are rarely used for original research papers.[ 7 , 10 ] These are used for case reports, reviews, opinions, and so on.[ 7 , 10 ] Informative abstracts (which may be structured or unstructured as described above) give a complete detailed summary of the article contents and truly reflect the actual research done.[ 7 , 10 ]

Drafting a suitable abstract

It is important to religiously stick to the instructions to authors (format, word limit, font size/style, and subheadings) provided by the journal for which the abstract and the paper are being written.[ 7 , 8 , 9 , 10 , 13 ] Most journals allow 200–300 words for formulating the abstract and it is wise to restrict oneself to this word limit.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 22 ] Though some authors prefer to draft the abstract initially, followed by the main text of the paper, it is recommended to draft the abstract in the end to maintain accuracy and conformity with the main text of the paper (thus maintaining an easy linkage/alignment with title, on one hand, and the introduction section of the main text, on the other hand).[ 2 , 7 , 9 , 10 , 11 ] The authors should check the subheadings (of the structured abstract) permitted by the target journal, use phrases rather than sentences to draft the content of the abstract, and avoid passive voice.[ 1 , 7 , 9 , 12 ] Next, the authors need to get rid of redundant words and edit the abstract (extensively) to the correct word count permitted (every word in the abstract “counts”!).[ 7 , 8 , 9 , 10 , 13 ] It is important to ensure that the key message, focus, and novelty of the paper are not compromised; the rationale of the study and the basis of the conclusions are clear; and that the abstract is consistent with the main text of the paper.[ 1 , 2 , 3 , 7 , 9 , 11 , 12 , 13 , 14 , 17 , 22 ] This is especially important while submitting a revision of the paper (modified after addressing the reviewer's comments), as the changes made in the main (revised) text of the paper need to be reflected in the (revised) abstract as well.[ 2 , 10 , 12 , 14 , 22 ] Abbreviations should be avoided in an abstract, unless they are conventionally accepted or standard; references, tables, or figures should not be cited in the abstract.[ 7 , 9 , 10 , 11 , 13 ] It may be worthwhile not to rush with the abstract and to get an opinion by an impartial colleague on the content of the abstract; and if possible, the full paper (an “informal” peer-review).[ 1 , 7 , 8 , 9 , 11 , 17 ] Appropriate “Keywords” (three to ten words or phrases) should follow the abstract and should be preferably chosen from the Medical Subject Headings (MeSH) list of the U.S. National Library of Medicine ( https://meshb.nlm.nih.gov/search ) and are used for indexing purposes.[ 2 , 3 , 11 , 12 ] These keywords need to be different from the words in the main title (the title words are automatically used for indexing the article) and can be variants of the terms/phrases used in the title, or words from the abstract and the main text.[ 3 , 12 ] The ICMJE (International Committee of Medical Journal Editors; http://www.icmje.org/ ) also recommends publishing the clinical trial registration number at the end of the abstract.[ 7 , 14 ]

Checklist for a good abstract

Table 3 gives a checklist/useful tips for formulating a good abstract for a research paper.[ 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 17 , 22 ]

Checklist/useful tips for formulating a good abstract for a research paper

Concluding Remarks

This review article has given a detailed account of the importance and types of titles and abstracts. It has also attempted to give useful hints for drafting an appropriate title and a complete abstract for a research paper. It is hoped that this review will help the authors in their career in medical writing.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgement

The author thanks Dr. Hemant Deshmukh - Dean, Seth G.S. Medical College & KEM Hospital, for granting permission to publish this manuscript.

• Harvard Library
• Research Guides
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Library Research Guide for the History of Science: Introduction

• What is a Primary Source?
• Senior Theses 2023
• Background and Context/Biography
• Exploring Your Topic
• Using HOLLIS
• What is a Secondary Source?

Page Contents

Knowing a primary source when you see one, kinds of primary sources, find primary sources in hollis, using digital libraries and collections online, using bibliographies.

• Exploring the Special Collections at Harvard
• Citing Sources & Organizing Research

Primary sources provide first-hand testimony or direct evidence concerning a topic under investigation. They are created by witnesses or recorders who experienced the events or conditions being documented.

Often these sources are created at the time when the events or conditions are occurring, but primary sources can also include autobiographies, memoirs, and oral histories recorded later.

Primary sources are characterized by their content, regardless of the format available. (Handwritten notes could be published; the published book might be digitized or put on microfilm, but those notes are still primary sources in any format).

Some types of primary sources:

• Original documents (excerpts or translations acceptable): Diaries, speeches, manuscripts, letters, interviews, news film footage, contemporary newspaper articles, autobiographies, official records, pamphlets, meeting notes, photographs, contemporary sketches
• Creative works : Poetry, drama, novels, music, art 
• Relics or artifacts : Furniture, clothing, buildings

Examples of primary sources include:

• A poster from the Brotherhood of Sleeping Car Porters' 1962 strike
• The papers of William James
• A 1970 U.S. State Dept document updating Nixon on U.S.-Soviet space cooperation activities (Harvard login)
• A British pamphlet: "Electric Lighting for Country Houses," 1898
• Phineas Gage's skull
• The text of J. Robert Oppenheimer's "Atomic Weapons" presentation to the American Philosophical Society

Outline of Primary Sources for History

Archives and Manuscripts

Archives and manuscripts are the unpublished records of persons (letters, notes, diaries, etc.) and organizations. What are Archives?   Usually each archival collection has a (short) catalog record and a detailed finding aid (which is often available online).

• "Catalog record” refers to the kind of record found in library online catalogs, similar to those for books, although often a bit longer. Example of an Archive record .
• “Finding aid” (sometimes called an inventory) generally refers to a list of the folder labels for the collection, accompanied by a brief collection overview (scope and contents note) and a biographical (or institutional) note on the creator of the collection.  Finding aids may be as long as needed given the size of the collection.  They vary considerably according to the practices of individual repositories. Example of a Finding aid .

To find  Archives and manuscripts  at Harvard, go to  HOLLIS Advanced search .  Search your keywords or Subject terms (see the  HOLLIS page of this guide ) in the Library Catalog, limiting to Resource Type: Archives/Manuscripts.  You can choose the library at the right (Search Scope).  Countway  Medicine has abundant medical archives, and Schlesinger has many archives of women activists, many in health and reproductive rights fields.    Sample search on Subject: Women health .

Library Research Guide for Finding Manuscripts and Archival Collections explains

• How to find archives and manuscripts at Harvard
• How to find archives and manuscripts elsewhere in US via search tools and via subject guides .
• How to find archives and manuscripts in Europe and elsewhere.
• Requesting digitization of archival material from Harvard and from other repositories .

For digitized archival material together with other kinds of primary sources:

• Finding Primary Sources Online offers general instructions for finding primary sources online and a list of resources by region and country
• Online Primary Source Collections for the History of Science lists digital collections at Harvard and beyond by topic.
• Online Primary Source Collections for History lists digital collections at Harvard and beyond by topic.

Methods for finding books are described under the HOLLIS page  of this guide and in the Finding Primary Sources in HOLLIS box on this page. 

• Book Reviews may give an indication as to how a scientific work was received. See:   Finding Book Reviews . 
• Numerous, especially pre-1923 books (as well as periodicals and other sources) can be found and full text searched in several digital libraries (see box on this page).

Periodicals

Scientific articles :

Web of Science Citation Indexes (Harvard Login)  (1900- ) articles in all areas of science. Includes medical articles not in PubMed. You can use the Cited Reference search in the Web of Science to find primary source articles that cite a specified article, thus getting an idea of its reception. More information on the Web of Science .

PubMed (1946- ) covers, usually with abstracts, periodical articles on all areas of medicine. - --Be sure to look at the MeSH (Medical Subject Headings)  at the bottom of pertinent records. Very recent articles may not as yet received their MeSH terms.  So look at older records to find the MeSH terms, and use a variety of keywords as well as MeSH terms to find the new records. --​The MeSH terms are the same as the Medical Subject terms found in HOLLIS. --Hit Free article or Try Harvard Library, not the publisher's name to see full text

JSTOR (Harvard Login)  offers full-text of complete runs (up to about 5 years ago) of over 400 journals. JSTOR allows simultaneous or individual searching, full-text searching optional, numerous journals in a variety of fields of science and medicine. See the list at the bottom of the Advanced search screen. JSTOR searches the "Notes and News" sections of journals ( Science is especially rich in this material). In Advanced Search choose Item Type: Miscellaneous to limit largely to "Notes and News".

PsycINFO) (Harvard Login)  (1872- ) indexes the professional and academic literature in psychology and related disciplines

Many more scientific periodical indexes are listed in the Library Research Guide for the History of Science .

General interest magazines and periodicals see:

American Periodicals Series Online (Harvard Login)  (1740-1900) offers full text of about 1100 American periodicals. Includes several scientific and medical journals including the American Journal of Science and the Medical Repository. In cases where a periodical started before 1900, coverage is included until 1940.

British Periodicals (Harvard Login)  (1681-1920) offers full text for several hundred British periodicals.

Ethnic NewsWatch (Harvard Login)  (1959- ) is a full text database of the newspapers, magazines, and journals of the ethnic, minority and native press.

Periodicals Index Online (Harvard Login)  indexes contents of thousands of US and European journals in the humanities and social sciences, from their first issues to 1995.

Reader's Guide Retrospective (WilsonWeb) (Harvard Login)  (1890-1982)  indexes many American popular periodicals.

Many more general periodical indexes are listed in Finding Articles in General and Popular Periodicals (North America and Western Europe) .

Articles in non-science fields (religion, public policy): see the list in the Library Research Guide for History .

Professional/Trade : Aimed at particular trades or professions.  See the Library Research Guide for History

Newspaper articles : see the Guide to Newspapers and Newspaper Indexes .

Personal accounts . These are first person narratives recalling or describing a person’s life and opinions. These include Diaries, memoirs, autobiographies, and when delivered orally and recorded: Oral histories and Interviews.

National Library of Medicine Oral Histories

Regulatory Oral History Hub  (Kenan Institute for Ethics, Duke University) offers links to digital collections containing interviews with regulators, lawyers, and judges. Mainly U.S.

Visual sources :

Records for many, but by no means all, individual Harvard University Library images are available in  HOLLIS Images , an online catalog of images. Records include subjects and a thumbnail image.  HOLLIS Images is included in HOLLIS  searches.

Science & Society Picture Library offers over 50,000 images from the Science Museum (London), the National Museum of Photography, Film & Television and the National Railway Museum.

Database of Scientific Illustrators  (DSI) includes over 12500 illustrators in natural history, medicine, technology and various sciences worldwide, c.1450-1950. Living illustrators excluded. 

NYPL Digital Gallery Pictures of Science: 700 Years of Scientific and Medical Illustration

Images from the History of Medicine (IHM) includes prints and photographs from the U.S. National Library of Medicine. (The IHM is contained within a larger NLM image database, so this link goes to a specialized search).

Images From the History of the Public Health Service: a Photographic Exhibit .

Wellcome Images

Films/Videos

To find films in  HOLLIS , search your topic keywords, then on the right side of the results screen, look at Resource Type and choose video/film.

To find books about films about your topic, search your topic keywords AND "in motion pictures" ​  (in "")

​Film Platform  offers numerous documentary films on a wide variety of subjects.  There are collections on several topics. Searches can be filtered by topic, country of production, and language. 

A list of general sources for images and film is available in the Library Research Guide for History and additional sources for the history of science in Library Research Guide for the History of Science .

Government documents often concern matters of science and health policy.  For Congressional documents, especially committee reports, see ProQuest Congressional (Harvard Login ). 

HathiTrust Digital Library . Each full text item is linked to a standard library catalog record, thus providing good metadata and subject terms. The catalog can be searched separately.  Many government documents are full text viewable.  Search US government department as Author.

More sources are listed in the Library Research Guide for History

For artifacts and other objects , the Historic Scientific Instruments Collection in the Science Center includes over 15,000 instruments, often with contemporary documentation, from 1450 through the 20th century worldwide.

Waywiser, online database of the Collection of Historical Scientific Instruments .

Warren Anatomical Museum of the Center for the History of Medicine in the Countway Library of Medicine has a rich collection of medical artifacts and specimens.

Peabody Museum of Archaeology and Ethnology

Fall 2020: these collections are closed during the pandemic. Check out their links above to see what they have available online.

Primary Source Terms :

You can limit HOLLIS  searches to your time period, but sources may be published later, such as a person's diary published posthumously. Find these with these special Subject terms.

You can use the following terms to search HOLLIS for primary sources:

• Correspondence
• Description and travel
• Manuscripts
• Notebooks, sketchbooks, etc.
• Personal narratives (refers to accounts of wars and diseases only)
• Pictorial works
• Sources (usually refers to collections of published primary sources)

Include these terms with your topical words in HOLLIS searches. For example: tuberculosis personal narratives

Online Primary Source Collections for the History of Science lists digital collections at Harvard and beyond by topic

Google Book Search, HathiTrust Digital Library and Internet Archives offer books and periodicals digitized from numerous libraries.  Only out-of-copyright, generally post-1923, books are fully viewable.  Each of these three digital libraries allows searching full text over their entire collections.

Google Book Search

HathiTrust Digital Library . Each full text item is linked to a standard library catalog record, thus providing good metadata and subject terms. The catalog can be searched separately.  Many post-1923 out-of-copyright books, especially government documents, are full text viewable. You can search within copyright books to see what page your search term is on.

Internet Archive now offers a beta full text search. Put your terms (phrases or personal names, in quotation marks (""), work best) in the search box. 

The Online Books Page arranges electronic texts by Library of Congress call numbers and is searchable (but not full text searchable).  Includes books not in Google Books, HathiTrust, or Internet Archive. Has many other useful features.

Medical Heritage Library . Information about the Medical Heritage Library. Now searchable full text.

UK Medical Heritage Library

Biodiversity Heritage Library

Contagion: Historical Views of Diseases and Epidemics (1493-1922) provides digitized historical, manuscript, and image resources selected from Harvard University libraries and archives.

Expeditions and Discoveries (1626-1953) features nine expeditions in anthropology and archaeology, astronomy, botany, and oceanography in which Harvard University played a significant role. Includes manuscripts and records, published materials, visual works, and maps from 14 Harvard repositories.

Defining Gender Online: Five Centuries of Advice Literature for Men and Women (1450-1910).

Twentieth Century Advice Literature: North American Guides on Race, Sex, Gender, and the Family.

Many more general History digital libraries and collections: Library Research Guide for History

More History of Science digital libraries: Library Research Guide for the History of Science .

There may already be a detailed list of sources (a bibliography) for your topic.

For instance:

A bibliography of eugenics , by Samuel J. Holmes ... Berkeley, Calif., University of California press, 1924, 514 p. ( University of California publications in zoology . vol. XXV)  Full text online .

Look for specialized subject bibliographies in HOLLIS Catalog . Example .   WorldCat can do similar searches in the Subject Keyword field for non-Harvard holdings.

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Research Paper – Structure, Examples and Writing Guide

Table of Contents

Research Paper

Definition:

Research Paper is a written document that presents the author’s original research, analysis, and interpretation of a specific topic or issue.

It is typically based on Empirical Evidence, and may involve qualitative or quantitative research methods, or a combination of both. The purpose of a research paper is to contribute new knowledge or insights to a particular field of study, and to demonstrate the author’s understanding of the existing literature and theories related to the topic.

Structure of Research Paper

The structure of a research paper typically follows a standard format, consisting of several sections that convey specific information about the research study. The following is a detailed explanation of the structure of a research paper:

The title page contains the title of the paper, the name(s) of the author(s), and the affiliation(s) of the author(s). It also includes the date of submission and possibly, the name of the journal or conference where the paper is to be published.

The abstract is a brief summary of the research paper, typically ranging from 100 to 250 words. It should include the research question, the methods used, the key findings, and the implications of the results. The abstract should be written in a concise and clear manner to allow readers to quickly grasp the essence of the research.

Introduction

The introduction section of a research paper provides background information about the research problem, the research question, and the research objectives. It also outlines the significance of the research, the research gap that it aims to fill, and the approach taken to address the research question. Finally, the introduction section ends with a clear statement of the research hypothesis or research question.

Literature Review

The literature review section of a research paper provides an overview of the existing literature on the topic of study. It includes a critical analysis and synthesis of the literature, highlighting the key concepts, themes, and debates. The literature review should also demonstrate the research gap and how the current study seeks to address it.

The methods section of a research paper describes the research design, the sample selection, the data collection and analysis procedures, and the statistical methods used to analyze the data. This section should provide sufficient detail for other researchers to replicate the study.

The results section presents the findings of the research, using tables, graphs, and figures to illustrate the data. The findings should be presented in a clear and concise manner, with reference to the research question and hypothesis.

The discussion section of a research paper interprets the findings and discusses their implications for the research question, the literature review, and the field of study. It should also address the limitations of the study and suggest future research directions.

The conclusion section summarizes the main findings of the study, restates the research question and hypothesis, and provides a final reflection on the significance of the research.

The references section provides a list of all the sources cited in the paper, following a specific citation style such as APA, MLA or Chicago.

How to Write Research Paper

You can write Research Paper by the following guide:

• Choose a Topic: The first step is to select a topic that interests you and is relevant to your field of study. Brainstorm ideas and narrow down to a research question that is specific and researchable.
• Conduct a Literature Review: The literature review helps you identify the gap in the existing research and provides a basis for your research question. It also helps you to develop a theoretical framework and research hypothesis.
• Develop a Thesis Statement : The thesis statement is the main argument of your research paper. It should be clear, concise and specific to your research question.
• Plan your Research: Develop a research plan that outlines the methods, data sources, and data analysis procedures. This will help you to collect and analyze data effectively.
• Collect and Analyze Data: Collect data using various methods such as surveys, interviews, observations, or experiments. Analyze data using statistical tools or other qualitative methods.
• Organize your Paper : Organize your paper into sections such as Introduction, Literature Review, Methods, Results, Discussion, and Conclusion. Ensure that each section is coherent and follows a logical flow.
• Write your Paper : Start by writing the introduction, followed by the literature review, methods, results, discussion, and conclusion. Ensure that your writing is clear, concise, and follows the required formatting and citation styles.
• Edit and Proofread your Paper: Review your paper for grammar and spelling errors, and ensure that it is well-structured and easy to read. Ask someone else to review your paper to get feedback and suggestions for improvement.
• Cite your Sources: Ensure that you properly cite all sources used in your research paper. This is essential for giving credit to the original authors and avoiding plagiarism.

Research Paper Example

Note : The below example research paper is for illustrative purposes only and is not an actual research paper. Actual research papers may have different structures, contents, and formats depending on the field of study, research question, data collection and analysis methods, and other factors. Students should always consult with their professors or supervisors for specific guidelines and expectations for their research papers.

Research Paper Example sample for Students:

Title: The Impact of Social Media on Mental Health among Young Adults

Abstract: This study aims to investigate the impact of social media use on the mental health of young adults. A literature review was conducted to examine the existing research on the topic. A survey was then administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO (Fear of Missing Out) are significant predictors of mental health problems among young adults.

Introduction: Social media has become an integral part of modern life, particularly among young adults. While social media has many benefits, including increased communication and social connectivity, it has also been associated with negative outcomes, such as addiction, cyberbullying, and mental health problems. This study aims to investigate the impact of social media use on the mental health of young adults.

Literature Review: The literature review highlights the existing research on the impact of social media use on mental health. The review shows that social media use is associated with depression, anxiety, stress, and other mental health problems. The review also identifies the factors that contribute to the negative impact of social media, including social comparison, cyberbullying, and FOMO.

Methods : A survey was administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The survey included questions on social media use, mental health status (measured using the DASS-21), and perceived impact of social media on their mental health. Data were analyzed using descriptive statistics and regression analysis.

Results : The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO are significant predictors of mental health problems among young adults.

Discussion : The study’s findings suggest that social media use has a negative impact on the mental health of young adults. The study highlights the need for interventions that address the factors contributing to the negative impact of social media, such as social comparison, cyberbullying, and FOMO.

Conclusion : In conclusion, social media use has a significant impact on the mental health of young adults. The study’s findings underscore the need for interventions that promote healthy social media use and address the negative outcomes associated with social media use. Future research can explore the effectiveness of interventions aimed at reducing the negative impact of social media on mental health. Additionally, longitudinal studies can investigate the long-term effects of social media use on mental health.

Limitations : The study has some limitations, including the use of self-report measures and a cross-sectional design. The use of self-report measures may result in biased responses, and a cross-sectional design limits the ability to establish causality.

Implications: The study’s findings have implications for mental health professionals, educators, and policymakers. Mental health professionals can use the findings to develop interventions that address the negative impact of social media use on mental health. Educators can incorporate social media literacy into their curriculum to promote healthy social media use among young adults. Policymakers can use the findings to develop policies that protect young adults from the negative outcomes associated with social media use.

References :

• Twenge, J. M., & Campbell, W. K. (2019). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive medicine reports, 15, 100918.
• Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., … & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in Human Behavior, 69, 1-9.
• Van der Meer, T. G., & Verhoeven, J. W. (2017). Social media and its impact on academic performance of students. Journal of Information Technology Education: Research, 16, 383-398.

Appendix : The survey used in this study is provided below.

Social Media and Mental Health Survey

• How often do you use social media per day?
• Less than 30 minutes
• 30 minutes to 1 hour
• 1 to 2 hours
• 2 to 4 hours
• More than 4 hours
• Which social media platforms do you use?
• Others (Please specify)
• How often do you experience the following on social media?
• Social comparison (comparing yourself to others)
• Cyberbullying
• Fear of Missing Out (FOMO)
• Have you ever experienced any of the following mental health problems in the past month?
• Do you think social media use has a positive or negative impact on your mental health?
• Very positive
• Somewhat positive
• Somewhat negative
• Very negative
• In your opinion, which factors contribute to the negative impact of social media on mental health?
• Social comparison
• In your opinion, what interventions could be effective in reducing the negative impact of social media on mental health?
• Education on healthy social media use
• Counseling for mental health problems caused by social media
• Social media detox programs
• Regulation of social media use

Thank you for your participation!

Applications of Research Paper

Research papers have several applications in various fields, including:

• Advancing knowledge: Research papers contribute to the advancement of knowledge by generating new insights, theories, and findings that can inform future research and practice. They help to answer important questions, clarify existing knowledge, and identify areas that require further investigation.
• Informing policy: Research papers can inform policy decisions by providing evidence-based recommendations for policymakers. They can help to identify gaps in current policies, evaluate the effectiveness of interventions, and inform the development of new policies and regulations.
• Improving practice: Research papers can improve practice by providing evidence-based guidance for professionals in various fields, including medicine, education, business, and psychology. They can inform the development of best practices, guidelines, and standards of care that can improve outcomes for individuals and organizations.
• Educating students : Research papers are often used as teaching tools in universities and colleges to educate students about research methods, data analysis, and academic writing. They help students to develop critical thinking skills, research skills, and communication skills that are essential for success in many careers.
• Fostering collaboration: Research papers can foster collaboration among researchers, practitioners, and policymakers by providing a platform for sharing knowledge and ideas. They can facilitate interdisciplinary collaborations and partnerships that can lead to innovative solutions to complex problems.

When to Write Research Paper

Research papers are typically written when a person has completed a research project or when they have conducted a study and have obtained data or findings that they want to share with the academic or professional community. Research papers are usually written in academic settings, such as universities, but they can also be written in professional settings, such as research organizations, government agencies, or private companies.

Here are some common situations where a person might need to write a research paper:

• For academic purposes: Students in universities and colleges are often required to write research papers as part of their coursework, particularly in the social sciences, natural sciences, and humanities. Writing research papers helps students to develop research skills, critical thinking skills, and academic writing skills.
• For publication: Researchers often write research papers to publish their findings in academic journals or to present their work at academic conferences. Publishing research papers is an important way to disseminate research findings to the academic community and to establish oneself as an expert in a particular field.
• To inform policy or practice : Researchers may write research papers to inform policy decisions or to improve practice in various fields. Research findings can be used to inform the development of policies, guidelines, and best practices that can improve outcomes for individuals and organizations.
• To share new insights or ideas: Researchers may write research papers to share new insights or ideas with the academic or professional community. They may present new theories, propose new research methods, or challenge existing paradigms in their field.

Purpose of Research Paper

The purpose of a research paper is to present the results of a study or investigation in a clear, concise, and structured manner. Research papers are written to communicate new knowledge, ideas, or findings to a specific audience, such as researchers, scholars, practitioners, or policymakers. The primary purposes of a research paper are:

• To contribute to the body of knowledge : Research papers aim to add new knowledge or insights to a particular field or discipline. They do this by reporting the results of empirical studies, reviewing and synthesizing existing literature, proposing new theories, or providing new perspectives on a topic.
• To inform or persuade: Research papers are written to inform or persuade the reader about a particular issue, topic, or phenomenon. They present evidence and arguments to support their claims and seek to persuade the reader of the validity of their findings or recommendations.
• To advance the field: Research papers seek to advance the field or discipline by identifying gaps in knowledge, proposing new research questions or approaches, or challenging existing assumptions or paradigms. They aim to contribute to ongoing debates and discussions within a field and to stimulate further research and inquiry.
• To demonstrate research skills: Research papers demonstrate the author’s research skills, including their ability to design and conduct a study, collect and analyze data, and interpret and communicate findings. They also demonstrate the author’s ability to critically evaluate existing literature, synthesize information from multiple sources, and write in a clear and structured manner.

Characteristics of Research Paper

Research papers have several characteristics that distinguish them from other forms of academic or professional writing. Here are some common characteristics of research papers:

• Evidence-based: Research papers are based on empirical evidence, which is collected through rigorous research methods such as experiments, surveys, observations, or interviews. They rely on objective data and facts to support their claims and conclusions.
• Structured and organized: Research papers have a clear and logical structure, with sections such as introduction, literature review, methods, results, discussion, and conclusion. They are organized in a way that helps the reader to follow the argument and understand the findings.
• Formal and objective: Research papers are written in a formal and objective tone, with an emphasis on clarity, precision, and accuracy. They avoid subjective language or personal opinions and instead rely on objective data and analysis to support their arguments.
• Citations and references: Research papers include citations and references to acknowledge the sources of information and ideas used in the paper. They use a specific citation style, such as APA, MLA, or Chicago, to ensure consistency and accuracy.
• Peer-reviewed: Research papers are often peer-reviewed, which means they are evaluated by other experts in the field before they are published. Peer-review ensures that the research is of high quality, meets ethical standards, and contributes to the advancement of knowledge in the field.
• Objective and unbiased: Research papers strive to be objective and unbiased in their presentation of the findings. They avoid personal biases or preconceptions and instead rely on the data and analysis to draw conclusions.

Advantages of Research Paper

Research papers have many advantages, both for the individual researcher and for the broader academic and professional community. Here are some advantages of research papers:

• Contribution to knowledge: Research papers contribute to the body of knowledge in a particular field or discipline. They add new information, insights, and perspectives to existing literature and help advance the understanding of a particular phenomenon or issue.
• Opportunity for intellectual growth: Research papers provide an opportunity for intellectual growth for the researcher. They require critical thinking, problem-solving, and creativity, which can help develop the researcher’s skills and knowledge.
• Career advancement: Research papers can help advance the researcher’s career by demonstrating their expertise and contributions to the field. They can also lead to new research opportunities, collaborations, and funding.
• Academic recognition: Research papers can lead to academic recognition in the form of awards, grants, or invitations to speak at conferences or events. They can also contribute to the researcher’s reputation and standing in the field.
• Impact on policy and practice: Research papers can have a significant impact on policy and practice. They can inform policy decisions, guide practice, and lead to changes in laws, regulations, or procedures.
• Advancement of society: Research papers can contribute to the advancement of society by addressing important issues, identifying solutions to problems, and promoting social justice and equality.

Limitations of Research Paper

Research papers also have some limitations that should be considered when interpreting their findings or implications. Here are some common limitations of research papers:

• Limited generalizability: Research findings may not be generalizable to other populations, settings, or contexts. Studies often use specific samples or conditions that may not reflect the broader population or real-world situations.
• Potential for bias : Research papers may be biased due to factors such as sample selection, measurement errors, or researcher biases. It is important to evaluate the quality of the research design and methods used to ensure that the findings are valid and reliable.
• Ethical concerns: Research papers may raise ethical concerns, such as the use of vulnerable populations or invasive procedures. Researchers must adhere to ethical guidelines and obtain informed consent from participants to ensure that the research is conducted in a responsible and respectful manner.
• Limitations of methodology: Research papers may be limited by the methodology used to collect and analyze data. For example, certain research methods may not capture the complexity or nuance of a particular phenomenon, or may not be appropriate for certain research questions.
• Publication bias: Research papers may be subject to publication bias, where positive or significant findings are more likely to be published than negative or non-significant findings. This can skew the overall findings of a particular area of research.
• Time and resource constraints: Research papers may be limited by time and resource constraints, which can affect the quality and scope of the research. Researchers may not have access to certain data or resources, or may be unable to conduct long-term studies due to practical limitations.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Primary Sources: An Introduction: Home

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Library Liaison for History, Philosophy, Political Science, & Theology

This is introductory description of what can be considered a primary source for the purposes of a research paper. Students and faculty have access to a wide range of primary source databases. It is highly recommended that student contact a liaison librarian for a research consultation when undertaking a research project using these sources. See the link below to set up a consult:

• Schedule a Research Consultation

There are many resources for primary source materials at Marquette. Physical examples of these include newspaper microfilms, government or non-profit reports, reproductions of historical documents or text, and published diaries or autobiographies. The link below connects to digitized primary sources databases that can accessed by Marquette students and faculty. Please use the research consultation link above for guidance on any of these materials. 

• Primary source digital collections at Marquette Primary source sigital collections are databases where the bulk of materials are documents and objects that provide first-hand documentation of events. Follow this link to view primary source digital collections at the library catalog where you can find database descriptions and links to connect to the databases themselves.
• Historical publication digital collection at Marquette Historical publication digital collections are databases where the bulk of their materials are printed texts published before 1900. Follow this link to view historical publication digital collections at the library catalog where you can find database descriptions and links to connect to the databases themselves.

A primary source is a first-hand or contemporary account of an event. Primary sources date to the time an event took place and offer original account or thoughts on a topic that has not been framed by second-hand interpretation. Primary sources are usually original materials, but they may be reproduced digitally or republished in a physical format.  

This guide from Fresno State University can help you determine if something is a Primary Source.  If you answer 'yes' to any of the following questions, the resource is most like a Primary Source. 

• Did the author personally witness or experience the subject in question?
• Does the author know about this subject because of personal experience rather than having just read about it?
• Is this source a diary, letter, memoir, autobiography, oral history, or interview of a person with first hand experience of the subject?
• Is this source an official document or record published at the time of the event by the government, courts, or another organization?
• Is this source a newspaper or magazine article written at the time of the event?
• Is this a creative work such as a novel, poem, art or music piece created by a firsthand witness of the subject in question?
• Is this an excerpt from a primary source, such as the constitution or a letter written by a Civil War soldier that has been imbedded in a secondary source, such as a textbook? Remember, secondary sources may include reprints of primary sources.
• Is this an artifact or relic such as jewelry, pottery, clothing, music, art, architecture, dance or weaponry that was used by witnesses of the subject in question?
• Is this a compilation of raw scientific data or statistics, such as census statistics published by the U.S. Census Bureau, that is being published without commentary or interpretation?
•  newspapers or other news accounts
•  personal accounts in diaries, letters, interviews, or oral histories
•  government documents or publications
•  speeches
•  photographs/ video footage
•  internal organizational documents
•  memoirs or autobiographies
•  novels, poems, or other works of art

Please note that, in the correct context, many things that are typically considered to be Secondary Sources - such as autobiographies or books about an event or historical period - can also be considered primary sources. For example, if you are writing an analysis of how historians have viewed a certain event over time, written histories on the event can be used as primary sources. 

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How to Write a Research Paper Introduction (with Examples)

The research paper introduction section, along with the Title and Abstract, can be considered the face of any research paper. The following article is intended to guide you in organizing and writing the research paper introduction for a quality academic article or dissertation.

The research paper introduction aims to present the topic to the reader. A study will only be accepted for publishing if you can ascertain that the available literature cannot answer your research question. So it is important to ensure that you have read important studies on that particular topic, especially those within the last five to ten years, and that they are properly referenced in this section. 1 What should be included in the research paper introduction is decided by what you want to tell readers about the reason behind the research and how you plan to fill the knowledge gap. The best research paper introduction provides a systemic review of existing work and demonstrates additional work that needs to be done. It needs to be brief, captivating, and well-referenced; a well-drafted research paper introduction will help the researcher win half the battle.

The introduction for a research paper is where you set up your topic and approach for the reader. It has several key goals:

• Present your research topic
• Capture reader interest
• Summarize existing research
• Position your own approach
• Define your specific research problem and problem statement
• Highlight the novelty and contributions of the study
• Give an overview of the paper’s structure

The research paper introduction can vary in size and structure depending on whether your paper presents the results of original empirical research or is a review paper. Some research paper introduction examples are only half a page while others are a few pages long. In many cases, the introduction will be shorter than all of the other sections of your paper; its length depends on the size of your paper as a whole.

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Table of Contents

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The introduction in a research paper is placed at the beginning to guide the reader from a broad subject area to the specific topic that your research addresses. They present the following information to the reader

• Scope: The topic covered in the research paper
• Context: Background of your topic
• Importance: Why your research matters in that particular area of research and the industry problem that can be targeted

The research paper introduction conveys a lot of information and can be considered an essential roadmap for the rest of your paper. A good introduction for a research paper is important for the following reasons:

• It stimulates your reader’s interest: A good introduction section can make your readers want to read your paper by capturing their interest. It informs the reader what they are going to learn and helps determine if the topic is of interest to them.
• It helps the reader understand the research background: Without a clear introduction, your readers may feel confused and even struggle when reading your paper. A good research paper introduction will prepare them for the in-depth research to come. It provides you the opportunity to engage with the readers and demonstrate your knowledge and authority on the specific topic.
• It explains why your research paper is worth reading: Your introduction can convey a lot of information to your readers. It introduces the topic, why the topic is important, and how you plan to proceed with your research.
• It helps guide the reader through the rest of the paper: The research paper introduction gives the reader a sense of the nature of the information that will support your arguments and the general organization of the paragraphs that will follow. It offers an overview of what to expect when reading the main body of your paper.

What are the parts of introduction in the research?

A good research paper introduction section should comprise three main elements: 2

• What is known: This sets the stage for your research. It informs the readers of what is known on the subject.
• What is lacking: This is aimed at justifying the reason for carrying out your research. This could involve investigating a new concept or method or building upon previous research.
• What you aim to do: This part briefly states the objectives of your research and its major contributions. Your detailed hypothesis will also form a part of this section.

How to write a research paper introduction?

The first step in writing the research paper introduction is to inform the reader what your topic is and why it’s interesting or important. This is generally accomplished with a strong opening statement. The second step involves establishing the kinds of research that have been done and ending with limitations or gaps in the research that you intend to address. Finally, the research paper introduction clarifies how your own research fits in and what problem it addresses. If your research involved testing hypotheses, these should be stated along with your research question. The hypothesis should be presented in the past tense since it will have been tested by the time you are writing the research paper introduction.

The following key points, with examples, can guide you when writing the research paper introduction section:

• Highlight the importance of the research field or topic
• Describe the background of the topic
• Present an overview of current research on the topic

Example: The inclusion of experiential and competency-based learning has benefitted electronics engineering education. Industry partnerships provide an excellent alternative for students wanting to engage in solving real-world challenges. Industry-academia participation has grown in recent years due to the need for skilled engineers with practical training and specialized expertise. However, from the educational perspective, many activities are needed to incorporate sustainable development goals into the university curricula and consolidate learning innovation in universities.

• Reveal a gap in existing research or oppose an existing assumption
• Formulate the research question

Example: There have been plausible efforts to integrate educational activities in higher education electronics engineering programs. However, very few studies have considered using educational research methods for performance evaluation of competency-based higher engineering education, with a focus on technical and or transversal skills. To remedy the current need for evaluating competencies in STEM fields and providing sustainable development goals in engineering education, in this study, a comparison was drawn between study groups without and with industry partners.

• State the purpose of your study
• Highlight the key characteristics of your study
• Describe important results
• Highlight the novelty of the study.
• Offer a brief overview of the structure of the paper.

Example: The study evaluates the main competency needed in the applied electronics course, which is a fundamental core subject for many electronics engineering undergraduate programs. We compared two groups, without and with an industrial partner, that offered real-world projects to solve during the semester. This comparison can help determine significant differences in both groups in terms of developing subject competency and achieving sustainable development goals.

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The purpose of the research paper introduction is to introduce the reader to the problem definition, justify the need for the study, and describe the main theme of the study. The aim is to gain the reader’s attention by providing them with necessary background information and establishing the main purpose and direction of the research.

The length of the research paper introduction can vary across journals and disciplines. While there are no strict word limits for writing the research paper introduction, an ideal length would be one page, with a maximum of 400 words over 1-4 paragraphs. Generally, it is one of the shorter sections of the paper as the reader is assumed to have at least a reasonable knowledge about the topic. 2 For example, for a study evaluating the role of building design in ensuring fire safety, there is no need to discuss definitions and nature of fire in the introduction; you could start by commenting upon the existing practices for fire safety and how your study will add to the existing knowledge and practice.

When deciding what to include in the research paper introduction, the rest of the paper should also be considered. The aim is to introduce the reader smoothly to the topic and facilitate an easy read without much dependency on external sources. 3 Below is a list of elements you can include to prepare a research paper introduction outline and follow it when you are writing the research paper introduction. Topic introduction: This can include key definitions and a brief history of the topic. Research context and background: Offer the readers some general information and then narrow it down to specific aspects. Details of the research you conducted: A brief literature review can be included to support your arguments or line of thought. Rationale for the study: This establishes the relevance of your study and establishes its importance. Importance of your research: The main contributions are highlighted to help establish the novelty of your study Research hypothesis: Introduce your research question and propose an expected outcome. Organization of the paper: Include a short paragraph of 3-4 sentences that highlights your plan for the entire paper

Cite only works that are most relevant to your topic; as a general rule, you can include one to three. Note that readers want to see evidence of original thinking. So it is better to avoid using too many references as it does not leave much room for your personal standpoint to shine through. Citations in your research paper introduction support the key points, and the number of citations depend on the subject matter and the point discussed. If the research paper introduction is too long or overflowing with citations, it is better to cite a few review articles rather than the individual articles summarized in the review. A good point to remember when citing research papers in the introduction section is to include at least one-third of the references in the introduction.

The literature review plays a significant role in the research paper introduction section. A good literature review accomplishes the following: Introduces the topic – Establishes the study’s significance – Provides an overview of the relevant literature – Provides context for the study using literature – Identifies knowledge gaps However, remember to avoid making the following mistakes when writing a research paper introduction: Do not use studies from the literature review to aggressively support your research Avoid direct quoting Do not allow literature review to be the focus of this section. Instead, the literature review should only aid in setting a foundation for the manuscript.

Remember the following key points for writing a good research paper introduction: 4

• Avoid stuffing too much general information: Avoid including what an average reader would know and include only that information related to the problem being addressed in the research paper introduction. For example, when describing a comparative study of non-traditional methods for mechanical design optimization, information related to the traditional methods and differences between traditional and non-traditional methods would not be relevant. In this case, the introduction for the research paper should begin with the state-of-the-art non-traditional methods and methods to evaluate the efficiency of newly developed algorithms.
• Avoid packing too many references: Cite only the required works in your research paper introduction. The other works can be included in the discussion section to strengthen your findings.
• Avoid extensive criticism of previous studies: Avoid being overly critical of earlier studies while setting the rationale for your study. A better place for this would be the Discussion section, where you can highlight the advantages of your method.
• Avoid describing conclusions of the study: When writing a research paper introduction remember not to include the findings of your study. The aim is to let the readers know what question is being answered. The actual answer should only be given in the Results and Discussion section.

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1. Jawaid, S. A., & Jawaid, M. (2019). How to write introduction and discussion. Saudi Journal of Anaesthesia, 13(Suppl 1), S18.

2. Dewan, P., & Gupta, P. (2016). Writing the title, abstract and introduction: Looks matter!. Indian pediatrics, 53, 235-241.

3. Cetin, S., & Hackam, D. J. (2005). An approach to the writing of a scientific Manuscript1. Journal of Surgical Research, 128(2), 165-167.

4. Bavdekar, S. B. (2015). Writing introduction: Laying the foundations of a research paper. Journal of the Association of Physicians of India, 63(7), 44-6.

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• Open access
• Published: 20 April 2024

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada

• Magali Brousseau-Foley 1 , 2 ,
• Virginie Blanchette 1 , 3 ,
• Julie Houle 4 &
• François Trudeau 1  

BMC Primary Care volume  25 , Article number:  123 ( 2024 ) Cite this article

210 Accesses

Metrics details

Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model.

A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement.

Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken.

Conclusions

This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Peer Review reports

Introduction

Diabetes mellitus prevalence has been constantly on the rise for over two decades. Worldwide, 536.6 million people were living with diabetes in 2021 [ 1 ]. In Canada, this represents 10% of the population in 2022 [ 2 ]. Lifetime risk of suffering from a diabetes-related foot ulcer (DFU) is estimated at 34%, with a 20% risk of limb amputation [ 3 ]. A DFU is defined as “a foot ulcer in a person with current or previously diagnosed diabetes mellitus, and usually accompanied by peripheral neuropathy and/or peripheral artery disease in the lower extremity” [ 4 ]. Adherence to a comprehensive evidence-based coordinated treatment regimen provided by an interdisciplinary care team decreases the need for major amputations and improves healing rates [ 3 , 5 , 6 ]. However, current clinical practices in primary care, specifically within the family medicine group (FMG) model in the province of Quebec, Canada, have difficulties to adhere to DFUs management guidelines, plus coordinating the continuum of care between primary care professionals and second-line specialists. An audit previously conducted by our research team highlighted some issues that led people with diabetes to be admitted to our regional hospital because of a DFU or a DFU complication as the main admission diagnosis [ 7 ]. The following discrepancies from current best practice recommendations were identified: absence of a DFU team resulting in poor coordination of care, silo work from health professionals, inefficient communication between stakeholders, lack of knowledge about the scope of practice of other professions relevant to DFU care, insufficient wound care training and inability to prioritize concurrent health needs in this complex population. Therefore, there is a failure to provide their patients with the best possible chance for healing DFUs and avoiding amputations [ 8 , 9 , 10 ]. FMGs provide most of the primary care services to Quebec’s population since their establishment in 2002 as a means to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits [ 11 , 12 ]. FMGs professionals are mostly primary care physicians (PCPs) supported by registered nurses (RN) usually in a 4 to 6 PCPs to 1 RN ratio based on number of people enrolled in the FMG. It encourages PCPs to be available in priority, if not exclusively, to people enrolled in his or her FMG. The model was developed so RN could alleviate PCPs workload by taking care of minor ailments not requiring physician expertise [ 13 ]. Other healthcare professionals (physiotherapists, psychologist, social workers, etc.) are also sometimes present. Moreover, in exchange for its staff and material resources being partially financed by the public health system, the FMG has the obligation to offer medical services in the evenings and weekends. The FMG model was therefore mostly developed to provide increased access and continuity of care in the mean of extended practice hours and added professionals, rather than true interdisciplinary care, which is more dependent on each clinic local organization and available staff [ 14 ]. Despite its specificities, the FMG model in Quebec, Canada, can been seen as a variation of other team-based primary care models elsewhere in the world where professionals offer longitudinal continuous general healthcare services [ 12 ]. In the absence of dedicated wound clinics, DFU assessment and management often falls under the responsibility of FMGs professionals, whom then frequently refer patients to state-financed healthcare community services or podiatric private practices when patients have private insurances covering these services.

The need for a decision support tool to guide DFUs’ management has already been expressed in various clinical settings [ 15 , 16 , 17 , 18 ] but was never addressed specifically for the Quebec’s FMG model, where only a few clinical settings have access to specialized wounds clinics [ 8 , 19 , 20 ]. Practice guidelines originating from national [ 21 , 22 , 23 ] and international interest groups [ 6 , 24 ] are widely available but often represent documents not practical in clinical setting. Additionally, implementation of guidelines can be challenging as their recommendations can be heterogeneous [ 25 ]. Decision support tools developed for other complex medical problems managed in primary care proved to help with achieving better quality and more coherent care [ 26 , 27 ]. We therefore advocate that a decision support tool for DFU management in primary care could similarly improve outcomes in this population. A Delphi protocol was chosen as the most effective method to develop and validate the decision support tool. A Delphi protocol is an iterative, structured process, widely used in multiple disciplines, namely in health sciences, to obtain a consensus from answers to questionnaires based on anonymous opinions of a group of participants selected because of their personal expertise on a topic under study [ 28 ]. A Delphi protocol have previously been used to develop and validate decision aid tools for primary care professionals [ 29 , 30 ] and DFU management [ 31 , 32 ]. The purpose of this study is to develop and validate a comprehensive decision support tool to guide the management of DFUs diagnosed by professionals within FMGs. This validation process is necessary in order to ensure that the tool is relevant, clear and feasible before its implementation.

Decision support tool development

The interdisciplinary research team (MBF, VB, JH) and collaborators (a PCP, a RN and a podiatrist) developed a one-page decision tool to help FMGs’ professionals manage DFUs based on a rapid review of current literature including practice guidelines and related evidence-based literature [ 33 ] during the fall of 2019. Identified actions to be taken in the management of DFUs were classified according to the severity (uncomplicated vs complicated) and divided into professional roles to reflect what was available from the literature as well as professional practices in the province of Quebec.

Decision support tool validation

The initial version (43 items) of the decision support tool was validated through a modified Delphi protocol. This Delphi validation was led and reported according to the Guidance on Conducting and REporting DElphi Studies (CREDES) [ 34 ]. Because of the complexity of producing a structured, comprehensive and multidisciplinary tool, it was decided to diverge from the classical Delphi protocol which usually presents participants with open-ended questions in order to generate qualitative data that will become the items to be evaluated for consensus in subsequent rounds, hence the modified Delphi protocol [ 28 ]. The alternative pathways represented in the tool reflect well the adjustable composition of the ideal team [ 23 , 35 ]. Also, because of the facilitator’s role of filtering participants’ answers and providing controlled feedback, the final version of the tool cannot be totally exempt from the subjective interpretation of the authors on the matter [ 28 ]. A maximum number of three rounds to achieve consensus was predetermined in accordance with scientific evidence [ 28 ].

Figure  1 illustrates the modified Delphi protocol. Expert panel’s recommendations were collected for the first round from December 2019 to May 2020 using a three-part paper questionnaire and a one-page decision support tool in its initial version. Questionnaires developed by the research team for all three rounds are available in translated English language versions in Additional file 1 . The first part included 13 questions about participants sociodemographic and professional characteristics. The second part included 43 questions corresponding to each item of the decision support tool. For each item, the expert had to evaluate four criteria: the item is clear, relevant, feasible, and which healthcare professional should be responsible for it. The following definitions [ 36 ] were provided to guide participants:

Clarity means that the wording to describe the item is easily understandable;

Relevance indicates that the item is in relation to the matter at hand;

Feasibility means that one is capable of doing or of carrying out the action; and

Responsibility is liability for an action (based on the professional scope of practice, competencies and availability in the healthcare system organization).

Flow chart illustrating the stages of the modified Delphi protocol

The third part of the questionnaire asked three open-ended questions: 1) regarding additional items or supplementary resources that should have been included in the decision support tool, 2) if the graphic layout and organization of the tool was user-friendly and straightforward, and 3) if the participant had any additional comments. The time required to complete the first-round questionnaire was estimated at 60 to 90 min.

The second and third Delphi rounds were conducted through an online questionnaire using the Université du Québec à Trois-Rivières online questionnaire tool from March to May 2021 and from July to September 2021 respectively. The time required to complete questionnaires was approximately 15 min for the second round and approximately 5 min for the third round. The format was similar to the second part of the first-round questionnaire. A new section of the questionnaire allowed participants to determine which supplementary resources proposed in the first round should be included into the decision support tool. All experts from the first round were invited to participate. Items from the first round that reached consensus were removed. Controlled feedback regarding the previous round statistical aggregation of experts’ answers was provided both with an updated version of the decision support tool and through the questions developed from first-round items that did not meet consensus. The second-round questionnaire comprised a total of 34 questions.

For the third round of the Delphi questionnaire, all experts from the second round were invited to participate in the third round. Feedback regarding the previous round statistical aggregation of experts’ answers was provided both with an updated version of the decision support tool and through the questions developed from second-round items that did not meet consensus. The third-round questionnaire comprised a total of 4 questions.

Participants

As the projected decision support tool users are primary care professionals, an expert panel to validate its content and structure needed to include both content experts but also professionals with wound care management expertise representative of most professionals working in this environment. We aimed at inviting for the first round’s questionnaire five professionals from each 12 predetermined areas of expertise: 1) PCPs, 2) RNs, 3) podiatrists, 4) RNs specialized in wounds, 5) physiatrists, 6) occupational therapists, 7) physiotherapists, 8) orthotists, 9) infectious disease or internal medicine physicians, 10) vascular surgeons, 11) orthopedic surgeons, and 12) wound care researchers for a total of about 60 participants. An expert panel’s member had to individually and anonymously share their opinion in the questionnaires. All experts needed to have knowledge or clinical experience with the management of DFU in the province of Quebec, Canada. They had to be competent in French as this is the language in which the tool was developed, French being the official language of this province. Participants identified by the authors in their network of contacts were individually solicited to participate. All received an information letter and consent form to be signed. Delphi rounds took place between December 2019 and August 2021. The sample size was determined according to what is recommended for this study design [ 28 ] and based on the expected initial response rate and attrition rate throughout sequential Delphi rounds.

Ethics approval

This research project was performed in accordance with the declaration of Helsinki and received ethical approbation from the Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec ethical board CÉRM-2019–002. Written informed consent was obtained from all subjects.

Statistical analysis

All answers were entered into an Excel spreadsheet (Microsoft, version 16.16.7) for quantitative and qualitative analysis. Consensus threshold was defined as 80% agreement for each item. Clarity was noted as 0 (unclear) or 1 (clear). All items that did not reach 80% agreement for clarity were submitted with alternative wording in the next round. Relevance was evaluated with a four-point Likert scale (1 being of low relevance and 4 high relevance). For each item, values of three and four were considered as agreement. Feasibility was evaluated with a five-point Likert scale (1 being of low feasibility and 5 high feasibility). For each item, values four and five were considered as agreement. A relative frequency of 80% or higher of values three and four for an item was considered to have reached agreement consensus and was excluded from the next round. The choice between a four-point and a five-point Likert scale was based on the nature of the data to collect. Regarding relevance, because items were identified from evidence-based literature, a higher consensus was expected for the relevance criterion and it was chosen to avoid the possibility of a neutral response in order to force experts to take a stance. On the other hand, as resources are often limited within the healthcare system and vary in different geographical locations, neutral responses on a five-point scale was considered unfeasible and therefore excluded the item, as the tool had to propose actions achievable for most professionals no matter the care setting. For the responsibility criterion, participants had to choose from a predetermined list of professionals (PCP, RN, podiatrist, RN specialized in wound care, rehabilitation team, infectious disease specialist, vascular surgeon and orthopedic surgeon) or other and specify the professional title. The relative frequency in percentage of answers was calculated for each item. A choice of professional that reached a relative frequency of 20% and higher for an item was retained. It was therefore possible to have more than one professional identified as responsible for an item. In the absence of a clear consensus, all choices of professional individually and in all possible combinations were submitted in the second round. All open-ended answers were manually organized by subject and theme in the same spreadsheet. All additional resources to be added to the decision support tool suggested by participants more than three times in answer to open-ended questions were listed to be evaluated in the second round. In the second round, for each item and criterion, consensus threshold was calculated in the same manner as in the first round. Supplementary resources were evaluated using four-point Likert scales (1 being of low relevance and 4 high relevance of the proposed additional resource). Values of three and four were considered as agreement. A relative frequency of 80% or higher of values three and four for an item was considered to have reached agreement threshold. Supplementary resources that did not reach consensus were excluded. For the third Delphi round, a simple majority (50% and more agreement) was required to achieve consensus on each item and criterion.

Final version of decision aid tool

As the initial version of the decision aid tool was developed based on literature available in 2019, once data collection and analysis were completed, the research team verified if any significant changes appeared in national and international guidelines and best practice documents between 2019 and 2023 that would require to add to, remove or modify any items included in the tool. As for the additional resources to appear at the back of the tool selected by the expert panel, the hyperlinks and resources provided were chosen by the research team in 2023, prioritizing national resources when available and if not, resources from international organizations.

Delphi first round

Fifty-nine experts were invited to participate in the study. A total of 39 participants (66.1% response rate) returned the completed first-round questionnaire (mean age = 40.9 years old; SD = 10.21 years). All professional titles were represented by at least two participants except for occupational therapist which was not present. The first-round panel was composed mostly of PCPs and RNs (Table  1 ). A majority of experts were working in clinical settings (Table  2 ).

Participants were mostly women (64%). Participants accumulated 14.7 ± 9.2 (M ± SD) years of professional experience in their field and a mean of 8.3 ± 8.5 years specifically in wound care. Agreement obtained for all items and criteria for each Delphi round is detailed in Table  3 .

For responsibility, three items were shared between more than one professional, resulting in 13 possible individual professionals or combinations of professionals. Out of the 13 supplementary resources to be added to the decision support tool, nine reached consensus. The decision support tool was adjusted based on these results by the authors and graphic designer.

Delphi second round

Out of the 39 experts invited to the second round, a total of 34 participants (87.2% response rate) completed the second-round questionnaire. All professional titles were represented by at least two participants except for physiotherapist and occupational therapist. A majority of PCPs, RNs and RNs specialized in wounds made for 66.6% (26 participants) of the expert panel. Based on agreement, the decision support tool was again adjusted based on these results by the authors and graphic designer.

Delphi third round

Out of the 34 experts invited to the second round, a total of 22 participants (64.7% response rate) completed the third-round questionnaire. All professional titles were represented by at least one participant (infectious disease physician and orthotist) or more, except for physiotherapist, occupational therapist and orthopedic surgeon. A majority of PCPs, RNs and RNs specialized in wounds made for 63.6% (14 participants) of the expert panel. The decision support tool was adjusted for its final version based on the attained results, which was translated to English (Fig.  2 ). The complete final version of the tool in color and translated to English is available in Additional file 2 . The original French version in available in Additional file 3 .

Final version of the front page of the decision support tool (translated to English)

The front page of the tool is divided into three columns of different colors, from left to right green, orange and red, respectively representing actions to be taken for uncomplicated ulcers, wound care and complicated ulcers. The green column includes actions under the responsibility of primary care professionals (PCPs, RNs, and podiatrists if available). The orange column shows actions that may be realized by first or second-line professionals or by professionals working in community or private settings dependent on local care organizations. The red column lists actions and specifies reasons for referral to second-line specialists. Arrows indicate the direction of the pathway at different steps along the continuum of care, and symbols highlight important actions where primary care professionals might consider a referral to a second-line specialist. An updated rapid-review of the literature available in 2023 after data analysis was completed and did not compel any change in the items validated by the expert panel. The back of the tool provides up-to-date references and hyperlinks for additional resources to further inform and educate professionals to help them achieve evidence-based practices.

The purpose of this study was to develop and validate a comprehensive decision support tool to guide the assessment and management of DFUs in primary care. The tool was produced and validated using a Delphi protocol by an expert panel including professionals susceptible to compose an ideal interdisciplinary specialized wound care team. The tool targets primary care professionals in order to guide them in delivering coordinated care following up to date practice guidelines to people with DFU. It also serves to improve communications and trajectories between primary care professionals and second-line specialists. It is not intended to be used for screening and stratification of the at-risk diabetic foot in primary care as a recent validated tool is already available [ 37 ]. As any decision aid tool, it should not take precedent over health professionals’ clinical judgment.

It is demonstrated that timely and coordinated interventions for people with DFU with a specialized team involved in integrated prevention and care obtain better outcomes, namely improve DFU healing rates [ 35 ], reduce major amputations [ 38 , 39 ], and lower health care costs [ 40 , 41 ]. However, DFU specialized teams are not available and integrated care is absent in the majority of Quebec and Canadian regions and there is heterogeneity in the resources available locally [ 42 ]. To our knowledge, this is the first study in Canada to develop and validate a decision support tool intended for FMG’s professionals, mostly PCPs and RNs, to be used as a care pathway and checklist of actions to be completed when taking care of people with a DFU. A recent study implemented an acute care DFU pathway for people requiring hospitalization, reducing length of stay and costs [ 18 ]. Yet, the interest of a tool to be used in primary care is to decrease the necessity for people with DFU to visit the emergency department and to be admitted to hospital. This is known to reduce costs [ 43 ] and morbidity [ 44 ] associated with hospital stays. We postulate that our tool could improve primary care professionals’ capacity to manage DFU and consequently could enhance outpatient care. This also aligns with the primary purpose that led to the development of FMGs, namely to provide continuity of care outside of the hospital setting [ 13 ]. FMGs’ teams usually know their enrollees well and are easily accessible, especially for those with chronic diseases such as diabetes. In that perspective, the patient’s primary care team is often best placed to coordinate the complex needs arising with the occurrence of a DFU. Unfortunately, many obstacles still exist in the healthcare system organization that sometimes makes it easier for professionals and patients to manage DFUs in a hospital setting.

The comments formulated by the expert panel members were not formally analyzed but were considered by the research team when adjusting the tool after each Delphi round. One main theme that was recurrent is the lack of equipment, poor access to the hospital technical platform and limited availability of professionals outside the FMG staff. This was especially true regarding the vascular evaluation that needs to be performed on initial presentation of a person with a DFU. Having access to simple equipment such as a portable Doppler with the proper probe was reported to be challenging for many experts. Even in a hospital setting, well-equipped vascular labs appeared to be as rare as dedicated interprofessional wound care teams. This explains why toe pressure or toe pressure index was not included in the tool. Also, long delays to obtain arterial Doppler or angiography through a radiology department was perceived to have a negative impact on DFU care quality. Current practice for most experts was therefore to consult with a vascular surgeon when vascular status was uncertain, and the tool was made to reflect this. Health promotion interventions such as nutritional evaluation and diabetic education were also identified as actions for which there were insufficient resources available, even though many experts highlighted the importance of patients’ empowerment and education to self-management of disease. In this instance, it was mostly due to time constraints rather than equipment or expertise as FMG professionals were deemed capable of providing this service, but the difficulty resided in time limitation secondary to an already excessive work load. Access to nutritionists and diabetes educators was also challenging for patients that depend solely on resources available through publicly funded healthcare. Similarly, lack of access to podiatrists, which is not covered by the public healthcare system in Quebec, was judged to have a negative impact on DFU management as they were considered by most experts to be the best professionals to provide wound debridement and decide on offloading modality. When a podiatrist was not implicated, many experts felt debridement and offloading were not done or were inadequately done. Finally, a very significant obstacle that was pointed out by numerous members of the expert panel is that most offloading modalities have to be paid out of pocket by patients, and for a large proportion, this financial burden is too much, transforming healable DFUs into maintenance wounds.

Access to limb preservation interventions prior to hospitalization is known to be heterogenous as shown in Ontario (Canada) and seems particularly inadequate in regions distant from major medical centers [ 45 ]. Providing PCPs with standardized criteria for referral to second line specialists before amputation becomes unavoidable could improve relevance and timing of consultations with vascular and orthopedic surgeons. It could also improve communication and facilitates collaboration between PCPs and tertiary center consultants through telemedicine when local resources are not available. Telemedicine has demonstrated benefits for the management of many complex diseases, including DFU [ 46 ]. Because the decision support tool is intended for primary care professionals, the same team of professionals that will continue to provide comprehensive healthcare after the DFU episode, their interventions might have a beneficial impact lowering DFU recurrence rate and improve limb preservation, as about 80% of amputations are preventable [ 47 ]. Such a tool as also the potential to serve as a basis to discuss basic prevention and health promotion interventions between health professionals and patients as it provides an overview of all that require consideration when caring for people with DFU. It might be of interest that future studies aim at transforming this tool into a knowledge transfer tool both for health professionals, their patients and caregivers.

It is needed to mention that the rapid-review that was conducted to develop the initial version of the decision aid tool submitted during the initial round of the Delphi validation was completed in 2019, and the three rounds of questionnaires took place from 2019 to 2021. However, no specific references were provided to the expert panel during the Delphi validation, only a list of items to be evaluated. Also, most items stated general recommendations regarding DFU evaluation and management which are unlikely to evolve with time so significantly as to become obsolete. Therefore, once data collection and analysis were completed, the research team verified if any changes appeared in national and international guidelines and best practice documents between 2019 and 2023 that would require to add to, remove or modify any items included in the tool. As there were no significant changes, the reference list was updated, and the tool remained the same. As for the additional resources provided at the back of the tool, the expert panel only provided a list of themes pertaining to DFU management rather than specific resources, therefore, the hyperlinks and resources selected were chosen by the research team once the Delphi process was completed, prioritizing national resources when available and if not, resources from international organizations. The English (Fig.  2 and Additional File 2 ) and French (Additional File 3 ) versions are different as in the original French version of the tool, French language resources were prioritized over English language resources when available and up to date.

Limitations

Some of the limitations inherent to the study design is the selection process of the expert panel, which could introduce a selection bias. However, we consider that our sample was representative in composition and proportions of both the main users (primary care professionals and second line specialists) and available resources within the local healthcare system organization. Even though only 25.64% of the first-round expert panel members currently worked within a FMG as their main occupation, many worked within a FMG as a secondary occupation or had worked in a FMG in the past. Moreover, 38.46% of experts were PCPs or RNs, the two mandatory professions composing FMGs. One member of the research team (MBF) who participated in all steps of this study is also a PCP working in a FMG. The response rate and presence of most professional titles in each round were acceptable for this study design [ 48 , 49 ], especially considering that professionals’ availability was more challenging due to the ongoing COVID-19 pandemic at the time of data collection. Also, even though the FMG model is specific to the province of Quebec, Canada, it is merely a variation of many other primary care models elsewhere in Canada and worldwide as it is a team-based approach in which primary care professionals (mostly PCPs and RNs supported by other first line professionals) provide longitudinal continuous general healthcare services [ 12 ]. Therefore, we think that the validated tool could easily be adapted and implemented in other similar settings. Another limit to our study is that no patient was part of the research team. This means that even though the decision support tool was validated by health professionals, it might not be well adapted to DFU patients’ needs. This perspective could however be addressed in the future in a patient-oriented research project, and the tool adapted to the findings of such a study.

This study describes the development process and validation of a decision support tool to guide primary care professionals manage DFUs based on current practice guidelines through a modified Delphi protocol. Our tool is all at once a checklist of actions that need to be taken by different professionals, a care pathway and a quick read reference for professionals to be informed about recommended treatments and expected outcomes at different steps along the continuum of care. We believe that it has the potential to contribute to standardizing and to optimizing the provision of care for people with DFUs in primary care. The implementation and evaluation of the tool in the clinical setting will be undertaken as a next step to determine if its use impacts on users’ satisfaction both for professionals and patients, as well as on clinical outcomes.

Availability of data and materials

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

Abbreviations

• Diabetic foot ulcer

Family medicine group

Registered nurse

Primary care physician

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Acknowledgements

The authors thank Pierre-Luc Yao, PhD, Université du Québec à Trois-Rivières for his contribution with the data analysis. Mr. Yao received no financial support for his participation. They also thank Frédérique Beauchamp for the graphic design. Ms. Beauchamp was compensated for her work.

This work was supported by the Chaire Docteur Sadok Besrour en médecine familiale affiliated with the University of Montreal Faculty of Medicine and Research Center.

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M.B.F. was responsible for the concept and design of the study, the acquisition of data analysis and interpretation, the writing of the first draft and the critical revision for important intellectual content. V.B., J.H. and F.T. revised the article critically for important intellectual content. All authors contributed to the design of the decision support tool. All authors gave the final approval of the version to be published. M.B.F. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Additional file 1. .

Questionnaires developed by the research team for all three Delphi rounds in translated English language versions.

Additional file 2. 

Final version of the decision support tool in colors translated to English.

Additional file 3. 

Original French version of the final version of the decision support tool.

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Brousseau-Foley, M., Blanchette, V., Houle, J. et al. Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada. BMC Prim. Care 25 , 123 (2024). https://doi.org/10.1186/s12875-024-02387-4

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Abstract: The use of multimodal data in assisted diagnosis and segmentation has emerged as a prominent area of interest in current research. However, one of the primary challenges is how to effectively fuse multimodal features. Most of the current approaches focus on the integration of multimodal features while ignoring the correlation and consistency between different modal features, leading to the inclusion of potentially irrelevant information. To address this issue, we introduce an innovative Multimodal Information Cross Transformer (MicFormer), which employs a dual-stream architecture to simultaneously extract features from each modality. Leveraging the Cross Transformer, it queries features from one modality and retrieves corresponding responses from another, facilitating effective communication between bimodal features. Additionally, we incorporate a deformable Transformer architecture to expand the search space. We conducted experiments on the MM-WHS dataset, and in the CT-MRI multimodal image segmentation task, we successfully improved the whole-heart segmentation DICE score to 85.57 and MIoU to 75.51. Compared to other multimodal segmentation techniques, our method outperforms by margins of 2.83 and 4.23, respectively. This demonstrates the efficacy of MicFormer in integrating relevant information between different modalities in multimodal tasks. These findings hold significant implications for multimodal image tasks, and we believe that MicFormer possesses extensive potential for broader applications across various domains. Access to our method is available at this https URL

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Embattled Columbia University president Nemat “Minouche” Shafik screwed a former underling out of credit on a research paper published 30 years ago, a Yale University professor claims.

Ahmed Mushfiq Mobarak posted the bombshell allegations in a blistering thread on X early Friday, juxtaposing images of a 1992 report Shafik co-authored for World Bank with researcher Sushenjit Bandyopadhyay, along with a journal published in Oxford Economic Papers two years later in which Bandyopadhyay’s name was removed.

Mobarak, an economics and management professor at Yale, told The Post the findings and research cited in both papers are pretty much equal.

“It got rewritten, but fundamentally it’s the same paper,” he alleged.

“We can’t get in the room and [learn] what sentences did he write and what sentences she wrote, but what we do know is his contribution was sufficient to warrant co-authorship [in 1992],” he added. “What is not common is for someone to be a co-author and then suddenly their name is taken off.”

Instead, Bandyopadhyay is only “thanked” in an acknowledgement section in the back of the 1994 published journal — which screams of “power asymmetry” considering Shafik was then Bandyopadhyay’s boss, alleged Mobarak.

Bandyopadhyay declined comment when asked whether he felt slighted.

However, Mobarak, also a former World Bank consultant and University of Maryland graduate, said he spoke to Bandyopadhyay about the issue and that Bandyopadhyay believes he should have been credited as a co-author in the second paper. The professor conceded Bandyopadhyay never said anything “negative” about the Columbia president.

“This [1994] paper is lifted almost entirely from a 1992 report coauthored with consultant not credited in the publication,” wrote Mobarak on X. “This is wholesale intellectual theft, not subtle plagiarism.”

At the time both papers were written, Shafik was a vice president for World Bank and Bandyopadhyay, a consultant who also attended the University of Maryland.

Mobarak’s allegations echo plagiarism accusations leveled against former Harvard University president Claudine Gay, who eventually resigned in disgrace in January .

Columbia University spokesperson Ben Chang shot down the Yale professor’s claims, saying “this is an absurd attempt at running a well-known playbook, and it has no credibility.”

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This paper is in the following e-collection/theme issue:

Published on 3.4.2024 in Vol 10 (2024)

This is a member publication of University of Oxford (Jisc)

Postpandemic Sentinel Surveillance of Respiratory Diseases in the Context of the World Health Organization Mosaic Framework: Protocol for a Development and Evaluation Study Involving the English Primary Care Network 2023-2024

Authors of this article:

• Xinchun Gu 1 * , PhD   ; 
• Conall Watson 2 * , PhD   ; 
• Utkarsh Agrawal 1 * , PhD   ; 
• Heather Whitaker 3 * , PhD   ; 
• William H. Elson 1 * , MBBS, MSc   ; 
• Sneha Anand 1 , PhD   ; 
• Ray Borrow 4 , PhD   ; 
• Anna Buckingham 5 , BMedSci, BMBS, MRCP   ; 
• Elizabeth Button 1 , MSc   ; 
• Lottie Curtis 6 , MSc   ; 
• Dominic Dunn 1   ; 
• Alex J. Elliot 7 , PhD   ; 
• Filipa Ferreira 1 , PhD   ; 
• Rosalind Goudie 1 , MSc   ; 
• Uy Hoang 1 , BSc, MBBS, MPH, MD   ; 
• Katja Hoschler 8 , PhD   ; 
• Gavin Jamie 1 , MSc   ; 
• Debasish Kar 1 , MSc   ; 
• Beatrix Kele 8 , PhD   ; 
• Meredith Leston 1 , MSc   ; 
• Ezra Linley 4 , PhD   ; 
• Jack Macartney 1   ; 
• Gemma L Marsden 6 , BSc, MSc, PhD   ; 
• Cecilia Okusi 1 , MRES   ; 
• Omid Parvizi 1, 8 , PhD   ; 
• Catherine Quinot 2 , PhD   ; 
• Praveen Sebastianpillai 9 , BSc   ; 
• Vanashree Sexton 1 , PhD   ; 
• Gillian Smith 7 , MBBS   ; 
• Timea Suli 1 , PhD   ; 
• Nicholas P B Thomas 6 , BSc, PhD   ; 
• Catherine Thompson 8 , PhD   ; 
• Daniel Todkill 7 , MBChB   ; 
• Rashmi Wimalaratna 1 , BSc, MBBS   ; 
• Matthew Inada-Kim 5 , MBBS   ; 
• Nick Andrews 2 , PhD   ; 
• Victoria Tzortziou-Brown 6 , PhD   ; 
• Rachel Byford 1 , BA   ; 
• Maria Zambon 9 , PhD   ; 
• Jamie Lopez-Bernal 2 , PhD   ; 
• Simon de Lusignan 1 , MSc, MD, CITP  

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom

2 Immunisation and Vaccine-Preventable Diseases Division, UK Health Security Agency, London, United Kingdom

3 Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom

4 Vaccine Evaluation Unit, UK Health Security Agency, Manchester, United Kingdom

5 NHS England, London, United Kingdom

6 Royal College of General Practitioners, London, United Kingdom

7 Real-time Syndromic Surveillance Team, UK Health Security Agency, Birmingham, United Kingdom

8 Respiratory Virus Unit, UK Health Security Agency, London, United Kingdom

9 Virus Reference Department, UK Health Security Agency, London, United Kingdom

*these authors contributed equally

Corresponding Author:

Simon de Lusignan, MSc, MD, CITP

Nuffield Department of Primary Care Health Sciences

University of Oxford

Radcliffe Primary Care Building, Radcliffe Observatory Quarter

Woodstock Road

Oxford, OX2 6GG

United Kingdom

Phone: 44 01865 617 283 ext 17 283

Email: [email protected]

Background: Prepandemic sentinel surveillance focused on improved management of winter pressures, with influenza-like illness (ILI) being the key clinical indicator. The World Health Organization (WHO) global standards for influenza surveillance include monitoring acute respiratory infection (ARI) and ILI. The WHO’s mosaic framework recommends that the surveillance strategies of countries include the virological monitoring of respiratory viruses with pandemic potential such as influenza. The Oxford-Royal College of General Practitioner Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA) has provided sentinel surveillance since 1967, including virology since 1993.

Objective: We aim to describe the RSC’s plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework.

Methods: Our approach, which includes patient and public involvement, contributes to surveillance objectives across all 3 domains of the mosaic framework. We will generate an ARI phenotype to enable reporting of this indicator in addition to ILI. These data will support UKHSA’s sentinel surveillance, including vaccine effectiveness and burden of disease studies. The panel of virology tests analyzed in UKHSA’s reference laboratory will remain unchanged, with additional plans for point-of-care testing, pneumococcus testing, and asymptomatic screening. Our sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC and virology data, including sequencing data, held by the UKHSA. We describe the governance framework for the RSC.

Results: We are co-designing our communication about data sharing and sampling, contextualized by the mosaic framework, with national and general practice patient and public involvement groups. We present our ARI digital phenotype and the key data RSC network members are requested to include in computerized medical records. We will share data with the UKHSA to report vaccine effectiveness for COVID-19 and influenza, assess the disease burden of respiratory syncytial virus, and perform syndromic surveillance. Virological surveillance will include COVID-19, influenza, respiratory syncytial virus, and other common respiratory viruses. We plan to pilot point-of-care testing for group A streptococcus, urine tests for pneumococcus, and asymptomatic testing. We will integrate test requests and results with the laboratory-computerized medical record system. A biomedical resource will enable research linking clinical data to virology data. The legal basis for the RSC’s pseudonymized data extract is The Health Service (Control of Patient Information) Regulations 2002, and all nonsurveillance uses require research ethics approval.

Conclusions: The RSC extended its surveillance activities to meet more but not all of the mosaic framework’s objectives. We have introduced an ARI indicator. We seek to expand our surveillance scope and could do more around transmissibility and the benefits and risks of nonvaccine therapies.

Introduction

Prior to the COVID-19 pandemic, sentinel surveillance was orientated toward influenza and its associated winter pressures [ 1 - 6 ]. It has subsequently evolved to include a systematic collection of acute respiratory infections (ARIs) and a wider range of indicators. The World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) was launched in 1952 to provide a global response to influenza and other respiratory infections [ 7 , 8 ]. The focus of the GISRS and other national surveillance networks is seasonal influenza monitoring and associated vaccination effectiveness studies [ 9 , 10 ], as well as pandemic preparedness [ 11 , 12 ]. Virology testing became an essential component, with serosurveillance introduced into some systems [ 13 ]. Prepandemic virological testing was largely carried out in the winter season with influenza-like illness (ILI) as the key clinical indicator of community influenza infection [ 14 ]. In addition to ILI, ARI started to be used by the European Centre for Disease Prevention and Control as a surveillance indicator [ 15 , 16 ]. The WHO 2013 global epidemiological standards for influenza surveillance proposed the use of severe ARI (SARI) as an indicator. SARI is defined as an incident ARI in a person admitted to a hospital [ 17 , 18 ]. The WHO mosaic framework suggests sentinel ILI, ARI, and SARI surveillance as the core approach for monitoring the epidemiological characteristics of respiratory viruses in interpandemic periods [ 16 ].

Subsequent to the COVID-19 pandemic, the WHO published its mosaic framework for respiratory disease surveillance [ 16 , 19 ]. It recommended that the surveillance strategies of countries include the virological monitoring of influenza, SARS-CoV-2, respiratory syncytial virus (RSV), and other viruses with pandemic potential. The mosaic has a broad framework and includes 14 surveillance objectives set out across three domains: (1) detection and assessment of respiratory viruses; (2) monitoring their epidemiological characteristics; and (3) informing on the use of health interventions [ 16 , 19 ].

The Royal College of General Practitioners (RCGP) has been collecting data about respiratory and other infections in England in its epidemic research center since 1957 [ 20 ]. This research center became rebranded as the RCGP Research and Surveillance Centre (RSC) and has been conducting sentinel surveillance since 1967 [ 21 ], in collaboration with the UK Health Security Agency (UKHSA) and its predecessor bodies. The RSC has included reference laboratory virology since the 1993-1994 season [ 22 ]. The network has grown to almost 2000 practices in England and Wales (31.6% of the active practices) with a contemporary extract of over 19 million patients (31.9% of the England and Wales population) in 2023 [ 23 ].

This protocol describes the Oxford-RCGP RSC’s plans for the 2023-2024 sentinel surveillance season and evaluates them against the WHO mosaic framework. The RSC will be offering all-year-round virology and sentinel surveillance of respiratory infections in collaboration with the UKHSA. Our extended surveillance includes the adoption of SARI as an important severity indicator, alongside ILI and other components of the WHO mosaic framework.

The objectives are as follows: (1) describe the planned patient and public involvement (PPI) with the RSC, with the aims of improving public understanding of the RSC’s program and co-designing changes to our sentinel surveillance; (2) develop an ARI digital phenotype and contemporaneously report the incidence of ARI and SARI, including new severity indicators, using primary care data; (3) collect and share high-quality data to support vaccine effectiveness (VE) studies for COVID-19 and influenza vaccines in the coming season and enable the reporting of RSV’s disease burden; (4) ensure that the volume of virology and serology sampling from member practices following our sampling framework is sufficient to determine VE by vaccine type and has the minimum required clinical data recorded; (5) introduce technological developments by using general practitioner (GP) and laboratory links to support virology and serology sampling, establishing a messaging system to enable more representative sampling and targeted sampling when required, increasing point-of-care testing (POCT) capability, piloting virology sampling from asymptomatic individuals, and testing for pneumococcus infection; (6) create a biomedical resource that provides a unique longitudinal clinical resource and enables genomic surveillance by linking individual-level human phenotypes to the genomic sequences of viruses detected in those individuals; and (7) describe the legal basis and governance framework for conducting sentinel surveillance.

Comparison With the WHO Mosaic Framework

We describe our approach to sentinel surveillance in functional components. Many of these, such as PPI, span across all of the mosaic’s sentinel objectives. Others sit outside or beyond its scope, for example, bacterial causes of infection and information governance requirements. We conclude the results section with a table summarizing the surveillance objectives achieved and those to be delivered beyond its scope.

We will use 2 channels of PPI and engagement within the RSC. The first channel is with national PPI groups, the Health Data Research-UK and the RCGP Patient and Carer Participation Groups. Additional national patient representatives will be recruited from the People in Research portal of the National Institute for Health and Care Research [ 24 ] to ensure geographical representation across England. The second channel includes local patient participation groups of general practice members of the RSC network. Opportunities for patients to provide feedback will be communicated to all network practices in England.

We will invite patient representatives to participate in 2 meetings per year held with the UKHSA and Oxford-RCGP RSC. The meetings aim to raise awareness of surveillance, including its use of patient data, and to gain input on the RSC’s work, particularly on optimizing the acceptability of sampling and the feedback of results. PPI feedback will be used mainly to improve communication with patients, but may inform other areas of the surveillance. We will send a monthly newsletter covering topics and findings related to surveillance to increase transparency and patient engagement ( Multimedia Appendix 1 ). We will use the cube framework to plan and evaluate PPI [ 25 ]. To improve transparency in reporting PPI and its impact, we will use a standard international guideline (GRIPP2 checklist) [ 26 ].

ARI Phenotype

A digital phenotype is a set of rules that allows the identification of cases, such as ILI or ARI, from the computerized medical record (CMR) [ 27 ]. At the RSC, we have a well-established digital phenotype for ILI. To bring our strategy in line with the most recent WHO recommendations, we are developing a new ARI phenotype for the coming season.

The phenotype is being built around Systematized Nomenclature of Medicine (SNOMED) Clinical Terms (CT) as this is the medical terminology mandated by the National Health Service (NHS) and used by all primary care providers [ 28 ]. The phenotype consists of code lists representing common conditions that make up the ARI concept. This allows the identification of ARI events coded by member practices in the CMR.

We plan to build on the ARI phenotype by characterizing the nature and severity of ARI events. We will do this by exploring primary care codes recorded in association with ARI and by linking the primary care data to secondary care records [ 29 , 30 ]. We differentiate ARI from SARI by checking whether ARI leads to hospitalization, as recorded in the CMR.

Our phenotype development uses the Phenotype Execution Modeling Architecture (PhEMA) toolkit [ 31 ]. The Health Level-7 Fast Healthcare Interoperability Resources (FHIR) is a global standard for passing health care data between systems [ 31 ] and is used by the NHS. The PhEMA comprises developing an ontological layer using clinical query language and then presenting a “code list” using the Health Level-7 FHIR value set format or as a SNOMED CT refset. For example, the SNOMED clinical term “Lower respiratory tract infection (disorder)” (SCTID: 5041700) has 10 child codes (also known as subtypes), which are all automatically included. If extra child codes are included, they will automatically be included in our definition, unlike the extensional process where “code lists” need frequent review [ 32 ]. We have a “Helper Tool” developed in-house to facilitate the selection of SNOMED CT ( Figure 1 ).

High-Quality Data to Support Influenza and COVID-19 VE and Other Studies

We will collect and share high-quality data, such as primary care CMR and vaccine exposure data, to support VE studies for COVID-19 and influenza vaccines and enable the reporting of RSV’s disease burden in the coming season. We will focus on the data collection areas that need better data quality as follows: (1) Identifying and coding cases of ARI, SARI, and ILI as a problem title in CMRs, including whether these are first or new episodes [ 33 ]; (2) Consistent capturing of symptoms, signs, and any markers of severity upon the presentation of people with ARI; (3) Complete recording of vaccine exposure data, particularly for influenza and COVID-19 vaccines, but other vaccines, such as pneumococcus, may be relevant; (4) Complete recording of sociodemographic and comorbidity data; and (5) Recording of outcomes in both primary care and linked secondary care data sets. This is particularly important for people who have had virology sampling (see the next section) and practices that are incentivized through data quality payments.

We also need sufficient data (ie, sample size) to support UKHSA’s syndromic surveillance [ 34 , 35 ], our Weekly Return [ 36 , 37 ], and our Annual Report [ 38 ]. The Weekly Return and Annual Report will be in their 56th year of production. This will set out to make the network as nationally and regionally representative as possible by recruiting additional practices, particularly to improve virology sampling.

Virology and Serology Sampling and Testing

We collect serology samples from volunteer patients who are attending their practice for a routine blood sample appointment by asking them to contribute one more blood sample to the serology surveillance. Patients are invited through messages before their routine blood tests and are provided a link for further information about the serology surveillance. Verbal consent is taken from the patients before the sampling. We aim to collect 500 serology samples per month from each of the 3 age groups (younger than 18 years, 18 to 64 years, and 65 years or older) with representative sampling across the network. We plan to divide the younger than 18 years age group based on immunization age groups in the future to allow more granular information to be collected. Serology samples are batch processed in different labs depending on operational needs, for example, understanding vaccine waning in immunocompromised people.

We collect virology samples (nasal and pharyngeal swabs) all year round from patients who present ILI or ARI symptoms to general practices and meanwhile capture their symptom onset day. We aim to reach 1000 samples per week every week in the coming year. Virological samples collected in RSC surveillance practices are analyzed in UKHSA’s respiratory virus reference laboratory in Colindale, London. Practices code the results returned from the UKHSA according to SNOMED CT or Read Code ( Multimedia Appendix 2 ), along with the date that the swab was taken. The test results are used for virological surveillance as well as test-negative case-control studies [ 39 ] that evaluate VE for influenza and COVID-19 vaccines.

The UKHSA tests for a panel of 8 viruses ( Figure 2 ), including (1) SARS-CoV-2; (2) influenza (influenza A subtypes are differentiated based on their hemagglutinin [H] and neuraminidase [N] surface proteins; the 2 subtypes that are commonly in circulation are H1N1 and H3N2, though some influenza A cases are only reported as influenza A; influenza B is reported collectively, with close monitoring of circulating lineages); (3) RSV A and B; (4) human metapneumovirus (hMPV); (5) other seasonal coronaviruses (NL63, 229E, OC43, and HKU1), in addition to SARS-CoV-2; (6) adenovirus; (7) human rhinovirus; and (8) enterovirus.

To reach a sufficient volume of tests, the behavioral change we want primary care clinicians to achieve is conducting virology and serology sampling where possible and making CMR system entries of high data quality. We will use the behavioral change wheel, otherwise known as the COM-B model, to theorize behavioral change expected in clinicians. This suggests that for a behavioral change (B) to take place, an individual requires capability (C), opportunity (O), and motivation (M) [ 40 ]. We are using the COM-B model as a high-level theoretical frame to describe our interaction with practices rather than a formal experimental work.

New Technologies and Capabilities

We have an ambitious program of introducing new technologies and extending the scope of our surveillance. We are looking to introduce 3 new technologies in the coming year: (1) LabLinks, integrating our surveillance sampling with online pathology test requests carried out via primary care CMR systems; (2) creating a POCT-ready nested cohort within the RSC; and (3) introducing a messaging system that enables us to effectively target specific groups for sampling.

The 2 surveillance capabilities we are looking to introduce are (1) urinary antigen (UAG) tests that test for pneumococcus infection, and (2) collecting virology swabs from asymptomatic infections.

We will conduct a feasibility study of testing for Streptococcus pneumoniae infection using UAG. We would like to perform this study over 1 to 2 years, recruiting 2 practices from each NHS region, with ARI patients having both respiratory swabs and urine tests. We will also pilot asymptomatic testing for our panel of viral tests [ 41 ]. Running this within the RSC will enable linkage of virology results to medical records and the monitoring of household transmission as we can identify people in the same household [ 42 - 44 ]. The protocols for the feasibility and pilot studies will be published separately.

Creation of a Biomedical Resource

We will complete the work to create a unique biomedical resource that offers 2 unique opportunities for research. First, we will create a longitudinal database that runs back to the start of the RSC’s involvement in sentinel surveillance in 1967. Second, we will link clinical records and the virology results for all tests performed at UKHSA’s reference laboratory. This will create a resource to support the emerging discipline of genomic surveillance [ 45 , 46 ] by linking clinical phenotype, as defined in an individual’s CMR, at the individual level with details of the infecting virus, including its genome sequence. Summary results of the unique longitudinal data are presented.

Ethical Considerations

Pseudonymized primary care data and samples from general practices collected for surveillance purposes are processed under Regulation 3 of the Health Service (Control of Patient Information Regulations 2002) and annually renewed under Regulation 7 by UKHSA’s Caldicott Guardian [ 47 ]. Any further research or studies require their own ethical approval and approval of the Joint RSC Committee of the University of Oxford and RCGP.

There are data-sharing agreements in place with every GP practice within the network, where the purpose of data collection and the processing of activities are stated. We link primary care data collected via sentinel surveillance to secondary care data provided by NHS England via a bespoke data sharing agreement that is renewed annually. All the data controllers (UKHSA, RCGP, and University of Oxford) complete NHS England’s data security and protection toolkit to meet the performance standards set by the National Data Guardian [ 48 ].

We presented the protocol to patient representatives in July 2023. Patient representatives proposed promoting self-testing for virology to help increase the uptake of sampling. They also suggested considering swabbing in different settings, including a pharmacy, as patients with respiratory illnesses may be more likely to visit a pharmacy rather than a GP.

The patient groups have suggested that the following themes and content should form part of our PPI communications: (1) information about how patient data are used in surveillance, (2) information about how sentinel surveillance fits in with pandemic preparedness, and (3) further personal areas of interest, for example, to better understand patterns in patients with post–COVID-19 condition. The PPI representatives expressed that some patients may have concerns about patient confidentiality and data use, which can be overcome by written dissemination and regular engagement.

Based on initial feedback, we have tailored our communication to focus on key areas of interest to the public. For example, we have delivered a presentation and discussion group to patients at a Midlands practice, which focused on how data are used for surveillance and how transparency can be improved. We have developed a poster designed for practice waiting rooms to promote awareness of the RSC. We consider patient feedback in training our surveillance practices (eg, we inform new practices that patients like to receive their swab results, which may enhance patients’ experience of care).

To ensure that we identify and classify all relevant coded events in the CMR, the ARI phenotype will be hierarchical. The top level will represent the overall ARI concept. The middle level will include codes for upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), exacerbations of chronic lung disease, and ILI. The bottom level will include codes for lower-level syndromes, such as sinusitis, that are descendants of middle-level syndromes ( Figure 3 ). We will recommend that RSC network member practices consider coding ARI-associated diseases and symptoms as the diagnosis when patients present with ARI symptoms.

We have also developed a recommended coding sequence for patients presenting with ARI to primary care. The overall ARI and ILI signals are important for respiratory surveillance; hence, we recommend considering ILI first, using the RSC’s ILI definition: ARI with measured or clinically plausible temperature ≥38 °C, cough, systemic upset, such as headache or myalgia, sudden onset, and absence of a more plausible diagnosis. Our current surveillance categories do not reliably capture exacerbations of chronic lung diseases, which are vulnerable to severe outcomes from infective exacerbations [ 49 , 50 ]. We are therefore asking practices to consider this next. We then ask the consulting clinician to consider LRTI and subsequently URTI ( Figure 4 ).

We are also standardizing the recording of symptoms, signs, and any emergency management decisions made for ARI events, so we request RSC practices to record these in the CMR. We fully understand the pressures on consulting time, so we will be producing data entry forms that practices can use in the major brands of CMR systems to facilitate high-quality data entry. The key symptom data to be coded are as follows: (1) date of onset of symptoms; (2) presence of “absence of fever” because infections, particularly in older people, may not be associated with fever [ 51 ]; (3) sore throat symptoms; (4) cough or no cough, and if coughing, is it productive; (5) coryza and nasal symptoms; and (6) presence or absence of shortness of breath and wheezing. The signs we would like to see coded are as follows: (1) measured tympanic temperature; (2) peripheral oxygen saturation, where available; (3) pulse rate; (4) respiratory rate; (5) upper respiratory signs where present, including cervical and anterior cervical lymphadenopathy, and any tonsillar exudate or enlargement; and (6) lower respiratory signs, including wheezing or other physical signs.

High-Quality Data to Support VE and Other Studies

To enhance data quality, RSC member practices will receive feedback about their recording of key sociodemographic variables, vaccine exposure, and risk groups. We also provide a dashboard to enable RSC practices to compare their rate of vaccination with the rest of the network ( Figure 5 ).

Most of the relevant data in VE studies are recorded as part of standard care, but some are not recorded to a satisfactory standard. For example, some important sociodemographic data are not automatically recorded, including ethnicity, smoking status, and obesity. Vaccine exposure data should include brand and batch wherever possible, but these recordings are problematic for vaccinations outside general practices.

Risk groups and patient outcomes are also important for VE and other studies, and most of these data are recorded well as part of chronic disease management. We used these data to derive the Cambridge Multimorbidity Score, a single measure of multimorbidity for all adults, and the electronic frailty index (eFI). While the eFI can be used from the age of 50 years, we will use it in the coming season for people aged 65 years or older [ 52 , 53 ].

Our data are linked to national collection of hospital and death data, so we can report severe outcomes [ 54 ]. Our data are also linkable with the National Immunization Management System, which provides vaccination data for COVID-19 and influenza in England. These data will be used to estimate VE, with mid-season and end-of-season studies for influenza, an autumn VE study for COVID-19 vaccines, and a burden of disease study for RSV. These results will contribute to the Joint Committee on Vaccination and Immunization impact of vaccine policy, contribute to WHO reviews, and be published in peer-reviewed journals. 

The protocol for our VE studies is included in Multimedia Appendix 3 .

Ongoing recruitment and checking the representativeness of the network by region will ensure the RSC is representative. Maps of the distribution of virology and serology sampling practices and the entire network are included in Multimedia Appendix 4 . We plan to increase the number of virology samples taken each week. The total so far for the 2022-2023 season is 11,001, with 878 as the highest number of virology swabs collected in week 51 of the year 2022. The median weekly total is 259 samples, with an interquartile range of 173 to 304 samples. These data have been and will be used to estimate VE for influenza and COVID-19 vaccines with a test-negative design, and can be used in the future to study the VE of RSV.

Applying COM-B, our practice liaison team will be working with practices to achieve higher rates of virology samples. We will be continuing our regular visits and weekly and monthly reports to practices, and the scope will be driven by our learning from visits about how best to change (increase) sampling behavior and from our PPI input ( Multimedia Appendix 5 ). Our virology dashboard provides practices with a comparison of what viruses are circulating in their practices compared with nationally ( Figure 6 ). This can support practices to review their antibiotic prescriptions and antiviral medication uptake, and support better antibiotic stewardship.

We will need to control numbers in subgroups to achieve better representativeness of our serology sampling in the coming year, and produce a dashboard that practices can use to monitor activity ( Figure 7 ). We will implement a technology-driven or manual approach to ensure national representativeness by age band and region. We will also offer pediatric phlebotomy training to encourage sampling in young people and children ( Multimedia Appendix 6 ). The scale of serology sampling will be determined according to season.

We plan to integrate LabLinks into the RSC. Currently, customized kits are provided to RSC practices for virology and serology sampling, and these kits are returned to UKHSA laboratories through the post. We plan instead to integrate RSC sampling with the electronic pathology test–requesting system currently integrated into primary care CMR systems. The details of the LabLinks program are described in Multimedia Appendix 7 . Figure 8 provides an overview of the process.

We will create a POCT nested cohort of practices willing to participate in feasibility studies. The key area of interest is POCT for group A streptococcal infection because there was a higher peak in the incidence of group A streptococcal infection in late 2022 than in the previous 8 years ( Figure 9 ). A protocol for using molecular POCT is included in Multimedia Appendix 8 [ 55 - 57 ].

We will test EMIS Recruit [ 58 ] as a messaging system to invite targeted risk groups (immunocompromised) or younger people who had a booked blood test to consider volunteering to provide an extra blood sample for serology. The messaging system runs through EMIS Recruit to detect patients in target groups that have a recent blood test request. A message is sent to the patients to invite them to participate in our serology sampling. The patients will remind the practitioners of their eligibility at the blood test appointment. We will also be asking practices whether there would be interest in pediatric phlebotomy training to increase the sample number in younger children.

We will recruit one or two virology sampling practices per region that volunteer to collect urinary samples for UAG testing to infer pneumococcal infection.

We plan a pilot study of asymptomatic virology sampling. We will start with children under 5 years of age coming for vaccination. We may then move on to include people aged 40 to 74 years attending NHS health checks and people aged 40 years or older attending hypertension clinics in primary care.

The RSC has unique longitudinal data stretching back to 1967. Currently, we are progressing with the assembly of these data into a single quinquagenarian resource ( Figure 10 ). We have curated ILI incidences between 1967 and 2022 as an example ( Figure 11 ).

Legal Basis and Governance Framework for Conducting Sentinel Surveillance

Surveillance is authorized each year through a commissioning letter, authorized by the UKHSA, and sent out to all RSC sentinel network general practices. Privacy notices for individuals registered at a GP within the network are publicly available [ 59 ]. We request all member practices to share these with their registered patients.

Evaluation of RSC Surveillance Compared With the WHO Mosaic Framework

The RSC meets many of the surveillance objectives of the WHO mosaic framework but within the scope of its virology plus primary and secondary care data ( Table 1 ).

In Domain I ( detection and assessment of respiratory viruses ), we have a comprehensive virology panel and a nationally representative primary care network. Our data are strong but could be stronger with respect to having detailed information about clinical presentation. Our household key and information about residential care provide only limited information about transmission [ 43 ], and piloting whether there is asymptomatic spread will provide additional evidence about the spread of the disease.

In Domain II ( epidemiological characteristics of respiratory viruses ), our data are strong. Our linked data set allows us to monitor severe outcomes and mortality. We do not have sufficient coverage of all high-risk settings and do not collect data from hospitals where nosocomial infection is common. We can readily identify community-recorded vulnerable populations, and we term these “risk groups” [ 60 ]. We do not directly measure whether health care systems are overwhelmed, but we do record community rates of illnesses compared with other years [ 61 ].

In Domain III ( informing about health interventions ), we are able to infer the impact of interventions, such as lockdowns and shielding, during the COVID-19 pandemic, and we can see from our data the impact of school closures [ 62 , 63 ]. We are strong in measuring vaccine uptake and effectiveness, and our data have been used for vaccine adverse events [ 60 , 64 ]. We only have limited abilities to assess the effectiveness of some antivirals and other therapeutics owing to their central administration, and our capabilities are greater where these are recorded in the GP CMR. We have the capability to assess diagnostic tests and will compare POCT with reference virology laboratory results [ 55 , 65 ]. NHS England ARI hubs are planned to join the network, and we plan to evaluate the impact of these networks. We do not provide candidate vaccine viruses.

The RSC has additional surveillance objectives ( Table 2 ). PPI and bacterial surveillance are essential. We could have a role at the system level of exploring how POCT might have an impact on treatment selection and health outcomes. Additionally, we see compliance with information governance standards as essential and linkage between clinical and viral sequencing data as enabling genomic surveillance.

a WHO: World Health Organization.

b RSC: Research and Surveillance Centre.

c Each row is cumulative. Only new features are added in each row.

d ARI: acute respiratory infection.

e POCT: point-of-care testing.

f UKHSA: UK Health Security Agency.

g ILI: influenza-like illness.

h SARI: severe acute respiratory infection.

a RSC: Research and Surveillance Centre.

b Each row is cumulative. Only new features are added in each row.

c PPI: patient and public involvement.

d UKHSA: UK Health Security Agency.

Principal Findings

The RSC and UKHSA are providing the most comprehensive primary care respiratory infection surveillance in the United Kingdom. We have extended the number of surveillance approaches for the coming season, meeting more of the areas proposed in the WHO mosaic framework ( Table 1 ) [ 19 ].

In Domain I ( detection and assessment of respiratory viruses ), we have a robust system that has run over decades. However, we have scope to improve the rapidity and reliability of our results by increasing our sampling numbers and data quality so we can better detect changes.

In Domain II ( epidemiological characteristics ), we also have a robust system. There is potential to integrate work about asymptomatic infection, do more to include high-risk settings in our system, and develop indicators of our health care system’s ability to cope.

Domain III ( informing the use of health interventions ) is an area where we provide some key data, but this could be strengthened. We are able to monitor the impact of nonmedical interventions like social distancing [ 62 , 63 ], but other data are also needed to extend our capability of informing health interventions. We do report vaccine coverage, though data about vaccine exposure where vaccines are not given in primary care are more limited. We have primary care data and can link to other data to monitor the effectiveness of antivirals and other therapies, but access to centrally held data sets can be slow. We are well placed to report VE and adverse events of interest following vaccination [ 37 , 54 ] rapidly when using primary care data but with a greater lead time when we need to link to secondary care data. We can measure the costs of medically attended conditions. However, including measures of health-related quality of life would extend our ability to assess the disease burden.

Finally, we propose additional objectives that might be added (see Table 2 ). Among these, we consider that PPI and addressing the burden of primary and secondary bacterial infections are the most important.

Comparison With Prior Work

The strength of the RSC’s sentinel surveillance has long been established, but it has now been greatly extended, with the network more than doubling in size during the pandemic [ 66 ]. Other countries adapted their surveillance during the COVID-19 pandemic, including setting patient sampling routes outside of primary care (Sweden, Netherlands, and Scotland), decentralizing reference testing laboratories (France, Portugal, Scotland, and Spain), and optimizing digital data collection (Sweden, Netherlands, England, Scotland, France, Portugal, and Spain) [ 67 ]. Most of these changes were temporary, but the changes in the RSC network, such as the expanded sentinel practices and the introduction of electronic links to laboratories, have remained and will be further developed.

Australia, Belgium, the Netherlands, and the United States have shown that GPs would like to use more POCT to help them diagnose acute conditions [ 68 ]. Currently, the Welsh government has introduced a pharmacy-led service to undertake a structured clinical assessment using clinical prediction scores and POCT for cases of suspected strep A infection [ 69 ].

Strengths and Limitations

The strengths of our network are its size (just under a third of the English national population), the level of sampling, and the commitment to improving data quality. The network has shown adaptability through the COVID-19 pandemic and a strong partnership working with the UKHSA. We also have collaborations with other European sentinel networks and international collaborations [ 67 ]. The United Kingdom has a registration-based system that is free at the point of care, which allows good population coverage and facilitates the presentation of population-based infection rates. A unique national ID, the NHS number, ensures that primary care data can be linked to hospital and death data, allowing severe outcomes to be reported.

The limitations of routine data are that they are recorded by busy clinicians often working under pressure, and thus, they can be incomplete. Despite our best efforts, there can be gaps in data quality [ 70 ]. It is inevitable that our data will not capture all cases, and disease etiology might not be precise. While primary care data can be reliably reported within 3 days in arrears, it is much slower to gain access to secondary care data and other data sets. The national policy is to move toward a smaller number of secure data environments, and the RSC may need to migrate into one of these [ 21 ]. NHS primary care is increasingly working at scale, with the NHS setting up ARI hubs to work across geographical areas. We are exploring recruiting ARI hubs into our network.

Conclusions

The RSC has grown and adapted through the pandemic. Our biggest areas of change will be the introduction of an ARI phenotype, using technology to reduce the barriers to virology sampling and hopefully increase the scale and representativeness of virology sampling. The challenges in implementing change and the requests for more consistent data recording risk discouraging practices from remaining part of the RSC. Overall, our plans for the coming season will deliver more of the WHO surveillance mosaic.

Acknowledgments

We thank participating Research and Surveillance Centre (RSC) member practices and their patients for sharing pseudonymized data for disease surveillance, quality improvement, research, and education. We also thank computer system suppliers in English primary care: EMIS, TPP, In Practice Systems, and Wellbeing (Magentus). The RSC’s respiratory disease surveillance work is funded by the UK Health Security Agency. The Wellcome Biomedical resource is funded by the Wellcome Trust (212763/Z/18/Z).

Conflicts of Interest

SdL has received funding through his university from Astra-Zeneca, Eli-Lilly, GSK, MSD, Novo Nordisk, Sanofi, Seqirus, and Takeda, and has been a member of advisory boards for Astra- Zeneca, Sanofi, and Seqirus. He is the Director of the Oxford-Royal College of General Practitioner Research and Surveillance Centre. MZ is the chair of the charitable organization International Society for Influenza and other Respiratory Viruses (ISIRV) (not remunerated) and a member of the UK Government Scientific Advisory Groups Scientific Advisory Group for Emergencies (SAGE), New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), and Joint Committee on Vaccination and Immunization (JCVI) (not remunerated). UH has received funding from Sanofi for vaccine-related workshops and has been a member of the advisory board for Janssen. All other authors declare no conflicts of interest.

Patient and public involvement: Images from the first monthly newsletter.

Coding virology swab results.

Proposals for vaccine effectiveness studies for the coming season.

Distribution of virology and serology sampling practices and the entire network.

Practice liaison team communications.

Summary of a pilot study to introduce pediatric phlebotomy training in the Research and Surveillance Centre network by region.

An introduction to LabLinks.

A protocol for a study using point-of-care testing.

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Abbreviations

Edited by A Mavragani, O Leal Neto; submitted 30.08.23; peer-reviewed by A Azcoaga-Lorenzo, L Kent; comments to author 19.12.23; revised version received 02.01.24; accepted 17.01.24; published 03.04.24.

©Xinchun Gu, Conall Watson, Utkarsh Agrawal, Heather Whitaker, William H. Elson, Sneha Anand, Ray Borrow, Anna Buckingham, Elizabeth Button, Lottie Curtis, Dominic Dunn, Alex J. Elliot, Filipa Ferreira, Rosalind Goudie, Uy Hoang, Katja Hoschler, Gavin Jamie, Debasish Kar, Beatrix Kele, Meredith Leston, Ezra Linley, Jack Macartney, Gemma L Marsden, Cecilia Okusi, Omid Parvizi, Catherine Quinot, Praveen Sebastianpillai, Vanashree Sexton, Gillian Smith, Timea Suli, Nicholas P B Thomas, Catherine Thompson, Daniel Todkill, Rashmi Wimalaratna, Matthew Inada-Kim, Nick Andrews, Victoria Tzortziou-Brown, Rachel Byford, Maria Zambon, Jamie Lopez-Bernal, Simon de Lusignan. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 03.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.

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NeurIPS 2024

Conference Dates: (In person) 9 December - 15 December, 2024

Homepage: https://neurips.cc/Conferences/2024/

Call For Papers 

Author notification: Sep 25, 2024

Camera-ready, poster, and video submission: Oct 30, 2024 AOE

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PENN GLOBAL RESEARCH & ENGAGEMENT GRANT PROGRAM 2024 Grant Program Awardees

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In 2024, Penn Global will support 24 new faculty-led research and engagement projects at a total funding level of $1.5 million.

The Penn Global Research and Engagement Grant Program prioritizes projects that bring together leading scholars and practitioners across the University community and beyond to develop new insight on significant global issues in key countries and regions around the world, a core pillar of Penn’s global strategic framework. 

PROJECTS SUPPORTED BY THE HOLMAN AFRICA RESEARCH AND ENGAGEMENT FUND

• Global Medical Physics Training & Development Program  Stephen Avery, Perelman School of Medicine
• Developing a Dakar Greenbelt with Blue-Green Wedges Proposal  Eugenie Birch, Weitzman School of Design
• Emergent Judaism in Sub-Saharan Africa  Peter Decherney, School of Arts and Sciences / Sara Byala, School of Arts and Sciences
• Determinants of Cognitive Aging among Older Individuals in Ghana  Irma Elo, School of Arts and Sciences
• Disrupted Aid, Displaced Lives Guy Grossman, School of Arts and Sciences
• A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe Thabo Lenneiye, Kleinman Energy Center / Weitzman School of Design
• Penn Computerized Neurocognitive Battery Use in Botswana Public Schools Elizabeth Lowenthal, Perelman School of Medicine
• Podcasting South African Jazz Past and Present Carol Muller, School of Arts and Sciences
• Lake Victoria Megaregion Study: Joint Lakefront Initiative Frederick Steiner, Weitzman School of Design
• Leveraging an Open Source Software to Prevent and Contain AMR Jonathan Strysko, Perelman School of Medicine
• Poverty reduction and children's neurocognitive growth in Cote d'Ivoire Sharon Wolf, Graduate School of Education
• The Impacts of School Connectivity Efforts on Education Outcomes in Rwanda  Christopher Yoo, Carey Law School

PROJECTS SUPPORTED BY THE INDIA RESEARCH AND ENGAGEMENT FUND

• Routes Beyond Conflict: A New Approach to Cultural Encounters in South Asia  Daud Ali, School of Arts and Sciences
• Prioritizing Air Pollution in India’s Cities Tariq Thachil, Center for the Advanced Study of India / School of Arts and Sciences
• Intelligent Voicebots to Help Indian Students Learn English Lyle Ungar, School of Engineering and Applied Sciences

PROJECTS SUPPORTED BT THE CHINA RESEARCH AND ENGAGEMENT FUND

• Planning Driverless Cities in China Zhongjie Lin, Weitzman School of Design

PROJECTS SUPPORTED BY THE GLOBAL ENGAGEMENT FUND 

• Education and Economic Development in Nepal Amrit Thapa, Graduate School of Education
• Explaining Climate Change Regulation in Cities: Evidence from Urban Brazil Alice Xu, School of Arts and Sciences
• Nurse Staffing Legislation for Scotland: Lessons for the U.S. and the U.K.  Eileen Lake, School of Nursing
• Pathways to Education Development & Their Consequences: Finland, Korea, US Hyunjoon Park, School of Arts and Sciences
• Engaged Scholarship in Latin America: Bridging Knowledge and Action Tulia Falleti, School of Arts and Sciences
• Organizing Migrant Communities to Realize Rights in Palermo, Sicily  Domenic Vitiello, Weitzman School of Design
• Exploiting Cultural Heritage in 21st Century Conflict   Fiona Cunningham, School of Arts and Sciences
• Center for Integrative Global Oral Health   Alonso Carrasco-Labra, School of Dental Medicine

This first-of-its-kind Global Medical Physics Training and Development Program (GMPTDP) seeks to serve as an opportunity for PSOM and SEAS graduate students to enhance their clinical requirement with a global experience, introduce them to global career opportunities and working effectively in different contexts, and strengthens partnerships for education and research between US and Africa. This would also be an exceptional opportunity for pre-med/pre-health students and students interested in health tech to have a hands-on global experience with some of the leading professionals in the field. The project will include instruction in automated radiation planning through artificial intelligence (AI); this will increase access to quality cancer care by standardizing radiation planning to reduce inter-user variability and error, decreasing workload on the limited radiation workforce, and shortening time to treatment for patients. GMPTDP will offer a summer clinical practicum to Penn students during which time they will also collaborate with UGhana to implement and evaluate AI tools in the clinical workflow.

The proposal will address today’s pressing crises of climate change, land degradation, biodiversity loss, and growing economic disparities with a holistic approach that combines regional and small-scale actions necessary to achieve sustainability. It will also tackle a key issue found across sub-Saharan Africa, many emerging economies, and economically developed countries that struggle to control rapid unplanned urbanization that vastly outpaces the carrying capacity of the surrounding environment.

The regional portion of the project will create a framework for a greenbelt that halts the expansion of the metropolitan footprint. It will also protect the Niayes, an arable strip of land that produces over 80% of the country’s vegetables, from degradation. This partnership will also form a south-south collaboration to provide insights into best practices from a city experiencing similar pressures.

The small-scale portion of the project will bolster and create synergy with ongoing governmental and grassroots initiatives aimed at restoring green spaces currently being infilled or degraded in the capital. This will help to identify overlapping goals between endeavors, leading to collaboration and mobilizing greater funding possibilities instead of competing over the same limited resources. With these partners, we will identify and design Nature-based Solutions for future implementation.

Conduct research through fieldwork to examine questions surrounding Jewish identity in Africa. Research will be presented in e.g. articles, photographic images, and films, as well as in a capstone book. In repeat site-visits to Uganda, South Africa, Ghana, and Zimbabwe, we will conduct interviews with and take photographs of stakeholders from key communities in order to document their everyday lives and religious practices.

The overall aim of this project is the development of a nationally representative study on aging in Ghana. This goal requires expanding our network of Ghanian collaborators and actively engage them in research on aging. The PIs will build on existing institutional contacts in Ghana that include:

1). Current collaboration with the Navrongo Health Research Center (NCHR) on a pilot data collection on cognitive aging in Ghana (funded by a NIA supplement and which provides the matching funds for this Global Engagement fund grant application);

2) Active collaboration with the Regional Institute for Population Studies (RIPS), University of Ghana. Elo has had a long-term collaboration with Dr. Ayaga Bawah who is the current director of RIPS.

In collaboration with UNHCR, we propose studying the effects of a dramatic drop in the level of support for refugees, using a regression discontinuity design to survey 2,500 refugee households just above and 2,500 households just below the vulnerability score cutoff that determines eligibility for full rations. This study will identify the effects of aid cuts on the welfare of an important marginalized population, and on their livelihood adaptation strategies. As UNHCR faces budgetary cuts in multiple refugee-hosting contexts, our study will inform policymakers on the effects of funding withdrawal as well as contribute to the literature on cash transfers.

The proposed project, titled "A History of Regenerative Agriculture Practices from the Global South: Case Studies from Ethiopia, Kenya, and Zimbabwe," aims to delve into the historical and contemporary practices of regenerative agriculture in sub-Saharan Africa. Anticipated Outputs and Outcomes:

1. Research Paper: The primary output of this project will be a comprehensive research paper. This paper will draw from a rich pool of historical and contemporary data to explore the history of regenerative agriculture practices in Ethiopia, Kenya, and Zimbabwe. It will document the indigenous knowledge and practices that have sustained these regions for generations.

2. Policy Digest: In addition to academic research, the project will produce a policy digest. This digest will distill the research findings into actionable insights for policymakers, both at the national and international levels. It will highlight the benefits of regenerative agriculture and provide recommendations for policy frameworks that encourage its adoption.

3. Long-term Partnerships: The project intends to establish long-term partnerships with local and regional universities, such as Great Lakes University Kisumu, Kenya. These partnerships will facilitate knowledge exchange, collaborative research, and capacity building in regenerative agriculture practices. Such collaborations align with Penn Global's goal of strengthening institutional relationships with African partners.

The Penn Computerized Neurocognitive Battery (PCNB) was developed at the University of Pennsylvania by Dr. Ruben C. Gur and colleagues to be administered as part of a comprehensive neuropsychiatric assessment. Consisting of a series of cognitive tasks that help identify individuals’ cognitive strengths and weaknesses, it has recently been culturally adapted and validated by our team for assessment of school-aged children in Botswana . The project involves partnership with the Botswana Ministry of Education and Skills Development (MoESD) to support the rollout of the PCNB for assessment of public primary and secondary school students in Botswana. The multidisciplinary Penn-based team will work with partners in Botswana to guide the PCNB rollout, evaluate fidelity to the testing standards, and track student progress after assessment and intervention. The proposed project will strengthen a well-established partnership between Drs. Elizabeth Lowenthal and J. Cobb Scott from the PSOM and in-country partners. Dr. Sharon Wolf, from Penn’s Graduate School of Education, is an expert in child development who has done extensive work with the Ministry of Education in Ghana to support improvements in early childhood education programs. She is joining the team to provide the necessary interdisciplinary perspective to help guide interventions and evaluations accompanying this new use of the PCNB to support this key program in Africa.

This project will build on exploratory research completed by December 24, 2023 in which the PI interviewed about 35 South Africans involved in jazz/improvised music mostly in Cape Town: venue owners, curators, creators, improvisers.

• Podcast series with 75-100 South African musicians interviewed with their music interspersed in the program.
• 59 minute radio program with extended excerpts of music inserted into the interview itself.
• Create a center of knowledge about South African jazz—its sound and its stories—building knowledge globally about this significant diasporic jazz community
• Expand understanding of “jazz” into a more diffuse area of improvised music making that includes a wide range of contemporary indigenous music and art making
• Partner w Lincoln Center Jazz (and South African Tourism) to host South Africans at Penn

This study focuses on the potential of a Megaregional approach for fostering sustainable development, economic growth, and social inclusion within the East African Community (EAC), with a specific focus on supporting the development of A Vision for An Inclusive Joint Lakefront across the 5 riparian counties in Kenya.

By leveraging the principles of Megaregion development, this project aims to create a unified socio-economic, planning, urbanism, cultural, and preservation strategy that transcends county boundaries and promotes collaboration further afield, among the EAC member countries surrounding the Lake Victoria Basin.

Anticipated Outputs and Outcomes:

1. Megaregion Conceptual Framework: The project will develop a comprehensive Megaregion Conceptual Framework for the Joint Lakefront region in East Africa. This framework, which different regions around the world have applied as a way of bridging local boundaries toward a unified regional vision will give the Kisumu Lake region a path toward cooperative, multi-jurisdictional planning. The Conceptual Framework will be both broad and specific, including actionable strategies, projects, and initiatives aimed at sustainable development, economic growth, social inclusion, and environmental stewardship.

2. Urbanism Projects: Specific urbanism projects will be proposed for key urban centers within the Kenyan riparian counties. These projects will serve as tangible examples of potential improvements and catalysts for broader development efforts.

3. Research Publication: The findings of the study will be captured in a research publication, contributing to academic discourse and increasing Penn's visibility in the field of African urbanism and sustainable development

Antimicrobial resistance (AMR) has emerged as a global crisis, causing more deaths than HIV/AIDS and malaria worldwide. By engaging in a collaborative effort with the Botswana Ministry of Health’s data scientists and experts in microbiology, human and veterinary medicine, and bioinformatics, we will aim to design new electronic medical record system modules that will:

Aim 1: Support the capturing, reporting, and submission of microbiology data from sentinel surveillance laboratories as well as pharmacies across the country

Aim 2: Develop data analytic dashboards for visualizing and characterizing regional AMR and AMC patterns

Aim 3: Submit AMR and AMC data to regional and global surveillance programs

Aim 4: Establish thresholds for alert notifications when disease activity exceeds expected incidence to serve as an early warning system for outbreak detection.

  Using a novel interdisciplinary approach that bridges development economics, psychology, and neuroscience, the overall goal of this project is to improve children's development using a poverty-reduction intervention in Cote d'Ivoire (CIV). The project will directly measure the impacts of cash transfers (CTs) on neurocognitive development, providing a greater understanding of how economic interventions can support the eradication of poverty and ensure that all children flourish and realize their full potential. The project will examine causal mechanisms by which CTs support children’s healthy neurocognitive development and learning outcomes through the novel use of an advanced neuroimaging tool, functional Near Infrared Spectroscopy (fNIRS), direct child assessments, and parent interviews.

The proposed research, the GIGA initiative for Improving Education in Rwanda (GIER), will produce empirical evidence on the impact of connecting schools on education outcomes to enable Rwanda to better understand how to accelerate the efforts to bring connectivity to schools, how to improve instruction and learning among both teachers and students, and whether schools can become internet hubs capable of providing access e-commerce and e-government services to surrounding communities. In addition to evaluating the impact of connecting schools on educational outcomes, the research would also help determine which aspects of the program are critical to success before it is rolled out nationwide.

Through historical epigraphic research, the project will test the hypothesis that historical processes and outcomes in the 14th century were precipitated by a series of related global and local factors and that, moreover, an interdisciplinary and synergistic analysis of these factors embracing climatology, hydrology, epidemiology linguistics and migration will explain the transformation of the cultural, religious and social landscapes of the time more effectively than the ‘clash of civilizations’ paradigm dominant in the field. Outputs include a public online interface for the epigraphic archive; a major international conference at Penn with colleagues from partner universities (Ghent, Pisa, Edinburgh and Penn) as well as the wider South Asia community; development of a graduate course around the research project, on multi-disciplinary approaches to the problem of Hindu-Muslim interaction in medieval India; and a public facing presentation of our findings and methods to demonstrate the path forward for Indian history. Several Penn students, including a postdoc, will be actively engaged.  

India’s competitive electoral arena has failed to generate democratic accountability pressures to reduce toxic air. This project seeks to broadly understand barriers to such pressures from developing, and how to overcome them. In doing so, the project will provide the first systematic study of attitudes and behaviors of citizens and elected officials regarding air pollution in India. The project will 1) conduct in-depth interviews with elected local officials in Delhi, and a large-scale survey of elected officials in seven Indian states affected by air pollution, and 2) partner with relevant civil society organizations, international bodies like the United Nations Environment Program (UNEP), domain experts at research centers like the Public Health Foundation of India (PHFI), and local civic organizations (Janagraaha) to evaluate a range of potential strategies to address pollution apathy, including public information campaigns with highly affected citizens (PHFI), and local pollution reports for policymakers (Janagraaha).

The biggest benefit from generative AI such as GPT, will be the widespread availability of tutoring systems to support education. The project will use this technology to build a conversational voicebot to support Indian students in learning English. The project will engage end users (Indian tutors and their students) in the project from the beginning. The initial prototype voice-driven conversational system will be field-tested in Indian schools and adapted. The project includes 3 stages of development:

1) Develop our conversational agent. Specify the exact initial use case and Conduct preliminary user testing.

2) Fully localize to India, addressing issues identified in Phase 1 user testing.

3) Do comprehensive user testing with detailed observation of 8-12 students using the agent for multiple months; conduct additional assessments of other stakeholders.

The project partners with Ashoka University and Pratham over all three stages, including writing scholarly papers.

Through empirical policy analysis and data-based scenario planning, this project actively contributes to this global effort by investigating planning and policy responses to autonomous transportation in the US and China. In addition to publishing several research papers on this subject, the PI plans to develop a new course and organize a forum at PWCC in 2025. These initiatives are aligned with an overarching endeavor that the PI leads at the Weitzman School of Design, which aims to establish a Future Cities Lab dedicated to research and collaboration in the pursuit of sustainable cities.

This study aims to fill this gap through a more humanistic approach to measuring the impact of education on national development. Leveraging a mixed methods research design consisting of analysis of quantitative data for trends over time, observations of schools and classrooms, and qualitative inquiry via talking to people and hearing their stories, we hope to build a comprehensive picture of educational trends in Nepal and their association with intra-country development. Through this project we strive to better inform the efforts of state authorities and international organizations working to enhance sustainable development within Nepal, while concurrently creating space and guidance for further impact analyses. Among various methods of dissemination of the study’s findings, one key goal is to feed this information into writing a book on this topic.

Developing cities across the world have taken the lead in adopting local environmental regulation. Yet standard models of environmental governance begin with the assumption that local actors should have no incentives for protecting “the commons.” Given the benefits of climate change regulation are diffuse, individual local actors face a collective action problem. This project explores why some local governments bear the costs of environmental regulation while most choose to free-ride. The anticipated outputs of the project include qualitative data that illuminate case studies and the coding of quantitative spatial data sets for studying urban land-use. These different forms of data collection will allow me to develop and test a theoretical framework for understanding when and why city governments adopt environmental policy.

The proposed project will develop new insights on the issue of legislative solutions to the nurse staffing crisis, which will pertain to many U.S. states and U.K. countries. The PI will supervise the nurse survey data collection and to meet with government and nursing association stakeholders to plan the optimal preparation of reports and dissemination of results. The anticipated outputs of the project are a description of variation throughout Scotland in hospital nursing features, including nurse staffing, nurse work environments, extent of adherence to the Law’s required principles, duties, and method, and nurse intent to leave. The outcomes will be the development of capacity for sophisticated quantitative research by Scottish investigators, where such skills are greatly needed but lacking.  

The proposed project will engage multi-cohort, cross-national comparisons of educational-attainment and labor-market experiences of young adults in three countries that dramatically diverge in how they have developed college education over the last three decades: Finland, South Korea and the US. It will produce comparative knowledge regarding consequences of different pathways to higher education, which has significant policy implications for educational and economic inequality in Finland, Korea, the US, and beyond. The project also will lay the foundation for ongoing collaboration among the three country teams to seek external funding for sustained collaboration on educational analyses.

With matching funds from PLAC and CLALS, we will jointly fund four scholars from diverse LAC countries to participate in workshops to engage our community regarding successful practices of community-academic partnerships.

These four scholars and practitioners from Latin America, who are experts on community-engaged scholarship, will visit the Penn campus during the early fall of 2024. As part of their various engagements on campus, these scholars will participate after the workshops as key guest speakers in the 7th edition of the Penn in Latin America and the Caribbean (PLAC) Conference, held on October 11, 2024, at the Perry World House. The conference will focus on "Public and Community Engaged Scholarship in Latin America, the Caribbean, and their Diasporas."

Palermo, Sicily, has been a leading center of migrant rights advocacy and migrant civic participation in the twenty-first century. This project will engage an existing network of diverse migrant community associations and anti-mafia organizations in Palermo to take stock of migrant rights and support systems in the city. Our partner organizations, research assistants, and cultural mediators from different communities will design and conduct a survey and interviews documenting experiences, issues and opportunities related to various rights – to asylum, housing, work, health care, food, education, and more. Our web-based report will include recommendations for city and regional authorities and other actors in civil society. The last phase of our project will involve community outreach and organizing to advance these objectives. The web site we create will be designed as the network’s information center, with a directory of civil society and services, updating an inventory not current since 2014, which our partner Diaspore per la Pace will continue to update.

This interdisciplinary project has four objectives: 1) to investigate why some governments and non-state actors elevated cultural heritage exploitation (CHX) to the strategic level of warfare alongside nuclear weapons, cyberattacks, political influence operations and other “game changers”; 2) which state or non-state actors (e.g. weak actors) use heritage for leverage in conflict and why; and 3) to identify the mechanisms through which CHX coerces an adversary (e.g. catalyzing international involvement); and 4) to identify the best policy responses for non-state actors and states to address the challenge of CHX posed by their adversaries, based on the findings produced by the first three objectives.

Identify the capacity of dental schools, organizations training oral health professionals and conducting oral health research to contribute to oral health policies in the WHO Eastern Mediterranean region, identify the barriers and facilitators to engage in OHPs, and subsequently define research priority areas for the region in collaboration with the WHO, oral health academia, researchers, and other regional stakeholders.

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Gender pay gap in U.S. hasn’t changed much in two decades

The gender gap in pay has remained relatively stable in the United States over the past 20 years or so. In 2022, women earned an average of 82% of what men earned, according to a new Pew Research Center analysis of median hourly earnings of both full- and part-time workers. These results are similar to where the pay gap stood in 2002, when women earned 80% as much as men.

As has long been the case, the wage gap is smaller for workers ages 25 to 34 than for all workers 16 and older. In 2022, women ages 25 to 34 earned an average of 92 cents for every dollar earned by a man in the same age group – an 8-cent gap. By comparison, the gender pay gap among workers of all ages that year was 18 cents.

While the gender pay gap has not changed much in the last two decades, it has narrowed considerably when looking at the longer term, both among all workers ages 16 and older and among those ages 25 to 34. The estimated 18-cent gender pay gap among all workers in 2022 was down from 35 cents in 1982. And the 8-cent gap among workers ages 25 to 34 in 2022 was down from a 26-cent gap four decades earlier.

The gender pay gap measures the difference in median hourly earnings between men and women who work full or part time in the United States. Pew Research Center’s estimate of the pay gap is based on an analysis of Current Population Survey (CPS) monthly outgoing rotation group files ( IPUMS ) from January 1982 to December 2022, combined to create annual files. To understand how we calculate the gender pay gap, read our 2013 post, “How Pew Research Center measured the gender pay gap.”

The COVID-19 outbreak affected data collection efforts by the U.S. government in its surveys, especially in 2020 and 2021, limiting in-person data collection and affecting response rates. It is possible that some measures of economic outcomes and how they vary across demographic groups are affected by these changes in data collection.

In addition to findings about the gender wage gap, this analysis includes information from a Pew Research Center survey about the perceived reasons for the pay gap, as well as the pressures and career goals of U.S. men and women. The survey was conducted among 5,098 adults and includes a subset of questions asked only for 2,048 adults who are employed part time or full time, from Oct. 10-16, 2022. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used in this analysis, along with responses, and its methodology .

The  U.S. Census Bureau has also analyzed the gender pay gap, though its analysis looks only at full-time workers (as opposed to full- and part-time workers). In 2021, full-time, year-round working women earned 84% of what their male counterparts earned, on average, according to the Census Bureau’s most recent analysis.

Much of the gender pay gap has been explained by measurable factors such as educational attainment, occupational segregation and work experience. The narrowing of the gap over the long term is attributable in large part to gains women have made in each of these dimensions.

Related: The Enduring Grip of the Gender Pay Gap

Even though women have increased their presence in higher-paying jobs traditionally dominated by men, such as professional and managerial positions, women as a whole continue to be overrepresented in lower-paying occupations relative to their share of the workforce. This may contribute to gender differences in pay.

Other factors that are difficult to measure, including gender discrimination, may also contribute to the ongoing wage discrepancy.

Perceived reasons for the gender wage gap

When asked about the factors that may play a role in the gender wage gap, half of U.S. adults point to women being treated differently by employers as a major reason, according to a Pew Research Center survey conducted in October 2022. Smaller shares point to women making different choices about how to balance work and family (42%) and working in jobs that pay less (34%).

There are some notable differences between men and women in views of what’s behind the gender wage gap. Women are much more likely than men (61% vs. 37%) to say a major reason for the gap is that employers treat women differently. And while 45% of women say a major factor is that women make different choices about how to balance work and family, men are slightly less likely to hold that view (40% say this).

Parents with children younger than 18 in the household are more likely than those who don’t have young kids at home (48% vs. 40%) to say a major reason for the pay gap is the choices that women make about how to balance family and work. On this question, differences by parental status are evident among both men and women.

Views about reasons for the gender wage gap also differ by party. About two-thirds of Democrats and Democratic-leaning independents (68%) say a major factor behind wage differences is that employers treat women differently, but far fewer Republicans and Republican leaners (30%) say the same. Conversely, Republicans are more likely than Democrats to say women’s choices about how to balance family and work (50% vs. 36%) and their tendency to work in jobs that pay less (39% vs. 30%) are major reasons why women earn less than men.

Democratic and Republican women are more likely than their male counterparts in the same party to say a major reason for the gender wage gap is that employers treat women differently. About three-quarters of Democratic women (76%) say this, compared with 59% of Democratic men. And while 43% of Republican women say unequal treatment by employers is a major reason for the gender wage gap, just 18% of GOP men share that view.

Pressures facing working women and men

Family caregiving responsibilities bring different pressures for working women and men, and research has shown that being a mother can reduce women’s earnings , while fatherhood can increase men’s earnings .

Employed women and men are about equally likely to say they feel a great deal of pressure to support their family financially and to be successful in their jobs and careers, according to the Center’s October survey. But women, and particularly working mothers, are more likely than men to say they feel a great deal of pressure to focus on responsibilities at home.

About half of employed women (48%) report feeling a great deal of pressure to focus on their responsibilities at home, compared with 35% of employed men. Among working mothers with children younger than 18 in the household, two-thirds (67%) say the same, compared with 45% of working dads.

When it comes to supporting their family financially, similar shares of working moms and dads (57% vs. 62%) report they feel a great deal of pressure, but this is driven mainly by the large share of unmarried working mothers who say they feel a great deal of pressure in this regard (77%). Among those who are married, working dads are far more likely than working moms (60% vs. 43%) to say they feel a great deal of pressure to support their family financially. (There were not enough unmarried working fathers in the sample to analyze separately.)

About four-in-ten working parents say they feel a great deal of pressure to be successful at their job or career. These findings don’t differ by gender.

Gender differences in job roles, aspirations

Overall, a quarter of employed U.S. adults say they are currently the boss or one of the top managers where they work, according to the Center’s survey. Another 33% say they are not currently the boss but would like to be in the future, while 41% are not and do not aspire to be the boss or one of the top managers.

Men are more likely than women to be a boss or a top manager where they work (28% vs. 21%). This is especially the case among employed fathers, 35% of whom say they are the boss or one of the top managers where they work. (The varying attitudes between fathers and men without children at least partly reflect differences in marital status and educational attainment between the two groups.)

In addition to being less likely than men to say they are currently the boss or a top manager at work, women are also more likely to say they wouldn’t want to be in this type of position in the future. More than four-in-ten employed women (46%) say this, compared with 37% of men. Similar shares of men (35%) and women (31%) say they are not currently the boss but would like to be one day. These patterns are similar among parents.

Note: This is an update of a post originally published on March 22, 2019. Anna Brown and former Pew Research Center writer/editor Amanda Barroso contributed to an earlier version of this analysis. Here are the questions used in this analysis, along with responses, and its methodology .

What is the gender wage gap in your metropolitan area? Find out with our pay gap calculator

• Gender & Work
• Gender Equality & Discrimination
• Gender Pay Gap
• Gender Roles

Carolina Aragão is a research associate focusing on social and demographic trends at Pew Research Center

Women have gained ground in the nation’s highest-paying occupations, but still lag behind men

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ABOUT PEW RESEARCH CENTER  Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of  The Pew Charitable Trusts .

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