importance of research gap in research work

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Robinson KA, Akinyede O, Dutta T, et al. Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Feb.

Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet].

Introduction.

The identification of gaps from systematic reviews is essential to the practice of “evidence-based research.” Health care research should begin and end with a systematic review. 1 - 3 A comprehensive and explicit consideration of the existing evidence is necessary for the identification and development of an unanswered and answerable question, for the design of a study most likely to answer that question, and for the interpretation of the results of the study. 4

In a systematic review, the consideration of existing evidence often highlights important areas where deficiencies in information limit our ability to make decisions. We define a research gap as a topic or area for which missing or inadequate information limits the ability of reviewers to reach a conclusion for a given question. A research gap may be further developed, such as through stakeholder engagement in prioritization, into research needs. Research needs are those areas where the gaps in the evidence limit decision making by patients, clinicians, and policy makers. A research gap may not be a research need if filling the gap would not be of use to stakeholders that make decisions in health care. The clear and explicit identification of research gaps is a necessary step in developing a research agenda. Evidence reports produced by Evidence-based Practice Centers (EPCs) have always included a future research section. However, in contrast to the explicit and transparent steps taken in the completion of a systematic review, there has not been a systematic process for the identification of research gaps.

In a prior methods project, our EPC set out to identify and pilot test a framework for the identification of research gaps. 5 , 6 We searched the literature, conducted an audit of EPC evidence reports, and sought information from other organizations which conduct evidence synthesis. Despite these efforts, we identified little detail or consistency in the frameworks used to determine research gaps within systematic reviews. In general, we found no widespread use or endorsement of a specific formal process or framework for identifying research gaps using systematic reviews.

We developed a framework to systematically identify research gaps from systematic reviews. This framework facilitates the classification of where the current evidence falls short and why the evidence falls short. The framework included two elements: (1) the characterization the gaps and (2) the identification and classification of the reason(s) for the research gap.

The PICOS structure (Population, Intervention, Comparison, Outcome and Setting) was used in this framework to describe questions or parts of questions inadequately addressed by the evidence synthesized in the systematic review. The issue of timing, sometimes included as PICOTS, was considered separately for Intervention, Comparison, and Outcome. The PICOS elements were the only sort of framework we had identified in an audit of existing methods for the identification of gaps used by EPCs and other related organizations (i.e., health technology assessment organizations). We chose to use this structure as it is one familiar to EPCs, and others, in developing questions.

It is not only important to identify research gaps but also to determine how the evidence falls short, in order to maximally inform researchers, policy makers, and funders on the types of questions that need to be addressed and the types of studies needed to address these questions. Thus, the second element of the framework was the classification of the reasons for the existence of a research gap. For each research gap, the reason(s) that most preclude conclusions from being made in the systematic review is chosen by the review team completing the framework. To leverage work already being completed by review teams, we mapped the reasons for research gaps to concepts from commonly used evidence grading systems. Briefly, these categories of reasons, explained in detail in the prior JHU EPC report 5 , are:

• Insufficient or imprecise information
• Biased information
• Inconsistent or unknown consistency results
• Not the right information

The framework facilitates a systematic approach to identifying research gaps and the reasons for those gaps. The identification of where the evidence falls short and how the evidence falls short is essential to the development of important research questions and in providing guidance in how to address these questions.

As part of the previous methods product, we developed a worksheet and instructions to facilitate the use of the framework when completing a systematic review (See Appendix A ). Preliminary evaluation of the framework and worksheet was completed by applying the framework to two completed EPC evidence reports. The framework was further refined through peer review. In this current project, we extend our work on this research gaps framework.

Our objective in this project was to complete two types of further evaluation: (1) application of the framework across a larger sample of existing systematic reviews in different topic areas, and (2) implementation of the framework by EPCs. These two objectives were used to evaluate the framework and instructions for usability and to evaluate the application of the framework by others, outside of our EPC, including as part of the process of completing an EPC report. Our overall goal was to produce a revised framework with guidance that could be used by EPCs to explicitly identify research gaps from systematic reviews.

• Cite this Page Robinson KA, Akinyede O, Dutta T, et al. Framework for Determining Research Gaps During Systematic Review: Evaluation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Feb. Introduction.
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Home » Research Gap – Types, Examples and How to Identify

Research Gap – Types, Examples and How to Identify

Table of Contents

Research Gap

Definition:

Research gap refers to an area or topic within a field of study that has not yet been extensively researched or is yet to be explored. It is a question, problem or issue that has not been addressed or resolved by previous research.

How to Identify Research Gap

Identifying a research gap is an essential step in conducting research that adds value and contributes to the existing body of knowledge. Research gap requires critical thinking, creativity, and a thorough understanding of the existing literature . It is an iterative process that may require revisiting and refining your research questions and ideas multiple times.

Here are some steps that can help you identify a research gap:

• Review existing literature: Conduct a thorough review of the existing literature in your research area. This will help you identify what has already been studied and what gaps still exist.
• Identify a research problem: Identify a specific research problem or question that you want to address.
• Analyze existing research: Analyze the existing research related to your research problem. This will help you identify areas that have not been studied, inconsistencies in the findings, or limitations of the previous research.
• Brainstorm potential research ideas : Based on your analysis, brainstorm potential research ideas that address the identified gaps.
• Consult with experts: Consult with experts in your research area to get their opinions on potential research ideas and to identify any additional gaps that you may have missed.
• Refine research questions: Refine your research questions and hypotheses based on the identified gaps and potential research ideas.
• Develop a research proposal: Develop a research proposal that outlines your research questions, objectives, and methods to address the identified research gap.

Types of Research Gap

There are different types of research gaps that can be identified, and each type is associated with a specific situation or problem. Here are the main types of research gaps and their explanations:

Theoretical Gap

This type of research gap refers to a lack of theoretical understanding or knowledge in a particular area. It can occur when there is a discrepancy between existing theories and empirical evidence or when there is no theory that can explain a particular phenomenon. Identifying theoretical gaps can lead to the development of new theories or the refinement of existing ones.

Empirical Gap

An empirical gap occurs when there is a lack of empirical evidence or data in a particular area. It can happen when there is a lack of research on a specific topic or when existing research is inadequate or inconclusive. Identifying empirical gaps can lead to the development of new research studies to collect data or the refinement of existing research methods to improve the quality of data collected.

Methodological Gap

This type of research gap refers to a lack of appropriate research methods or techniques to answer a research question. It can occur when existing methods are inadequate, outdated, or inappropriate for the research question. Identifying methodological gaps can lead to the development of new research methods or the modification of existing ones to better address the research question.

Practical Gap

A practical gap occurs when there is a lack of practical applications or implementation of research findings. It can occur when research findings are not implemented due to financial, political, or social constraints. Identifying practical gaps can lead to the development of strategies for the effective implementation of research findings in practice.

Knowledge Gap

This type of research gap occurs when there is a lack of knowledge or information on a particular topic. It can happen when a new area of research is emerging, or when research is conducted in a different context or population. Identifying knowledge gaps can lead to the development of new research studies or the extension of existing research to fill the gap.

Examples of Research Gap

Here are some examples of research gaps that researchers might identify:

• Theoretical Gap Example : In the field of psychology, there might be a theoretical gap related to the lack of understanding of the relationship between social media use and mental health. Although there is existing research on the topic, there might be a lack of consensus on the mechanisms that link social media use to mental health outcomes.
• Empirical Gap Example : In the field of environmental science, there might be an empirical gap related to the lack of data on the long-term effects of climate change on biodiversity in specific regions. Although there might be some studies on the topic, there might be a lack of data on the long-term effects of climate change on specific species or ecosystems.
• Methodological Gap Example : In the field of education, there might be a methodological gap related to the lack of appropriate research methods to assess the impact of online learning on student outcomes. Although there might be some studies on the topic, existing research methods might not be appropriate to assess the complex relationships between online learning and student outcomes.
• Practical Gap Example: In the field of healthcare, there might be a practical gap related to the lack of effective strategies to implement evidence-based practices in clinical settings. Although there might be existing research on the effectiveness of certain practices, they might not be implemented in practice due to various barriers, such as financial constraints or lack of resources.
• Knowledge Gap Example: In the field of anthropology, there might be a knowledge gap related to the lack of understanding of the cultural practices of indigenous communities in certain regions. Although there might be some research on the topic, there might be a lack of knowledge about specific cultural practices or beliefs that are unique to those communities.

Examples of Research Gap In Literature Review, Thesis, and Research Paper might be:

• Literature review : A literature review on the topic of machine learning and healthcare might identify a research gap in the lack of studies that investigate the use of machine learning for early detection of rare diseases.
• Thesis : A thesis on the topic of cybersecurity might identify a research gap in the lack of studies that investigate the effectiveness of artificial intelligence in detecting and preventing cyber attacks.
• Research paper : A research paper on the topic of natural language processing might identify a research gap in the lack of studies that investigate the use of natural language processing techniques for sentiment analysis in non-English languages.

How to Write Research Gap

By following these steps, you can effectively write about research gaps in your paper and clearly articulate the contribution that your study will make to the existing body of knowledge.

Here are some steps to follow when writing about research gaps in your paper:

• Identify the research question : Before writing about research gaps, you need to identify your research question or problem. This will help you to understand the scope of your research and identify areas where additional research is needed.
• Review the literature: Conduct a thorough review of the literature related to your research question. This will help you to identify the current state of knowledge in the field and the gaps that exist.
• Identify the research gap: Based on your review of the literature, identify the specific research gap that your study will address. This could be a theoretical, empirical, methodological, practical, or knowledge gap.
• Provide evidence: Provide evidence to support your claim that the research gap exists. This could include a summary of the existing literature, a discussion of the limitations of previous studies, or an analysis of the current state of knowledge in the field.
• Explain the importance: Explain why it is important to fill the research gap. This could include a discussion of the potential implications of filling the gap, the significance of the research for the field, or the potential benefits to society.
• State your research objectives: State your research objectives, which should be aligned with the research gap you have identified. This will help you to clearly articulate the purpose of your study and how it will address the research gap.

Importance of Research Gap

The importance of research gaps can be summarized as follows:

• Advancing knowledge: Identifying research gaps is crucial for advancing knowledge in a particular field. By identifying areas where additional research is needed, researchers can fill gaps in the existing body of knowledge and contribute to the development of new theories and practices.
• Guiding research: Research gaps can guide researchers in designing studies that fill those gaps. By identifying research gaps, researchers can develop research questions and objectives that are aligned with the needs of the field and contribute to the development of new knowledge.
• Enhancing research quality: By identifying research gaps, researchers can avoid duplicating previous research and instead focus on developing innovative research that fills gaps in the existing body of knowledge. This can lead to more impactful research and higher-quality research outputs.
• Informing policy and practice: Research gaps can inform policy and practice by highlighting areas where additional research is needed to inform decision-making. By filling research gaps, researchers can provide evidence-based recommendations that have the potential to improve policy and practice in a particular field.

Applications of Research Gap

Here are some potential applications of research gap:

• Informing research priorities: Research gaps can help guide research funding agencies and researchers to prioritize research areas that require more attention and resources.
• Identifying practical implications: Identifying gaps in knowledge can help identify practical applications of research that are still unexplored or underdeveloped.
• Stimulating innovation: Research gaps can encourage innovation and the development of new approaches or methodologies to address unexplored areas.
• Improving policy-making: Research gaps can inform policy-making decisions by highlighting areas where more research is needed to make informed policy decisions.
• Enhancing academic discourse: Research gaps can lead to new and constructive debates and discussions within academic communities, leading to more robust and comprehensive research.

Advantages of Research Gap

Here are some of the advantages of research gap:

• Identifies new research opportunities: Identifying research gaps can help researchers identify areas that require further exploration, which can lead to new research opportunities.
• Improves the quality of research: By identifying gaps in current research, researchers can focus their efforts on addressing unanswered questions, which can improve the overall quality of research.
• Enhances the relevance of research: Research that addresses existing gaps can have significant implications for the development of theories, policies, and practices, and can therefore increase the relevance and impact of research.
• Helps avoid duplication of effort: Identifying existing research can help researchers avoid duplicating efforts, saving time and resources.
• Helps to refine research questions: Research gaps can help researchers refine their research questions, making them more focused and relevant to the needs of the field.
• Promotes collaboration: By identifying areas of research that require further investigation, researchers can collaborate with others to conduct research that addresses these gaps, which can lead to more comprehensive and impactful research outcomes.

Disadvantages of Research Gap

While research gaps can be advantageous, there are also some potential disadvantages that should be considered:

• Difficulty in identifying gaps: Identifying gaps in existing research can be challenging, particularly in fields where there is a large volume of research or where research findings are scattered across different disciplines.
• Lack of funding: Addressing research gaps may require significant resources, and researchers may struggle to secure funding for their work if it is perceived as too risky or uncertain.
• Time-consuming: Conducting research to address gaps can be time-consuming, particularly if the research involves collecting new data or developing new methods.
• Risk of oversimplification: Addressing research gaps may require researchers to simplify complex problems, which can lead to oversimplification and a failure to capture the complexity of the issues.
• Bias : Identifying research gaps can be influenced by researchers’ personal biases or perspectives, which can lead to a skewed understanding of the field.
• Potential for disagreement: Identifying research gaps can be subjective, and different researchers may have different views on what constitutes a gap in the field, leading to disagreements and debate.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Identifying Research Gaps to Pursue Innovative Research

This article is an excerpt from a lecture given by my Ph.D. guide, a researcher in public health. She advised us on how to identify research gaps to pursue innovative research in our fields.

What is a Research Gap?

Today we are talking about the research gap: what is it, how to identify it, and how to make use of it so that you can pursue innovative research. Now, how many of you have ever felt you had discovered a new and exciting research question , only to find that it had already been written about? I have experienced this more times than I can count. Graduate studies come with pressure to add new knowledge to the field. We can contribute to the progress and knowledge of humanity. To do this, we need to first learn to identify research gaps in the existing literature.

A research gap is, simply, a topic or area for which missing or insufficient information limits the ability to reach a conclusion for a question. It should not be confused with a research question, however. For example, if we ask the research question of what the healthiest diet for humans is, we would find many studies and possible answers to this question. On the other hand, if we were to ask the research question of what are the effects of antidepressants on pregnant women, we would not find much-existing data. This is a research gap. When we identify a research gap, we identify a direction for potentially new and exciting research.

How to Identify Research Gap?

Considering the volume of existing research, identifying research gaps can seem overwhelming or even impossible. I don’t have time to read every paper published on public health. Similarly, you guys don’t have time to read every paper. So how can you identify a research gap?

There are different techniques in various disciplines, but we can reduce most of them down to a few steps, which are:

• Identify your key motivating issue/question
• Identify key terms associated with this issue
• Review the literature, searching for these key terms and identifying relevant publications
• Review the literature cited by the key publications which you located in the above step
• Identify issues not addressed by  the literature relating to your critical  motivating issue

It is the last step which we all find the most challenging. It can be difficult to figure out what an article is  not  saying. I like to keep a list of notes of biased or inconsistent information. You could also track what authors write as “directions for future research,” which often can point us towards the existing gaps.

Different Types of Research Gaps

Identifying research gaps is an essential step in conducting research, as it helps researchers to refine their research questions and to focus their research efforts on areas where there is a need for more knowledge or understanding.

1. Knowledge gaps

These are gaps in knowledge or understanding of a subject, where more research is needed to fill the gaps. For example, there may be a lack of understanding of the mechanisms behind a particular disease or how a specific technology works.

2. Conceptual gaps

These are gaps in the conceptual framework or theoretical understanding of a subject. For example, there may be a need for more research to understand the relationship between two concepts or to refine a theoretical framework.

3. Methodological gaps

These are gaps in the methods used to study a particular subject. For example, there may be a need for more research to develop new research methods or to refine existing methods to address specific research questions.

4. Data gaps

These are gaps in the data available on a particular subject. For example, there may be a need for more research to collect data on a specific population or to develop new measures to collect data on a particular construct.

5. Practical gaps

These are gaps in the application of research findings to practical situations. For example, there may be a need for more research to understand how to implement evidence-based practices in real-world settings or to identify barriers to implementing such practices.

Examples of Research Gap

Limited understanding of the underlying mechanisms of a disease:.

Despite significant research on a particular disease, there may be a lack of understanding of the underlying mechanisms of the disease. For example, although much research has been done on Alzheimer’s disease, the exact mechanisms that lead to the disease are not yet fully understood.

Inconsistencies in the findings of previous research:

When previous research on a particular topic has inconsistent findings, there may be a need for further research to clarify or resolve these inconsistencies. For example, previous research on the effectiveness of a particular treatment for a medical condition may have produced inconsistent findings, indicating a need for further research to determine the true effectiveness of the treatment.

Limited research on emerging technologies:

As new technologies emerge, there may be limited research on their applications, benefits, and potential drawbacks. For example, with the increasing use of artificial intelligence in various industries, there is a need for further research on the ethical, legal, and social implications of AI.

How to Deal with Literature Gap?

Once you have identified the literature gaps, it is critical to prioritize. You may find many questions which remain to be answered in the literature. Often one question must be answered before the next can be addressed. In prioritizing the gaps, you have identified, you should consider your funding agency or stakeholders, the needs of the field, and the relevance of your questions to what is currently being studied. Also, consider your own resources and ability to conduct the research you’re considering. Once you have done this, you can narrow your search down to an appropriate question.

Tools to Help Your Search

There are thousands of new articles published every day, and staying up to date on the literature can be overwhelming. You should take advantage of the technology that is available. Some services include  PubCrawler ,  Feedly ,  Google Scholar , and PubMed updates. Stay up to date on social media forums where scholars share new discoveries, such as Twitter. Reference managers such as  Mendeley  can help you keep your references well-organized. I personally have had success using Google Scholar and PubMed to stay current on new developments and track which gaps remain in my personal areas of interest.

The most important thing I want to impress upon you today is that you will struggle to  choose a research topic  that is innovative and exciting if you don’t know the existing literature well. This is why identifying research gaps starts with an extensive and thorough  literature review . But give yourself some boundaries.  You don’t need to read every paper that has ever been written on a topic. You may find yourself thinking you’re on the right track and then suddenly coming across a paper that you had intended to write! It happens to everyone- it happens to me quite often. Don’t give up- keep reading and you’ll find what you’re looking for.

Class dismissed!

How do you identify research gaps? Share your thoughts in the comments section below.

Frequently Asked Questions

A research gap can be identified by looking for a topic or area with missing or insufficient information that limits the ability to reach a conclusion for a question.

Identifying a research gap is important as it provides a direction for potentially new research or helps bridge the gap in existing literature.

Gap in research is a topic or area with missing or insufficient information. A research gap limits the ability to reach a conclusion for a question.

Thank u for your suggestion.

Very useful tips specially for a beginner

Thank you. This is helpful. I find that I’m overwhelmed with literatures. As I read on a particular topic, and in a particular direction I find that other conflicting issues, topic a and ideas keep popping up, making me more confused.

I am very grateful for your advice. It’s just on point.

The clearest, exhaustive, and brief explanation I have ever read.

Thanks for sharing

Thank you very much.The work is brief and understandable

Thank you it is very informative

Thanks for sharing this educative article

Thank you for such informative explanation.

Great job smart guy! Really outdid yourself!

Nice one! I thank you for this as it is just what I was looking for!😃🤟

Thank you so much for this. Much appreciated

Thank you so much.

Thankyou for ur briefing…its so helpful

Thank you so much .I’ved learn a lot from this.❤️

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• Research Process

What is a Research Gap

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Table of Contents

If you are a young researcher, or even still finishing your studies, you’ll probably notice that your academic environment revolves around certain research topics, probably linked to your department or to the interest of your mentor and direct colleagues. For example, if your department is currently doing research in nanotechnology applied to medicine, it is only natural that you feel compelled to follow this line of research. Hopefully, it’s something you feel familiar with and interested in – although you might take your own twists and turns along your career.

Many scientists end up continuing their academic legacy during their professional careers, writing about their own practical experiences in the field and adapting classic methodologies to a present context. However, each and every researcher dreams about being a pioneer in a subject one day, by discovering a topic that hasn’t been approached before by any other scientist. This is a research gap.

Research gaps are particularly useful for the advance of science, in general. Finding a research gap and having the means to develop a complete and sustained study on it can be very rewarding for the scientist (or team of scientists), not to mention how its new findings can positively impact our whole society.

How to Find a Gap in Research

How many times have you felt that you have finally formulated THAT new and exciting question, only to find out later that it had been addressed before? Probably more times than you can count.

There are some steps you can take to help identify research gaps, since it is impossible to go through all the information and research available nowadays:

• Select a topic or question that motivates you: Research can take a long time and surely a large amount of physical, intellectual and emotional effort, therefore choose a topic that can keep you motivated throughout the process.
• Find keywords and related terms to your selected topic: Besides synthesizing the topic to its essential core, this will help you in the next step.
• Use the identified keywords to search literature: From your findings in the above step, identify relevant publications and cited literature in those publications.
• Look for topics or issues that are missing or not addressed within (or related to) your main topic.
• Read systematic reviews: These documents plunge deeply into scholarly literature and identify trends and paradigm shifts in fields of study. Sometimes they reveal areas or topics that need more attention from researchers and scientists.

Keeping track of all the new literature being published every day is an impossible mission. Remember that there is technology to make your daily tasks easier, and reviewing literature can be one of them. Some online databases offer up-to-date publication lists with quite effective search features:

• Elsevier’s Scope
• Google Scholar

Of course, these tools may be more or less effective depending on knowledge fields. There might be even better ones for your specific topic of research; you can learn about them from more experienced colleagues or mentors.

Find out how FINER research framework can help you formulate your research question.

Literature Gap

The expression “literature gap” is used with the same intention as “research gap.” When there is a gap in the research itself, there will also naturally be a gap in the literature. Nevertheless, it is important to stress out the importance of language or text formulations that can help identify a research/literature gap or, on the other hand, making clear that a research gap is being addressed.

When looking for research gaps across publications you may have noticed sentences like:

…has/have not been… (studied/reported/elucidated) …is required/needed… …the key question is/remains… …it is important to address…

These expressions often indicate gaps; issues or topics related to the main question that still hasn’t been subject to a scientific study. Therefore, it is important to take notice of them: who knows if one of these sentences is hiding your way to fame.

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How To Find A Research Gap, Quickly

A step-by-step guide for new researchers

By: Derek Jansen (MBA) | Reviewer: Eunice Rautenbach (DTech) | April 2023

If you’ve got a dissertation, thesis or research project coming up, one of the first (and most important) things you’ll need to do is find a suitable research gap . In this post, we’ll share a straightforward process to help you uncover high-quality, original research gaps in a very time-efficient manner.

Overview: Finding Research Gaps

• What exactly is a research gap?
• Research gap vs research topic
• How to find potential research gaps
• How to evaluate research gaps (and topics)
• Key takeaways

What is a research gap?

As a starting point, it’s useful to first define what we mean by research gap, to ensure we’re all on the same page. The term “research gap” gets thrown around quite loosely by students and academics alike, so let’s clear that up.

Simply put, a research gap is any space where there’s a lack of solid, agreed-upon research regarding a specific topic, issue or phenomenon. In other words, there’s a lack of established knowledge and, consequently, a need for further research.

Let’s look at a hypothetical example to illustrate a research gap.

Within the existing research regarding factors affect job satisfaction , there may be a wealth of established and agreed-upon empirical work within a US and UK context , but very little research within Eastern nations such as Japan or Korea . Given that these nations have distinctly different national cultures and workforce compositions compared to the West, it’s plausible that the factors that contribute toward job satisfaction may also be different. Therefore, a research gap emerges for studies that explore this matter.

This example is purely hypothetical (and there’s probably plenty of research covering this already), but it illustrates the core point that a research gap reflects a lack of firmly established knowledge regarding a specific matter . Given this lack, an opportunity exists for researchers (like you) to go on and fill the gap.

So, it’s the same as a research topic?

Not quite – but they are connected. A research gap refers to an area where there’s a lack of settled research , whereas a research topic outlines the focus of a specific study . Despite being different things, these two are related because research gaps are the birthplace of research topics. In other words, by identifying a clear research gap, you have a foundation from which you can build a research topic for your specific study. Your study is unlikely to resolve the entire research gap on it’s own, but it will contribute towards it .

If you’d like to learn more, we’ve got a comprehensive post that covers research gaps (including the different types of research gaps), as well as an explainer video below.

How to find a research gap

Now that we’ve defined what a research gap is, it’s time to get down to the process of finding potential research gaps that you can use as a basis for potential research topics. Importantly, it’s worth noting that this is just one way (of many) to find a research gap (and consequently a topic). We’re not proposing that it’s the only way or best way, but it’s certainly a relatively quick way to identify opportunities.

Step 1: Identify your broad area of interest

The very first step to finding a research gap is to decide on your general area of interest . For example, if you were undertaking a dissertation as part of an MBA degree, you may decide that you’re interested in corporate reputation, HR strategy, or leadership styles. As you can see, these are broad categories – there’s no need to get super specific just yet. Of course, if there is something very specific that you’re interested in, that’s great – but don’t feel pressured to narrow it down too much right now.

Equally important is to make sure that this area of interest is allowed by your university or whichever institution you’ll be proposing your research to. This might sound dead obvious, but you’ll be surprised how many times we’ve seen students run down a path with great excitement, only to later learn that their university wants a very specific area of focus in terms of topic (and their area of interest doesn’t qualify).

Step 2: Do an initial literature scan

Once you’ve pinned down your broad area (or areas) of interest, the next step is to head over to Google Scholar to undertake an initial literature scan . If you’re not familiar with this tool, Google Scholar is a great starting point for finding academic literature on pretty much any topic, as it uses Google’s powerful search capabilities to hunt down relevant academic literature. It’s certainly not the be-all and end-all of literature search tools, but it’s a useful starting point .

Within Google Scholar, you’ll want to do a few searches using keywords that are relevant to your area of interest. Sticking with our earlier example, we could use the key phrase “job satisfaction”, or we may want to get a little more specific – perhaps “job satisfaction for millennials” or “job satisfaction in Japan”.

It’s always a good idea to play around with as many keywords/phrases as you can think up.  Take an iterative approach here and see which keywords yield the most relevant results for you. Keep each search open in a new tab, as this will help keep things organised for the next steps.

Once you’ve searched for a few different keywords/phrases, you’ll need to do some refining for each of the searches you undertook. Specifically, you’ll need to filter the results down to the most recent papers . You can do this by selecting the time period in the top left corner (see the example below).

Filtering to the current year is typically a good choice (especially for fast-moving research areas), but in some cases, you may need to filter to the last two years . If you’re undertaking this task in January or February, for example, you’ll likely need to select a two-year period.

Need a helping hand?

Step 3: Review and shortlist articles that interest you

Once you’ve run a few searches using different keywords and phrases, you’ll need to scan through the results to see what looks most relevant and interesting to you. At this stage, you can just look at the titles and abstracts (the description provided by Google Scholar) – don’t worry about reading the actual article just yet.

Next, select 5 – 10 articles that interest you and open them up. Here, we’re making the assumption that your university has provided you with access to a decent range of academic databases. In some cases, Google Scholar will link you directly to a PDF of the article, but in most cases, you’ll need paid access. If you don’t have this (for example, if you’re still applying to a university), you can look at two options:

Open-access articles – these are free articles which you can access without any journal subscription. A quick Google search (the regular Google) will help you find open-access journals in your area of interest, but you can also have a look at DOAJ and Elsevier Open Access.

DeepDyve – this is a monthly subscription service that allows you to get access to a broad range of journals. At the time of shooting this video, their monthly subscription is around $50 and they do offer a free trial, which may be sufficient for your project.

Step 4: Skim-read your article shortlist

Now, it’s time to dig into your article shortlist and do some reading. But don’t worry, you don’t need to read the articles from start to finish – you just need to focus on a few key sections.

Specifically, you’ll need to pay attention to the following:

• The abstract (which you’ve probably already read a portion of in Google Scholar)
• The introduction – this will give you a bit more detail about the context and background of the study, as well as what the researchers were trying to achieve (their research aims)
• The discussion or conclusion – this will tell you what the researchers found

By skimming through these three sections for each journal article on your shortlist, you’ll gain a reasonable idea of what each study was about, without having to dig into the painful details. Generally, these sections are usually quite short, so it shouldn’t take you too long.

Step 5: Go “FRIN hunting”

This is where the magic happens. Within each of the articles on your shortlist, you’ll want to search for a few very specific phrases , namely:

• Future research
• Further research
• Research opportunities
• Research directions

All of these terms are commonly found in what we call the “FRIN” section . FRIN stands for “further research is needed”. The FRIN is where the researchers explain what other researchers could do to build on their study, or just on the research area in general. In other words, the FRIN section is where you can find fresh opportunities for novel research . Most empirical studies will either have a dedicated FRIN section or paragraph, or they’ll allude to the FRIN toward the very end of the article. You’ll need to do a little scanning, but it’s usually pretty easy to spot.

It’s worth mentioning that naturally, the FRIN doesn’t hand you a list of research gaps on a platter. It’s not a silver bullet for finding research gaps – but it’s the closest thing to it. Realistically, the FRIN section helps you shortcut the gap-hunting process  by highlighting novel research avenues that are worth exploring.

This probably sounds a little conceptual, so let’s have a look at a few examples:

The impact of overeducation on job outcomes: Evidence from Saudi Arabia (Alzubaidi, 2020)

If you scroll down to the bottom of this article, you’ll see there’s a dedicated section called “Limitations and directions for future research”. Here they talk about the limitations of the study and provide suggestions about how future researchers could improve upon their work and overcome the limitations.

Perceived organizational support and job satisfaction: a moderated mediation model of proactive personality and psychological empowerment (Maan et al, 2020)

In this article, within the limitations section, they provide a wonderfully systematic structure where they discuss each limitation, followed by a proposal as to how future studies can overcome the respective limitation. In doing so, they are providing very specific research opportunities for other researchers.

Medical professionals’ job satisfaction and telemedicine readiness during the COVID-19 pandemic: solutions to improve medical practice in Egypt (El-Mazahy et al, 2023)

In this article, they don’t have a dedicated section discussing the FRIN, but we can deduct it based on the limitations section. For example, they state that an evaluation of the knowledge about telemedicine and technology-related skills would have enabled studying their independent effect on the perception of telemedicine.

Follow this FRIN-seeking process for the articles you shortlisted and map out any potentially interesting research gaps . You may find that you need to look at a larger number of articles to find something interesting, or you might find that your area of interest shifts as you engage in the reading – this is perfectly natural. Take as much time as you need to develop a shortlist of potential research gaps that interest you.

Importantly, once you’ve developed a shortlist of potential research gaps, you need to return to Google Scholar to double-check that there aren’t fresh studies that have already addressed the gap. Remember, if you’re looking at papers from two years ago in a fast-moving field, someone else may have jumped on it . Nevertheless, there could still very well be a unique angle you could take – perhaps a contextual gap (e.g. a specific country, industry, etc.).

Ultimately, the need for originality will depend on your specific university’s requirements and the level of study. For example, if you’re doing an undergraduate research project, the originality requirements likely won’t be as gruelling as say a Masters or PhD project. So, make sure you have a clear understanding of what your university’s expectations are. A good way to do this is to look at past dissertations and theses for your specific programme. You can usually find these in the university library or by asking the faculty.

How to evaluate potential research gaps

Once you’ve developed a shortlist of potential research gaps (and resultant potential research topics) that interest you, you’ll need to systematically evaluate  them  to choose a winner. There are many factors to consider here, but some important ones include the following:

• Originality and value – is the topic sufficiently novel and will addressing it create value?
• Data access – will you be able to get access to the sample of interest?
• Costs – will there be additional costs involved for data collection and/or analysis?
• Timeframes – will you be able to collect and analyse the data within the timeframe required by your university?
• Supervisor support – is there a suitable supervisor available to support your project from start to finish?

To help you evaluate your options systematically, we’ve got a topic evaluation worksheet that allows you to score each potential topic against a comprehensive set of criteria. You can access the worksheet completely free of charge here .

Recap: Key Takeaways

We’ve covered quite a lot of ground in this post. Here are the key takeaways:

• A research gap is any space where there’s a lack of solid, agreed-upon research regarding a specific topic/issue/phenomenon.
• Unique research topics emerge from research gaps , so it’s essential to first identify high-quality research gaps before you attempt to define a topic.
• To find potential research gaps, start by seeking out recent journal articles on Google Scholar and pay particular attention to the FRIN section to identify novel opportunities.
• Once you have a shortlist of prospective research gaps and resultant topic ideas, evaluate them systematically using a comprehensive set of criteria.

If you’d like to get hands-on help finding a research gap and research topic, be sure to check out our private coaching service , where we hold your hand through the research journey, step by step.

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This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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Very useful for me, but i am still confusing review of literature review, how to find out topic related previous research.

Powerful notes! Thanks a lot.

This is helpful. Thanks a lot.

Thank you very much for this. It is really a great opportunity for me to learn the research journey.

Very Useful

It nice job

You have sharpened my articulations of these components to the core. Thanks so much.

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How to identify research gaps

Anthony Newman

About this video

Researching is an ongoing task, as it requires you to think of something nobody else has thought of before. This is where the research gap comes into play.

We will explain what a research gap is, provide you with steps on how to identify these research gaps, as well as provide you several tools that can help you identify them.

About the presenter

Senior Publisher, Life Sciences, Elsevier

Anthony Newman is a Senior Publisher with Elsevier and is based in Amsterdam. Each year he presents numerous Author Workshops and other similar trainings worldwide. He is currently responsible for fifteen biochemistry and laboratory medicine journals, he joined Elsevier over thirty years ago and has been Publisher for more than twenty of those years. Before then he was the marketing communications manager for the biochemistry journals of Elsevier.  By training he is a polymer chemist and was active in the surface coating industry before leaving London and moving to Amsterdam in 1987 to join Elsevier.

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• Volume 10, Issue 11
• Key stakeholders’ perspectives and experiences with defining, identifying and displaying gaps in health research: a qualitative study
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• http://orcid.org/0000-0003-0822-6736 Linda Nyanchoka 1 , 2 , 3 ,
• Catrin Tudur-Smith 2 ,
• Raphaël Porcher 1 , 3 , 4 ,
• http://orcid.org/0000-0001-6465-6568 Darko Hren 5
• 1 Universite de Paris , Paris , Île-de-France , France
• 2 Institute of Translational Medicine , University of Liverpool Institute of Translational Medicine , Liverpool , UK
• 3 Hôpital Hôtel-Dieu, Center for Clinical Epidemiology , Paris , France
• 4 Assistance Publique—Hopitaux de Paris , Paris , Île-de-France , France
• 5 University of Split Faculty of Humanities and Social Sciences , Split , Croatia
• Correspondence to Linda Nyanchoka; lnyanchoka{at}gmail.com

Introduction Mapping the current body of evidence including what is missing helps provide a better understanding of what research is available, ongoing and needed and should be prioritised. Identifying research gaps can inform the design and conduct of health research by providing additional context information about the body of evidence in a given topic area. Despite the commonly used term ‘research gap’ in scientific literature, little is written on how to find a ‘research gap’ in the first place. Moreover, there is no clear methodological guidance to identify and display gaps.

Objective This study aimed to explore how key stakeholders define research gaps and characterise methods/practices used to identify and display gaps in health research to further advance efforts in this area.

Design This was an exploratory qualitative study using semistructured in-depth interviews. The study sample included the following stakeholder groups: researchers, funders, healthcare providers, patients/public and policy-makers. Interview transcripts were subjected to thematic analysis.

Results Among the 20 interviews conducted (20 participants), a variety of research gap definitions were expressed (ie, five main themes, including gaps in information, knowledge/evidence gaps, uncertainties, quality and patient perspective). We identified three main themes for methods used to identify gaps (primary, secondary and both primary and secondary) and finally six main themes for the methods to display gaps (forest plots, diagrams/illustrations, evidence maps, mega maps, 3IE gap maps and info graphics).

Conclusion This study provides insights into issues related to defining research gaps and methods used to identify and display gaps in health research from the perspectives of key stakeholders involved in the process. Findings will be used to inform methodological guidance on identifying research gaps.

• qualitative research
• public health
• health policy

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/bmjopen-2020-039932

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Strengths and limitations of this study

This study used qualitative methodology that provided an in-depth understanding of key stakeholders’ perspectives and experiences in identifying, describing and displaying gaps in health research.

The study benefited from having a variety of different stakeholders participating in semistructured interviews, which provided a wider scope of perspectives and experiences in identifying, describing and displaying gaps in health research.

This study could have benefited from involving patient/public perspectives to inform the design of the study to improve the importance and relevance of the findings for this population.

Identifying research gaps can help inform the design and conduct of health research, practice and policies by providing a better understanding of the current body of evidence. Healthcare decisions for individual patients, public health policies and clinical guidelines should be informed by the best available research while taking into account research gaps.

The identification of research gaps has no well-defined process, although research gaps serve as the basis in developing a new research question and informing future research, healthcare delivery and health policies. In addition, research gaps in healthcare do not necessarily align directly with research needs. Hence, research gaps are critical in that knowledge gaps substantially inhibit the decision-making ability of stakeholders such as patients, healthcare providers and policy-makers, thus creating a need to fill the knowledge gap. 1

Moreover, identifying and characterising research gaps often highlight multiple competing gaps that are worthwhile to be explored. 1 Initiatives such as the James Lind Alliance (JLA), UK Database of Uncertainties about the Effects of Treatments, Cochrane Agenda and Priority Setting Methods Group, and Evidence-based Research Network are some examples of existing efforts to identify and prioritise research gaps in health. 2

The term ‘research gap’ is not well defined, and its meaning can differ depending on the researcher and research context. A recent scoping review of methods used to identify, prioritise and display gaps in health research reported 12 different definitions related to gaps in health research, each describing research gaps differently. 2 This finding shows the ambiguity of the term ‘research gap’ and the different practices it may relate to.

As a basis for further exploring and understanding ‘research gaps’, we start from the definition given by the National Collaborating Centre for Methods and Tools in Canada based on the work by Robinson et al , whereby a research gap is defined as a topic or area for which missing or insufficient information limits the ability to reach a conclusion for a question. 3 Given the different meanings and definitions of research gaps identified in the scoping review, 2 we considered it important to further explore key stakeholders’ perspectives to better understand the topic area. Clearly defining the type of research gap can help determine how to better identify, characterise, prioritise and address research gaps.

Different methods for identifying research gaps reported include scoping reviews and umbrella reviews for mapping and summarising evidence. These methods have an explicit aim of identifying research gaps in a broad area compared with systematic reviews, which focus on answering a specific research question. 4–8 Furthermore, investigating experiences with practices/methods used to identify research gaps can inform explicit methodological approaches in identifying and describing research gaps. This investigation can enhance practices of different stakeholder groups (ie, health professionals, health commissioners, researchers, patients/public and decision-makers) when addressing areas of uncertainty within the research problem and topic area. 9

The specific objectives of the study were to (1) investigate key stakeholders’ knowledge and perceptions of and experiences with defining research gaps and (2) characterise methods/practices used to identify and display gaps in health research.

Methods and analysis

Qualitative study design.

We conducted an exploratory qualitative study using semistructured interviews. This method was selected to provide an in-depth understanding of key stakeholders’ perspectives, experiences and practices in defining, identifying and displaying research gaps. This method also ensured that we explored key stakeholders’ understanding and practices related to identifying research gaps through a variety of lenses from different stakeholder groups. In turn, this process provided multiple facets of research gap definitions and methodological practices to identify and display gaps. 10

Study sample and recruitment

We used purposive sampling to ensure that the perspectives of all identified stakeholder groups were represented. Purposive sampling is widely used in qualitative research to identify and select information-rich cases. The study sample included the following stakeholder groups: researchers, funders, healthcare providers, patients/public and policy-makers. The stakeholder groups were determined according to the findings of a previously conducted scoping review 2 and organised into three main categories focusing on the use of evidence to inform health policy, health practice and health research ( table 1 ). A detailed description of participant categories was given in the previously published study protocol. 11 Study participants were recruited via contacts and organisations identified in the scoping review, relevant scientific publications, existing professional networks (eg, H2020 International Training Network ‘Methods in Research on Research’) and contacts from conference attendance (eg, Evidence Live and Cochrane Colloquium).

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Participant characteristics (n=20)

The main inclusion criteria for the study were as follows:

Adults aged ≥18 years (researchers, funders, healthcare providers, patients/public and policy-makers).

Experience with the use of evidence to inform health decisions/choices, policy, practice or research.

Ability to converse in English.

Consent for research.

The sample size for qualitative studies usually depends on the point when data saturation is reached (ie, the point when new data do not add to a better understanding of the studied phenomenon but rather repeat what was previously expressed 12 ). Considering that the point of saturation cannot be specified in advance, we planned to conduct between 14 and 28 interviews, owing to usual points of data saturation reported in qualitative studies. 11 The point of data saturation was determined based on the seven parameters identified by Hennink et al , 13 14 including the study purpose, population, sampling strategy, data quality, type of codes, code book and saturation goal, and focus retrieved from the study. These parameters were discussed throughout the study primarily between the lead researcher (LN) and the senior researcher (DH).

Data collection and recording

Semistructured interviews were used for this study. The main reason for selecting semi-structured interviews was to allow for specific areas to be addressed while giving the interviewees the opportunity to reflect on their experiences and perspectives related to defining, identifying and presenting research gaps that are relevant to them and that may not have been explored or anticipated by the researcher(s). 15

The guide was developed by focusing on exploring key stakeholders’ perspectives and experiences with the following key areas:

Participant background information.

Definitions of research gaps.

Knowledge and perceptions of and experiences with methods/practices used to identify and display gaps in health research to inform further health policy, practice and research.

These three categories were developed with information from the scoping review to guide the questions. The interview topic guide was piloted before data collection. It was also adapted according to key stakeholder groups to ensure that it was meaningful to their background and to gather more relevant information based on their experiences and knowledge. 16

The semistructured interview guide contained two levels of questions: main themes and follow‐up questions. The main themes covered the general content of the research gaps aimed at encouraging participants to speak freely about their perceptions, experiences and practices. The follow-up questions were used as prompts and probes aiming to follow respondents’ answers and to investigate the issues raised more in depth. The interview guide covered the main topics of the study, providing a focused structure for the discussion during the interview. 17

We conducted in-person, telephone and teleconference interviews. In-person interviews were conducted with participants residing or reachable in London, UK, and other participants were interviewed via telephone or teleconference (for the interview guide for both in-person and teleconference interviews, see online supplemental appendix ).

Supplemental material

All interviews were digitally recorded, transcribed verbatim and anonymised. The lead researcher (LN) transcribed two interviews to help inform the analytical process, and the other audio files were transcribed by a professional transcription agency licensed from the University of Liverpool.

Data analysis

We used analytical categories to describe and explain definitions, experiences and practices reported among the groups of participants. All data relevant to each category (defining research gaps, experiences with methods/practices used to identify and display gaps in health research) were identified and examined to ensure that each data item was checked accordingly.

Our approach was based on the thematic analysis outlined by Braun and Clarke. 18 The steps included the following: (1) transcription and checking transcripts with recordings for accuracy, (2) open coding from interview responses performed by two researchers independently (LN and DH), (3) agreement of initial codes discussed among the researchers and an initial codebook developed, (4) developing the code structure used for analysing the remaining responses with openness that included new codes and refined existing ones and (5) themes and subthemes identified from the final code structure and their relationships presented. 18

The initial coding framework for our analysis started from broad categories identified in the previous scoping review with which the interviews were structured. Within these broad categories (ie, defining research gaps, experiences with methods/practices used to identify and display gaps in health research), analytical categories were inductively derived from the data. In this sense, our approach includes both top-down and bottom-up development of analytical categories and themes.

QSR International’s NVivo V.12 qualitative data analysis software was used for data management and analysis.

Ensuring study quality

To further ensure rigour and trustworthiness, the study was guided by Lincoln and Guba ’s concepts for defining and investigating quality in qualitative research that can be considered parallel to quantitative research concepts of validity and reliability. 13 19 20 The concepts include credibility, transferability, dependability, confirmability, audit trails and reflexivity. They are interrelated, and thinking through them from the onset and incorporating them into a study improve the study’s rigour.

The main researcher’s (LN) past experience as a Public Health Advisor at a National Institute of Public Health in Europe influenced the conceptualisation and conduct of this study, including the interviews. Her previous role focused on knowledge production for the health sector and providing knowledge about the health status of the population, influencing factors and how the status can be improved. She recognised the need for evidence to inform research planning, implementation and evaluation. Therefore, the design and conduct of this study were informed by her previous role and influenced the development of the interview guide, and interpretation and reporting of study findings. Throughout the different steps of the study, she consulted a senior researcher (DH) to discuss all matters related to the study design, conduct and reporting.

Patient and public involvement

Patients and the public were not involved in the design or analysis of this study. However, we involved them as study participants and will disseminate the study findings that pertain to them using a patient/public online platform, peopleinresearch.org.

Among the 30 key stakeholders contacted, 20 agreed to participate in the study. Hence, we conducted 20 interviews with 20 participants involved in using evidence for informing health policy, practice or future research ( table 1 ).

Definitions of gaps in health research

We first explored what participants reported as gaps in health research. Given the nature of our interest, all participants’ answers were grouped under a single theme ‘Definitions of Gaps in Health Research’. However, the focus of the definitions differed, and within this main theme, we identified five subthemes related to gaps in health research described by the participants (ie, gaps in information, knowledge/evidence-related gaps, quality of evidence, uncertainties and patient-related gaps; summarised in figure 1 ). The discrepancies and similarities of terms used are further illustrated in the online supplemental appendix . Terms ranged from lack of information/insufficient information, known unknowns/unanswered research questions and evidence uncertainty to treatment uncertainty, among others.

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Reported descriptions of gaps in health research.

We identified some similarities among the participants on how they defined research gaps, for example, researchers and oversight bodies mainly defined gaps in health research as a lack of information/insufficient information, known unknowns and no primary studies (more information can be found in online supplemental appendix ). Patient/public participants defined research gaps in a much more literal manner, for example, ‘The gap is to get more patients involved in doing … clinical trials; have [someone] at the beginning introduce me, [educate me], [provide] awareness [because] I didn’t know what [a clinical trial] was. I [didn’t] know what they’re talking about’ (patient/public person, PPI01) and ‘Get me involved in co-production. That is the gap that is missing in clinical research’ (patient/public person, PPI01). The most common description research participants provided was the absence of scientific information to answer a research question, for example,

An area where there is missing or … insufficient information. And because of this … you cannot reach a conclusion for a question. So … it is a field, it is an area, a question an issue to which you don’t have an appropriate answer because there is missing … information or the research that still needs to be done in that particular area. (Funding body, F01)

One participant related research gaps to quality of evidence by use of Grades of Recommendation, Assessment, Development and Evaluation (GRADE), an approach for rating the quality of evidence and grading the strength of recommendations in healthcare. 21 Another participant emphasised the importance of public and community involvement in gap identification to ensure that it takes into account their perspectives and contributions to the research ecosystem:

existing knowledge but not documented is of key importance in understanding the current body of knowledge on a particular topic area …. Evidence gaps need to be defined not only by [the] research community but also according to the key stakeholders including community members. Community knowledge is of key importance to inform the evidence base. Further evaluation on research findings to characterise the nature of research gaps can be carried out by evaluating community perspectives and local evidence to confirm scientific evidence. (Health research PhD student, R01)

We identified variability in participant responses on how to define gaps in health research; this variability was mainly observed in individual responses for the three main categories (research, practice, and policy and funding).

Methods to identify gaps in health research

Participants reported a range of applicable methods to identify gaps in health research (eg, surveys, reviews, syntheses, priority-setting partnerships and assessments) as shown in figure 2 . The methods were also characterised by the different research methodologies used (ie, primary, secondary and both). Participants also expressed their difficulty in identifying research gaps, for example,

It is really difficult to identify research gaps. Lots of people you know will try and use the discussion section from research, [whereas] other authors have asked for further research, but in my experience that has not been a very useful method because sometimes authors will write that you know without really seeing or understanding that there has been something similar done in that field. (Health research methodologist, R02)

The variety of identified methods reflected the state of the field in the sense of the wide array of methods currently used, in line with the variety of specific goals of studies on research gaps ( figure 1 ). The difficulty in identifying research gaps raised by participants, together with the plurality of definition of gaps and range of methodologies, may, however, also reflect a possible lack of consensus and guidance on what method would be best suited for a given objective.

Methods used to identify gaps in health research.

Methods to display gaps in health research

Participants referred to a number of different methods used to display gaps in health research (ie, forest plots, diagrams/illustrations, evidence maps, mega maps, 3IE gap maps and info graphics) ( figure 3 ). Participant perspectives varied; one of the interviewees pointed out,

I think with the growth of technology, it is very important to use sophisticated methods to better communicate evidence for policy-making and decision-making. I think the availability of evidence is not enough on its own and finding different methods to communicate is important, not only the analysis and findings but also sharing it in different platforms online for a greater audience. (Health policy and guideline developer, P02)

Another participant highlighted that one of the key benefits of visually presenting research is being able to immediately see what information is available and missing.

Methods used to display gaps in health research.

The participants mainly expressed the importance of using data visualisation in research; there was a common understanding on the use of data visualisation as a whole, particularly with the growth of technology and the need to capitalise on it. The main challenges expressed were how to identify an appropriate visualisation to present the research and also how to effectively present data. We summarise these general experiences with data visualisation in health research in figure 3 and the online supplemental appendix .

This study provides insight into issues related to defining, identifying and displaying research gaps in health from the perspectives of key stakeholders. The findings indicate several definitions of gaps in health research and methods used to identify and display research gaps.

Our study confirmed the ambiguity in defining research gaps and methodological approaches to identify 3 22 and display research gaps. 2 The methods used to identify research gaps were closely linked to the definition of research gaps. For example, the JLA method of gap identification and setting priorities for research begins by clearly defining what the alliance refers to as evidence uncertainty, that is, there is no up-to-date, reliable systematic review of research evidence addressing the uncertainty or showing that uncertainty. 23 This step further informs the rest of the methodology used and is critical in identifying treatment uncertainties and determining future research priorities. This method combines both primary and secondary approaches and not only identifies research gaps but also verifies them across different relevant stakeholders, including researchers, patients, their carers and clinicians, to ensure the relevance and potential benefit to them. 23 This verification is important, given that some research gaps may be of key interest to researchers but have little relevance and importance to patients or the public, who should be the main beneficiaries of research to improve their health and well-being.

The overall method to identify research gaps involved primary, secondary or both approaches ( figure 2 ). Most of the participants mentioned the use of secondary research methods; this is in accordance with the research that has been conducted on research gaps, which has also primarily focused on the use of secondary research and developed frameworks for identifying research gaps. 2 3 8 24 25 The most commonly adopted framework involves identifying research gaps from systematic reviews using the Population, Intervention, Comparison and Outcome framework to characterise a research gap. 3 The other framework involves identifying research gaps in qualitative literature reviews. 25 In addition, the GRADE approach for rating the quality of evidence and grading the strength of recommendations in healthcare 21 presents the use of a prominent framework for evaluating the certainty of evidence that can inform the research gap and characterise it. 26 Moreover, scoping reviews are commonly used, and the definition includes aiming to identify research gaps by mapping the current body of evidence. These examples focus on the use of secondary research methods, but we lack studies that specifically explore the use of primary or both primary and secondary methods to identify research gaps, yet these methods equally exist and are being used. Additional exploration of applicable methods for identifying gaps can improve their usefulness and relevance in health research.

In summary, this study showed that research gaps need to be defined by researchers and confirmed by different research stakeholders such as patients and the public to ensure societal relevance and importance. 1 We also found that clearly defining research gaps can provide information on the most appropriate methodological approach to adopt in identifying and displaying gaps, for example, for exploring research gaps in a specific or broad area. For a specific area, a systematic review can be considered, and within a broad area, an umbrella review can be considered. The study also showed that the use of both primary and secondary methods (JLA method) to identify gaps is the most robust method for gap identification. The main reported advantage of this method is that it identifies gaps (treatment uncertainties) and involves different stakeholders, including patients and the public, to confirm and prioritise gaps. The main disadvantage is that it is labor-intensive (requires a team of different specialists) and expensive (administrative support, meeting rooms and catering, among others) compared with secondary methods (evidence synthesis) or primary methods (survey).

Participants mainly expressed the importance of data visualisation in communicating research; no specific methods or formats to present gaps were expressed. Thus, the use of data visualisation is desirable among different stakeholders, particularly researchers, when communicating research, although we found few examples of experiences with developing and using data visualisation. The participants mainly expressed their difficulty in finding the right tool to use to present research findings.

Finally, although scientific articles often refer to the existence of research gaps in studies, few respondents were able to define research gaps, unless contextualising them within a specific study or area, or methods of identification. Fully understanding research gaps in health research and adequately addressing them are difficult. In this study, we highlighted three key items on the topic: (1) clearly defining research gaps provides a context to understand better what the gaps are and what they are caused by; (2) a clear definition of research gaps can inform the methods used to identify research gaps, similar to how a clear research question can inform the research study methodology; and (3) on adopting the most appropriate methods to identify research gaps, finding the right visualisation to communicate them effectively is important. Last but not least, public involvement, when applicable, is needed to verify that gaps are important and relevant to the public.

To conclude, our study found that various methods can be used to identify gaps (ie, primary, secondary and both primary and secondary). Of all the methods used to identify gaps, secondary methods are the most common, specifically systematic reviews, which are considered the gold standard in that they address a highly focused question related to the existing evidence and thus present difficulties for explicitly identifying research gaps in a general area. 3 8 27 Other secondary research methods reported were overviews of reviews, also known as umbrella reviews, scoping reviews and evidence mapping. Overviews of reviews focus on a much broader area, compiling evidence from multiple reviews into one accessible and usable document and highlighting other reviews within the specified topic area. 28 29 Given the resource requirements of formal evidence reviews, topic prioritisation is needed to best allocate resources to those areas deemed the most relevant for the health system. Regardless of the topic, the prioritisation process is likely to be stakeholder-dependent. Priorities for evidence synthesis will vary depending on the mission of the healthcare system and the local needs of the healthcare stakeholders. 1 Hence, using both primary and secondary methods is the most robust because it involves the participation of patients, caregivers and healthcare and social care professionals in identifying research questions and then prioritising them using a combination of primary and secondary research. 30–49

To advance efforts in identifying research gaps, further work and different study designs are needed to take this work to the next step, to find consensus on definitions and different practices for methods in identifying research gaps. Subsequently, also assessing the best methods according to different stakeholders will be informative and important.

One of the main challenges of this study was that because the topic area is still very vague and unclear, the recruitment and interview process was challenging. Therefore, this study was primarily limited to what participants were familiar with and not necessarily representative of the full scope of the status of health researchers, health practitioners, oversight bodies and patients/public. A more generalisable understanding of this topic area would require a larger sample of participants and methodology, such as a Delphi survey, and/or a priority-setting partnership with representatives using evidence to inform policy, practice and research. This study would also have benefited from widening the scope of the stakeholder categories (use of evidence to inform health policy, health practice and health research). 2 This would have enriched our study findings and provided a wider view of stakeholder experiences outside our categories. Another limitation of this study is not including patients/public in designing the study. Including patient/public perspectives would have benefited the study design by being able to improve the importance and relevance of the findings for this population.

One of the main strengths of the study is improving the definition of research gaps and subsequently improving the accurate reporting of research gaps to elucidate the characteristics, which can help in evidence-based decisions. For example, a decision based on a research gap contributing to lack of primary research on a specific health problem can differ from the one based on a research gap related to lack of secondary research summarising the research. Hence, all these factors regarding research gaps need to be highlighted if they are known and made explicit when disseminating and communicating research. In addition, providing more information on what the gap represents may inform users of evidence of more specific information about the research gap and how it can be addressed more accurately.

Acknowledgments

The authors thank the interviewees for their time and input. They also thank Laura Smales (BioMedEditing, Toronto, ON) for editing the manuscript.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Twitter @LindaNyanchoka

Contributors LN and DH conceived the study with guidance and feedback from RP and CT-S. All authors read and approved the final manuscript.

Funding This project is a part of an MiRoR (Methods in Research on Research)-funded PhD undertaken by LN. MiRoR received funding from the European Union’s Horizon 2020 research and innovation programme under a Marie Sklodowska-Curie grant (agreement no. 676207).

Competing interests None declared.

Patient consent for publication Not required.

Ethics approval Informed consent was obtained in accordance with the University of Liverpool Ethics Committee board requirements. Verbal consent was sought for phone interviews and written consent for in-person interviews. Confidentiality and data protection will be ensured in accordance with the University of Liverpool Ethics Committee board. All participant information will be anonymised, and hard-copy data will be stored in a locked unit. Soft-copy material will be stored in a password-protected file. On completion of the study and publication of the study results, all study material will be stored and disposed of according to the rules and regulations of the University of Liverpool. The study protocol was stored in the data repository Zenodo. The research obtained ethical approval from the University of Liverpool, UK. This research project is part of a doctoral thesis of the PhD fellow (LN).

Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. Supporting data items can be found on Zenodo, https://zenodo.org/record/3664981%23.X4g7otAzY2y .

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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THE IMPORTANCE OF RESEARCH GAPS

2019, Tshidi M Wyllie

There is usually a number of reasons why research is carried out. One of such being to find answers and close existing research limitations or gaps. Every research project addresses or closes a knowledge gap; i.e. research has to answer an existing question that may or may not have emanated from previous research. The purpose of conducting research mostly is to close an existing research gap by providing a new body of knowledge which is why it’s important for researchers to identify research gaps in their area of interest. In a nutshell, research attempts to contribute new scientific research literature rather than duplicate what already exists (Miles, 2017).

Related Papers

Journal of Research Methods and Strategies

D. Anthony Miles

One of the most prevailing issues in the craft of research is to develop a research agenda and build the research on the development of the research gap. Most research of any endeavor is attributed to the development of the research gap, which is a primary basis in the investigation of any problem, phenomenon or scientific question. Given this accepted tenet of engagement in research, surprising in the research fraternity, we do not train researchers on how to systematically identify research gaps as basis for the investigation. This is has continued to be a common problem with novice researchers. Unfailingly, very little theory and research has been developed on identifying research gaps as a basis for a line in inquiry. The purpose of this research is threefold. First, the proposed theoretical framework builds on the five-point theoretical model of Robinson, Saldanhea, and McKoy (2011) on research gaps. Second, this study builds on the six-point theoretical model of Müller-Bloch and Franz (2014) on research gaps. Lastly, the purpose of this research is to develop and propose a theoretical model that is an amalgamation of the two preceding models and re-conceptualizes the research gap concepts and their characteristics. Thus, this researcher proposes a seven-point theoretical model. This article discusses the characteristics of each research and the situation in which its application is warranted in the literature review The significance of this article is twofold. First, this research provides theoretical significance by developing a theoretical model on research gaps. Second, this research attempts to build a solid taxonomy on the different characteristics of research gaps and establish a foundation. The implication for researchers is that research gaps should be structured and characterized based on their functionality. Thus, this provides researchers with a basic framework for identifying them in the literature investigation.

ISSAH BAAKO

Various researchers have established the need for researchers to position their research problem in the research gap of the study area. This does not only indicate the relevance of the study but it demonstrates the significant contribution it would make in the field of study. The purpose of this paper is to conduct a systematic literature review on the concept of research gaps and provoke a discussion on the contemporary literature on types of research gaps. The paper discusses the various approaches for researchers to identify, align and position research problems, research design, and methodology in the research gaps to achieve relevance in their findings and study. A systematic review of the current literature on research gaps might assist beginning researchers in the justification of research problems. Given the acceptable tenet of developing a research agenda, design, and development on a research gap, many early career researchers especially (post)graduate students have difficulties in systematically identifying research gaps as a basis for conducting research work. The significance of this paper is twofold. First, it provides a systematic review of literature on the identification of research gaps to undertake research that would challenge assumptions and underlying existing theories in a significant way. Second, it provides a theoretical discussion on the importance of developing research problems on research gaps to structure their study.

Sid Ahmed KHETTAB

A research gap is generally any problem a scientific article, an academic book or a thesis may contain. In the previous article [https://discourse.clevious.com/2019/12/how-to-come-up-with-research-idea.html], based on Dr. Anthony Miles' article on research gaps, I summarized the 7 research gaps into three main categories: theoretical problems, reasoning problems, and empirical problems.

Kayode Oyediran

Problem in a research as well as human body calls for perfect diagnosis of illness. This is important to avoid treating the symptoms instead of the actual disease. A research problem could be identified through professional or/and academic efforts. This poses a lot of problems to students, both at the undergraduate and postgraduate levels, as this determines the title of their articles or research works. Many of them have to submit many topics to their supervisors before one could be reframed and approved. At times, students appealed to their supervisors to provide them with researchable topics. This to the supervisor(s) almost writing the dissertations/theses for them. The argument of this paper is to let students understand "problem identification" using an analogy from the Holy Bible. The study employed a conversation analysis methodology, which is empirically grounded, exploratory in process and inferential. This involves using every conversation between two or more parties to explore facts/lesson. It was recommended that seasoned lecturers should explain to students how to identify research problems using what are familiar to them to make them understand this important aspect of research.

UNICAF University - Zambia

Ivan Steenkamp

In this second part of The Reason to Replicate Research, I develop with more details and explanations the Reasoning Gaps idea I briefly discussed in the article “How to Come Up with Research Question Easily Like a Pro”. (https://discourse.clevious.com/2019/12/how-to-come-up-with-research-idea.html) And just like in Part I (https://discourse.clevious.com/2020/01/the-empirical-gap-to-replicate-research.html), I will try to pivot the explanation around an example and show why they are important to fill.

Aljamar Muhallus

Patrick Van Der Duin , Hans Stavleu

In this special issue several scientists and practitioners from various types of organizations have provided their thoughts, opinions and solutions on to how to bridge the gap between technology foresight and market research in previewing the potential of breakthrough technologies. The gap is observed from different perspectives: methodological, temporal, and (even) geographical. Each perspective helps reduce the gap. Most contributions were able to provide empirical support for their solutions. Joseph Schumpeter often spoke about 'Neue Kombinationen' (New Combinations), by which he meant that many innovations are the outcome of a combination of two or more existing innovations, technologies or ideas. Renewing science, in particular renewing the methods to preview the potential of breakthrough technologies, also seems to benefit from this type of combination. The papers in this special issue try to close the gap between the scientific disciplines of technology foresight and market research with the aim of improving our ability to predict the potential of breakthrough technologies. Many authors have attempted to preview this potential, both from a theoretical and from a practical perspective. For us, the editors, this is a clear indication that the topic is not only scientifically interesting, but that it is also practically relevant for futures researchers and market researchers. Thus, in this special issue of Technological Forecasting & Social Change, a number of scientists and practitioners have proposed various solutions to narrow the gap. Un and Price from Philips Design recommend involving people at the early stages of technology development. They argue that the gap should not be examined only from the macro-level at which technology foresight and market research usually take place. Instead, they emphasize the importance of focusing on people research, which is " aimed at understanding people, their values and needs, in the context of their daily lives, rather than sizing up potential markets and competitors the way it is done in

Research to Action: The Global Guide to Research Impact

Steven E Wallis, PhD

The basics of research are seemingly clear. Read a lot of articles, see what’s missing, and conduct research to fill the gap in the literature. Wait a minute. What is that? “See what’s missing?” How can we see something that is not there? In this post, we will show you how to “see the invisible;” How to identify the missing pieces in any study, literature review, or program analysis. With these straight-forward techniques, you will be able to better target your research in a more cost-effective way to fill those knowledge gaps to develop more effective theories, plans, and evaluations.

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• Published: 16 May 2024

Promoting equality, diversity and inclusion in research and funding: reflections from a digital manufacturing research network

• Oliver J. Fisher 1 ,
• Debra Fearnshaw   ORCID: orcid.org/0000-0002-6498-9888 2 ,
• Nicholas J. Watson 3 ,
• Peter Green 4 ,
• Fiona Charnley 5 ,
• Duncan McFarlane 6 &
• Sarah Sharples 2  

Research Integrity and Peer Review volume  9 , Article number:  5 ( 2024 ) Cite this article

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Metrics details

Equal, diverse, and inclusive teams lead to higher productivity, creativity, and greater problem-solving ability resulting in more impactful research. However, there is a gap between equality, diversity, and inclusion (EDI) research and practices to create an inclusive research culture. Research networks are vital to the research ecosystem, creating valuable opportunities for researchers to develop their partnerships with both academics and industrialists, progress their careers, and enable new areas of scientific discovery. A feature of a network is the provision of funding to support feasibility studies – an opportunity to develop new concepts or ideas, as well as to ‘fail fast’ in a supportive environment. The work of networks can address inequalities through equitable allocation of funding and proactive consideration of inclusion in all of their activities.

This study proposes a strategy to embed EDI within research network activities and funding review processes. This paper evaluates 21 planned mitigations introduced to address known inequalities within research events and how funding is awarded. EDI data were collected from researchers engaging in a digital manufacturing network activities and funding calls to measure the impact of the proposed method.

Quantitative analysis indicates that the network’s approach was successful in creating a more ethnically diverse network, engaging with early career researchers, and supporting researchers with care responsibilities. However, more work is required to create a gender balance across the network activities and ensure the representation of academics who declare a disability. Preliminary findings suggest the network’s anonymous funding review process has helped address inequalities in funding award rates for women and those with care responsibilities, more data are required to validate these observations and understand the impact of different interventions individually and in combination.

Conclusions

In summary, this study offers compelling evidence regarding the efficacy of a research network's approach in advancing EDI within research and funding. The network hopes that these findings will inform broader efforts to promote EDI in research and funding and that researchers, funders, and other stakeholders will be encouraged to adopt evidence-based strategies for advancing this important goal.

Peer Review reports

Introduction

Achieving equality, diversity, and inclusion (EDI) is an underpinning contributor to human rights, civilisation and society-wide responsibility [ 1 ]. Furthermore, promoting and embedding EDI within research environments is essential to make the advancements required to meet today’s research challenges [ 2 ]. This is evidenced by equal, diverse and inclusive teams leading to higher productivity, creativity and greater problem-solving ability [ 3 ], which increases the scientific impact of research outputs and researchers [ 4 ]. However, there remains a gap between EDI research and the everyday implementation of inclusive practices to achieve change [ 5 ]. This paper presents and reflects on the EDI measures trialled by the UK Engineering and Physical Sciences Research Council (EPSRC) funded digital manufacturing research network, Connected Everything (grant number: EP/S036113/1) [ 6 ]. The EPSRC is a UK research council that funds engineering and physical sciences research. By sharing these reflections, this work aims to contribute to the wider effort of creating an inclusive research culture. The perceptions of equality, diversity, and inclusion may vary among individuals. For the scope of this study, the following definitions are adopted:

Equality: Equality is about ensuring that every individual has an equal opportunity to make the most of their lives and talents. No one should have poorer life chances because of the way they were born, where they come from, what they believe, or whether they have a disability.

Diversity: Diversity concerns understanding that each individual is unique, recognising our differences, and exploring these differences in a safe, positive, and nurturing way to value each other as individuals.

Inclusion: Inclusion is an effort and practice in which groups or individuals with different backgrounds are culturally and socially accepted, welcomed and treated equally. This concerns treating each person as an individual, making them feel valued, and supported and being respectful of who they are.

Research networks have varied goals, but a common purpose is to create new interdisciplinary research communities, by fostering interactions between researchers and appropriate scientific, technological and industrial groups. These networks aim to offer valuable career progression opportunities for researchers, through access to research funding, forming academic and industrial collaborations at network events, personal and professional development, and research dissemination. However, feedback from a 2021 survey of 19 UK research networks, suggests that these research networks are not always diverse, and whilst on the face of it they seem inclusive, they are perceived as less inclusive by minority groups (including non-males, those with disabilities, and ethnic minority respondents) [ 7 ]. The exclusivity of these networks further exacerbates the inequality within the academic community as it prevents certain groups from being able to engage with all aspects of network activities.

Research investigating the causes of inequality and exclusivity has identified several suggestions to make research culture more inclusive, including improving diverse representation within event programmes and panels [ 8 , 9 ]; ensuring events are accessible to all [ 10 ]; providing personalised resources and training to build capacity and increase engagement [ 11 ]; educating institutions and funders to understand and address the barriers to research [ 12 ]; and increasing diversity in peer review and funding panels [ 13 ]. Universities, research institutions and research funding bodies are increasingly taking responsibility to ensure the health of the research and innovation system and to foster inclusion. For example, the EPSRC has set out their own ‘Expectation for EDI’ to promote the formation of a diverse and inclusive research culture [ 14 ]. To drive change, there is an emphasis on the importance of measuring diversity and links to measured outcomes to benchmark future studies on how interventions affect diversity [ 5 ]. Further, collecting and sharing EDI data can also drive aspirations, provide a target for actions, and allow institutions to consider common issues. However, there is a lack of available data regarding the impact of EDI practices on diversity that presents an obstacle, impeding the realisation of these benefits and hampering progress in addressing common issues and fostering diversity and inclusion [ 5 ].

Funding acquisition is important to an academic’s career progression, yet funding may often be awarded in ways that feel unequal and/or non-transparent. The importance of funding in academic career progression means that, if credit for obtaining funding is not recognised appropriately, careers can be damaged, and, as a result of the lack of recognition for those who have been involved in successful research, funding bodies may not have a complete picture of the research community, and are unable to deliver the best value for money [ 15 ]. Awarding funding is often a key research network activity and an area where networks can have a positive impact on the wider research community. It is therefore important that practices are established to embed EDI consideration within the funding process and to ensure that network funding is awarded without bias. Recommendations from the literature to make the funding award process fairer include: ensuring a diverse funding panel; funders instituting reviewer anti-bias training; anonymous review; and/or automatic adjustments to correct for known biases [ 16 ]. In the UK, the government organisation UK Research and Innovation (UKRI), tasked with overseeing research and innovation funding, has pledged to publish data to enhance transparency. This initiative aims to furnish an evidence base for designing interventions and evaluating their efficacy. While the data show some positive signs (e.g., the award rates for male and female PI applicants were equal at 29% in 2020–21), Ottoline Leyser (UKRI Chief Executive) highlights the ‘persistent pernicious disparities for under-represented groups in applying for and winning research funding’ [ 17 ]. This suggests that a more radical approach to rethinking the traditional funding review process may be required.

This paper describes the approach taken by the ‘Connected Everything’ EPSRC-funded Network to embed EDI in all aspects of its research funding process, and evaluates the impact of this ambition, leading to recommendations for embedding EDI in research funding allocation.

Connected everything’s equality diversity and inclusion strategy

Connected Everything aims to create a multidisciplinary community of researchers and industrialists to address key challenges associated with the future of digital manufacturing. The network is managed by an investigator team who are responsible for the strategic planning and, working with the network manager, to oversee the delivery of key activities. The network was first funded between 2016–2019 (grant number: EP/P001246/1) and was awarded a second grant (grant number: EP/S036113/1). The network activities are based around three goals: building partnerships, developing leadership and accelerating impact.

The Connected Everything network represents a broad range of disciplines, including manufacturing, computer science, cybersecurity, engineering, human factors, business, sociology, innovation and design. Some of the subject areas, such as Computer Science and Engineering, tend to be male-dominated (e.g., in 2021/22, a total of 185,42 higher education student enrolments in engineering & technology subjects was broken down as 20.5% Female and 79.5% Male [ 18 ]). The networks also face challenges in terms of accessibility for people with care responsibilities and disabilities. In 2019, Connected Everything committed to embedding EDI in all its network activities and published a guiding principle and goals for improving EDI (see Additional file 1 ). When designing the processes to deliver the second iteration of Connected Everything, the team identified several sources of potential bias/exclusion which have the potential to impact engagement with the network. Based on these identified factors, a series of mitigation interventions were implemented and are outlined in Table  1 .

Connected everything anonymous review process

A key Connected Everything activity is the funding of feasibility studies to enable cross-disciplinary, foresight, speculative and risky early-stage research, with a focus on low technology-readiness levels. Awards are made via a short, written application followed by a pitch to a multidisciplinary diverse panel including representatives from industry. Six- to twelve-month-long projects are funded to a maximum value of £60,000.

The current peer-review process used by funders may reveal the applicants’ identities to the reviewer. This can introduce dilemmas to the reviewer regarding (a) deciding whether to rely exclusively on information present within the application or search for additional information about the applicants and (b) whether or not to account for institutional prestige [ 34 ]. Knowing an applicant’s identity can bias the assessment of the proposal, but by focusing the assessment on the science rather than the researcher, equality is more frequently achieved between award rates (i.e., the proportion of successful applications) [ 15 ]. To progress Connected Everything’s commitment to EDI, the project team created a 2-stage review process, where the applicants’ identity was kept anonymous during the peer review stage. This anonymous process, which is outlined in Fig.  1 , was created for the feasibility study funding calls in 2019 and used for subsequent funding calls.

Connected Everything’s anonymous review process [EDI: Equality, diversity, and inclusion]

To facilitate the anonymous review process, the proposal was submitted in two parts: part A the research idea and part B the capability-to-deliver statement. All proposals were first anonymously reviewed by a random selection of two members from the Connected Everything executive group, which is a diverse group of digital manufacturing experts and peers from academia, industry and research institutions that provide guidance and leadership on Connected Everything activities. The reviewers rated the proposals against the selection criteria (see Additional file 1 , Table 1) and provided overall comments alongside a recommendation on whether or not the applicant should be invited to the panel pitch. This information was summarised and shared with a moderation sift panel, made up of a minimum of two Connected Everything investigators and a minimum of one member of the executive group, that tensioned the reviewers’ comments (i.e. comments and evaluations provided by the peer reviewers are carefully considered and weighed against each other) and ultimately decided which proposals to invite to the panel. This tension process included using the identifying information to ensure the applicants did have the capability to deliver the project. If this remained unclear, the applicants were asked to confirm expertise in an area the moderation sift panel thought was key or asked to bring in additional expertise to the project team during the panel pitch.

During stage two the applicants were invited to pitch their research idea to a panel of experts who were selected to reflect the diversity of the community. The proposals, including applicants’ identities, were shared with the panel at least two weeks ahead of the panel. Individual panel members completed a summary sheet at the end of the pitch session to record how well the proposal met the selection criteria (see Additional file 1 , Table 1). Panel members did not discuss their funding decision until all the pitches had been completed. A panel chair oversaw the process but did not declare their opinion on a specific feasibility study unless the panel could not agree on an outcome. The panel and panel chair were reminded to consider ways to manage their unconscious bias during the selection process.

Due to the positive response received regarding the anonymous review process, Connected Everything extended its use when reviewing other funded activities. As these awards were for smaller grant values (~ £5,000), it was decided that no panel pitch was required, and the researcher’s identity was kept anonymous for the entire process.

Data collection and analysis methods

Data collection.

Equality, diversity and inclusion data were voluntarily collected from applicants for Connected Everything research funding and from participants who won scholarships to attend Connected Everything funded activities. Responses to the EDI data requests were collected from nine Connected Everything coordinated activities between 2019 and 2022. Data requests were sent after the applicant had applied for Connected Everything funding or had attended a Connected Everything funded activity. All data requests were completed voluntarily, with reassurance given that completion of the data requested in no way affected their application. In total 260 responses were received, of which the three feasibility study calls comprised 56.2% of the total responses received. Overall, there was a 73.8% response rate.

To understand the diversity of participants engaging with Connected Everything activities and funding, the data requests asked for details of specific diversity characteristics: gender, transgender, disability, ethnicity, age, and care responsibilities. Although sex and gender are terms that are often used interchangeably, they are two different concepts. To clarify, the definitions used by the UK government describe sex as a set of biological attributes that is generally limited to male or female, and typically attributed to individuals at birth. In contrast, gender identity is a social construction related to behaviours and attributes, and is self-determined based on a person’s internal perception, identification and experience. Transgender is a term used to describe people whose gender identity is not the same as the sex they were registered at birth. Respondents were first asked to identify their gender and then whether their gender was different from their birth sex.

For this study, respondents were asked to (voluntarily) self-declare whether they consider themselves to be disabled or not. Ethnicity within the data requests was based on the 2011 census classification system. When reporting ethnicity data, this study followed the AdvanceHE example to aggregate the census categories into six groups to enable benchmarking against the available academic ethnicity data. AdvanceHE is a UK charity that works to improve the higher education system for staff, students and society. However, it was acknowledged that there were limitations with this grouping, including the assumption that minority ethnic staff or students are a homogenous group [ 16 ]. Therefore, this study made sure to breakdown these groups during the discussion of the results. The six groups are:

Asian: Asian/Asian British: Indian, Pakistani, Bangladeshi, and any other Asian background;

Black: Black/African/Caribbean/Black British: African, Caribbean, and any other Black/African/Caribbean background;

Other ethnic backgrounds, including Arab.

White: all white ethnic groups.

Benchmarking data

Published data from the Higher Education Statistics Agency [ 26 ] (a UK organisation responsible for collecting, analysing, and disseminating data related to higher education institutions and students), UKRI funding data [ 19 , 35 ] and 2011 census data [ 36 ] were used to benchmark the EDI data collected within this study. The responses to the data collected were compared to the engineering and technology cluster of academic disciplines, as this is most represented by Connected Everything’s main funded EPSRC. The Higher Education Statistics Agency defines the engineering and technology cluster as including the following subject areas: general engineering; chemical engineering; mineral, metallurgy & materials engineering; civil engineering; electrical, electronic & computer engineering; mechanical, aero & production engineering and; IT, systems sciences & computer software engineering [ 37 ].

When assessing the equality in funding award rates, previous studies have focused on analysing the success rates of only the principal investigators [ 15 , 16 , 38 ]; however, Connected Everything recognised that writing research proposals is a collaborative task, so requested diversity data from the whole research team. The average of the last six years of published principal investigator and co-investigator diversity data for UKRI and EPSRC funding awards (2015–2021) was used to benchmark the Connected Everything funding data [ 35 ]. The UKRI and EPSRC funding review process includes a peer review stage followed by panel pitch and assessment stage; however, the applicant's track record is assessed during the peer review stage, unlike the Connected Everything review process.

The data collected have been used to evaluate the success of the planned migrations to address EDI factors affecting the higher education research ecosystem, as outlined in Table  1 (" Connected Everything’s Equality Diversity and Inclusion Strategy " Section).

Dominance of small number of research-intensive universities receiving funding from network

The dominance of a small number of research-intensive universities receiving funding from a network can have implications for the field of research, including: the unequal distribution of resources; a lack of diversity of research, limited collaboration opportunities; and impact on innovation and progress. Analysis of published EPSRC funding data between 2015 and 2021 [ 19 ], shows that the funding has been predominately (74.1%, 95% CI [71.%, 76.9%] out of £3.98 billion) awarded to Russell Group universities. The Russell Group is a self-selected association of 24 research-intensive universities (out of the 174 universities) in the UK, established in 1994. Evaluation of the universities that received Connected Everything feasibility study funding between 2016–2019, shows that Connected Everything awarded just over half (54.6%, 95% CI [25.1%, 84.0%] out of 11 awards) to Russell Group universities. Figure  2 shows that the Connected Everything funding awarded to Russell Group universities reduced to 44.4%, 95% CI [12.0%, 76.9%] of 9 awards between 2019–2022.

A comparison of funding awarded by EPSRC (total = £3.98 billion) across Russell Group universities and non-Russell Group universities, alongside the allocations for Connected Everything I (total = £660 k) and Connected Everything II (total = £540 k)

Dominance of successful applications from men

The percentage point difference between the award rates of researchers who identified as female, those who declare a disability, or identified as ethnic minority applicants and carers and their respective counterparts have been plotted in Fig.  3 . Bars to the right of the axis mean that the award rate of the female/declared-disability/ethnic-minority/carer applicants is greater than that of male/non- disability/white/not carer applicants.

Percentage point (PP) differences in award rate by funding provider for gender, disability status, ethnicity and care responsibilities (data not collected by UKRI and EPSRC [ 35 ]). The total number of applicants for each funder are as follows: Connected Everything = 146, EPSRC = 37,960, and UKRI = 140,135. *The numbers of applicants were too small (< 5) to enable a meaningful discussion

Figure  3 (A) shows that between 2015 and 2021 research team applicants who identified as male had a higher award rate than those who identified as female when applying for EPSRC and wider UKRI research council funding. Connected Everything funding applicants who identified as female achieved a higher award rate (19.4%, 95% CI [6.5%, 32.4%] out of 146) compared to male applicants (15.6%, 95% CI [8.8%, 22.4%] out of 146). These data suggest that biases have been reduced by the Connected Everything review process and other mitigation strategies (e.g., visible gender diversity in panel pitch members and publishing CE principal and goals to demonstrate commitment to equality and fairness). This finding aligns with an earlier study that found gender bias during the peer review process, resulting in female investigators receiving less favourable evaluations than their male counterparts [ 15 ].

Over-representation of people identifying as male in engineering and technology academic community

Figure  4 shows the response to the gender question, with 24.2%, 95% CI [19.0%, 29.4%] of 260 responses identifying as female. This aligns with the average for the engineering and technology cluster (21.4%, 95% CI [20.9%, 21.9%] female of 27,740 academic staff), which includes subject areas representative of our main funder, EPSRC [ 22 ]. We also sought to understand the representation of transgender researchers within the network. However, following the rounding policy outlined by UK Government statistics policies and procedures [ 39 ], the number of responses that identified as a different sex to birth was too low (< 5) to enable a meaningful discussion.

Gender question responses from a total of 260 respondents

Dominance of successful applications from white academics

Figure  3 (C) shows that researchers with a minority ethnicity consistently have a lower award rate than white researchers when applying for EPSRC and UKRI funding. Similarly, the results in Fig.  3 (C) indicate that white researchers are more successful (8.0% percentage point, 95% CI [-8.6%, 24.6%]) when applying for Connected Everything funding. These results indicate that more measures should be implemented to support the ethnic minority researchers applying for Connected Everything funding, as well as sense checking there is no unconscious bias in any of the Connected Everything funding processes. The breakdown of the ethnicity diversity of applicants at different stages of the Connected Everything review process (i.e. all applications, applicants invited to panel pitch and awarded feasibility studies) has been plotted in Fig.  5 to help identify where more support is needed. Figure  5 shows an increase in the proportion of white researchers from 54%, 95% CI [45.4%, 61.8%] of all 146 applicants to 66%, 95% CI [52.8%, 79.1%] of the 50 researchers invited to the panel pitch. This suggests that stage 1 of the Connected Everything review process (anonymous review of written applications) may favour white applicants and/or introduce unconscious bias into the process.

Ethnicity questions responses from different stages during the Connected Everything anonymous review process. The total number of applicants is 146, with 50 at the panel stage and 23 ultimately awarded

Under-representation of those from black or minority ethnic backgrounds

Connected Everything appears to have a wide range of ethnic diversity, as shown in Fig.  6 . The ethnicities Asian (18.3%, 95% CI [13.6%, 23.0%]), Black (5.1%, 95% CI [2.4%, 7.7%]), Chinese (12.5%, 95% CI [8.4%, 16.5%]), mixed (3.5%, 95% CI [1.3%, 5.7%]) and other (7.8%, 95% CI [4.5%, 11.1%]) have a higher representation among the 260 individuals engaging with network’s activities, in contrast to both the engineering and technology academic community and the wider UK population. When separating these groups into the original ethnic diversity answers, it becomes apparent that there is no engagement with ‘Black or Black British: Caribbean’, ‘Mixed: White and Black Caribbean’ or ‘Mixed: White and Asian’ researchers within Connected Everything activities. The lack of engagement with researchers from a Caribbean heritage is systemic of a lack of representation within the UK research landscape [ 25 ].

Ethnicity question responses from a total of 260 respondents compared to distribution of the 13,085 UK engineering and technology (E&T) academic staff [ 22 ] and 56 million people recorded in the UK 2011 census data [ 36 ]

Under-representation of disabilities, chronic conditions, invisible illnesses and neurodiversity in funded activities and events.

Figure  7 (A) shows that 5.7%, 95% CI [2.4%, 8.9%] of 194 responses declared a disability. This is higher than the average of engineering and technology academics that identify as disabled (3.4%, 95% CI [3.2%, 3.7%] of 27,730 academics). Between Jan-March 2022, 9.0 million people of working age (16–64) within the UK were identified as disabled by the Office for National Statistics [ 40 ], which is 21% of the working age population [ 27 ]. Considering these statistics, there is a stark under-representation of disabilities, chronic conditions, invisible illnesses and neurodiversity amongst engineering and technology academic staff and those engaging in Connected Everything activities.

Responses to A  Disability and B  Care responsibilities questions colected from a total of 194 respondents

Between 2015 and 2020 academics that declared a disability have been less successful than academics without a disability in attracting UKRI and EPSRC funding, as shown in Fig.  3 (B). While Fig.  3 (B) shows that those who declare a disability have a higher Connected Everything funding award rate, the number of applicants who declared a disability was too small (< 5) to enable a meaningful discussion regarding this result.

Under-representation of those with care responsibilities in funded activities and events

In response to the care responsibilities question, Fig.  7 (B) shows that 27.3%, 95% CI [21.1%, 33.6%] of 194 respondents identified as carers, which is higher than the 6% of adults estimated to be providing informal care across the UK in a UK Government survey of the 2020/2021 financial year [ 41 ]. However, the ‘informal care’ definition used by the 2021 survey includes unpaid care to a friend or family member needing support, perhaps due to illness, older age, disability, a mental health condition or addiction [ 41 ]. The Connected Everything survey included care responsibilities across the spectrum of care that includes partners, children, other relatives, pets, friends and kin. It is important to consider a wide spectrum of care responsibilities, as key academic events, such as conferences, have previously been demonstrably exclusionary sites for academics with care responsibilities [ 42 ]. Breakdown analysis of the responses to care responsibilities by gender in Fig.  8 reveals that 37.8%, 95% CI [25.3%, 50.3%] of 58 women respondents reported care responsibilities, compared to 22.6%, 95% CI [61.1%, 76.7%] of 136 men respondents. Our findings reinforce similar studies that conclude the burden of care falls disproportionately on female academics [ 43 ].

Responses to care responsibilities when grouped by A  136 males and B  58 females

Figure  3 (D) shows that researchers with careering responsibilities applying for Connected Everything funding have a higher award rate than those researchers applying without care responsibilities. These results suggest that the Connected Everything review process is supportive of researchers with care responsibilities, who have faced barriers in other areas of academia.

Reduced opportunities for ECRs

Early-career researchers (ECRs) represent the transition stage between starting a PhD and senior academic positions. EPSRC defines an ECR as someone who is either within eight years of their PhD award, or equivalent professional training or within six years of their first academic appointment [ 44 ]. These periods exclude any career break, for example, due to family care; health reasons; and reasons related to COVID-19 such as home schooling or increased teaching load. The median age for starting a PhD in the UK is 24 to 25, while PhDs usually last between three and four years [ 45 ]. Therefore, these data would imply that the EPSRC median age of ECRs is between 27 and 37 years. It should be noted, however, that this definition is not ideal and excludes ECRs who may have started their research career later in life.

Connected Everything aims to support ECRs via measures that include mentoring support, workshops, summer schools and podcasts. Figure  9 shows a greater representation of researchers engaging with Connected Everything activities that are aged between 30–44 (62.4%, 95% CI [55.6%, 69.2%] of 194 respondents) when compared to the wider engineering and technology academic community (43.7%, 95% CI [43.1%, 44.3%] of 27,780 academics) and UK population (26.9%, 95% CI [26.9%, 26.9%]).

Age question responses from a total of 194 respondents compared to distribution of the 27,780 UK engineering and technology (E&T) academic staff [ 22 ] and 56 million people recorded in the UK 2011 census data [ 36 ]

High competition for funding has a greater impact on ECRs

Figure  10 shows that the largest age bracket applying for and winning Connected Everything funding is 31–45, whereas 72%, CI 95% [70.1%, 74.5%] of 12,075 researchers awarded EPSRC grants between 2015 and 2021 were 40 years or older. These results suggest that measures introduced by Connected Everything has been successful at providing funding opportunities for researchers who are likely to be early-mid career stage.

Age of researchers at applicant and awarded funding stages for A  Connected Everything between 2019–2022 (total of 146 applicants and 23 awarded) and B  EPSRC funding between 2015–2021 [ 35 ] (total of 35,780 applicants and 12,075 awarded)

The results of this paper provide insights into the impact that Connected Everything’s planned mitigations have had on promoting equality, diversity, and inclusion (EDI) in research and funding. Collecting EDI data from individuals who engage with network activities and apply for research funding enabled an evaluation of whether these mitigations have been successful in achieving the intended outcomes outlined at the start of the study, as summarised in Table  2 .

The results in Table  2 indicate that Connected Everything’s approach to EDI has helped achieve the intended outcome to improve representation of women, ECRs, those with a declared disability and black/minority ethnic backgrounds engaging with network events when compared to the engineering and technology academic community. In addition, the network has helped raise awareness of the high presence of researchers with care responsibilities at network events, which can help to track progress towards making future events inclusive and accessible towards these carers. The data highlights two areas for improvement: (1) ensuring a gender balance; and (2) increasing representation of those with declared disabilities. Both these discrepancies are indicative of the wider imbalances and underrepresentation of these groups in the engineering and technology academic community [ 26 ], yet represent areas where networks can strive to make a difference. Possible strategies include: using targeted outreach; promoting greater representation of these groups in event speakers; and going further to create a welcoming and inclusive environment. One barrier that can disproportionately affect women researchers is the need to balance care responsibilities with attending network events [ 46 ]. This was reflected in the Connected Everything data that reported 37.8%, 95% CI [25.3%, 50.3%] of women engaging with network activities had care responsibilities, compared to 22.6%, 95% CI [61.1%, 76.7%] of men. Providing accommodations such as on-site childcare, flexible scheduling, or virtual attendance options can therefore help to promote inclusivity and allow more women researchers to attend.

Only 5.7%, 95% CI [2.4%, 8.9%] of responses engaging with Connected Everything declared a disability, which is higher than the engineering and technology academic community (3.4%, 95% CI [3.2%, 3.7%]) [ 26 ], but unrepresentative of the wider UK population. It has been suggested that academics can be uncomfortable when declaring disabilities because scholarly contributions and institutional citizenship are so prized that they feel they cannot be honest about their issues or health concerns and keep them secret [ 47 ]. In research networks, it is important to be mindful of this hidden group within higher education and ensure that measures are put in place to make the network’s activities inclusive to all. Future considerations for accommodations to improve research events inclusivity include: improving physical accessibility of events; providing assistive technology such as screen readers, audio descriptions, and captioning can help individuals with visual or hearing impairments to access and participate; providing sign language interpreters; offering flexible scheduling options; and the provision of quiet rooms, written materials in accessible formats, and support staff trained to work with individuals with cognitive disabilities.

Connected Everything introduced measures (e.g., anonymised reviewing process, Q&A sessions before funding calls, inclusive design of panel pitch) to help address inequalities in how funding is awarded. Table 2 shows success in reducing the dominance of researchers who identify as male and research-intensive universities in winning research funding and that researchers with care responsibilities were more successful at winning funding than those without care responsibilities. The data revealed that the proposed measures were unable to address the inequality in award rates between white and ethnic minority researchers, which is an area to look to improve. The inequality appears to occur during the anonymous review stage, with a greater proportion of white researchers being invited to panel. Recommendations to make the review process fairer include: ensuring greater diversity of reviewers; reviewer anti-bias training; and automatic adjustments to correct for known biases in writing style [ 16 , 32 ].

When reflecting on the development of a strategy to embed EDI throughout the network, Connected Everything has learned several key lessons that may benefit other networks undergoing a similar activity. These include:

EDI is never ‘done’: There is a constant need to review approaches to EDI to ensure they remain relevant to the network community. Connected Everything could review its principles to include the concept of justice in its approach to diversity and inclusion. The concept of justice concerning EDI refers to the removal of systematic barriers that stop fair and equitable distribution of resources and opportunities among all members of society, regardless of their individual characteristics or backgrounds. The principles and subsequent actions could be reviewed against the EDI expectations [ 14 ], paying particular attention to areas where barriers may still be present. For example, shifting from welcoming people into existing structures and culture to creating new structures and culture together, with specific emphasis on decision or advisory mechanisms within the network. This activity could lend itself to focusing more on tailored support to overcome barriers, thus achieving equity, if it is not within the control of the network to remove the barrier itself (justice).

Widen diversity categories: By collecting data on a broad range of characteristics, we can identify and address disparities and biases that might otherwise be overlooked. A weakness of this dataset is that ignores the experience of those with intersectional identities, across race, ethnicity, gender, class, disability and/ or LGBTQI. The Wellcome Trust noted how little was known about the socio-economic background of scientists and researchers [ 48 ].

Collect data on whole research teams: For the first two calls for feasibility study funding, Connected Everything only asked the Principal Investigator to voluntarily provide their data. We realised that this was a limited approach and, in the third call, asked for the data regarding the whole research team to be shared anonymously. Furthermore, we do not currently measure the diversity of our event speakers, panellists or reviewers. Collecting these data in the future will help to ensure the network is accountable and will ensure that all groups are represented during our activities and in the funding decision-making process.

High response rate: Previous surveys measuring network diversity (e.g., [ 7 ]) have struggled to get responses when surveying their memberships; whereas, this study achieved a response rate of 73.8%. We attribute this high response rate to sending EDI data requests on the point of contact with the network (e.g., on submitting funding proposals or after attending network events), rather than trying to survey the entire network membership at anyone point in time.

Improve administration: The administration associated with collecting EDI data requires a commitment to transparency, inclusivity, and continuous improvement. For example, during the first feasibility funding call, Connected Everything made it clear that the review process would be anonymous, but the application form was not in separate documents. This made anonymising the application forms extremely time-consuming. For the subsequent calls, separate documents were created – Part A for identifying information (Principal Investigator contact details, Project Team and Industry collaborators) and Part B for the research idea.

Accepting that this can be uncomfortable: Trying to improve EDI can be uncomfortable because it often requires challenging our assumptions, biases, and existing systems and structures. However, it is essential if we want to make real progress towards equity and inclusivity. Creating processes to support embedding EDI takes time and Connected Everything has found it is rare to get it right the first time. Connected Everything is sharing its learning as widely as possible both to support others in their approaches and continue our learning as we reflect on how to continually improve, even when it is challenging.

Enabling individual engagement with EDI: During this work, Connected Everything recognised that methods for engaging with such EDI issues in research design and delivery are lacking. Connected Everything, with support from the Future Food Beacon of Excellence at the University of Nottingham, set out to develop a card-based tool [ 49 ] to help researchers and stakeholders identify questions around how their work may promote equity and increase inclusion or have a negative impact towards one or more protected groups and how this can be overcome. The results of this have been shared at conference presentations [ 50 ] and will be published later.

While this study provides insights into how EDI can be improved in research network activities and funding processes, it is essential to acknowledge several limitations that may impact the interpretation of the findings.

Sample size and generalisability: A total of 260 responses were received, which may not be representative of our overall network of 500 + members. Nevertheless, this data provides a sense of the current diversity engaging in Connected Everything activities and funding opportunities, which we can compare with other available data to steer action to further diversify the network.

Handling of missing data: Out of the 260 responses, 66 data points were missing for questions regarding age, disability, and caring responsibilities. These questions were mistakenly omitted from a Connected Everything summer school survey, contributing to 62 missing data points. While we assumed the remainer of missing data to be at random during analysis, it's important to acknowledge it could be related to other factors, potentially introducing bias into our results.

Emphasis on quantitative data: The study relies on using quantitative data to evaluate the impact of the EDI measures introduced by Connected Everything. However, relying solely on quantitative metrics may overlook nuanced aspects of EDI that cannot be easily quantified. For example, EDI encompasses multifaceted issues influenced by historical, cultural, and contextual factors. These nuances may not be fully captured by numbers alone. In addition, some EDI efforts may not yield immediate measurable outcomes but still contribute to a more inclusive environment.

Diversity and inclusion are not synonymous: The study proposes 21 measures to contribute towards creating an equal, diverse and inclusive research culture and collects diversity data to measure the impact of these measures. However, while diversity is simpler to monitor, increasing diversity alone does not guarantee equality or inclusion. Even with diverse research groups, individuals from underrepresented groups may still face barriers, microaggressions, or exclusion.

Balancing anonymity and rigour in grant reviews:The proposed anonymous review process proposed by Connected Everything removes personal and organisational details from the research ideas under reviewer evaluation. However, there exists a possibility that a reviewer could discern the identity of the grant applicant based on the research idea. Reviewers are expected to be subject matter experts in the field relevant to the grant proposal they are evaluating. Given the specialised nature of scientific research, it is conceivable that a well-known applicant could be identified through the specifics of the work, the methodologies employed, and even the writing style.

Expanding gender identity options: A limitation of this study emerged from the restricted gender options (male, female, other, prefer not to say) provided to respondents when answering the gender identity question. This limitation reflects the context of data collection in 2018, a time when diversity monitoring guidance was still limited. As our understanding of gender identity evolves beyond binary definitions, future data collection efforts should embrace a more expansive and inclusive approach, recognising the diverse spectrum of gender identities.

In conclusion, this study provides evidence of the effectiveness of a research network's approach to promoting equality, diversity, and inclusion (EDI) in research and funding. By collecting EDI data from individuals who engage with network activities and apply for research funding, this study has shown that the network's initiatives have had a positive impact on representation and fairness in the funding process. Specifically, the analysis reveals that the network is successful at engaging with ECRs, and those with care responsibilities and has a diverse range of ethnicities represented at Connected Everything events. Additionally, the network activities have a more equal gender balance and greater representation of researchers with disabilities when compared to the engineering and technology academic community, though there is still an underrepresentation of these groups compared to the national population.

Connected Everything introduced measures to help address inequalities in how funding is awarded. The measures introduced helped reduce the dominance of researchers who identified as male and research-intensive universities in winning research funding. Additionally, researchers with care responsibilities were more successful at winning funding than those without care responsibilities. However, inequality persisted with white researchers achieving higher award rates than those from ethnic minority backgrounds. Recommendations to make the review process fairer include: ensuring greater diversity of reviewers; reviewer anti-bias training; and automatic adjustments to correct for known biases in writing style.

Connected Everything’s approach to embedding EDI in network activities has already been shared widely with other EPSRC-funded networks and Hubs (e.g. the UKRI Circular Economy Hub and the UK Acoustics Network Plus). The network hopes that these findings will inform broader efforts to promote EDI in research and funding and that researchers, funders, and other stakeholders will be encouraged to adopt evidence-based strategies for advancing this important goal.

Availability of data and materials

The data collected was anonymously, however, it may be possible to identify an individual by combining specific records of the data request form data. Therefore, the study data has been presented in aggregate form to protect the confidential of individuals and the data utilised in this study cannot be made openly accessible due to ethical obligations to protect the privacy and confidentiality of the data providers.

Abbreviations

Early career researcher

Equality, diversity and inclusion

Engineering physical sciences research council

UK research and innovation

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Acknowledgements

The authors would like to acknowledge the support Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/S036113/1], Connected Everything II: Accelerating Digital Manufacturing Research Collaboration and Innovation. The authors would also like to gratefully acknowledge the Connected Everything Executive Group for their contribution towards developing Connected Everything’s equality, diversity and inclusion strategy.

This work was supported by the Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/S036113/1].

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Oliver J. Fisher

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Debra Fearnshaw & Sarah Sharples

School of Food Science and Nutrition, University of Leeds, Leeds, UK

Nicholas J. Watson

School of Engineering, University of Liverpool, Liverpool, UK

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Centre for Circular Economy, University of Exeter, Exeter, UK

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OJF analysed and interpreted the data, and was the lead author in writing and revising the manuscript. DF led the data acquisition and supported the interpretation of the data. DF was also a major contributor to the design of the equality diversity and inclusion (EDI) strategy proposed in this work. NJW supported the design of the EDI strategy and was a major contributor in reviewing and revising the manuscript. PG supported the design of the EDI strategy, and was a major contributor in reviewing and revising the manuscript. FC supported the design of the EDI strategy and the interpretation of the data. DM supported the design of the EDI strategy. SS led the development EDI strategy proposed in this work, and was a major contributor in data interpretation and reviewing and revising the manuscript. All authors read and approved the final manuscript.

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Fisher, O.J., Fearnshaw, D., Watson, N.J. et al. Promoting equality, diversity and inclusion in research and funding: reflections from a digital manufacturing research network. Res Integr Peer Rev 9 , 5 (2024). https://doi.org/10.1186/s41073-024-00144-w

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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

INTRODUCTION

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

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

I.     Global Cultural Perspective of Embryonic Stem Cells

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

a.     US and Rights-Based Cultures

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

b.     Ubuntu and Collective Cultures

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

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

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

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

c.     Asia

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

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

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

d.     Middle East

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

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

e.     Europe

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

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

II.     Religious Perspectives on ESC

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

The Qur'an states:

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

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

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

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

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

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

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

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

III.     A Flexible Ethical Approach

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

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

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

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

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

IV.     Concerns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

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

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Facility for Rare Isotope Beams

At michigan state university, international research team uses wavefunction matching to solve quantum many-body problems, new approach makes calculations with realistic interactions possible.

FRIB researchers are part of an international research team solving challenging computational problems in quantum physics using a new method called wavefunction matching. The new approach has applications to fields such as nuclear physics, where it is enabling theoretical calculations of atomic nuclei that were previously not possible. The details are published in Nature (“Wavefunction matching for solving quantum many-body problems”) .

Ab initio methods and their computational challenges

An ab initio method describes a complex system by starting from a description of its elementary components and their interactions. For the case of nuclear physics, the elementary components are protons and neutrons. Some key questions that ab initio calculations can help address are the binding energies and properties of atomic nuclei not yet observed and linking nuclear structure to the underlying interactions among protons and neutrons.

Yet, some ab initio methods struggle to produce reliable calculations for systems with complex interactions. One such method is quantum Monte Carlo simulations. In quantum Monte Carlo simulations, quantities are computed using random or stochastic processes. While quantum Monte Carlo simulations can be efficient and powerful, they have a significant weakness: the sign problem. The sign problem develops when positive and negative weight contributions cancel each other out. This cancellation results in inaccurate final predictions. It is often the case that quantum Monte Carlo simulations can be performed for an approximate or simplified interaction, but the corresponding simulations for realistic interactions produce severe sign problems and are therefore not possible.

Using ‘plastic surgery’ to make calculations possible

The new wavefunction-matching approach is designed to solve such computational problems. The research team—from Gaziantep Islam Science and Technology University in Turkey; University of Bonn, Ruhr University Bochum, and Forschungszentrum Jülich in Germany; Institute for Basic Science in South Korea; South China Normal University, Sun Yat-Sen University, and Graduate School of China Academy of Engineering Physics in China; Tbilisi State University in Georgia; CEA Paris-Saclay and Université Paris-Saclay in France; and Mississippi State University and the Facility for Rare Isotope Beams (FRIB) at Michigan State University (MSU)—includes  Dean Lee , professor of physics at FRIB and in MSU’s Department of Physics and Astronomy and head of the Theoretical Nuclear Science department at FRIB, and  Yuan-Zhuo Ma , postdoctoral research associate at FRIB.

“We are often faced with the situation that we can perform calculations using a simple approximate interaction, but realistic high-fidelity interactions cause severe computational problems,” said Lee. “Wavefunction matching solves this problem by doing plastic surgery. It removes the short-distance part of the high-fidelity interaction, and replaces it with the short-distance part of an easily computable interaction.”

This transformation is done in a way that preserves all of the important properties of the original realistic interaction. Since the new wavefunctions look similar to that of the easily computable interaction, researchers can now perform calculations using the easily computable interaction and apply a standard procedure for handling small corrections called perturbation theory.  A team effort

The research team applied this new method to lattice quantum Monte Carlo simulations for light nuclei, medium-mass nuclei, neutron matter, and nuclear matter. Using precise ab initio calculations, the results closely matched real-world data on nuclear properties such as size, structure, and binding energies. Calculations that were once impossible due to the sign problem can now be performed using wavefunction matching.

“It is a fantastic project and an excellent opportunity to work with the brightest nuclear scientist s in FRIB and around the globe,” said Ma. “As a theorist , I'm also very excited about programming and conducting research on the world's most powerful exascale supercomputers, such as Frontier , which allows us to implement wavefunction matching to explore the mysteries of nuclear physics.”

While the research team focused solely on quantum Monte Carlo simulations, wavefunction matching should be useful for many different ab initio approaches, including both classical and  quantum computing calculations. The researchers at FRIB worked with collaborators at institutions in China, France, Germany, South Korea, Turkey, and United States.

“The work is the culmination of effort over many years to handle the computational problems associated with realistic high-fidelity nuclear interactions,” said Lee. “It is very satisfying to see that the computational problems are cleanly resolved with this new approach. We are grateful to all of the collaboration members who contributed to this project, in particular, the lead author, Serdar Elhatisari.”

This material is based upon work supported by the U.S. Department of Energy, the U.S. National Science Foundation, the German Research Foundation, the National Natural Science Foundation of China, the Chinese Academy of Sciences President’s International Fellowship Initiative, Volkswagen Stiftung, the European Research Council, the Scientific and Technological Research Council of Turkey, the National Natural Science Foundation of China, the National Security Academic Fund, the Rare Isotope Science Project of the Institute for Basic Science, the National Research Foundation of Korea, the Institute for Basic Science, and the Espace de Structure et de réactions Nucléaires Théorique.

Michigan State University operates the Facility for Rare Isotope Beams (FRIB) as a user facility for the U.S. Department of Energy Office of Science (DOE-SC), supporting the mission of the DOE-SC Office of Nuclear Physics. Hosting what is designed to be the most powerful heavy-ion accelerator, FRIB enables scientists to make discoveries about the properties of rare isotopes in order to better understand the physics of nuclei, nuclear astrophysics, fundamental interactions, and applications for society, including in medicine, homeland security, and industry.

The U.S. Department of Energy Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of today’s most pressing challenges. For more information, visit energy.gov/science.

• Open access
• Published: 16 May 2024

Competency gap among graduating nursing students: what they have achieved and what is expected of them

• Majid Purabdollah 1 , 2 ,
• Vahid Zamanzadeh 2 , 3 ,
• Akram Ghahramanian 2 , 4 ,
• Leila Valizadeh 2 , 5 ,
• Saeid Mousavi 2 , 6 &
• Mostafa Ghasempour 2 , 4  

BMC Medical Education volume  24 , Article number:  546 ( 2024 ) Cite this article

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Nurses’ professional competencies play a significant role in providing safe care to patients. Identifying the acquired and expected competencies in nursing education and the gaps between them can be a good guide for nursing education institutions to improve their educational practices.

In a descriptive-comparative study, students’ perception of acquired competencies and expected competencies from the perspective of the Iranian nursing faculties were collected with two equivalent questionnaires consisting of 85 items covering 17 competencies across 5 domains. A cluster sampling technique was employed on 721 final-year nursing students and 365 Iranian nursing faculties. The data were analyzed using descriptive statistics and independent t-tests.

The results of the study showed that the highest scores for students’ acquired competencies and nursing faculties’ expected competencies were work readiness and professional development, with mean of 3.54 (SD = 0.39) and 4.30 (SD = 0.45), respectively. Also, the lowest score for both groups was evidence-based nursing care with mean of 2.74 (SD = 0.55) and 3.74 (SD = 0.57), respectively. The comparison of competencies, as viewed by both groups of the students and the faculties, showed that the difference between the two groups’ mean scores was significant in all 5 core-competencies and 17 sub-core competencies ( P  < .001). Evidence-based nursing care was the highest mean difference (mean diff = 1) and the professional nursing process with the lowest mean difference (mean diff = 0.70).

The results of the study highlight concerns about the gap between expected and achieved competencies in Iran. Further research is recommended to identify the reasons for the gap between the two and to plan how to reduce it. This will require greater collaboration between healthcare institutions and nursing schools.

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Introduction| Background

Nursing competence refers to a set of knowledge, skills, and behaviors that are necessary to successfully perform roles or responsibilities [ 1 ]. It is crucial for ensuring the safe and high-quality care of patients [ 2 , 3 , 4 , 5 ]. However, evaluating nursing competence is challenging due to the complex, dynamic, and multi factorial nature of the clinical environment [ 3 ]. The introduction of nursing competencies and their assessment as a standard measure of clinical performance at the professional level has been highlighted by the Association of American Colleges of Nursing [ 6 , 7 ]. As a result, AACN (2020) introduces competence assessment as an emerging concept in nursing education [ 7 ].

On the other hand, the main responsibility of nursing education is to prepare graduates who have the necessary competencies to provide safe and quality care [ 3 ]. Although it is believed that it is impossible to teach everything to students, acquiring some competencies requires entering a real clinical setting and gaining work experience [ 8 ]. However, nursing students are expected to be competent to ensure patient safety and quality of care after graduation [ 9 ]. To the extent that the World Health Organization (WHO), while expressing concern about the low quality of nursing education worldwide, has recommended investing in nursing education and considers that the future to require nurses who are theoretically and clinically competent [ 5 ]. Despite efforts, the inadequate preparation of newly graduated nursing students and doubts about the competencies acquired in line with expectations to provide safe care for entering the nursing setting have become a global concern [ 10 , 11 , 12 , 13 ]. The results of studies in this field are different. The results of Amsalu et al. showed that the competence of newly graduated nursing students to provide quality and safe care was not satisfactory [ 14 ]. Some studies have also highlighted shortcomings in students’ “soft” skills, such as technical competency, critical thinking, communication, teamwork, helping roles, and professionalism [ 15 ]. Additionally, prior research has indicated that several nursing students have an unrealistic perception of their acquired competencies before entering the clinical setting and they report a high level of competence [ 2 ]. In other study, Hickerson et al. showed that the lack of preparation of nursing students is associated with an increase in patient errors and poor patient outcomes [ 16 ]. Some studies also discussed nursing competencies separately; Such as patient safety [ 17 ], clinical reasoning [ 18 ], interpersonal communication [ 19 ], and evidence-based care competence [ 20 ].

On the other hand, the growing need for safe nursing care and the advent of new educational technologies, the emergence of infectious diseases has increased the necessity of nursing competence. As a result, the nursing profession must be educated to excellence more than ever before [ 5 , 21 , 22 ]. Therefore, the self-assessment of students’ competence levels as well as the evaluation of nursing managers about the competencies expected from them is an essential criterion for all healthcare stakeholders, educators, and nursing policymakers to ensure the delivery of safe, and effective nursing care [ 9 , 23 , 24 ].

However, studies of nurse managers’ perceptions of the competence of newly graduated nursing students are limited and mostly conducted at the national level. Hence, further investigation is needed in this field [ 25 , 26 ]. Some other studies have been carried out according to the context and the needs of societies [ 3 , 26 , 27 , 28 ]. The results of some other studies in the field of students’ self-assessment of perceived competencies and managers’ and academic staff’s assessment of expected competency levels are different and sometimes contradictory, and there is the “academic-clinical gap” between expected and achieved competencies [ 25 , 29 , 30 ]. A review of the literature showed that this gap has existed for four decades, and the current literature shows that it has not changed much over time. The academe and practice settings have also been criticized for training nurses who are not sufficiently prepared to fully engage in patient care [ 1 ]. Hence, nursing managers must understand the expected competencies of newly graduated students, because they have a more complete insight into the healthcare system and the challenges facing the nursing profession. Exploration of these gaps can reveal necessities regarding the work readiness of nursing graduates and help them develop their competencies to enter the clinical setting [ 1 , 25 ].

Although research has been carried out on this topic in other countries, the educational system in those countries varies from that of Iran’s nursing education [ 31 , 32 ]. Iran’s nursing curriculum has tried to prepare nurses who have the necessary competencies to meet the care needs of society. Despite the importance of proficiency in nursing education, many nursing graduates often report feeling unprepared to fulfill expected competencies and they have deficiencies in applying their knowledge and experience in practice [ 33 ]. Firstly, the failure to define and identify the expected competencies in the nursing curriculum of Iran led to the absence of precise and efficient educational objectives. Therefore, it is acknowledged that the traditional nursing curriculum of Iran focuses more on lessons organization than competencies [ 34 ]. Secondly, insufficient attention has been given to the scheduling, location, and level of competencies in the nursing curriculum across different semesters [ 35 ]. Thirdly, the large volume of content instead of focusing on expected competencies caused nursing graduates challenged to manage complex situations [ 36 ]. Therefore, we should not expect competencies such as critical thinking, clinical judgment, problem-solving, decision-making, management, and leadership from nursing students and graduates in Iran [ 37 ]. Limited research has been conducted in this field in Iran. Studies have explored the cultural competence of nursing students [ 38 ] and psychiatric nurses [ 39 ]. Additionally, the competence priorities of nurses in acute care have been investigated [ 40 ], as well as the competency dimensions of nurses [ 41 ].

In Iran, after receiving the diploma, the students participate in a national exam called Konkur. Based on the results of this exam, they enter the field of nursing without conducting an aptitude test interview and evaluating individual and social characteristics. The 4-year nursing curriculum in Iran has 130 units including 22 general, 54 specific, 15 basic sciences, and 39 internship units. In each semester, several workshops are held according to the syllabus [ 42 ]. Instead of the expected competencies, a list of general competencies is specified as learning outcomes in the program. Accepted students based on their rank in the exam and their choice in public and Islamic Azad Universities (non-profit), are trained with a common curriculum. Islamic Azad Universities are not supported by government funding and are managed autonomously, this problem limits the access to specialized human resources and sufficient educational fields, and the lower salaries of faculty members in Azad Universities compared to the government system, students face serious challenges. Islamic Azad Universities must pay exorbitant fees to medical universities for training students in clinical departments and medical training centers, doubling these Universities’ financial problems. In some smaller cities, these financial constraints cause students to train in more limited fields of clinical training and not experience much of what they have learned in the classroom in practice and the real world of nursing. The evaluation of learners in the courses according to the curriculum is based on formative and summative evaluation with teacher-made tests, checklists, clinical assignments, conferences, and logbooks. The accreditation process of nursing schools includes two stages internal evaluation, which is done by surveying students, professors and managers of educational groups, and external accreditation is done by the nursing board. After completing all their courses, to graduate, students must participate in an exam called “Final”, which is held by each faculty without the supervision of an accreditation institution, the country’s assessment organization or the Ministry of Health, and obtain at least a score of 10 out of 20 to graduate.

Therefore, we conducted this comprehensive study as the first study in Iran to investigate the difference between the expected and perceived competence levels of final year nursing students. The study’s theoretical framework is based on Patricia Benner’s “From Novice to Expert” model [ 43 ].

Materials and methods

The present study had the following three objectives:

Determining self-perceived competency levels from the perspective of final year nursing students in Iran.

Determining expected levels of competency from the perspective of nursing faculties in Iran.

To determine the difference between the expected competencies from the perspective of nursing faculties and the achieved competencies from the perspective of final-year nursing students.

This study is a descriptive-comparative study.

First, we obtained a list of all nursing schools in the provinces of Iran from the Ministry of Health ( n  = 31). From 208 Universities, 72 nursing schools were randomly selected using two-stage cluster sampling. Among the selected faculties, we chose 721 final-year nursing students and 365 nursing faculties who met the eligibility criteria for the study. Final-year nursing students who consented to participate in the study were selected. Full-time faculty members with at least 2 years of clinical experience and nurse managers with at least 5 years of clinical education experience were also included. In this study, nursing managers, in addition to their educational roles in colleges, also have managerial roles in the field of nursing. Some of these roles include nursing faculty management, nursing board member, curriculum development and review, planning and supervision of nursing education, evaluation, and continuous improvement of nursing education. The selection criteria were based on the significant role that managers play in nursing education and curriculum development [ 44 ]. Non-full-time faculty members and managers without clinical education experience were excluded from the study.

The instrument used in this study is a questionnaire developed and psychometrically tested in a doctoral nursing dissertation [ 45 ]. To design the tool, the competencies expected of undergraduate nursing students in Iran and worldwide were first identified through a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI) and supported by the PAGER framework. Summative content analysis by Hsieh and Shannon (2005) was used for analysis, which included: counting and comparing keywords and content, followed by interpretation of textual meaning. In the second step, the results of the first step were used to create tool statements. Then the validity of the instrument was checked by face validity, content validity (determination of the ratio and index of content validity), and validity of known groups. Its reliability was also checked by internal consistency using Cronbach’s alpha method and stability using the test-retest method. The competency questionnaire comprises 85 items covering 17 competencies across 5 domains: “individualized care” (4 competencies with 21 items), “evidence-based nursing care” (2 competencies with 10 items), “professional nursing process” (3 competencies with 13 items), “nursing management” (2 competencies with 16 items), and “work readiness and professional development” (6 competencies with 25 items) [ 45 ]. “The Bondy Rating Scale was utilized to assess the competency items, with ratings ranging from 1 (Dependent) to 5 (Independent) on a 5-point Likert scale [ 46 ]. The first group (nursing students) was asked to indicate the extent to which they had acquired each competency. The second group (nursing faculties) was asked to specify the level to which they expected nursing students to achieve each competency.

Data collection

First, the researcher contacted the deans and managers of the selected nursing schools by email to obtain permission. After explaining the aims of the study and the sampling method, we obtained the telephone number of the representative of the group of final year nursing students and also the email of the faculty members. The representative of the student group was then asked to forward the link to the questionnaire to 10 students who were willing to participate in the research. Informed consent for students to participate in the online research was provided through the questionnaires, while nursing faculty members who met the eligibility criteria for the study received an informed consent form attached to the email questionnaire. The informed consent process clarified the study objectives and ensured anonymity of respondent participation in the research, voluntary agreement to participate and the right to revoke consent at any time. An electronic questionnaire was then sent to 900 final year nursing students and 664 nursing faculties (from 4 March 2023 to 11 July 2023). Reminder emails were sent to nursing faculty members three times at two-week intervals. The attrition rate in the student group was reported to be 0 (no incomplete questionnaires). However, four questionnaires from nursing faculty members were discarded because of incomplete responses. Of the 900 questionnaires sent to students and 664 sent to nursing faculties, 721 students and 365 nursing faculty members completed the questionnaire. The response rates were 79% and 66% respectively.

Data were analyzed using SPSS version 22. Frequencies and percentages were used to report categorical variables and mean and standard deviations were used for quantitative variables. The normality of the quantitative data was confirmed using the Shapiro-Wilk and Skewness tests. An independent t-test was used for differences between the two groups.

Data analysis revealed that out of 721 students, 441 (61.20%) was female. The mean and deviation of the students’ age was 22.50 (SD = 1.21). Most of the students 577 (80%) were in their final semester. Also, of the total 365 faculties, the majority were female 253 (69.31%) with a mean of age 44.06 (SD = 7.46) and an age range of 22–65. The academic rank of most nursing faculty members 156 (21.60%) was assistant professor (Table  1 ).

The results of the study showed that in both groups the highest scores achieved by the students and expected by the nursing faculty members were work readiness and professional development with a mean and standard deviation of 3.54 (0.39) and 4.30 (0.45) respectively. The lowest score for both groups was also evidence-based nursing care with a mean and standard deviation of 2.74 (0.55) for students and 3.74 (0.57) for nursing faculty members (Table  2 ).

Also, the result of the study showed that the highest expected competency score from the nursing faculty members’ point of view was the safety subscale. In other words, faculty members expected nursing students to acquire safety competencies at the highest level and to be able to provide safe care independently according to the rating scale (Mean = 4.51, SD = 0.45). The mean score of the competencies achieved by the students was not above 3.77 in any of the subscales and the highest level of competency achievement according to self-report of students was related to safety competencies (mean = 3.77, SD = 0.51), preventive health services (mean = 3.69, SD = 0.79), values and ethical codes (mean = 3.67, SD = 0.77), and procedural/clinical skills (mean = 3.67, SD = 0.71). The other competency subscales from the perspective of the two groups are presented in Table  3 , from highest to lowest score.

The analysis of core competencies achieved and expected from both students’ and nursing faculty members’ perspectives revealed that, firstly, there was a significant difference between the mean scores of the two groups in all five core competencies ( P  < .001) and that the highest mean difference was related to evidence-based care with mean diff = 1 and the lowest mean difference was related to professional care process with mean diff = 0.70 (Table  4 ).

Table  5 indicates that there was a significant difference between the mean scores achieved by students and nursing faculty members in all 5 core competencies and 17 sub-core Competencies ( p  < .001).

The study aimed to determine the difference between nursing students’ self-perceived level of competence and the level of competence expected of them by their nursing faculty members. The study results indicate that students scored highest in work readiness and professional development. However, they were not independent in this competency and required support. The National League for Nursing (NLN) recognizes nursing professional development as the goal of nursing education programs [ 47 ] However, Aguayo-Gonzalez [ 48 ] believes that the appropriate time for professional development is after entering a clinical setting. This theme includes personal characteristics, legality, clinical/ procedural skills, patient safety, preventive health services, and mentoring competence. Personality traits of nursing students are strong predictors of coping with nursing stress, as suggested by Imus [ 49 ]. These outcomes reflect changes in students’ individual characteristics during their nursing education. Personality changes, such as the need for patience and persistence in nursing care and understanding the nurse identity prepare students for the nursing profession, which is consistent with the studies of Neishabouri et al. [ 50 ]. Although the students demonstrated a higher level of competence in this theme, an examination of the items indicates that they can still not adapt to the challenges of bedside nursing and to use coping techniques. This presents a concerning issue that requires attention and resolution. Previous studies have shown that nursing education can be a very stressful experience [ 51 , 52 , 53 ].

Of course, there is no consensus on the definition of professionalism and the results of studies in this field are different. For example, Akhtar et al. (2013) identified common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged humanists, portrayers, facilitators, and regulators [ 54 ]. The findings of another study showed that nursing students perceived vulnerability, symbolic representation, role modeling, discontent, and professional development are elements that show their professionalism [ 55 ]. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.

The legal aspects of nursing were the next item in this theme that students needed help with. The findings of studies regarding the legal competence of newly graduated nursing students are contradictory reported that only one-third of nurse managers were satisfied with the legal competence of newly graduated nursing students [ 56 , 57 ]. Whereas the other studies showed that legality was the highest acquired competence for newly graduated nursing students [ 58 , 59 ]. However, the results of this study indicated that legality may be a challenge for newly graduated nursing students. Benner [ 43 ] highlighted the significant change for new graduates in that they now have full legal and professional responsibility for the patient. Tong and Epeneter [ 60 ] also reported that facing an ethical dilemma is one of the most stressful factors for new graduates. Therefore, the inexperience of new graduates cannot reduce the standard of care that patients expect from them [ 60 ]. Legal disputes regarding the duties and responsibilities of nurses have increased with the expansion of their roles. This is also the case in Iran. Nurses are now held accountable by law for their actions and must be aware of their legal obligations. To provide safe healthcare services, it is essential to know of professional, ethical, and criminal laws related to nursing practice. The nursing profession is accountable for the quality of services delivered to patients from both professional and legal perspectives. Therefore, it is a valuable finding that nurse managers should support new graduates to better deal with ethical dilemmas. Strengthening ethical education in nursing schools necessitates integrating real cases and ethical dilemmas into the curriculum. Especially, Nursing laws are missing from Iran’s undergraduate nursing curriculum. By incorporating authentic case studies drawn from clinical practice, nursing schools provide students with opportunities to engage in critical reflection, ethical analysis, and moral deliberation. These real cases challenge students to apply ethical principles to complex and ambiguous situations, fostering the development of ethical competence and moral sensitivity. Furthermore, ethical reflection and debriefing sessions during clinical experiences enable students to discuss and process ethical challenges encountered in practice, promoting self-awareness, empathy, and professional growth. Overall, by combining theoretical instruction with practical application and the use of real cases, nursing schools can effectively prepare future nurses to navigate ethical dilemmas with integrity and compassion.

However, the theme of evidence-based nursing care was the lowest scoring, indicating that students need help with this theme. The findings from studies conducted in this field are varied. A limited number of studies reported that nursing students were competent to implement evidence-based care [ 61 ], while other researchers reported that nursing students’ attitudes toward evidence-based care to guide clinical decisions were largely negative [ 20 , 62 ]. The principal barriers to implementing evidence-based care are lack of authority to change patient care policy, slow dissemination of evidence and lack of time at the bedside to implement evidence [ 10 ], and lack of knowledge and awareness of the process of searching databases and evaluating research [ 63 ]. While the European Higher Education Area (EHEA) framework and the International Council of Nurses Code of Ethics introduce the ability to identify, critically appraise, and apply scientific information as expected learning outcomes for nursing students [ 64 , 65 ], the variation in findings highlights the complexity of the concept of competence and its assessment [ 23 ]. Evidence-Based Nursing (EBN) education for nursing students is most beneficial when it incorporates a multifaceted approach. Interactive workshops play a crucial role, providing students with opportunities to critically appraise research articles, identify evidence-based practices, and apply them to clinical scenarios. Simulation-based learning further enhances students’ skills by offering realistic clinical experiences in a safe environment. Additionally, clinical rotations offer invaluable opportunities for students to observe and participate in evidence-based practices under the guidance of experienced preceptors. Journal clubs foster a culture of critical thinking and ongoing learning, where students regularly review and discuss current research articles. Access to online resources such as databases and evidence-based practice guidelines allows students to stay updated on the latest evidence and best practices. To bridge the gap between clinical practice and academic theory, collaboration between nursing schools and healthcare institutions is essential. This collaboration can involve partnerships to create clinical learning environments that prioritize evidence-based practice, inter professional education activities to promote collaboration across disciplines, training and support for clinical preceptors, and continuing education opportunities for practicing nurses to strengthen their understanding and application of EBN [ 66 ]. By implementing these strategies, nursing education programs can effectively prepare students to become competent practitioners who integrate evidence-based principles into their clinical practice, ultimately improving patient outcomes.

The study’s findings regarding the second objective showed that nursing faculty members expected students to achieve the highest level of competence in work readiness and professional development, and the lowest in evidence-based nursing care competence. The results of the studies in this area revealed that there is a lack of clarity about the level of competence of newly graduated nursing students and that confusion about the competencies expected of them has become a major challenge [ 13 , 67 ]. Evidence of nurse managers’ perceptions of newly graduated nursing student’s competence is limited and rather fragmented. There is a clear need for rigorous empirical studies with comprehensive views of managers, highlighting the key role of managers in the evaluation of nurse competence [ 1 , 9 ]. Some findings also reported that nursing students lacked competence in primary and specialized care after entering a real clinical setting [ 68 ] and that nursing managers were dissatisfied with the competence of students [ 30 ].

The results of the present study on the third objective confirmed the gap between expected and achieved competence requirements. The highest average difference was related to evidence-based nursing care, and the lowest mean difference was related to the professional nursing process. The findings from studies in this field vary. For instance, Brown and Crookes [ 13 ] reported that newly graduated nursing students were not independent in at least 26 out of 30 competency domains. Similar studies have also indicated that nursing students need a structured program after graduation to be ready to enter clinical work [ 30 ]. It can be stated that the nursing profession does not have clear expectations of the competencies of newly graduated nursing students, and preparing them for entry into clinical practice is a major challenge for administrators [ 13 ]. These findings can be explained by the Duchscher transition shock [ 69 ]. It is necessary to support newly graduated nursing students to develop their competence and increase their self-confidence.

The interesting but worrying finding was the low expectations of faculty members and the low scores of students in the theme of evidence-based care. However, nursing students need to keep their competencies up to date to provide safe and high-quality care. The WHO also considers the core competencies of nurse educators to be the preparation of effective, efficient, and skilled nurses who can teach the evidence-based learning process and help students apply it clinically [ 44 ]. The teaching of evidence-based nursing care appears to vary across universities, and some clinical Faculties do not have sufficient knowledge to support students. In general, it can be stated that the results of the present study are in line with the context of Iran. Some of the problems identified include a lack of attention to students’ academic talent, a lack of a competency-based curriculum, a gap between theory and clinical practice, and challenges in teaching and evaluating the achieved competencies [ 42 ].

Strengths and limitations

The study was conducted on a national level with a sizable sample. It is one of the first studies in Iran to address the gap between students’ self-perceived competence levels and nursing faculty members’ expected competency levels. Nevertheless, one of the limitations of the study is the self-report nature of the questionnaire, which may lead to social desirability bias. In addition, the COVID-19 pandemic coinciding with the student’s first and second years could potentially impact their educational quality and competencies. The limitations established during the outbreak negatively affected the nursing education of students worldwide.

Acquiring nursing competencies is the final product of nursing education. The current study’s findings suggest the existence of an academic-practice gap, highlighting the need for educators, faculty members, and nursing managers to collaborate in bridging the potential gap between theory and practice. While nursing students were able to meet some expectations, such as value and ethical codes, there is still a distance between expectations and reality. Especially, evidence-based care was identified as one of the weaknesses of nursing students. It is recommended that future research investigates the best teaching strategies and more objective assessments of competencies. The findings of this study can be used as a guide for the revision of undergraduate nursing education curricula, as well as a guide for curriculum development based on the development of competencies expected of nursing students. Nursing managers can identify existing gaps and plan to fill them and use them for the professionalization of students. This requires the design of educational content and objective assessment tools to address these competencies at different levels throughout the academic semester. This significant issue necessitates enhanced cooperation between healthcare institutions and nursing schools. Enhancing nursing education requires the implementation of concrete pedagogical strategies to bridge the gap between theoretical knowledge and practical skills. Simulation-based learning emerges as a pivotal approach, offering students immersive experiences in realistic clinical scenarios using high-fidelity simulators [ 70 ]. Interprofessional education (IPE) is also instrumental, in fostering collaboration among healthcare professionals and promoting holistic patient care. Strengthening clinical preceptorship programs is essential, with a focus on providing preceptors with formal training and ongoing support to facilitate students’ clinical experiences and transition to professional practice [ 71 ]. Integrating evidence-based practice (EBP) principles throughout the curriculum cultivates critical thinking and inquiry skills among students, while technology-enhanced learning platforms offer innovative ways to engage students and support self-directed learning [ 72 ]. Diverse and comprehensive clinical experiences across various healthcare settings ensure students are prepared for the complexities of modern healthcare delivery. By implementing these practical suggestions, nursing education programs can effectively prepare students to become competent and compassionate healthcare professionals.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors extend their gratitude to all the nursing students and faculties who took part in this study.

This article is part of research approved with the financial support of the deputy of research and technology of Tabriz University of Medical Sciences.

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Majid Purabdollah

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Vahid Zamanzadeh

Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran

Akram Ghahramanian & Mostafa Ghasempour

Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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M P: conceptualized the study, data collection, analysis and interpretation, drafting of manuscript; V Z: conceptualized the study, analysis and interpretation, drafting of manuscript; LV: conceptualized the study, data collection and analysis, manuscript revision; A Gh: conceptualized the study, data collection, analysis, and drafting of manuscript; S M: conceptualized the study, analysis, and drafting of manuscript; M Gh: data collection, analysis, and interpretation, drafting of manuscript; All authors read and approved the final manuscript.

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Purabdollah, M., Zamanzadeh, V., Ghahramanian, A. et al. Competency gap among graduating nursing students: what they have achieved and what is expected of them. BMC Med Educ 24 , 546 (2024). https://doi.org/10.1186/s12909-024-05532-w

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Published : 16 May 2024

DOI : https://doi.org/10.1186/s12909-024-05532-w

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Female labor force participation

Across the globe, women face inferior income opportunities compared with men. Women are less likely to work for income or actively seek work. The global labor force participation rate for women is just over 50% compared to 80% for men. Women are less likely to work in formal employment and have fewer opportunities for business expansion or career progression. When women do work, they earn less. Emerging evidence from recent household survey data suggests that these gender gaps are heightened due to the COVID-19 pandemic.

Women’s work and GDP

Women’s work is posited to be related to development through the process of economic transformation.

Levels of female labor force participation are high for the poorest economies generally, where agriculture is the dominant sector and women often participate in small-holder agricultural work. Women’s participation in the workforce is lower in middle-income economies which have much smaller shares of agricultural activities. Finally, among high-income economies, female labor force participation is again higher, accompanied by a shift towards a service sector-based economy and higher education levels among women.

This describes the posited  U-shaped relationship  between development (proxied by GDP per capita) and female labor force participation where women’s work participation is high for the poorest economies, lower for middle income economies, and then rises again among high income economies.

This theory of the U-shape is observed globally across economies of different income levels. But this global picture may be misleading. As more recent studies have found, this pattern does not hold within regions or when looking within a specific economy over time as their income levels rise.

In no region do we observe a U-shape pattern in female participation and GDP per capita over the past three decades.

Structural transformation, declining fertility, and increasing female education in many parts of the world have not resulted in significant increases in women’s participation as was theorized. Rather, rigid historic, economic, and social structures and norms factor into stagnant female labor force participation.

Historical view of women’s participation and GDP

Taking a historical view of female participation and GDP, we ask another question: Do lower income economies today have levels of participation that mirror levels that high-income economies had decades earlier?

The answer is no.

This suggests that the relationship of female labor force participation to GDP for lower-income economies today is different than was the case decades past. This could be driven by numerous factors -- changing social norms, demographics, technology, urbanization, to name a few possible drivers.

Gendered patterns in type of employment

Gender equality is not just about equal access to jobs but also equal access for men and women to good jobs. The type of work that women do can be very different from the type of work that men do. Here we divide work into two broad categories: vulnerable work and wage work.

The Gender gap in vulnerable and wage work by GDP per capita

Vulnerable employment is closely related to GDP per capita. Economies with high rates of vulnerable employment are low-income contexts with a large agricultural sector. In these economies, women tend to make up the higher share of the vulnerably employed. As economy income levels rise, the gender gap also flips, with men being more likely to be in vulnerable work when they have a job than women.

From COVID-19 crisis to recovery

The COVID-19 crisis has exacerbated these gender gaps in employment. Although comprehensive official statistics from labor force surveys are not yet available for all economies,  emerging studies  have consistently documented that working women are taking a harder hit from the crisis. Different patterns by sector and vulnerable work do not explain this. That is, this result is not driven by the sectors in which women work or their higher rates of vulnerable work—within specific work categories, women fared worse than men in terms of COVID-19 impacts on jobs.

Among other explanations is that women have borne the brunt of the increase in the demand for care work (especially for children). A strong and inclusive recovery will require efforts which address this and other underlying drivers of gender gaps in employment opportunities.

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• http://orcid.org/0000-0002-5825-6733 Nico Pronk
• President , HealthPartners Institute , Bloomington , Minnesota , USA
• Correspondence to Prof Dr Nico Pronk, President, HealthPartners Institute, Bloomington, Minnesota, USA; nico.p.pronk{at}healthpartners.com

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• Physical activity
• Health promotion
• Sedentary Behavior

Physical activity is known to be good for one’s health. 1 2 On the other hand, physical inactivity and sedentary behaviour are known to be harmful to health. 2 3 Agreement exists about these general statements; however, emerging research points to a need to be more domain-specific as physical activity conducted during work may be harmful to health.

Most physical activity research is based on leisure-time physical activity (LTPA), that is, any form of physical activity undertaken during leisure time, such as exercise. Results support the notion that LTPA promotes cardiovascular health and may increase longevity. However, occupational physical activity (OPA), that is, physical activity undertaken during paid or voluntary work, may have opposing effects on health-related outcomes such as cardiovascular health, long-term sickness absence and mortality. 4 5 As a result, a phenomenon referred to as the ‘physical activity paradox’ has emerged which refers to the apparent contradiction that LTPA tends to confer positive health outcomes, yet OPA may confer negative effects on health. 4

Research is limited but corroborates these paradoxical findings. 4 5 Underlying mechanisms proposed to explain the paradox include (1) limited work task autonomy, (2) heavy lifting or static postures, (3) insufficient recovery time elevating 24-hour blood pressures, (4) increased inflammation, (5) elevated 24-hour heart rates and (6) too low-intensity activity for too long duration. 4 These mechanisms reflect early considerations, but additional research to clarify the scientific evidence and to close knowledge gaps is needed as the physical activity paradox emerges.

The need to address OPA concerns

Despite evidence linking occupational activity with poor health outcomes, the workplace remains an important setting for physical activity interventions. Estimates indicate OPA accounts for as much as 52% of overall physical activity 6 and, thus, represents a major opportunity for partnerships between the business and industry sector and public health that should not be lost. Emphasis should be placed on investigations focused on (1) OPA redesign that supports health and (2) the workplace as a convenient setting for adding healthful physical activity.

Second, the scientific literature is not lacking successful OPA interventions. 10–13 For example, following a 6-month exercise-focused intervention using telemonitoring systems in a prospective, randomised, parallel-group and assessor-blind study, Haufe et al reported reduced metabolic syndrome severity among workers. 10 While documenting increases in physical activity, a 12-month randomised controlled trial showed positive outcomes of treadmill desk use as an intervention on work performance. 11 Similarly, a year-long physical exercise intervention showed improvements in workability in Sweden. 12 A comprehensive assessment of available science was reported in a recent systematic review investigating the impact of workplace physical activity and nutrition interventions on productivity, work performance, absenteeism, presenteeism and workability. 39 studies were included in the analysis and results indicate that it is possible for workplace physical activity interventions to reduce disease risk while improving mental health, workability, productivity-related outcomes. 13 These types of studies, along with practice-based case reports, 14–16 provide examples of adding activities during work hours that may improve health and enhance performance. Additionally, complementary to activity during the workday, adding 15–30 min of daily LTPA for those who predominantly sit during work hours may mitigate inherent risks of prolonged sitting. 3 17 As the physical activity paradox intimates OPA not to be health enhancing, it behoves the business and public health sectors to partner with research to delve deeper into the issue.

How best to translate the evidence base into practical guidance?

Skills, motivation and health are what all employees bring to the workplace, regardless of job type. Hence, it makes good business sense for employers to invest in these three factors to optimise their human capital. However, guidance to do so needs to be supported by evidence of effectiveness and when it comes to the physical activity paradox, questions remain. Foundationally, a clear definition of OPA is needed. For example, if OPA relates to ‘activity undertaken during paid or voluntary work,’ then participation in workplace wellness programmes should be counted as OPA. Alternatively, if OPA is restricted to ‘energy expenditures distinctly part of the job tasks,’ then wellness programme participation would, arguably, not count. Other questions to be asked include (1) At what level of intensity does OPA become health detrimental? (2) Should physical activity interventions for sedentary workers be prioritised over those with high levels of OPA? (3) What circumstances lead to ‘too much’ physical activity during the workday (ie, mode, frequency, intensity and duration)? (4) When does OPA go from being health beneficial to health detrimental? (5) How can health detrimental OPA be redesigned to become health beneficial?

Specific physical activity prescriptions for the occupational setting are not available in the literature. 1 2 However, making sense of what we know can provide useful guidance for workplace activity programmes. Table 1 provides an example of pragmatic—yet evidence-informed—guidance for employers and recommendations for current guidance and future research are outlined here.

• View inline

Example of pragmatic physical activity guidance for occupational physical activity based on the FITT formula

Recommendations to mitigate the risks of OPA

Assess the work environment at the individual, team and organisational levels.

Provide the rationale and business case for physical activity promotion to support safety, a corporate culture of health, optimal team-based performance, and talent attraction and retention.

Encourage changes in the physical, social or economic workplace environment that enhance healthful physical activity, provide rest breaks and reduce prolonged sitting time.

Encourage employers to apply programmes, practices, policies or systems changes to optimise sustainability of physical activity outcomes.

Recommendations to safely promote OPA

Conduct workplace environment and specific job role assessments that document levels of exertion, physical job requirements, autonomy over job tasks, needs for breaks, and mental health and stress levels.

Consider how, when, where and for whom to avoid prolonged periods of exertion and static tension.

Consider how to avoid prolonged standing time and sitting time.

Recommendations for complementary activities outside the workplace setting

Promote LTPA, active transportation and household activity.

Promote general fitness, for example, cardiorespiratory fitness, flexibility and strength.

Promote the use of public transportation for commuters.

Conclusions

The physical activity paradox is an important observed phenomenon that makes a compelling case for domain-specific evidence-based guidance. Specific to OPA, there is a need for evidence-based guidance, yet many evidence gaps remain. While closing research gaps, pragmatic guidance based on what is known should support employer needs to avoid the potential loss of employers as partners for public health. Clarity on how to address the physical activity paradox is an important step in safeguarding the health and well-being of workers.

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• Physical Activity Guidelines Advisory Committee
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Contributors NP is solely responsible for all aspects of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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