research topic in health and social care

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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Effect of a Social Care Intervention on Health Care Experiences of Caregivers of Hospitalized Children : A Randomized Clinical Trial

• 1 Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois
• 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
• 3 Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois
• 4 Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
• 5 Institute for Translational Medicine, The University of Chicago, Chicago, Illinois
• 6 Department of Pediatrics, The University of Chicago, Chicago, Illinois
• 7 Section of Neonatology, The University of Chicago, Chicago, Illinois
• 8 Urban Institute, Washington, DC

Question   Can a social care assistance intervention targeting health-related social risks be universally implemented without promoting experiences of discrimination or compromising satisfaction among caregivers of hospitalized children?

Findings   This randomized clinical trial including 637 participants found that health care–related discrimination experiences were prevalent among participants who received a social care intervention but noninferior compared to control participants. Evidence was insufficient to establish noninferiority of the intervention with regard to caregivers’ satisfaction with the hospital discharge experience.

Meaning   The findings suggest that a social care assistance intervention can be delivered universally in a pediatric hospital setting without promoting caregiver experiences of discrimination but satisfaction may be affected.

Importance   Health-related social risks (HRSRs), like food and housing insecurity, are stigmatized conditions that, when addressed in clinical settings, could inadvertently compromise health care experiences.

Objective   To test the noninferiority hypothesis that a low-intensity, high-scale social care intervention does not promote experiences of discrimination or diminish satisfaction with care compared to usual care.

Design, Setting, and Participants   This was a double-blind randomized clinical trial conducted from November 2020 to June 2022 with 12-month follow-up analyzing data obtained 1 week after baseline intervention at a 155-bed academic urban children’s hospital with 5300 annual admissions. Participants were recruited from their children’s hospital rooms during their children’s inpatient hospital stays. Inclusion criteria were identifying as the primary caregiver of a child younger than 18 years who was hospitalized in the general, intensive care, or transplant units; living in 1 of 42 target zip codes; and consenting to receive text messages. Caregivers of healthy newborns and caregivers of children expected to be hospitalized for less than 24 hours or greater than 30 days were excluded. A total of 637 eligible parents and caregivers were enrolled.

Interventions   Participants were randomized to usual care or usual care plus CommunityRx, a low-intensity, universally delivered, electronic medical record–integrated social care assistance intervention providing personalized information about local resources alongside education about HRSRs and how to access additional support. Usual care included an admission brochure about hospital-based free food options and nonsystematic provision of resource information.

Main Outcomes and Measures   Experiences of discrimination, measured using the Discrimination in Medical Settings Scale (range 7-35; higher scores indicate more frequent discrimination) and satisfaction with hospital discharge 1 week postdischarge using Child HCAHPS (range 0-100; higher scores indicate higher satisfaction). The a priori noninferiority margins (control minus intervention) were −0.9 (discrimination) and 1.6 (satisfaction).

Results   Of 637 eligible caregiver participants, most identified as female (n = 600 [94.3%]), Black (n = 505 [79.4%]), and had household income less than $50 000 per year (n = 488 [78.5%]). One-third were experiencing food insecurity (n = 223). Half of participants reported discrimination experiences during the pediatric hospitalization (n = 259). Discrimination experiences among the intervention group were noninferior to those among the control group (mean [SD] score: control, 10.3 [4.7] vs intervention, 10.0 [4.6]; difference, 0.2; 90% CI, −0.5 to 0.9). Mean (SD) satisfaction with discharge was high (control, 84.2 [23.8] vs intervention, 81.9 [24.8]), but evidence was insufficient to support intervention noninferiority for this end point (difference, 2.3; 90% CI, −1.2 to 5.8). Food security status did not moderate the relationship between intervention and either outcome.

Conclusions and Relevance   The findings suggest that a universally delivered social care assistance intervention did not promote caregiver experiences of discrimination during a child’s hospitalization but were inconclusive regarding satisfaction.

Trial Registration   ClinicalTrials.gov Identifier: NCT04171999

Read More About

Glasser NJ , Lindau ST , Wroblewski K, et al. Effect of a Social Care Intervention on Health Care Experiences of Caregivers of Hospitalized Children : A Randomized Clinical Trial . JAMA Pediatr. 2023;177(12):1266–1275. doi:10.1001/jamapediatrics.2023.4596

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The Textbook of Health and Social Care

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See what’s new to this edition by selecting the Features tab on this page. Should you need additional information or have questions regarding the HEOA information provided for this title, including what is new to this edition, please email [email protected] . Please include your name, contact information, and the name of the title for which you would like more information. For information on the HEOA, please go to http://ed.gov/policy/highered/leg/hea08/index.html .

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Offers complete coverage of all the elements of a Health and Social Care programme and more. It is a comprehensive guide that is both informative and interesting; recommended for students and practitioners in the ever-changing field of Health and Social Care.

This is a comprehensive, insightful and timely textbook that offers health and social care students and professionals an accessible approach to theory, legislation, and practice.   

Combining a multi-disciplinary approach to health and social care, this text book will help students link theory with practice in a highly effective way. Providing insights into the diversity of health and social care, alongside broader social influences upon health and wellbeing.

This book gives a great introduction to the many aspects of health and social care that students will want to be aware of and up to date with.

Whilst studying for my nursing degree, this book has provided me with a wealth of knowledge. In particular, around the different socio-economic impacts and determinants of health in relation to patient wellbeing. This information has proved vital in helping me structure my field-specific nursing assignments relating to public health, as well as also providing me with a plan of how to structure any research-based assignments/arguments. I particularly enjoyed the activities throughout the book as they made me question things that I don’t usually think about, such as theories in psychology. The activities also provided me with some much-needed time to think about more generic subjects, such as the ‘world we live in’. It provided me with the opportunity to think outside the box.  Overall, a very enjoyable read.

As a student who has dyslexia, I found this book to be particularly helpful in developing my academic skills. As a result of reading the textbook, the overall structure and clarity of my assignments improved. The book is comprehensive and covers many aspects of health and social care that students will find beneficial for their studies. The interactive text and case studies enabled me to link theory to practice and the activities throughout made for an enjoyable and valuable read. I would highly recommend this textbook to students, at any stage of their studies, to support them throughout their degree. I wish I had this book sooner!

What a fabulous publication! Very comprehensive and informative. The authors efficiently combined the most recent findings with a historical perspective highlighting the healthcare system's changeable nature, its origins and consequences for all stakeholders. Each chapter, written by an expert in a field, covers important for nurses and healthcare delivery issues ending with extending the topic reading list relevant for furthering the knowledge. As a third-year nursing student, I have found this book very helpful. It provided interesting discourse for all my assignments and enhanced my understanding of the healthcare system's multifaceted nature. It is written in a sophisticated but accessible manner, even for a reader whose English is not a dominant language - a pleasure to read. 

I have really enjoyed reading this book and found it to include lots of helpful information for my learners

A great all rounder text covers some fantastic subject specific content. Very readable, engaging text. Have adopted this as a core text for degree in health and social care.

A great book, clearly set out and written. students, like the format and content of the book. I recommend as good overall text for the course

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Burnout in the Health, Social Care and Beyond: Integrating Individuals and Systems

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Occupational burnout is a complex combination of emotional, cognitive, and behavioural factors that represents a mismatch between personal and professional responsibilities that results from a prolonged exposure to occupational stressors. Burnout contributes to poor mental wellbeing, which can lead ...

Keywords : Burnout, Healthcare, Societal Cost, Organizational Burnout

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What is health and care research?

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Search for a study

You already conduct research in your day-to-day life. This research informs and broadens your understanding of things before you make a decision.  Health and care research is the same. It seeks to find answers to questions about the best options available.  It then uses these discoveries to make decisions about improvements or changes. This is so we can:

• diagnose diseases earlier or more accurately
• provide life-changing treatments
• prevent people from developing conditions
• improve health and care for generations to come
• ensure everyone has a better quality of life

Although health professionals already know a great deal, there are still so many questions that need answers. Sometimes, the outcome of research just confirms that what we have at the moment, is the best available to us right now. 

How research contributes to our NHS

This short film explains the important role that research plays in the NHS and how important it is for the future that we all consider taking part ( video transcript ).

Good research is: 

• Relevant – it answers questions that are important to the health and care of the public
• High quality – it has to follow strict legal standards 
• Safe   – it puts people’s safety and dignity first

The first clinical trial

The first clinical trial was conducted by James Lind.  He was a Scottish doctor and a pioneer of naval hygiene in the Royal Navy.  He conducted the first clinical trial in history in 1747.

James wanted to investigate whether citrus fruits cured scurvy. He selected twelve patients with scurvy on a ship, kept them together and gave them all different diets and monitored them. By the end of the week, the sailors whose daily diet included citrus fruits recovered, therefore proving that citrus fruit could cure scurvy.

We still celebrate this milestone each year on International Clinical Trials Day.  

Myths about research

Understanding the facts is really important when deciding whether to take part in research.  By clicking on the arrow next to each myth you can reveal the facts. 

All health and care research is high risk

All health and social care research has to go through very   strict ethical and regulatory checks   before it can go ahead. There are lots of   different ways to get involved with research . Some involve taking a new medicine or having a new form of treatment, others may be as simple as filling out a questionnaire or leaving a sample. People are very closely monitored while they are taking part in research, so although health and care research is not entirely risk-free, the chances of something going wrong are small.

My doctor will tell me about the research available

Not all health and care professionals will be fully informed about all of the research opportunities available to you. They might also not have the time to discuss it with you in your appointment.  However, it is important to ask about opportunities to get involved in research as your healthcare professional will know how to find out what might be available. You can search for studies on this website  by using the search bar at the very top of each page by typing in your town, postcode, body part, medicine or health condition.  You can also find a condition by pressing the “ view conditions ” button. 

Research can only take place in hospital

Health and care research can take place in many different places, from schools to care homes depending on the type of research. It is more common than ever before for research to take place in non-clinical settings. Digital technology provides a way of getting people involved from the comfort of their own homes.

Health and care research means taking lots of drugs

Not all health and care research involves taking drugs. The research may involve testing a new device to help monitor or administer a medicine for an illness. It could be about monitoring how certain changes in our diet and lifestyle could help the health of our nation in the future. Research might simply involve talking to someone, completing a short questionnaire or even using an app on a mobile device.   There are also many   different ways to be involved in research without being a participant in a research study .

People are treated like guinea pigs

Whatever the type of research, anyone who is involved should be treated with respect. The research is not being done to them but with them. People who participate in research often say that they feel well cared for as they have a dedicated contact within the research staff team. Research teams must follow   ethical guidance   and before the research can take place, they must seek approval for their plan from a Research Ethics Committee. Research that involves new medicines is not tested on people first. It will have gone through a process to ensure it is ready for use with people. 

Health and care research is only about finding a cure

Research aims to prevent diseases as well as cure them. There are a range of factors which can contribute to your health, for example: where you live, what you eat and whether you have a good support network of family and friends. Public health research seeks to answer questions about some of these factors.

Research seeks to find ways for people to live well with long-term conditions. It can help to find out the best ways to care for people living with life-limiting illness and pain, which is known as ’palliative care’. Research can lead to improvements in end-of-life care across all diseases and to help patients to live in comfort and die with dignity.

Health and social care research only involves physical diseases, it cannot help with mental health

People’s health is not limited to physical disease, it includes their mental well being. Research therefore seeks to answer questions about mental health such as is medicine, counselling or a combination of both the best treatment for individuals living with depression? Members of the public can   have a role in identifying and prioritising where health research is focused . Given increased awareness of the effects our mental health can have on our physical well being, this is likely to be a growing area of health and social care research. Read about all the research happening within the NIHR specialty for mental health .

Children are not allowed to participate in health and care research

Children can take part in health and care research with the permission of their legal guardian. The research team may meet with the child to make sure they understand what the research is about. They may use pictures to explain the study. Research in child health is vital to help find new and better ways to care for children. You can find studies for children by typing "Children" in the search box at the very top of this page.

Research only benefits the drug companies

Health research is funded by drug companies, charities and the government, although when the NHS undertakes research specifically for drug companies, the company pays the full cost.  Everyone benefits from the development of new medicines, and without commercial drug companies there would be less research taking place.

Different types of research

Healthcare research

Sometimes health research studies may be referred to as ‘clinical trials’.  They usually involve examining and observing people with different conditions and sometimes comparing them with people who don't have the condition. It can also involve research on samples of blood or other tissues, or tests such as scans or X-rays. Researchers can also analyse information in patient records, or the data from health and lifestyle surveys.

Public health research

Tackles some of the bigger health issues that affect society as a whole, for example, the impact of giving up smoking, how many steps a day for good health etc. It also looks at the benefits, costs, acceptability and the wider impact of treatments.

Social care research

Is about improving the lives of people who receive care and support from our social care sector. Research in social care could be about introducing new devices and technologies such as: lifting equipment to help with residents, exploring the impact of technology driven care environments or changing social care policies and practice. 

Important research discoveries

Launched in 1961,   the contraceptive pill was initially only prescribed to married women, but the law was relaxed in 1967. The pill works by suppressing fertility with either progesterone or oestrogen or, more commonly, a combination of both. 

Penicillin   was discovered in 1928 and developed into a drug in the early 1940s. Today it’s used to treat a broad range of bacterial infections accounting for around 45% of the antibiotics prescribed in the NHS in England.

Research in the 1980s and 1990s showed that low doses of blood-thinning drugs such as   aspirin and warfarin   significantly reduced the number of heart attacks and strokes in people at risk.

Before you go

Research is a team effort.  We need members of the public, like you, to take part. Without volunteers, it would not be possible for research to happen.

• Reasons why people take part in research
• How to take part in research
• Learn about how studies are made safe

Social Justice in Modern Health Care

How personal experience inspired u.s. health care leaders, published march 25, 2024, courses mentioned in this post: reducing racial disparities in health care series mentioned in this post: health care leadership.

Understanding health care disparities is personal for Aswita Tan-McGrory , Director of the Disparities Solutions Center and Director of Equity and Care Implementation at Massachusetts General Hospital (MGH). Inspired by her work at MGH and her own life experiences, Tan-McGrory co-leads our Harvard Online course Reducing Racial Disparities in Health Care to educate other industry leaders on inequalities in health care and how to address social justice issues.

To dive deeper into these complex topics, Tan-McGrory gathered with health care leaders from across the U.S. on a 45-minute webinar . Featured panelists included Dr. Lenny Lopez , Chief of Hospital Medicine and Associate Professor of Medicine at the University of California, San Francisco; Andrea Madu , Consultant at The Bridgespan Group; and Dr. Esteban Barreto , Director of Evaluation of Equity and Community Health at Massachusetts General Hospital.

The panelists shared how their personal experiences have led them to research and address health care disparities. Andrea Madu shared the story of her family emigrating from Nigeria and how she remembers “going to the hospital as a child and seeing how doctors treated my non-English-speaking grandmother very differently from me and my siblings… I've seen how this poor treatment can translate to poor outcomes for patients.”

Dr. Esteban Barreto shared his similar experiences as an immigrant to the U.S., often watching family members with language barriers try to deal with different systems. Dr. Barreto noted, “It's a combination of both lived experience and also early professional experience, I was able to explore barriers in a more tailored way and hear from those voices who may otherwise be excluded from different assessments.”

To summarize in Tan-McGrory’s words, “This is personal to us. Very personal. Not only are we motivated because, as many people say, it's the right thing to do, but it also resonates with many of us. It's the people that we love that we see as patients.”

Helping people get the care they need is the essence of health care. Unfortunately, too often, modern health care systems are selective about both the people and type of care based on racial bias. How can health care leaders address these inequitable practices in health care, regardless of whether they have relevant, lived experiences like our webinar panelists mentioned?

In her course , Tan-McGrory aims to answer this question and provide tools for industry leaders to tackle health care equality. And it truly does take a village—not just those new to the industry. Dr. Lopez shared, “Even after 20 years of working in the field of equity and health care disparities, I’m constantly learning. I'm constantly being pushed. I’m constantly needing to reflect on my own implicit biases… it’s key to realize that you don’t know everything.”

While the panelists highlighted the value of taking a course to learn about social justice in health care, they also provided some immediate solutions for health care workers to take towards addressing disparities:

• Have an honest and open dialogue about historical missteps that could damage the community’s trust in medical providers. Madu noted, “Understand the medical mistrust that has happened over decades or centuries, and why some people might not want to come to the doctor or adhere to treatments. There are reasons behind it, and it’s important to come to it with humility and empathy for patients.”
• Establish networks of passionate health care providers that reflect the community's varied backgrounds. Madu added, “What’s needed is a pipeline of doctors who look like the communities they’re serving and have that lived experience to understand the cultural context of what patients are saying.”
• Practice listening to patients and inviting them into the solution process. From Madu, “Treat patients as the subject matter experts of their lives. Build trust within the community to recognize where the core issues and root causes are before going into treatment planning.”
• Focus intentionally on specific areas to make forward progress. Dr. Lopez shared, “That’s where the change happens. We oftentimes have grandiose ideas about how the world is going to change, and often, it’s much smaller victories that add up over time. Those small things are what give you strength, courage, and energy to keep doing the work.”

As Andrea Madu puts it, the key to all of this vital work is this: “Equity is not something that we’re going to solve in our lifetime. But there are pieces of it that we can move along—a journey we’re working toward.”

To hear the full conversation between our panelists and Aswita Tan-McGrory, view the full webinar here .

To learn more about these solutions and other tools for addressing racial disparities in our health care system, check out our Reducing Racial Disparities in Health Care course here.

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• Open access
• Published: 17 April 2017

Understanding relevance of health research: considerations in the context of research impact assessment

• Mark J. Dobrow 1 ,
• Fiona A. Miller 1 ,
• Cy Frank 2 &
• Adalsteinn D. Brown 1  

Health Research Policy and Systems volume  15 , Article number:  31 ( 2017 ) Cite this article

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With massive investment in health-related research, above and beyond investments in the management and delivery of healthcare and public health services, there has been increasing focus on the impact of health research to explore and explain the consequences of these investments and inform strategic planning. Relevance is reflected by increased attention to the usability and impact of health research, with research funders increasingly engaging in relevance assessment as an input to decision processes. Yet, it is unclear whether relevance is a synonym for or predictor of impact, a necessary condition or stage in achieving it, or a distinct aim of the research enterprise. The main aim of this paper is to improve our understanding of research relevance, with specific objectives to (1) unpack research relevance from both theoretical and practical perspectives, and (2) outline key considerations for its assessment.

Our approach involved the scholarly strategy of review and reflection. We prepared a draft paper based on an exploratory review of literature from various fields, and gained from detailed and insightful analysis and critique at a roundtable discussion with a group of key health research stakeholders. We also solicited review and feedback from a small sample of expert reviewers.

Conclusions

Research relevance seems increasingly important in justifying research investments and guiding strategic research planning. However, consideration of relevance has been largely tacit in the health research community, often depending on unexplained interpretations of value, fit and potential for impact. While research relevance seems a necessary condition for impact – a process or component of efforts to make rigorous research usable – ultimately, relevance stands apart from research impact. Careful and explicit consideration of research relevance is vital to gauge the overall value and impact of a wide range of individual and collective research efforts and investments. To improve understanding, this paper outlines four key considerations, including how research relevance assessments (1) orientate to, capture and compare research versus non-research sources, (2) consider both instrumental versus non-instrumental uses of research, (3) accommodate dynamic temporal-shifting perspectives on research, and (4) align with an intersubjective understanding of relevance.

Peer Review reports

Various levels of government in Canada collectively invest multiple billions of dollars in health-related research per annum, above and beyond investments in the management and delivery of healthcare and public health services. In recognition of this sizeable collective commitment, much work has focused on the impact of health research to explore and explain the consequences of these investments and inform strategic planning. Relevance is tacit in the increased attention to the usability and impact of health research. Additionally, research funders increasingly engage in relevance assessment as an input to decision processes; yet, it is unclear whether relevance is a synonym for or predictor of impact, a necessary condition or stage in achieving it, or a distinct aim of the research enterprise. Therefore, the main aim of this paper is to improve our understanding of research relevance as it relates to research quality and research impact, with specific objectives to (1) unpack research relevance from both theoretical and practical perspectives, and (2) outline key considerations for the assessment of research relevance.

Globally, there has been increasing critical assessment of the value of health research investments [ 1 – 3 ], with growing interest in research impact assessment (RIA) in the health sector [ 4 – 6 ]. RIA focuses on understanding how research activity can directly and indirectly advance knowledge, influence decision-making, and effect health and socio-economic outcomes, with a small but growing body of work seeking to develop better measures to evaluate (and ideally attribute) the returns on health research investments [ 6 ]. The Canadian Academy of Health Sciences (CAHS) released a comprehensive report on the subject in 2009 that presented a call for action, with a number of recommendations including establishing collaborative efforts among Canadian research funders to advance frameworks and sets of indicators and metrics for health research impact [ 4 ]. The CAHS impact framework [ 4 ], which drew on the Buxton and Hanney [ 7 ] ‘payback model’, among others, has provided a thoughtful starting point for considering the impact of health research in Canada. Subsequent work by Alberta Innovates – Health Solutions (AIHS) on a Research to Impact Framework (described in Graham et al. [ 8 ]) provides further insights on operationalising RIA frameworks for health research in Canada.

These initiatives are part of a broadly discussed shift in approaches to knowledge production, from an emphasis on investigator-initiated, curiosity driven work judged and guided by scientists, to expanded approaches to knowledge production, drawing on a wider set of actors and approaches, and emphasising relevance and usability. This shift from science produced by and for scientists to knowledge production that is “ socially distributed, application-oriented, trans-disciplinary, and subject to multiple accountabilities ” [ 9 ] has been characterised as a shift from ‘mode 1’ to ‘mode 2’ knowledge regimes. In the language of mode 2, interest in research ‘impact’ expresses a concern for application or consequence, and – in the economic language of return on investment – a concern that the yield is at least equal to the investment in the research itself. Extending this reasoning, interest in research ‘relevance’ may reflect a concern for accountability – linking research to the actor(s) for whom the research is performed and who will, ideally, put it to use.

In Canada, interest in research impact and relevance appears to have been felt most forcefully in the context of health services and policy research, which has long been encouraged to orient to the needs of policymakers, health system planners and related decision makers. More recently, there has been increased attention to ensuring that all forms of health research are ‘patient oriented’ – that is, that the research is prioritised, conducted and applied in ways that are accountable to this important end user. This call has been picked up on several fronts, including by the Canadian Institutes of Health Research (CIHR), which released its Strategy for Patient-Oriented Research (SPOR) in 2011. The SPOR vision “…is to demonstrably improve health outcomes and enhance patients’ health care experience through integration of evidence at all levels in the health care system ” [ 10 ]. In some respects, it represents a fundamental re-orientation for the primary funder of health research in Canada.

Though relevance is tacit in attention to research impact and the wider concern with mode 2 knowledge production, explicit attention to the meaning or measurement of research relevance is limited. The CAHS and AIHS frameworks, for example, acknowledge ‘relevance’ of health research but do not clearly define the term nor describe approaches for assessing it [ 4 , 8 ]. Rather, these frameworks emphasise the role of broad stakeholder engagement approaches and feedback mechanisms as methods for addressing relevance. For example, the AIHS framework notes the challenge of, and need to, move “ …beyond the collection of traditional scientific indicators […] to include measures of greater interest to the broader stakeholder community… ” [ 8 ] without stating explicitly how “ greater interest ” or related concepts such as relevance should be judged. As currently constructed, these RIA frameworks provide important advances in how we think about the impact of health research, but they were not intended to provide guidance specifically to the assessment of the relevance of health research.

Despite this lack of specific guidance on research relevance from a scholarly or measurement perspective, attention to it as a practical component of health research funding and organisation is evolving. There is, for example, growing use of ‘relevance assessment’ by research funders. The Canadian Health Services Research Foundation, in particular, was an innovator in incorporating relevance review into its applied research funding programmes, including promoting partnerships and knowledge translation (KT) with health system stakeholders [ 11 ]. Current applications for funding from the Institute of Gender and Health at CIHR go through ‘relevance review’ ( http://www.cihr-irsc.gc.ca/e/45212.html ). Similarly, applications for Ontario’s Health System Research Fund are judged based on ‘internal review of relevance and impact’ ( http://www.health.gov.on.ca/en/pro/ministry/research/cihr.aspx ). However, given the lack of conceptual clarity on research relevance, and in particular, how relevance assessment aligns with and differs from impact assessment, there is a critical gap in our understanding that has implications for both its contemporary and ongoing application and our ability to make sound research investment decisions.

This work was commissioned by the Ontario SPOR SUPPORT (Support for People and Patient-Oriented Research and Trials) Unit (OSSU) – one of several units established at provincial and regional levels across Canada to work with CIHR in pursuing the SPOR. Like other research organisations, OSSU saw the need to consider the relevance of the research it supported, and it established both scientific and relevance advisory committees as part of its original governance structure [ 12 ], tasking the latter to “ …develop a measure, or small set of strategic measures, that serves to inspire the Ontario research, implementation, provider and patient communities to come together to make a difference for patients ” [ 12 ]. In the spirit of research and scholarship, OSSU then asked what exactly this commitment to research ‘relevance’ entailed.

Our approach to answering this question involved the scholarly strategy of review and reflection. As with the early investigations into research impact assessment, we were surprised to find so little reflexive attention to the topic within the health research community [ 13 ]. We prepared a draft paper based on an exploratory review of literature from various fields, and gained from detailed and insightful analysis and critique at a roundtable discussion with a small group of key health research stakeholders. We also solicited review and feedback from a small sample of expert reviewers.

The structure of our paper is as follows. First, to ‘unpack’ the concept of relevance, we review theoretical literature and then consider practical work both from within and outside the health sector, to ask what has been argued and concluded about the nature of relevance and its appropriate assessment. Next, we outline a series of forward-looking considerations for assessing research relevance and conclude with reflections on how research relevance assessment fits with evolving interest in RIA.

Unpacking relevance

Theoretical perspectives.

Before considering the relevance of health research, we need to step back and consider what we mean by the term ‘relevance’. A range of descriptors is often used to define relevance, including ‘pertinent to…’, ‘bearing upon…’, ‘connected with…’, or ‘appropriate to…’, ‘…the matter at hand’, as well as ‘germane’, ‘apropos’, ‘material’, ‘applicable’ and ‘satisfactory’. A large body of dedicated theoretical work on relevance, drawn from many fields and perspectives, such as computer science, information science, statistics/probability theory, artificial intelligence, cognitive science, epistemology, linguistics and jurisprudence [ 14 ], reflects its importance but also the challenge for establishing a common understanding of the term [ 14 , 15 ]. For example, Gärdenfors [ 16 ], in his discussion on the logic of relevance, noted that “ …relevance ought to be a central concept in the philosophy of science… ” given the position that “ …it is only relevant information that is of any importance… ” (p. 351). However, from a ‘research’ relevance perspective, the theoretical work on relevance has been linked to ‘information’, ‘evidence’, ‘reasoning’, ‘argument’ and ‘decision’ [ 15 – 18 ], each presenting variable framing that impedes practical definition or consistent comprehension of the term. Floridi [ 14 ] recently suggested that existing theories are “ …utterly useless when it comes to establish the actual relevance of some specific piece of information ” (p. 69), and goes on to advance a ‘subjectivist’ interpretation, with relevance judged by the questioner. While a subjectivist approach to relevance is intuitively appealing, its contribution to the assessment of research relevance presents particular challenges that we will discuss later in the paper.

Another approach to unpacking relevance is to consider the theoretical model behind the broad-based research strategies that have governed research investments and policies in high-income countries since the end of the Second World War. For the better part of the 20th century, a linear model was the dominant conceptual framework, whereby basic research was viewed as a necessary input for applied research, which then led to development and production [ 19 , 20 ]. In the late 1990s, an alternate thesis was introduced when Stokes proposed a new model for broad-based research strategy – known as Pasteur’s Quadrant – that highlighted the conceptual relationship between the ‘quest to understand’ and ‘practical needs’ [ 21 ]. While some research is clearly focused on advances in basic research (e.g. Niels Bohr’s foundational research on atomic structure and quantum theory), and some research is clearly focused on applied problems (e.g. Thomas Edison’s practical inventions), Stokes emphasised the potential for use-inspired basic research (e.g. Louis Pasteur’s foundational research on microbiology that addressed contemporaneous population health challenges). Pasteur’s Quadrant invokes consideration of ‘relevance’ with some commentators framing the two-by-two relationship as the relevance for advancement of basic knowledge and the relevance for immediate application [ 22 ]. Stokes’ model adds conceptual insight on the role of relevance when considering the value of research to society, however, it was not intended to specifically conceptualise the term and does not distinguish it from other related concepts such as research impact or value. Therefore, to provide further insights, we next consider relevance in practical settings.

Health sector perspectives

In the health sector, the idea that research should be ‘relevant’ is commonplace. Commitments to ‘knowledge translation’ and the ‘knowledge to action cycle’ [ 23 ] emphasise issues of relevance and provide considerable insight into approaches to ensuring research usability and use. At the same time, the health research community has given disproportionate attention to issues of research quality, with an emphasis on internal validity that may downplay external validity and suggest some tension between rigour and relevance. Thus, though the concept of relevance is of central importance to the health research enterprise, the failure to unpack it or explore it both theoretically and practically leaves room for misunderstanding and misapplication.

In the health sector, research relevance often arises as a practical question of the ‘fit’ between a body of knowledge or research approach and a specific field or issue (e.g. public health, primary healthcare, healthcare access, genomics, alternative healthcare, healthcare reform in rural areas). The results of two recent International Society for Pharmacoeconomics and Outcomes Research task forces take this approach. The task forces developed questionnaires to assess the relevance and credibility of research other than randomised controlled trials (e.g. observational research, meta-network analysis) to inform healthcare decision-making [ 24 , 25 ]. Both make similar observations about relevance, reinforcing the subjectivist approach noted earlier, and can be summarised by the following statement by Berger et al. [ 24 ]:

“ Relevance addresses whether the results of the study/apply [sic] to the setting of interest to the decision maker. It addresses issues of external validity similar to the population, interventions, comparators, outcomes, and setting framework from evidence based medicine. There is no correct answer for relevance. Relevance is determined by each decision maker, and the relevance assessment determined by one decision maker will not necessarily apply to other decision makers. Individual studies may be designed with the perspective of particular decision makers in mind (e.g. payer or provider) ” (p.148, emphasis added).

Research relevance in health is also noted in discussion and debate regarding the value of qualitative research relative to the more established forms of quantitative health research. For example, Mays and Pope [ 26 ] suggest that qualitative research can be assessed “… by two broad criteria: validity and relevance ”. Their further discussion provides some insight into the several ways that research might be relevant, suggesting that:

“[r] esearch can be relevant when it either adds to knowledge or increases the confidence with which existing knowledge is regarded. Another important dimension of relevance is the extent to which findings can be generalised beyond the setting in which they were generated ” [ 27 ].

The work of Mays and Pope positions research relevance amidst the longstanding tension between internal and external validity. This tension reflects opposing foci on internal validity as the quality/rigour of research methodology and external validity as the applicability/transferability of research to other settings or contexts. While external validity is not the only measure of relevance – as research may remain relevant to some contexts even when not generalisable to others – it is an important component, and one that has not always attracted sufficient attention. For example, the Canadian health research community has focused considerable practical attention on internal validity as a critical component of evidence for clinical and health policy decisions. Evidence-based medicine, the Cochrane Collaboration, the Canadian and United States task forces on preventive healthcare/services and a long list of aligned groups have developed and established many tools to assess the quality of research evidence (e.g. GRADE [ 28 ]), with a predominant focus on issues of internal validity, and an emphasis on evidence hierarchies that is sometimes seen to be incompatible with ‘real world’ relevance. The relative lack of similar approaches or tools that focus on external validity in health research is notable, though movements to marshal evidence in support of sound public policy, such as the Campbell Collaboration, have attended to issues of external validity in other areas of health and social policy [ 29 ]. Further, there are emerging approaches and tools for documenting the external validity of health research and facilitating its use [ 30 ]. For example, WHO has supported the development of workbooks to contextualise health systems guidance for different contexts [ 31 ] and the field of local applicability and transferability of research has emerged to facilitate the adaptation of interventions from one setting to another, including the development of some well-documented tools like RE-AIM [ 32 ].

Alongside these emerging approaches and tools sits the established field of KT. KT has a strong history in Canada with a distinctive feature being a reliance on stakeholder engagement to support a commitment to improve research relevance. For example, the AIHS framework relies heavily on KT and stakeholder engagement approaches as part of its RIA, describing the mobilisation of knowledge through “ …a process of interactions, feedback, and engagement using a variety of mechanisms (e.g. collaborations, partnerships, networks, knowledge brokering) with relevant target audiences (i.e. actors and performers) across the health sector ” ([ 8 ] p. 362). Experience in stakeholder engagement, particularly with clinical, management and policy decision-makers, has become fairly extensive and there is now increased attention on engaging patients as core stakeholders in health research. If relevance is truly subjective, then KT efforts (including engagement, dissemination, promotion, communication) would appear to represent reasonable approaches for articulating, conveying and improving research relevance. However, if there are underlying elements of relevance that are more universal, then there is a risk that KT efforts – and subjectivist approaches to ensuring relevance – are akin to commercial marketing or communication strategies where the aim is to ‘sell’ more product and/or generate more influence that may not align with a more objective lens.

In sum, the health research community in Canada has a longstanding history of critically appraising research quality based on study design and research methodology, with greater emphasis on internal rather than external validity. As the same time, there is established expertise in KT, emphasising engagement with research users and adaptation to settings or contexts of use – approaches that may imply a subjectivist interpretation of relevance. Thus, while relevance is an important concept for the health research enterprise, its use is largely tacit and taken for granted.

Non-health sector perspectives

To unpack relevance further we consider some non-health sector perspectives that give attention to the term, often with formal definitions or taxonomies established. Examples include the legal, financial accounting, education and web search (information retrieval) sectors, each of which are briefly described below.

From a legal perspective, relevance has a specific meaning that relates to the admissibility of evidence in terms of its probative value (i.e. the extent to which evidence contributes to proving an important matter of fact) [ 33 ]. For example, a common objection to legal testimony or evidence is that it is ‘irrelevant’ [ 34 ]. Legal processes for considering the admissibility or legal-relevance of evidence are firmly established, requiring explicit declaration of evidentiary sources and direct consideration of that evidence as it relates both to a specific case and related historical precedents, something that is undeveloped in the health sector [ 35 ]. It is the formality, explicitness and retrospective nature of this process, which is directly associated with a specific case (or decision), that is characteristic of the consideration of relevance in the legal context.

Financial accounting provides another perspective on relevance. In this field, relevance is viewed as a fundamental component of generally accepted accounting principles. Relevance and materiality are emphasised such that accountants and auditors focus on financial information that meets the decision-making needs of users and is expected to affect their decisions. In financial accounting, ‘value relevance’ provides a more focused perspective on relevance, defined as “ …the ability of information disclosed by financial statements to capture and summarise firm value. Value relevance can be measured through the statistical relations between information presented by financial statements and stock market values or returns ” [ 36 ]. Similar to the legal perspective, the financial accounting perspective on relevance is set with a formal context, where the focal point (i.e. financial performance) is clear and principles (i.e. generally accepted accounting principles) and processes (i.e. financial reporting and auditing) are clearly established and monitored.

Education provides a slightly more expansive approach to operationalising relevance, given the more general aim of the enterprise. In the United States, the Glossary of Education Reform [ 37 ] notes that “ …the term relevance typically refers to learning experiences that are either directly applicable to the personal aspirations, interests, or cultural experiences of students (personal relevance) or that are connected in some way to real-world issues, problems, and contexts (life relevance) ”. They further state that “ personal relevance occurs when learning is connected to an individual student’s interests, aspirations, and life experiences ”, while “ life relevance occurs when learning is connected in some way to real-world issues, problems, and contexts outside of school ”. A similar framing of relevance in this context suggests that it “…extends the learning beyond the classroom by teaching students to apply what they are learning to real world situations ” [ 38 ]. While the education sector also makes numerous references to a ‘rigour and relevance’ dyad [ 39 ] in contrast to the dominance of the internal validity focus in healthcare, it is the prominent dual focus on ‘personal’ relevance (with its subjectivist orientation) and ‘life’ or ‘real world’ relevance (with its more universal orientation) that seems to most clearly define the education sector’s perspective on relevance.

One of the most intensive and competitive sectors focusing on relevance is the web search (or information retrieval) field. This includes dominant search engines such as Google and Bing, as well as a wide range of commercial and social media sites such as Amazon, eBay, Facebook and LinkedIn, that compete either directly or indirectly on their ability to identify relevant information in response to user queries. Therefore, the ability of these organisations to advance the theory and practice related to relevance is fundamental to their success. For example, Google was built upon the effectiveness of its search algorithm, which is in a constant state of evolution. Both explicit and implicit approaches to assess relevance are used to contribute to search algorithm refinements [ 40 ]. The explicit approach focuses on ‘relevance ratings’, whereby evaluators (e.g. human raters) are contracted to assess the degree of ‘helpfulness’ of search results paired to specific search queries [ 41 ]. The implicit approach to assess relevance monitors and aggregates search behaviour of millions of users who are likely unaware that their behaviour is being assessed. Google has more recently advanced ‘personalised relevance’, which uses past individual search behaviour to personalise/tailor future search results for the same individual. Pariser has critiqued this concept as “ the filter bubble ” [ 42 ], warning that Google’s intent to optimise search algorithms for personal relevance creates a “ …personal ecosystem of information… ” that limits the diversity of search results and promotes insularity. This personal relevance is situated within the pervasiveness of social media, which facilitates the advancement of ‘social relevance’. Personal and social relevance highlight two important orientations towards relevance – one built on increasingly detailed understanding of individual preferences and the other reflecting the growing power and increasing accessibility of crowd-sourced perspectives. Overall, web search has made important contributions to how we understand and operationalise relevance, including the use of increasingly sophisticated explicit and implicit feedback mechanisms and the ability to draw upon and analyse big data sets. Web search has also exposed the contrasting orientations of personal and social relevance that underscore the challenges of combining or integrating different relevance assessments.

These non-health sector perspectives on relevance highlight several considerations. First, they reinforce general findings that point to perspective, decision context, timeliness and precision of focus or ‘fit’ as key elements of relevance. Additionally, they highlight a few distinctive considerations. The formalistic contexts of financial accounting and law emphasise issues such as precedent and legitimacy, implying that relevance in a research sense might require the demonstration of some legitimate or credible association between research and its use or user, among other considerations. Further, the complex consumerist world of social media highlights some of the challenges of a purely subjectivist definition of relevance. Whereas the International Society for Pharmacoeconomics and Outcomes Research guidance takes a subjectivist stance in suggesting that, “[t] here is no correct answer for relevance ” [ 24 ], the “ filter bubble ” criticised by Pariser [ 42 ] suggests otherwise. Relevance solely to the personally-perceived interests of a research user is unlikely to adequately serve the collective commitments to health and health equity that are especially germane to the health research enterprise.

Forward-looking considerations for assessing the relevance of health research

To this point, we have endeavoured to unpack relevance from theoretical and practical perspectives. In light of these insights and in the context of persistent interest in research impact assessment and evolving interest in research relevance, we now turn to some specific forward-looking considerations for research relevance assessment (RRA).

Relevance of research versus everything else

The first consideration for RRA is the acknowledgement that research is only one of many sources of insight to inform the needs or actions of research users. A research user is influenced by a wide range of political, legal, media, economic and other contextual information, interactions and experiences, as well as prevailing organisational governance, leadership, culture and values that all serve to complement (and often dominate) any insights that might be derived from research [ 43 ]. This reality implies that ‘relevance’ has a different meaning for researchers and research users. Researchers are typically interested in the relevance of a specific research product or activity for identifiable actions of (potentially) multiple research users; relevance is here judged relative to both the perceived needs of research users, and the extent and content of other related research. In contrast, research users are typically focused on identifying multiple relevant inputs to guide a specific action, only some of which may be research; relevance is here judged relative to both the research user’s needs and the form and content of the other inputs.

Given these distinct orientations to research relevance, RRA needs to be explicit about its comparative lens. Clear distinctions should be made between relevance based on the merits of the research product or activity (researcher lens) and relevance based on the relative value of research compared to other research and non-research sources (research user lens). RRA provides an opportunity to build more robust ways to characterise and assess the contribution of research to research users, including a more systematic and transparent articulation of anticipated research uses (akin to the Research Councils UK’s ‘Pathways to Impact’ [ 44 ] or descriptions of planned study design and methodological approach published in study protocols/registrations for randomised controlled trials or systematic reviews).

Beyond instrumental uses of research

The considerations noted above rely heavily on instrumental uses of research. Theoretically derived definitions of relevance, such as Floridi’s [ 14 ], tend to focus on the response to a specified question. This suggests a direct and tangible connection between research and its ‘use’. However, as Weiss [ 43 ] and others have observed, most types of research use are not instrumental, where use is documented and explicitly addresses a specific query or challenge for a research user. Rather, research use tends to be more conceptual, where use is indirect and evolves over time, or symbolic, where use may be politically or tactically motivated [ 43 ]. Research may also create externalities or unintended effects. For example, general research activity might support an engaged learning environment, interactive research relationships, and additional research-related discourse that provides benefits that are not attributable to any specific research product or activity. This has important ramifications for how research is funded and the role that relevance can play in that assessment. Ultimately, RRA needs to go beyond a singular understanding of research use as instrumental use, to develop better methods for capturing and assessing the relevance of the many non-instrumental uses of research.

The temporal factor

Another closely related consideration for RRA is the temporal context. Almost all research is conducted in a temporally defined period. Yet, while the quality of research is typically characterised by its methodology, which is a static feature typically not subject to temporal variation (e.g. the assessed quality of a randomised controlled trial should be consistent over time), relevance of research can be considered at any time (e.g. prior to the initiation of a research study or at different points in time post-completion) and is therefore subject to dynamic perceptions as they pertain to evolving action or decision contexts. Cohen [ 15 ] suggests that “ …relevance, like reasoning, has a prospective dimension as well as a retrospective one. It helps prediction as well as explanation ” (p. 182). The important insight is that, in contrast to research quality, the relevance of a specific research product can change over time, making assessment of research relevance more challenging.

This requires RRA to acknowledge the temporal factor and its associated implications for research relevance. At minimum, RRA should specify the temporal context as either pre-research (e.g. proposal/funding stage) or post-research (e.g. after research results have been produced). RRA at the pre-research stage focuses on proposed inputs and hypothetical outputs and outcomes, and may be more likely to overestimate instrumental research use and underestimate non-instrumental use. RRA at the post-research stage focuses mainly on the importance and value of actual outputs and tangible results, and may capture more non-instrumental research use. The pre-research stage is clearly aligned with research funding/investment processes, while the post-research stage can contribute to retrospective return-on-investment calculations and more general research impact assessment. However, employing this simple temporal categorisation should not lead us to lose sight of the dynamic, iterative nature of research relevance and the opportunity to assess it at interim and ongoing stages that captures re-interpretations or re-applications of research findings over time.

Moving from a subjective to an intersubjective understanding of relevance

An underlying theme in our review of relevance is subjectivity. Consider the broad scientific paradigms of positivism and interpretivism that are typically respectively aligned with research quality and research relevance. Research quality can be viewed as relating to characteristics or features that are assessed objectively, while research relevance may be seen as subjectively adjudicated. The subjective focus emphasises the variability of different perspectives and contexts and the suggestion that anyone can have a different take on the relevance of a specific research product or activity. For RRA, this reinforces a user-centred orientation to relevance assessment that privileges the judgment of the interrogator and raises the key question regarding who is positioned as the main arbiter of research relevance.

However, while relevance may never be characterised as universal, it could be argued that it is not purely subjective either. Rather, relevance may be more consistent with an intersubjective understanding that emphasises the extent of agreement or shared understanding among individual subjective perspectives representing a way to bridge the personal and the universal. The intersubjective view, while not presenting an objective approach to measuring relevance, does provide a road towards a meaningful and structured assessment of research relevance. It also emphasises the importance of representation in forging the intersubjective judgments that guide the research enterprise.

This paper has unpacked research relevance from different perspectives and outlined key considerations for its assessment. Alongside research impact assessment, research relevance seems increasingly important in justifying research investments and guiding strategic research planning. Indeed, judgments of ‘relevance’ are becoming a key component of the health research enterprise. However, consideration of relevance has been largely tacit in the health research community, often depending on unexplained interpretations of value, fit and potential for impact. Reviewing the various uses of relevance in health research, the concept is sometimes used as a synonym for research impact or positioned as a reliable predictor of later consequence. In many ways, research relevance seems a necessary condition for impact – a process or component of efforts to make rigorous research usable. However, relevance is not a necessary or sufficient condition to achieve impact. We expect that research that is relevant, and thus accountable to specific and legitimate users, will be impactful, but this may not necessarily be the case where other factors intervene. Additionally, we may expect that research that is impactful will be appropriately accountable – but again, this is not necessarily the case. Ultimately, relevance stands apart from research impact. Like rigour, relevance is a complementary but distinctive dimension of what it is that ensures ‘the good’ in health research.

While ‘relevance’ is ever-present, understanding of the concept in terms of health research is emergent and not well codified. To improve our understanding, this paper outlines four key considerations, including how research relevance assessments (1) orientate to, capture and compare research versus non-research sources, (2) consider both instrumental versus non-instrumental uses of research, (3) accommodate dynamic temporal-shifting perspectives on research, and (4) align with an intersubjective understanding of relevance. We believe careful and explicit consideration of research relevance, guided by transparent principles and processes is vital to gauge the overall value and impact of a wide range of individual and collective research efforts and investments. We hope this paper generates more discussion and debate to facilitate progress.

Abbreviations

Alberta Innovates – Health Solutions

Canadian Academy of Health Sciences

Canadian Health Services Research Foundation

Canadian Institutes of Health Research

knowledge translation

Ontario SPOR SUPPORT Unit

research impact assessment

research relevance assessment

Strategy for Patient-Oriented Research

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Acknowledgements

We acknowledge and appreciate the contributions of participants of a roundtable discussion to gather feedback on an earlier version of this paper. Participants included Simon Denegri, National Director for Public Participation and Engagement in Research, National Institute for Health Research (NIHR) UK, and Chair of INVOLVE, UK; Lee Fairclough, Vice-President, Quality Improvement, Health Quality Ontario; Michael Hillmer, Director, Planning, Research and Analysis Branch, Ontario Ministry of Health and Long-Term Care; John McLaughlin, Chief Science Officer and Senior Scientist, Public Health Ontario; Allison Paprica, Director, Strategic Partnerships, ICES; Michael Schull, President and CEO, ICES; and Vasanthi Srinivasan, Executive Director, Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU). We also want to thank John Lavis of the McMaster Health Forum for his very helpful comments on an earlier draft. Though we owe these individuals and organisations many thanks for their insights and support, we alone are responsible for the final product.

This work was commissioned by the Ontario SPOR Support Unit (OSSU). The executive director of the OSSU was one of the participants in a roundtable discussion to gather feedback on an earlier version of this paper, but beyond that, the OSSU did not have any role in the design of the study, collection, analysis or interpretation of the data, or writing of the manuscript.

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ADB acquired funding for the study. MJD, FAM and ADB conceptualised the study. MJD, FAM, CF and ADB participated in the review and writing of the manuscript. MJD, FAM and ADB participated in the roundtable discussion. MJD, FAM and ADB reviewed and approved the final version of the manuscript (CF passed away prior to submission of the manuscript).

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This article is dedicated to the memory of Dr Cy Frank, our co-author and esteemed colleague, whose untimely death occurred midway through development of this work. Among his many interests, Dr Frank was a champion for improving understanding of research impact assessment and provided many insights on the concept of research relevance, some of which we expand upon in this article. His many contributions to the health sector will live on, but he will be greatly missed.

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Dobrow, M.J., Miller, F.A., Frank, C. et al. Understanding relevance of health research: considerations in the context of research impact assessment. Health Res Policy Sys 15 , 31 (2017). https://doi.org/10.1186/s12961-017-0188-6

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Topic 9: Scope of Health care research

Research aim: The research aims to identify and analyse the significance of health care research and its effects on humans and society. The researcher will identify the necessity of the study in the field and its overall impact. 

Topic 10: The future of telemedicine

Research aim: Telemedicine refers to the use of technology to disseminate medical information, diagnose, or interact with a patient. Currently, it is gaining tremendous importance, especially due to the pandemic, but it is important to figure out how it will work out in the future.

The research aim of the research would be to find the significance of telemedicine and its prospects.

Topic 11: Controlling infectious diseases

Research aim: The research will aim to find out whether or not infectious diseases are difficult to deal with. The paper will identify all the elements responsible for making infectious diseases unstoppable. The researcher can make arguments in the context of the COVID-19.

Topic 12: Effective health care policies around the world

Research aim: Different countries have different health care systems with different policies around the world. The aim of the research will be to find out the most effective health care systems around the world. The research can incorporate both quantitive and qualitative methods for the study.

The researcher can pinpoint a respective area for the study—for example, the health care system of Nigeria, the United States, or South Asia etc.

Topic 13: Technology and health care system

Research aim: The advancements in technology have transformed all aspects of our life, and the health care system is no exception.

The main aim of the research will be to find out the impact of technology on the health care system.

Topic 14: Health care system in 2030

Research aim: The aim of the research will be to identify trends and forecast the future on their basis. The researcher will examine the health care system today and study the elements that may bring about change and may modify it in the future. The projections must base on evidence.

Topic 15: The emotional impacts of COVID-19

Research aim: The COVID-19 affected normal life significantly. People were locked in the homes, and the roads and streets were empty. In that perspective, it is significant to understand how(if it did) affected people emotionally.

The main aim of the research will be to find out how and to what extent COVID-19 affected people emotionally. 

Topic 16: Beauty standards and how they impact the health of humans

Research aim: Neither being skinny is healthy, nor starvation is the solution to getting a perfect body shape. The standard beauty standards have persistently put social pressure on individuals to become as per se. Otherwise, they will be neglected or segregated. The research will aim to find out how people who try to meet the standard beauty standards affect their health. 

Topic 17: Depression and anxiety in adults in developed countries

Research aim: Depression and anxiety are some common instances that occur to almost all people. It may apparently look like people in developed countries, having access to their basic needs, must not have anything to worry about. It might not be what looks from the outside. The research will measure the rate of increase or decrease in depression and anxiety in adults in developed countries and identify the key determining factors.

Topic 18: Creating awareness of Breast cancer in third world countries

Research aim: The aim of the research will be to identify why it is important to create awareness about breast cancer in third-world countries and identify how to do so.

Topic 19: Gene therapy for hemoglobinopathies

Research aim: Haemoglobinopathies are genetic problems that affect the structure or formation of haemoglobin. One recent research identifies gene therapy as a solution to the disorders. The research will aim to identify how effective gene therapy is and in what capacity it can be used in medicine in the future.

Topic 20: The unspoken problems of health care managemnt

Research aim: While it is so much it is stressed on ensuring the treatment of patients and advancing healthy life of humans in generals; there is a very little say about what problems, who are responsible for managing, may face. The research aims to identify the undiscussed problems faced by health care management to ensure a healthy life for people.

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Nursing care in mental health: Human rights and ethical issues

Affiliations.

• 1 67816University of São Paulo at Ribeirão Preto College of Nursing, Brazil.
• 2 3158University of Alberta, Canada.
• PMID: 33111635
• DOI: 10.1177/0969733020952102

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental illnesses? A scoping review methodology guided by Arksey and O'Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was "Ethics and Human Rights Boundaries to Mental Health Nursing practice". Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse.

Keywords: Ethics; human rights; nursing care; persons with mental illness.

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• Mental Health
• Nursing Care*
• Paternalism
• Psychiatric Nursing*

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• v.15(1); 2023 Jan

The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review

Khushbu chelak.

1 Public Health and Epidemiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND

Swarupa Chakole

2 Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND

Significant health disparities exist locally and even throughout the nation. Dipping health inequalities necessitates a focus on the inadequate spread of power, money, and resources, as well as the situations of daily living, which may be addressed through social determinants of health. This study aimed to review the role of health-related social factors in overcoming health disparities. We conducted a search of English-language literature, including studies published on health and health equalities or inequalities. Most reports show that social determinants of health have a higher effect on health. The elimination process of these health inequities occurs through well-designed economic and social policies. Every aspect of social determinants influences the health aspects of people; hence, some areas to focus on include employment, education, socioeconomic status, social support networks, health policies, and healthcare access. Launching interventions to reduce health disparities can help improve the community’s health and health equality.

Introduction and background

According to the World Health Organization (WHO), social determinants of health (SDH) are defined as the circumstances in which humans are born, develop, live, earn, and age. At the international, regional, and state or local levels, the distribution of money, power, and resources shapes these circumstances [ 1 ]. The WHO Commission on Social determinants of Health (CSDH) has stated that progress on SDH is the most successful means of enhancing all people’s well-being and raising disparities [ 2 ]. The WHO established the CSDH based on SDH intervention, which is the most effective strategy to improve well-being and reduce inequality [ 2 ]. Important aspects include governmental, financial, and traditional organizations, based on factors such as manageable healthcare and learning organizations; safe ecological conditions; aesthetically pleasant neighborhoods; and the availability of nutritious food [ 3 ]. Nowadays, health challenges such as being overweight, cardiovascular diseases, diabetes, and depression are prominent, wreaking havoc upon people because of the increasing demands of a high lifestyle. This leads to people suffering from non-communicable diseases. These socioeconomic variables contribute to societal stratification and health disparities among persons of different social and economic classes, genders, and ethnicity.

History of social determinants of health inequality

In the 19th century, people started becoming aware of the factors that had an impact on the health of the population [ 4 ]. Rudolf Virchow, a pioneer in this field, testified on the role of poverty in generating a disease that led to a plague outbreak in Prussia [ 4 ]. Friedrich Engels also studied to find out about the increased mortality. After that, Salvador Allende tried in Chile to demonstrate the importance of political and social variables in people’s health inequities [ 4 ]. All of them tried to frame how factors influence health and what role they play. Marmot emphasized that the workplace may be an important location for addressing disparities. Similarly, changing housing might have an impact on physical and mental health [ 5 ]. Cutting across the structural inequalities, health inequality is a more contemporary challenge and possibly a consequence of the imbalances in development planning and economic design [ 6 ]. Interventions on health and its disparities help overcome further problems [ 7 ]. There is a long history of housing evidence from several reviews [ 8 ]. People suffering from the financial crisis and economic disparities were also among the many who were deeply affected by the growing socioeconomic demands in the early days.

Methodology

This article presents a narrative review of SDH in promoting health equality. PubMed and Google Scholar were used to find all original and review articles with original reports. A set of keywords and Medical Subject Headings (MeSH) terms related to health inequalities and SDH were used. Keywords used were social inequalities, social inequities, poverty, health determinants, behavior, economic status, and social movement. The following MeSH terms were used interchangeably and in combination to find all relevant articles: social determinants, health inequities, and social movement. All free full-text PubMed Central articles were searched using Pubmed and Google Scholar. Studies that discussed the relationship between health inequities, the importance of social determinants, health inequities, health policies, social factors, health equality, and social movement were included. Articles that reviewed SDH in a more general way and whose main focus was not health inequalities and equalities were excluded (Figure ​ (Figure1 1 ).

Social determinants of health

A subcategory of health factors is SDH, as shown in Figure ​ Figure2 2 .

Source: Open access journal under a CC-BY license contributed by social determinants of health. Available at: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 [ 9 ].

The most significant health factors include government policy, medical availability, individual behavioral choices, and biological and genetic features [ 3 ]. Examples of SDH include occupation, job status, workplace safety, level of income, opportunities for education, job and place of work protection, inequity between men and women, and segregation based on race. The various health aspects of SDH include food poverty and limitations of access to nutritious food options, housing, and helpful facilities available; early childhood growth and experiences; inclusion in the community and social assistance; the prevalence of crime and exposure to violent behavior; neighborhood circumstances and physical environment; and possibilities for recreation and leisure, as shown in Table ​ Table1 1 .

Source: Open access journal under a CC-BY license contributed by social determinants of health (2018). Available at: https://www.christenseninstitute.org/wp-content/uploads/2018/10/Social-Determinants-of-Health-Table.png [ 10 ].

Social determinants of health indicators

Social determinants determine how health is affected, how they play a significant role in influencing health, and how we can improve health for all. Some of the effects of social determinants affect health in the long term. For example, a less educated person might have less knowledge about how to utilize resources which may affect their ability to use resources to the fullest. Thus, social determinants play a role which must be recognized and improved.

Socioeconomic Status

Financial stress and socioeconomic status are a combination of a family’s or ordinary citizen’s profession, academic performance, wealth, and economic standing. Wealth and power are characteristics that influence a person’s socioeconomic status. The total amount earned in earnings or compensation over a year is income. Income limits a family’s overall lifestyle and influences their consumption habits [ 11 ]. Discrimination based on caste, creed, and gender makes a person vulnerable, enabling them to stop asking for more. They are subjugated to extreme pressure, which only worsens their mental status and health. Health education and programs must be used to educate people about how beneficial it is to count everyone as a whole. The promotion of health equality and equity remains the most significant goal of balancing financial stress.

Equality Education

Education is a means of improving one’s socioeconomic standing. A wealthy family’s socioeconomic status suggests a higher chance of enrolling and graduating from college. Family background, rather than other factors, such as supplemental educational services, significantly influence how much and what kind of education people get and what kind of employment they obtain [ 11 ]. The goal of improving income equality and eradicating poverty through education has not been met. Higher wages and social policies that support low-income families are needed to enhance students’ social and economic conditions [ 11 ]. Educational perspectives allow us to take a comprehensive and clearer view of the causes of health and disease in a population and must be paid attention to [ 4 ].

Gender Inequality and Age Inequality

Women earn less and are more likely to be poor. Institutional discrimination in a patriarchal society, where women were supposed to be mothers and spouses rather than part of the formal workforce, is to blame for gender inequality [ 11 ]. Poverty is more prevalent among the youngest and oldest population groups. Children are more likely to be poor than other age groups. School attainment, high school graduation rates, and reading skills are all impacted by poverty [ 11 ]. Health inequality does not mean just some kind of health difference but the differences in health like that of a pregnant woman who has fewer resources and is deficient and the newborn child who might be underweight leading to problems such as stunting and growth retardation. This adversely affects the opportunities and performances of those afflicted by it and can be corrected by successfully evaluating the determinants affecting health [ 6 ].

Economic Inequality

The United States has the least poverty rates and the most restrictive social policies regarding escaping poverty. Except for Mexico and Turkey, all other developed countries have more significant income disparity than the United States. Young people, full-time workers in low-status jobs, people of color, illiterate people, and women are most likely to be poor [ 11 ]. In influenced market knowledge and customer needs individualized society, incomes or wealth are alternate socioeconomic indicators [ 3 ].

Economic Power

Economic power is the ability to improve the standard of living of a country or business. Economic power represents the status of people with higher socioeconomic status wielding more power than those with lower socioeconomic status. For example, employment provides income that shapes choices about housing, child care, education, medical care, and food, among others. Influence is a factor of being able to produce, buy, and sell. Power is the primary force in today’s era. Because the curriculum is governed by teachers, school board members, and national standards, teachers and students have power connections [ 11 ].

Implications of a System Approach

In a systems approach, the current state of affairs and its factors are both causes and outcomes. Rather than a linear path of socioeconomic variables leading to various health outcomes, they are interconnected in a causal web. The feedback loops result in outcomes that influence the causes. Low income and deprivation, for example, lead to inferior health outcomes, exacerbating the group’s poor and worsening health. A more advanced model, such as the system dynamic model, is necessary to operationalize [ 12 ]. Early events and life cycle, occupational considerations, social ties (social networks and support, discrimination, neighborhood characteristics), and healthcare are all identified as social risk factors [ 13 ]. Eliminating these health inequities indicates that well-designed economic and social policies can promote health and health equity. It outlines 10 guidelines to keep in mind while launching interventions to reduce health disparities [ 14 ]. The circumstances increase their impact on life [ 15 ]. The physical atmosphere, opportunities for learning, suitable housing, occupation, and wealth are examples of these circumstances, known as SDH [ 16 ]. Recommendations such as improving living conditions and inequalities among people are justified in their own right but the way these are linked to health is problematic [ 17 ]. The magnitude of inequalities should be viewed with caution because the study does not take caste into account, potentially exaggerating socioeconomic inequalities [ 18 ].

Policies for Improving Health Equality

While numerous public policies contribute to public health and equality, enhancing public health is not the society’s or the government’s only goal. Although these initiatives have been effective at commencing actions addressing SDH, continuing inequities, and diverse social, economic, and cultural differences across India, more cooperation is required across the current programs of different ministries [ 18 ], resulting in policy incoherence may develop. Due to a lack of policy coherence throughout the government, one branch of the government may ensure the introduction of a national development plan of action, for example, TB free response to the change of the WHO [ 19 ]. At the same time, other parts promote exports, industrialization, and proposals that are dangerous to human life. The single cause for these discrepancies is a lack of knowledge among areas of the connections between health and quality of life, on the one hand, and more significant health determinants, such as productivity expansion, on the other. Another cause is that unrelated initiatives may have unexpected consequences that are not monitored or addressed. In its preamble, the Indian Constitution provides core values for establishing a social order in the country. An orderly society is built on these core values. Equality, various freedoms, socioeconomic justice, and individual dignity are fundamental principles for governing a democratic country like India. The policy approach will protect the social rights of people [ 20 ].

The healthcare system must comprehend the obligations of other parts and establish mutual consideration of health, its consequences, and great social welfare or life characteristics to contribute to policy coherence across government. It needs novel solutions and institutions that create avenues for debate and decision-making that cut across typical policy silos in government. In practice, this entails taking a variety of acts, such as facilitating seminars of government policymakers, program leaders, and healthcare provider organizations, to promote policy, service, and program coherence in response to the needs of disadvantaged groups, such as via conferences conducted at numerous organizational stages and with private and government providers. For evaluation of policy progress and pitfalls, from a theoretical perspective, several policy-making frameworks can be used to describe how programs are developed and executed [ 21 ].

The policy windows model by Kingdom (1995) is crucial as it illustrates how and why issues become part of the policy agenda before implementation [ 22 ]. Three streams are coupled or decoupled problem, policy, and politics; according to Kingdom, open and close strategy opportunities. The gathering of proof regarding health inequality is essential but not enough for policy change. Problems must be viewed or identified as problems that can be addressed by legislation. Complicated by the fact that general populace initiatives in largely unrelated domains may have population health implications [ 23 ]. The collection of facts, particularly the Acheson Report, has aided in the designation of health disparities as a political issue. Similar inquiries have formed the issue in other places [ 24 ].

Socioeconomic Determinants and Health Inequities

SDH must all be incorporated into public health services to reduce health disparities. Health services must be adapted to the demands of distinct population groups. Due to the build-up of difficulty through several areas and over the life course, different social groups in the population differ in their empowerment to participate in health interventions. Many public health programs have not met or are not meeting their health equity targets due to a lack of healthcare-specific interventions and a failure to reach out to vulnerable people and address significant social variables that affect public health. Disparities exist between public and private health systems [ 25 ]. Policy efforts at the health system level are required to monitor and improve these disparities [ 25 ]. The coronavirus disease 2019 (COVID-19) pandemic has had the greatest impact on groups that have faced discrimination and historical injustices [ 26 ]. Poor living conditions and exploitative labor have become more prevalent, allowing for inequitable income distribution and health risks [ 26 ]. Governments have exploited the pandemic to further erode civil and human rights and promote extractives [ 26 ]. A post-COVID-19 world must ensure equity, social justice, solidarity, and a shift in the balance of power and resources for poor and marginalized people [ 26 ].

Lower-income societies with lower smoking rates have a lower incidence of lung cancer [ 27 ]. Individual smoking patterns or different rates of illness prevalence and incidence among social groups, i.e., inequalities, are caused by balances or imbalances in community norms and social structures. Sick people are diametrically opposed to the overall healthy population [ 27 ]. The term health inequalities in SDH (SDHI) has recently been taken to refer to settings, social structures, social norms, and some determinants. Three primary paths have been proposed to describe how the social environment causes fitness inequities [ 28 ]. Social choice, or mobility of community, suggests that health, relatively more than the other way around, determines socioeconomic status. As a result, healthier people will be happier. They move toward a higher socioeconomic status than others who were less beneficial, resulting in inequities. Social causation claims that discrepancies in health outcomes are caused by a variety of unequally distributed material, psychosocial, and behavioral factors [ 29 , 30 ].

A life path viewpoint indicates various features throughout life (e.g., malnutrition in the maternal prenatal period, low learning services in infancy, physically hazardous employment, influence, and manifest illness trends across time). The eco-social method tries to assimilate these organic, communal, and natural variables in illness through a vigorous process of incorporation which means we accurately integrate natural effects from the substantial and the social world [ 7 , 31 ]. Over the last 40 years, research on health inequalities and growth has shed light on the income well-being trend [ 32 ]. Measuring the disparity between subgroups requires using different health data based on the relevant dimension of inequality (i.e., demographic, socioeconomic, or geographic factors) [ 33 ]. Monitoring health inequality at the national level assists in assessing the impact of policies, programs, and practices on the disadvantaged subgroup [ 33 ]. This priority will be given to the proposed Sustainable Development Goals. which ask countries to increase the income, gender, geographical location, race, age, ethnicity, disability, migrant status, and other relevant characteristics at the national level [ 34 ].

Conceptual Limitations of Inequalities

SDHI covertly and overtly embraces substantial parts of a Newtonian view of reality (i.e., reductionism, linearity, and hierarchy), as do most notions connected to health outcomes [ 35 ]. This reductive approach is represented by a factor influencing health outcomes, for example, socioeconomic stratification of mortality due to asthma and the selection of interventions that focus on a single determinant, for example, improving thermal comfort in homes with insufficient heat [ 36 ]. Another common assumption in this debate is linearity, which argues that determinants of inequalities can be used in a variety of situations [ 30 ]. Differential access to healthcare or education is presumed to be health disparities in results [ 37 ], essentially in a linear pattern, whether overtly or implicitly [ 38 ]. In the case of what works in terms of tackling health inequalities, disappointingly very less relevant reviews have been conducted [ 39 ].

Conclusions

After reviewing the current literature on SDH and health inequalities, we conclude that economic and social factors such as poverty, social exclusion, and others are usually regarded as SDH. Interventions are the most effective strategies to improve everyone’s well-being and reduce inequalities. The severity of employment, geography, and education imply that better healthcare management and expanded education and work prospects are required. Additional efforts in this area will likely help overcome social health inequalities in communities and achieve health equality. Policies that reduce social disadvantage can reduce health inequalities. The current state of the health sector, for which the union and state governments are equally responsible, and the right to health is not equally distributed can only be corrected if the union and state governments start practicing and introducing more efforts to achieve health equality. Health rights should be given to all people, encouraging them to use more services. Hence, making them healthier, more productive, and fit.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

• Open access
• Published: 02 January 2022

The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis

• Faith Boutcher 1 ,
• Whitney Berta 2 ,
• Robin Urquhart 3 &
• Anna R. Gagliardi 4  

BMC Health Services Research volume  22 , Article number:  11 ( 2022 ) Cite this article

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Middle Managers (MMs) are thought to play a pivotal role as knowledge brokers (KBs) in healthcare organizations. However, the role of MMs who function as KBs (MM KBs) in health care is under-studied. Research is needed that contributes to our understanding of how MMs broker knowledge in health care and what factors influence their KB efforts.

We used a critical interpretive synthesis (CIS) approach to review both qualitative and quantitative studies to develop an organizing framework of how MMs enact the KB role in health care. We used compass questions to create a search strategy and electronic searches were conducted in MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC and the Cochrane Library. Searching, sampling, and data analysis was an iterative process, using constant comparison, to synthesize the results.

We included 41 articles (38 empirical studies and 3 conceptual papers) that met the eligibility criteria. No existing review was found on this topic. A synthesis of the studies revealed 12 MM KB roles and 63 associated activities beyond existing roles hypothesized by extant theory, and we elaborate on two MM KB roles: 1) convincing others of the need for, and benefit of an innovation or evidence-based practice; and 2) functioning as a strategic influencer. We identified organizational and individual factors that may influence the efforts of MM KBs in healthcare organizations. Additionally, we found that the MM KB role was associated with enhanced provider knowledge, and skills, as well as improved organizational outcomes.

Our findings suggest that MMs do enact KB roles in healthcare settings to implement innovations and practice change. Our organizing framework offers a novel conceptualization of MM KBs that advances understanding of the emerging KB role that MMs play in healthcare organizations. In addition to roles, this study contributes to the extant literature by revealing factors that may influence the efforts and impacts of MM KBs in healthcare organizations. Future studies are required to refine and strengthen this framework.

Trial registration

A protocol for this review was not registered.

Peer Review reports

Contributions to the literature

MMs may play an important KB role in healthcare organizations.

Additional support for the MM KB role may help enhance quality of care in healthcare settings.

An improved understanding of MM KBs will contribute to this nascent area of inquiry in health care.

Health systems are under increasing pressure to improve performance including productivity, quality of care, and efficiency in service delivery. To promote optimal performance, health systems hold healthcare organizations such as hospitals accountable for the quality of care they provide through accountability agreements tied to performance targets [ 1 , 2 ]. Despite such incentives, healthcare organizations face considerable challenges in providing high-quality care and research continues to show that the quality of hospital-based care is less than ideal [ 3 , 4 , 5 ]. Some researchers contend that this is attributed, in part, to the challenges that healthcare organizations face when integrating new knowledge into practice. Some challenges include dedicating sufficient resources to adopt or implement evidence-informed innovations that enhance service delivery and optimize patient health and outcomes [ 6 ].

Healthcare organizations use knowledge translation (KT) approaches to promote the use of evidence-based practices intended to optimize quality of care. The use of knowledge brokers (KBs) is one such approach. KBs are defined as the human component of KT who work collaboratively with stakeholders to facilitate the transfer and exchange of knowledge in diverse settings, [ 7 , 8 , 9 ]. KBs that facilitate the use of knowledge between people or groups have been referred to as opinion leaders, facilitators, champions, linking agents and change agents whose roles can be formal or informal [ 10 , 11 ]. These “influencer” roles are based on the premise that interpersonal contact improves the likelihood of behavioral change associated with use or adoption of new knowledge [ 12 ]. Research shows that KBs have had a positive effect on increasing knowledge and evidence-based practices among clinicians in hospitals, and on advocating for change on behalf of clinicians to executives [ 13 , 14 , 15 ]. However, greater insight is needed on how to equip and support KBs, so they effectively promote and enable clinicians to use evidence-based practices that improve quality of care [ 13 , 16 , 17 ].

Middle managers (MMs) play a pivotal role in facilitating high quality care and may play a brokerage role in the sharing and use of knowledge in healthcare organizations [ 18 , 19 ]. MMs are managers at the mid-level of an organization supervised by senior managers, and who, in turn, supervise frontline clinicians [ 20 ]. MMs facilitate the integration of new knowledge in healthcare organizations by helping clinicians appreciate the rationale for organizational changes and translating adoption decisions into on-the-ground implementation strategies [ 18 , 19 ]. Current research suggests that MMs may play an essential role as internal KBs because of their mid-level positions in healthcare organizations. Some researchers have called for a deeper understanding of the MM role in knowledge brokering, including how MMs enact internal KB roles [ 16 , 17 , 18 , 19 , 21 ].

To this end, further research is needed on who assumes the KB role and what they do. Prior research suggests that KBs may function across five key roles: knowledge manager, linking agent, capacity builder, facilitator, and evaluator, but it is not clear whether these roles are realized in all healthcare settings [ 7 , 21 , 22 ]. KBs are often distinguished as external or internal to the practice community that they seek to influence, and most studies have focused on external KBs with comparatively little research focused on the role of internal KBs [ 7 , 9 , 17 , 23 , 24 ]. To address this gap, we will focus on internal KBs (MMs) who hold a pivotal position because their credibility and detailed knowledge of local context allows them to overcome the barriers common to external KBs. One such barrier is resistance to advice from external sources unfamiliar with the local context [ 25 ].

With respect to what KBs do, two studies explored KB roles and activities, and generated frameworks that describe KB functions, processes, and outcomes in health care [ 7 , 22 ]. However, these frameworks are not specific to MMs and are limited in detail about KB roles and functions. This knowledge is required by healthcare organizations to develop KB capacity among MMs, who can then enhance quality of care. Therefore, the focus of this study was to synthesize published research on factors that influence the KB roles, activities, and impact of MMs in healthcare settings. In doing so, we will identify key concepts, themes, and the relationships among them to generate an organizing framework that categorizes how MMs function as KBs in health care to guide future policy, practice, and research.

We used a critical interpretive synthesis (CIS) to systematically review the complex body of literature on MM KBs. This included qualitative, quantitative, and theoretical papers. CIS offers an iterative, dynamic, recursive, and reflexive approach to qualitative synthesis. CIS was well-suited to review the MM KB literature than traditional systematic review methods because it integrates findings from diverse studies into a single, coherent framework based on new theoretical insights and interpretations [ 26 , 27 ]. A key feature that distinguishes CIS from other approaches to interpretive synthesis is the critical nature of the analysis that questions the way studies conceptualize and construct the topic under study and uses this as the basis for developing synthesizing arguments [ 26 ]. We ensured rigor by complying with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) criteria (Additional file  1 ) and other criteria of trustworthiness [ 28 , 29 ]. We did not register a protocol for this review.

With a medical librarian, we developed a search strategy (Additional file  2 ) that complied with the evidence-based checklist for peer review of electronic search strategies [ 30 ]. We included Medical Subject Headings and keywords that captured the concepts of MMs (e.g., nurse administrator, manager), explicit or non-explicit KB roles (e.g., diffusion of innovation, dissemination, broker, and facilitator), evidence-based practice (e.g., knowledge, evidence) and setting (e.g., hospital, healthcare, or health care). We searched MEDLINE, CINAHL, Social Sciences Abstracts, ABI/INFORM, EMBASE, PubMed, PsycINFO, ERIC, and the Cochrane Library from January 1, 2001, to August 14, 2020. We searched from 2001 onward because the field of KT did not substantially investigate KBs until 2001 [ 7 , 21 ]. We reviewed the reference lists of eligible articles for additional relevant studies not identified by searches. As is typical of CIS, this was an iterative process allowing search terms to be expanded to optimize search results [ 26 , 31 ].

Eligibility

We generated eligibility criteria based on the PICO framework (population, intervention, comparisons, and outcomes) (Additional file  3 ). Populations refer to MMs functioning as KBs in hospitals or other healthcare settings but did not necessarily use those labels. Because the MM literature is emergent, we included settings other than hospitals (e.g., public health department, Veteran Affairs Medical Centres). We included studies involving clinical and non-clinical administrators, managers, directors, or operational leaders if those studies met all other inclusion criteria. The intervention of interest was how MM KBs operated in practice for the creation, use and sharing of knowledge, implementation of evidence-based practice(s), or innovation implementation. Study comparisons may have evaluated one or more MM KB roles, approaches and associated barriers, enablers and impacts alone or in comparison with other types of approaches for the sharing or implementation of knowledge, evidence, evidence-based practices, or innovations. Outcomes included but were not limited to MM KB effectiveness (change in knowledge, skills, policies and/or practices, care delivery, satisfaction in role), behaviors, and outcomes. Searches were limited to English language quantitative, randomized, or pragmatic controlled trials, case studies, surveys, quasi-experimental, qualitative, or mixed methods studies and conceptual papers. Systematic reviews were not eligible, but we screened references for additional eligible primary studies. Publications in the form of editorials, abstracts, protocols, unpublished theses, conference proceedings were not eligible.

FB and ARG independently screened 50 titles and abstracts according to the eligibility criteria and compared and discussed results. Based on discrepancies, they modified the eligibility criteria and discussed how to apply them. Thereafter, FB screened all remaining titles, and discussed all uncertainties with ARG and the research team. FB retrieved all potentially eligible articles. FB and ARG independently screened a sample of 25 full-text articles, and again discussed selection discrepancies to further standardize how eligibility criteria were applied. Thereafter, FB screened all remaining full-text items.

Quality appraisal

We employed quality appraisal tools relevant to different research designs: Standards for Reporting Qualitative Research (SRQR) [ 32 ], the Good Reporting of a Mixed Methods Study (GRAMMS) tool [ 33 ], Critical Appraisal of a Questionnaire Study [ 34 ], Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) tool [ 35 ], and the Critical Appraisal Checklist for Quasi-Experimental Studies [ 36 ]. FB and ARG independently assessed and compared the quality of a sample of seven studies each. Thereafter, FB assessed the quality of the remaining 24 studies.

Data extraction

We developed a data extraction form to extract information on study characteristics (date of publication, country, purpose, research design) and MM KB characteristics, roles, activities, enablers, barriers, and impacts. To pilot test data extraction, FB and ARG independently extracted data from the same 25 articles, then compared results and discussed how to refine data extraction. Thereafter, FB extracted data from remaining articles, which was independently checked by ARG, and then reviewed by the research team.

Data analysis

FB and ARG conducted an initial reading and coding of a sample of articles independently. Codes were assigned to significant elements of data within the results and conclusions sections of the eligible articles and grouped into relevant categories with shared characteristics and organized into preliminary themes. This was an iterative process that involved ongoing consultation with the research team, who provided feedback on the codes and themes.

We created a matrix of MM KB roles and activities from extant MM and KB theory [ 7 , 18 , 22 , 37 ] and deductively mapped themes from included studies with the matrix to help inform the analysis and interpretation of our findings. As per CIS methodology, we developed an integrative grid (matrix table) where themes pertaining to MM KB roles and activities formed columns, and themes mapped to those roles/activities from individual studies formed rows [ 31 ]. The grid helped us integrate the evidence across studies and explore relationships between concepts and themes to inductively develop synthetic constructs [ 31 , 38 ]. Using a constant comparative approach, we critiqued the synthetic constructs with the full sample of papers to identify conceptual gaps in the available evidence in relation to our aims, and to ensure that the constructs were grounded in the data [ 31 , 38 ]. Our interpretive reflections on MM KB roles, activities, factors, and impacts led us to develop “synthetic arguments” and we used the arguments to structure our findings (attributes, roles, activities, impacts, enablers, barriers) in an organizing framework to capture our interpretation of how MMs function as KBs in healthcare organizations. We used NVivo 12 software to assist with data analysis.

Search results

The initial search yielded 9936 articles. Following removal of duplicates, 9760 titles were not eligible, and 176 items were retrieved as potentially relevant. Of those, 135 were excluded because the study design was ineligible (25), they did not examine MMs (27) or MM KBs (34), were not focused on the evaluation of an MM KB role (39), were editorials (4), or the publication was a duplicate (6). We included 41 articles for review (Fig.  1 PRISMA flow diagram). Additional file  4 includes all data extracted from included studies.

PRISMA flow diagram

Study characteristics

Eligible articles were published between 2003 and 2019. Three (7.3%) were conceptual and 38 (92.7%) were empirical studies. Conceptual articles discussed MM and KB theoretical constructs. Table  1 summarizes study characteristics. Studies examined the impacts of change efforts (47.3%), barriers to practice change (34.2%), and evaluation of KB interventions (18.4%). Most were qualitative (52.6%) and conducted in the United States (36.8%). Of study participants (34.2%) were MMs. In most studies, participants were nurses (63.1%) or allied health (13.2%) and based in hospitals (68.4%). Otherwise, (31.6%) were based in public health or occupational health departments, primary health care centers, Veterans Affairs Medical Centres, community care, and a senior’s care facility.

Quality assessment findings

A critical analysis of the included studies revealed issues related to research design, varying from data collected from heterogeneous healthcare settings and diverse types of MMs to the type of analyses completed (e.g., qualitative, mixed methods), to the strength of conclusions drawn from a few studies’ results (e.g., correlational, or causal). Fifteen (39.5%) studies met the criteria for quality. Twenty-three (60.5%) studies had minor methodological limitations (e.g., no research paradigm identified in qualitative studies, and mixed methods studies did not describe the integration of the two methods) (Additional file  5 ). These methodological flaws did not warrant exclusion of any studies as they provided relevant insights regarding the emerging framework.

MM KB attributes

Seven (18.4%) studies described MM KB attributes (Table  2 ). Of those, 4 (10.5%) identified MM attributes, 2 (5.2%) identified KB attributes, and 1 (2.6%) identified nurse knowledge broker attributes. MM KBs were described as confident, enthusiastic, and experienced with strong research skills [ 41 , 45 ]. They were also responsive and approachable, with an understanding of the complexity of an innovation and the organizational context [ 42 , 43 , 44 ].

MM KB roles and activities

Table  3 summarizes themes pertaining to roles and activities. A total of 63 activities were grouped in the following 12 MM KB roles: (1) gather data, (2) coordinate projects, (3) monitor and evaluate the progress of a project, (4) adjust implementation to organizational context, (5) disseminate information, (6) facilitate networks, (7) bridge the evidence-to-practice gap, (8) engage stakeholders, (9) convince others of the need for, and benefit of a project, (10) coach staff, (11) provide tools and resources and (12) function as a strategic influencer. Roles did not differ among MM KBs in hospital and non-hospital settings.

Table  4 summarizes the frequency of each of the 12 MM KB roles across included studies. The two most common MM KB roles were to monitor and evaluate the progress of a project (14, 36.8%) [ 40 , 41 , 47 , 48 , 49 , 50 , 51 , 54 , 57 , 60 , 63 , 64 , 65 , 66 ] and to convince others of the need for, and benefit of a project (12, 31.6%) [ 46 , 47 , 48 , 50 , 51 , 55 , 58 , 61 , 64 , 65 , 66 , 67 ]. For example, MM KBs played an important role in monitoring the progress of projects to evaluate and reinforce practice change [ 41 , 50 ]. To convince others of the need for, and benefit of a project and to promote staff buy-in, they held ongoing conversations with staff to help them understand the rationale for change, reinforce the message, and encourage staff to consistently maintain the innovations on their units [ 46 , 48 , 66 ]. The least common MM KB role was project coordination (4, 10.5%) [ 39 , 47 , 48 , 56 ].

Several of the identified MM KB roles aligned with five KB roles in prior published frameworks [ 7 , 22 ] and MM role theory [ 18 , 37 ] (Table  5 ). For example, 31 (81.6%) studies described MM KB roles of gather data, project coordination, disseminate information , and adjust implementation to organizational context , which aligned with the roles and activities of a KB knowledge manager. Twenty-nine (76.3%) studies described the MM KB roles of provide tools and resources, convince others of the need for and benefit of a project, and coach staff , which aligned with the roles and activities of a KB capacity builder. We found overlap between the MM KB roles and the four hypothesized roles in MM role theory: (1) disseminate and obtain information, (2) adapt information and the innovations, (3) mediate between strategy and day to day activities, and (4) selling innovation implementation) [ 18 , 37 ]. For example, we found that as capacity builders, MM KBs also mediated between strategy and day-to-day activities such as coaching staff and providing resources, and in the role of knowledge manager, MM KBs obtained, diffused, and synthesized information [ 18 , 37 ].

While MM KB roles identified in included studies aligned with the five previously identified KB roles, the CIS approach we employed identified 12 distinct roles that were further characterized based on corresponding activities associated with each of the 12 roles. Therefore, while this research agrees with prior work on MM KB roles, it represents a robust framework of MM KB roles and activities by elaborating the complexity of MM KB roles and activities.

We fully described two roles compared with prior frameworks: to convince others of the need for and benefit of a project, and function as a strategic influencer. To convince others of the need for and benefit of a project (e.g., a quality improvement, best practice guideline implementation, or innovation), MM KBs used tactics such as role modelling their commitment, providing the rationale for the change, being enthusiastic about its adoption, offering positive reinforcement, and providing emotional support [ 47 , 50 , 58 ]. The role of strategic influencer featured in 7 (18.4%) studies [ 39 , 48 , 52 , 56 , 62 , 65 , 68 ]. For example, MM KBs were influential at the executive level of the hospital, advocating for innovations among less involved team members and administrators, including the hospital board, were members of organizational decision-making groups for strategic planning, and served as an authoritative contact for initiatives.

Factors that influence MMs knowledge brokering

Table  6 summarizes the enablers and barriers of MM KB roles and activities, organized as individual or organizational factors. We identified four enablers at the organizational level: senior management support, availability of resources, engaged staff, and alignment to strategy. The most common was senior management support, featured in 12 (32.0%) studies. We found that senior management support enhanced the commitment of MM KBs to innovation implementation [ 16 , 17 , 19 , 44 , 45 , 52 , 61 , 63 , 66 , 67 , 68 , 69 , 70 ]. For example, senior managers empowered and supported MM KBs to make decisions by ensuring that the necessary structures and resources were in place, and by conveying that the implementation was an organizational priority [ 66 , 68 ]. We identified three individual-level facilitators: training and mentorship, personal attributes, and experience in the MM role. The most common facilitator was training and mentorship, featured in 8 (21.1%) studies. We found that training and mentorship with more experienced managers was important to the success of MM KBs and their projects, especially if they were new to their role [ 16 , 17 , 19 , 41 , 42 , 48 , 54 , 68 ].

Studies reported more barriers ( n  = 8) than enablers ( n  = 7). We found four organizational barriers: a lack of resources, lack of senior management support, staff resistance, and a lack of time. The most common barriers were lack of resources in 12 (32.0%) studies and lack of time in 12 (32.0%) studies. A lack of resources (budget constraints, limited staff) made it challenging for MM KBs to move their projects forward [ 39 , 42 , 44 , 47 , 52 , 55 , 57 , 64 , 68 , 69 , 70 , 71 ]. For example, inadequate funds interfered with obtaining appropriate resources and undermined the feasibility of implementing projects [ 47 , 55 ]. In addition, staffing issues created difficulty in engaging staff in project work and low staffing levels limited capacity to provide desired standards of care [ 42 , 64 ]. Additionally, a lack of protected time for data collection or other project work was identified as a significant barrier to implementing projects [ 17 , 19 , 39 , 42 , 44 , 47 , 52 , 55 , 57 , 64 , 68 , 71 ]. MM KBs also lacked the time to nurture, support and adequately coach staff [ 39 , 55 ].

We identified four individual-level barriers: lack of formal training, dissatisfaction with work life balance, being caught in the middle, and professional boundaries. The most common barriers were lack of formal training (8, 21.1%) and dissatisfaction with work life balance (8, 21.1%). For example, a lack of formal training resulted in MM KBs being unprepared for managerial roles and without the knowledge and skills to promote effective knowledge brokering and knowledge transfer with end users [ 17 , 39 , 41 , 42 , 55 , 57 , 69 , 71 ]. We also found that heavy workloads and conflicting priorities left MM KBs often dissatisfied with their work life balance and hindered their ability to successfully complete projects [ 42 , 44 , 51 , 52 , 57 , 61 , 64 , 71 ]. For example, because of multiple responsibilities and conflicting priorities, MM KBs were often pulled away to address problems or were so absorbed by administrative tasks that they had no time to complete project responsibilities [ 44 , 64 ].

Impact on service delivery and outcomes

Eight (21.1%) studies showed that MM KBs had some impact on organizational and provider outcomes [ 16 , 40 , 43 , 44 , 47 , 56 , 62 , 67 ]. One (2.6%) study reported that practice changes were greater when associated with higher MM leadership scores (OR 1.92 to 6.78) and when MMs worked to help create and sustain practice changes [ 40 ]. One (2.6%) study reported the impact of senior managers’ implementation of an evidence-based Hospital Elder Life Program on administrative outcomes (e.g., reduced length of stay and cost per patient), clinical outcomes (e.g., decreased episodes of delirium and reduced falls), and provider outcomes (e.g., increased knowledge and satisfaction) [ 67 ].

Two (5.3%) studies reported the impact of a Clinical Nurse Leader role on care processes at the service level in American hospitals. Benefits were evident in administrative outcomes such as RN hours per patient day (increased from 3.76 to 4.07) and in reduced surgical cancellation rates from 30 to 14%. There were also significantly improved patient outcomes in dementia care, pressure ulcer prevention, as well as ventilator-assisted pneumonia [ 56 , 62 ]. One (2.6%) study reported financial savings [ 56 ].

Four (10.5%) studies reported the effect of a KB strategy on health professionals’ knowledge, skills, and practices [ 16 , 43 , 44 , 47 ]. For example, Traynor et al. [ 44 ] found that participants who worked closely with a KB showed a statistically significant increase in knowledge and skill (average increase of 2.8 points out of a possible 36 (95% CI 2.0 to 3.6, p  < 0.001) from baseline.

Organizing framework of MM KBs in healthcare organizations

We sought to capture the roles, activities, enablers, barriers and impacts of MM KBs across diverse healthcare settings in an organizing framework (Fig.  2 Organizing framework of MMs who function as knowledge brokers in healthcare organizations). From our interpretation of the published evidence, the findings across studies were categorized into 12 roles and 63 associated activities to represent specific ways in which MM KBs described their roles and activities during project implementation. Influencing factors were categorized into individual and organizational enablers and barriers that influence the efforts of MM KBs in healthcare organizations. While attributes were categorized as enablers, their level of importance as enablers emerged from our synthesis in how they operated in practice. The types of outcomes that we examined also varied between changes in care practice, processes, and competencies which we constructed into provider and organizational outcomes. Our emergent insights were used to construct four synthesizing arguments from the available literature: (1) MM KBs have attributes that equip and motivate them to implement practice change and innovations in healthcare organizations, (2) MMs enact KB roles and activities in healthcare organizations, (3) enablers and barriers influence the knowledge brokering efforts of MMs in healthcare settings; and (4) MM KB efforts impact healthcare service delivery. These synthesizing arguments were used to structure the organizing framework presented in Fig. 2 , which depicts how MM function as KBs in healthcare organizations and their impact on service delivery.

Organizing framework of MMs who function as knowledge brokers in healthcare organizations

We conducted a CIS to synthesize published research on factors that influence the roles, activities, and impacts of MM KBs in healthcare organizations. As per CIS, our output was an organizing framework (Fig. 2 ) that promotes expansive thinking about and extends knowledge of MM KBs in healthcare settings. We identified 63 activities organized within 12 distinct MM KB roles, which is far more comprehensive than any other study [ 7 , 22 ]. We build on prior frameworks and characterize further the roles of strategic influencer and convincing others of the need for, and benefit of an innovation or evidence-based practice. We identified organizational and individual enablers and barriers that may influence the efforts and impact of MM KBs in health care. Of note, a key enabler was senior leadership support while a key barrier for MM KBs was a lack of formal training in project implementation. Such factors should be closely considered when looking at how to strengthen the MM KB role in practice. Furthermore, we found that the MM KB role was associated with enhanced provider knowledge and skills, as well as improved clinical and organizational outcomes.

We offer a novel conceptualization of MM KBs in healthcare organizations that has, thus far, not been considered in the literature. Our theoretical insights (summarized in Fig. 2 ) are an important first step in understanding how individual and organizational factors may influence how MMs enact KB roles, and the impact they have on service delivery and associated outcomes. We found that the many MM KB roles and activities corresponded to the characterization of KB roles in the literature and substantiated MM role theory. Our findings corroborate previous studies and systematic reviews by confirming that MMs function as KBs and build on the MM and KB theoretical constructs previously identified in the literature [ 7 , 18 , 21 , 22 , 37 , 46 , 48 ]. Building on Birken and colleagues’ theory [ 37 ], we found significant overlap between MM and KB roles and activities. Figure  2 helps to define and analyze the intersection of these roles while distinguishing MM KB roles and activities more clearly from other administrative roles.

We contend that Fig. 2 has applicability across a range of healthcare settings and may be used by hospital administrators, policymakers, service providers, and researchers to plan projects and programs. It may be used as a resource in strategic planning, to re-structure clinical programs, build staff capacity, and optimize HR practices. For example, Fig. 2 could be used as a foundation to establish goals, objectives, or key performance indicators for a new or existing clinical program; refine job postings for MM roles to encompass optimal characteristics of candidates to enable KB activities; or identify new evaluation criteria for staff performance and training gaps in existing HR practices. It could also help decision makers take on pilot projects to formalize the KB role in healthcare.

Figure 2 is intended to foster further discussion of the role that MMs play in brokering knowledge in healthcare settings. It can be modified for specific applications, although we encourage retaining the basic structure (reflecting the synthesizing arguments). For example, the factors may change depending on specific localized healthcare contexts (i.e., acute care versus long-term care, or rehabilitation). Although the use of our framework in practice has yet to be evaluated, it may be strengthened with the results of additional mixed methods studies examining MM KBs as well as quasi-experimental studies applying adapted HR practices based upon our framework. As more studies are reported in the literature, the roles, activities, factors, and outcomes can be further refined, organized, and contextualized. Figure 2 can also be used as a guide for future studies examining how MMs enact the KB role across healthcare settings and systems, disciplines, and geographic locations.

Our synthesis provides new insights into the roles of MM KBs in healthcare settings. For example, we further elucidate two MM KB roles: 1) functioning as a strategic influencer; and 2) convincing others of the need for, and benefit of an innovation or evidence-based practice. These are important roles that MM KBs enact when preparing staff for implementation and corroborate Birken et al.’s hypothesized MM role of selling innovation implementation [ 18 , 37 ]. Our findings validate the organizational change literature that emphasizes the important information broker role MMs play in communicating with senior management and helping frontline staff achieve desired changes by bridging information gaps that might otherwise impede innovation implementation [ 37 ]. Our new conceptualization of how MM KBs navigate and enact their roles, and the impact they may have on service delivery and associated outcomes extends the findings of recent studies. These studies found that the role of MMs in organizational change is evolving and elements such as characteristics and context may influence their ability to facilitate organizational adaptation and lead the translation of new ideas [ 53 , 72 , 73 ]. However, further research is required to test and further explicate these relationships in the broader context of practice change.

Our synthesis both confirms and extends previous research by revealing organizational and individual factors that both enabled and hindered MM KBs efforts in healthcare organizations. An important organizational factor in our study was having senior management support. We found that MM KBs who had healthy supportive working relationships with their senior leaders led to project success. This support was critical because without it they experienced significant stress at being “caught in the middle” trying to address the needs of staff while also meeting the demands of senior management. Recent studies confirm our finding that senior management engagement is essential to MM KBs’ ability to implement innovations and underscores the need for senior leaders to be aware of, and acknowledge, the impact that excessive workload, competing demands, and role stress can play in their effectiveness [ 19 , 74 ].

The personal attributes of MM KBs as well as their level of experience were both important factors in how they operated in practice. We identified that key attributes of MM KBs contributed to their ability to drive implementation of initiatives and enhanced staff acceptance and motivation to implement practice change [ 75 , 76 ]. Our findings corroborate recent studies that highlight how the key attributes of effective champions (those that are intrinsic and cannot be taught) [ 77 , 78 , 79 ] may contribute to their ability to lead teams to successful implementation outcomes in healthcare organizations [ 80 , 81 , 82 ]. We also found that experienced MM KBs were well trained, knowledgeable, and better prepared to understand the practice context than novice MM KBs, but a lack of formal training in project implementation was an impediment for both. This emphasizes the importance of providing opportunities for professional development and training to prepare both novice and experienced MM KBs to successfully implement practice change. Our findings contribute to the growing knowledge base regarding what makes an effective MM KB. However, future research should focus on generating evidence, not only on the attributes of MM KBs, but also on how those attributes contribute to their organizational KB roles as well as the relationships among specific “attributes” and specific KB roles. More research is also needed to better understand how and what skills can be taught to boost the professional growth of MM KBs in health care.

Organizational theory and research may provide further insight into our findings and guidance for future research on the role of MM KBs in healthcare organizations. For example, the literature suggests that by increasing MMs’ appreciation of evidence-based practice, context, and implementation strategies may enhance their role in implementing evidence-based practices in healthcare organizations [ 18 , 83 , 84 ]. We found that MM KBs’ commitment to the implementation of an evidence-based project was influenced by the availability of resources, alignment with organizational priorities, a supportive staff and senior leadership. Extending from organizational theory and research, further investigation is needed to explore the nature of the relationship between these factors and the commitment of MM KBs to evidence-based practice implementation and subsequent outcomes.

When assessing the impact of MM KBs in hospitals, we found some evidence of changes in organizational and provider outcomes, suggesting MM KB impact on service delivery. Given that the available outcome data were limited, associational in nature, or poorly evaluated, it was challenging to identify strong thematic areas. Like our study, several systematic reviews also reported the lack of available outcome data [ 7 , 18 , 21 ]. This highlights an important area for research. Future research must include evaluation of the effectiveness of MM KBs and establish rigorous evidence of their impact on service delivery.

Our findings have important implications for policy and practice. MMs are an untapped KB resource who understand the challenges of implementing evidence-based practices in healthcare organizations. Both policy makers and administrators need to consider the preparation and training of MM KBs. As with other studies, our study found that providing MM KBs with opportunities for training and development may yield a substantial return on investment in terms of narrowing evidence-to-practice gaps in health care [ 48 ]. Thus, an argument can be made for recruiting and training MM KBs in health care. However, the lack of guidance on how to identify, determine and develop a curriculum to prepare MM KBs requires more research.

Our synthesis revealed numerous activities associated with 12 MM KB roles providing further insight into the MM role in healthcare settings. Our list of 63 activities (Table 2 ) has implications for practice. We found that MMs enact numerous KB roles and activities, in addition to their day-to day operational responsibilities, highlighting the complexity of the MM KB role. Senior leaders and administrators must acknowledge this complexity. A greater understanding of these KB roles and activities may lead to MM implementation effectiveness, to sustainable MM staffing models, and to organizational structures to support the KB efforts that many MMs are already doing informally. For example, senior leaders and administrators need to take the MM KB role seriously and explicitly include KB activities as a core function of existing MM job descriptions. To date, the KB role and associated activities are not typically or explicitly written into the formal job descriptions for MMs in healthcare settings, as their focus is primarily on operational responsibilities. A formal job description for MM KBs would improve the KB capacity of MMs by giving them the permission and recognition to implement KB-related functions. Our findings inform future research by more clearly articulating the MM KB roles and activities that may be essential to the implementation of evidence-based practice and highlights a much-needed area for future work.

Our study features both strengths and weaknesses. One strength in using CIS methodology was the ability to cast a wide net representing a range of research designs of included studies. This included studies in which MMs were required to be KBs by senior leaders or functioned explicitly as KBs. This enabled us to identify and include diverse studies that made valuable theoretical contributions to the development of an emerging framework, which goes beyond the extant theories summarized in the literature to date [ 18 ]. In contrast to prior systematic reviews of MM roles in implementing innovations [ 18 ], the CIS approach is both systematic and iterative with an interpretive approach to analysis and synthesis that allowed us to capture and critically analyze an in-depth depiction of how MMs may enact the KB role in healthcare organizations. Our synthesis also revealed numerous activities associated with the 12 identified MM KB roles. The resulting theoretical insights were merged into a new organizing framework (Fig. 2 ). These insights are an important first step in understanding how individual and organizational factors may influence how MMs enact KB roles, and the impact they have on service delivery.

Although CIS is an innovative method of synthesizing the literature and continues to evolve, it does have limitations. CIS has yet to be rigorously evaluated [ 85 , 86 ]. While there is some precedent guiding the steps to conduct a CIS, one weakness is that CIS is difficult to operationalize. Another weakness is that the steps to conduct CIS reviews are still being refined and can lack transparency. Therefore, we used standardized, evidence-based checklists and reporting tools to assess transparency and methodological quality, and an established methodology for coding and synthesis. We provided an audit trail of the interpretive process in line with the ENTREQ guidance. Still, there was a risk of methodological bias [ 28 , 85 , 86 ]. Another weakness of qualitative synthesis is its inability to access first order constructs that is the full set of participants’ accounts in each study. As reviewers, we can only work with the data provided in the papers and, therefore, the findings of any review cannot assess primary datasets [ 31 ]. Study retrieval was limited to journals that are indexed in the databases that were searched. We did not search the grey literature, assuming that most empirical research on MM KBs would be found in the indexed databases. Finally, we may have synthesized too small a sample of papers to draw definitive conclusions regarding different aspects of MMs as KBs.

Our study is a first step in advancing the theoretical and conceptual conversation regarding MM KBs by articulating the attributes, roles, activities, and factors influencing their efforts and impact. Through the generation of a novel organizing framework, we identify a potential combination of roles for those in MM positions who may also function as KBs in healthcare organizations. Our study is a timely contribution to the literature and offers an initial understanding of extant evidence of the KB role MMs play in health care. Our framework has utility for policymakers, administrators, and researchers to strengthen the MM role and, ultimately, improve quality of care.

Availability of data and materials

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

Abbreviations

Middle Manager

Knowledge Broker

Middle managers who function as Knowledge brokers

Knowledge Translation

Critical Interpretive Synthesis

Quality Improvement

Enhancing Transparency in Reporting the Synthesis of Qualitative Research

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ENTREQ checklist

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Search strategy

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Additional file 4.

Data extraction form for eligible studies

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Quality appraisal tools and findings

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Boutcher, F., Berta, W., Urquhart, R. et al. The roles, activities and impacts of middle managers who function as knowledge brokers to improve care delivery and outcomes in healthcare organizations: a critical interpretive synthesis. BMC Health Serv Res 22 , 11 (2022). https://doi.org/10.1186/s12913-021-07387-z

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57+ Best Health and Social Care Dissertation Topics in 2023

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• Depression Health: Society is the biggest force that leads to the vehicle of depression among people of different age groups.
• Mitigation of diseases: How does society play the best role in the mitigation of diseases from the life of an orphan child by adopting them for medical expenditure?
• Health-Related Skills: Requirement of health-related skills for the people of society to show their social care towards the marginal sections of society.
• Health Problems and nurse role: How a nurse can aware of the people of society towards the different health problems and precautions related to them?
• Health Care Facilities: How people from lower-strata and marginal sections of society can be given the best health care facilities with the contribution of society?
• Depression Health Care: How to improve the condition of a person going through depression by providing him or her social support and care?
• Health Sector related to depression: What are the different aspects that fall under social care in the health sector related to depression?
• Health-related death: Improvement in the scenario of health-related death in developing countries through social care.
• Nurse role in providing health facilities: How nurses can play a significant role by providing health facilities to needy people free of cost?
• Nursing ethics suggest towards health: What does nursing ethics suggest towards the health and social care of people in society?
• Health Facilities for Old Age: Things that hinder the path of society in providing health-care facilities to needy people in old-age homes?
• Nursing care for old Age: How is the idea of part-time working in Orphanage-houses and old-age homes for nursing?
• Nursing profession: Social care is a vital part of the nursing profession as per its ethics.
• Care towards orphan children: Why it is important to make the adoption law easy to help society in showing their care towards orphan children?
• Social care importance in the health sector: Importance of social care in the health sector and how to enhance its level with law and policies?
• An analysis of the impact of the COVID-19 pandemic on the mental health of healthcare workers
• A comparative study of the effectiveness of different methods of managing chronic pain
• The role of community-based organizations in addressing health disparities
• An exploration of the use of telehealth in rural areas
• An analysis of the impact of social media on body image and disordered eating among young adults
• A comparative study of the effectiveness of different approaches to addiction treatment
• An exploration of the challenges and successes of implementing electronic health records in healthcare organizations
• An analysis of the impact of poverty on health outcomes
• A study of the effectiveness of interventions to reduce stigma surrounding mental illness
• An exploration of the challenges and successes of implementing health promotion programs in low-income communities
• A study of the relationship between social support and health outcomes in older adults
• An analysis of the impact of social determinants of health on cardiovascular disease risk
• A comparative study of the effectiveness of different approaches to managing obesity
• An exploration of the use of mindfulness-based therapies for anxiety and depression
• A study of the impact of workplace wellness programs on employee health and productivity
• An analysis of the role of cultural competence in healthcare delivery
• A comparative study of the effectiveness of different approaches to managing diabetes
• An exploration of the impact of social support on cancer outcomes
• A study of the effectiveness of interventions to reduce health disparities among racial and ethnic minorities
• An analysis of the impact of social media on the spread of misinformation about health
• A comparative study of the effectiveness of different approaches to managing hypertension
• An exploration of the challenges and successes of implementing palliative care in healthcare organizations
• A study of the impact of social support on the health of individuals with chronic illnesses
• An analysis of the impact of socioeconomic status on access to healthcare
• A comparative study of the effectiveness of different approaches to managing chronic fatigue syndrome
• An exploration of the impact of stigma on the mental health of LGBTQ+ individuals
• A study of the effectiveness of interventions to reduce health disparities among low-income communities
• An analysis of the role of community health workers in addressing health disparities
• A comparative study of the effectiveness of different approaches to managing rheumatoid arthritis
• An exploration of the impact of social support on the health of individuals with mental illnesses
• A study of the effectiveness of interventions to reduce health disparities among indigenous populations
• An analysis of the impact of social determinants of health on mental health outcomes
• A comparative study of the effectiveness of different approaches to managing asthma
• An exploration of the impact of stigma on the mental health of individuals with substance use disorders
• A study of the effectiveness of interventions to reduce health disparities among immigrants
• An analysis of the impact of social media on the spread of misinformation about vaccines
• A comparative study of the effectiveness of different approaches to managing multiple sclerosis
• An exploration of the impact of social support on the health of individuals with disabilities
• A study of the effectiveness of interventions to reduce health disparities among refugees
• An analysis of the impact of social determinants of health on infant mortality rates

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Social Science Research Topics for Global Health and Wellbeing

Table of contents.

Open Philanthropy strives to help others as much as we can with the resources available to us. To find the best opportunities to help others, we rely heavily on scientific and social scientific research.

If you know of any research that touches on these questions, we would welcome hearing from you. At this point, we are not actively making grants to further investigate these questions. It is possible we may do so in the future, though, so if you plan to research any of these, please email us .

Land Use Reform

Open Philanthropy has been making grants in land use reform since 2015. We believe that more permissive permitting and policy will encourage economic growth and allow people to access higher-paying jobs. However, we have a lot of uncertainty about which laws or policies would be most impactful (or neglected/tractable relative to their impact) on housing production.

• Why we care: We think that permitting speed might be an important category to target, but have high uncertainty about this. 
• What we know: There are a number of different studies of the effects of changes in zoning/land use laws (e.g. see a summary here in Appendix A), but we’re not aware of studies that attempt to disentangle any specific changes or rank their importance. We suspect that talking to advocates (e.g. CA YIMBY) would be useful as a starting point.
• Ideas for studying this: It seems unlikely that there have been “clean” changes that only affected a single part of the construction process, but from talking to advocates, it seems plausible that it would be possible to identify changes to zoning codes that primarily affect one parameter more than others. It also seems plausible that this is a topic where a systematic review, combining evidence from many other studies, would be unusually valuable.
• Why we care: We are highly uncertain about how to best encourage more construction, and thus about where to target our grants.
• What we know: there have been many recent changes to permitting requirements, such as the California ADU law that requires cities to respond to permit requests within 60 days and a new law in Florida that requires cities to respond to permit requests quickly or return permitting fees. This blog post by Dan Bertolet at Sightline predates those changes, but is the best summary we’ve seen on the impacts of permitting requirements.
• Ideas for studying this: one might compare projects that fall right below or above thresholds for permitting review (e.g. SEPA thresholds in Washington state), and try to understand how much extra delay projects faced as a result of qualifying for review. It could also be valuable to analyze the effects of the Florida law (e.g. a difference-in-difference design looking at housing construction in places that had long delays vs. short delays prior to the law passing).
• Why we care: Currently, estimates of this value are typically made at the level of the metro area, but it seems plausible that we should be differentiating more – e.g. putting higher values on units built in Manhattan relative to those built in Westchester.
• What we know: there’s a lot of work on the gradient of land/house prices with regards to transit costs across metro areas, but we aren’t aware of work that explicitly tries to estimate within-metro differences ( in the vein of Card, Rothstein, and Yi (2023) , for example) .
• Ideas for studying this: it should be possible to use similar designs looking at moves at a more granular level (e.g. rather than defining effects at the metro level, use changes in distance-weighted job availability). There may also be ways to directly use the land price gradient to estimate this (though in general that will also reflect amenity values).
• Why we care: Some people have proposed that a land value tax could encourage land redevelopment and reduce the economic inefficiency of taxation, but we do not know how well this reflects the real-world impact of land value taxes.
• What we know: Land value taxes have been used in some Pennsylvania cities, and in some countries outside the US. There has also been increasing interest in implementing a land value tax in other places (e.g. this FT editorial ). See here for many more arguments and references related to land value taxation.
• Ideas for studying this: one could use a difference-in-difference design looking at when cities adopt a land value tax (or a split value tax) and examine changes in construction or other outcomes (e.g. volume of land transactions). Alternatively, one could also try a border regression discontinuity looking at differences in land transactions or other metrics at the border between a place that implements a land value tax and one that does not.

Treatments now potentially within reach may extend the human lifespan and improve quality of life. We aim to support tractable and cost-effective research on the world’s most burdensome diseases , including cardiovascular disease, infectious diseases, malaria, and others.

• Why we care: Open Philanthropy makes many grants focused on South Asian air quality . However, we still have a lot of uncertainty about the impacts of air pollution. One potentially important variable is the type of pollutant; it would be important for our grantmaking to know if some forms of pollution were much more impactful to reduce than others.
• What we know: We know that the components of PM 2.5 pollution can vary substantially by location. There has been some associational work done on this in the US context, but we are more interested in areas with high baseline PM 2.5 levels.
• Ideas for studying this: there is some existing data on how the components of PM 2.5 pollution vary across India. This could be linked with mortality data for associational studies. One could also use policy changes that changed the makeup of particulate emissions in a certain area as a natural experiment.
• Why we care: Open Philanthropy has made some grants attempting to influence public health regulation. We are interested in knowing how successful other philanthropists have been when making similar grants, and are particularly interested in knowing the effects of Bloomberg’s anti-tobacco advocacy, which we see as one of the most focused (and promising) programs of its type.
• What we know: there has been substantial research on the effects of tobacco policy, but we are not aware of any work that focuses specifically on the effect of Bloomberg’s investments.
• Ideas for studying this: some of Bloomberg’s grantmaking in tobacco is public ; one could use a variety of approaches to assess the impact of those grants (e.g. a synthetic control).
• Why we care: we have made grants on reducing lead exposure in low-income countries in the past and are likely to make more in the future. These grants are made assuming that lead affects both health and income, but we are quite uncertain about the magnitude of the effect of either, especially on health (where we think there is less data). Better estimates of the effect of lead on health would reduce the level of uncertainty around the cost-effectiveness of these grants.
• What we know: according to epidemiological (observational) studies , lead has negative impacts on cardiovascular health (see a helpful systematic review here ). However, there is limited causal evidence on the impacts of lead on cardiovascular disease in humans; our primary evidence comes from a study that leverages exposure to NASCAR races to determine changes in ischemic heart disease in the elderly, but we don’t know much about chronic exposure and are reluctant to rely heavily on a single study.
• Why we care: Open Philanthropy invests in vaccines for a variety of illnesses, with the primary (though not exclusive) goal of reducing mortality. Having better estimates for how properties of vaccines translate to demand and eventual health impact will help us prioritize when to support “good” leads in clinical trials vs. hold out longer for “great” ones.
• What we know: the efficacy of vaccines for different diseases varies considerably, and improved technologies can lead to more promising candidates even for diseases where one or more products are already available.
• Ideas for studying this: one could interact the efficacy of a given year’s vaccine (see data here for example) with propensity to get the flu vaccine to determine how this changed flu dynamics. (Though data from South Asia or sub-Saharan Africa would be even better.)
• Why we care: Much of Open Philanthropy’s grantmaking in global health R&D is focused on preventing malaria in high-risk populations (as are several charities recommended by GiveWell, with whom we work closely on global health). However, we have little causal evidence on the long-run effects of having had malaria, on either health or income. Thus, we do not have a good sense of the true (long-run) value of preventing malaria.
• What we know: a Mendelian study found that the likelihood of stunting increases with each malaria infection.
• Ideas for studying this: Mendelian randomization is a technique that looks at people with different genes to determine the causal impact of genes on observable outcomes. Being heterozygous for the sickle cell variant is symptomless but protective against malaria. Thus, those with sickle cell trait are less likely to get malaria and can be compared against those without the trait to understand the long-run impacts of malaria.
• Why we care: Open Philanthropy is interested in cost-effectively improving health. Fractional dosing has the potential to lower cost and expand coverage of vaccines. If we had better evidence on this topic, OP could know in which cases (if any) to advocate for more fractional dosing.
• What we know: a fractional dose for yellow fever and flu appeared to be non-inferior, but fractional dosing for polio was less successful.
• Ideas for studying this: we are not aware of any systematic review of fractional vaccine trials, but many such trials have been run. Studying this topic could involve simply examining data from past trials, rather than running new trials.
• What we know: as GBD covers all deaths and DALYs in the world, the team behind it necessarily spends limited time researching any one cause of DALYs. While GBD revisions attempt to address issues with previous estimates, we believe that there may still be substantial errors.
• Ideas for studying this: one could look for sharp changes in burden figures between the current and previous GBD studies, or examine a particular cause of death in detail and compare one’s own estimates to those generated by the GBD at different levels of age or geographic aggregation. 
• Why we care: new medications and medical technologies can substantially improve disease burdens and make treating or eliminating an illness more cost-effective. However, different countries adopt technologies at different rates; we are interested in knowing why. Open Philanthropy might then be able to make grants to encourage adoption of particularly promising technologies in underserved areas.
• What we know: it seems that patents, price regulation , and market structure affect drug adoption.
• Ideas for studying this: follow up on the approach in Kyle (2007) . One could extend her estimates to estimate the diffusion of FDA-approved drugs globally via patent filings and then look at predictors of diffusion: disease burden, GDP per capita, price controls, language (English vs. not), and path dependency (whether the same companies sell to the same countries repeatedly).
• Why do we care: Open Philanthropy tries to cost-effectively improve health and income. Migration is often considered to be one of the best ways to improve income; for instance, a person moving from a low-income country to a high-income country might raise their income by a factor of 50. We have previously made grants in both international and internal migration, and are interested in knowing whether there are underutilized migration channels whereby migrants might substantially increase their income. Our understanding is that aging populations are causing some HICs to offer more work visas than they previously offered, but that the uptake of these visas is poorly understood (and may be quite low).
• What we know: there are some international borders that do not require authorization for labor migration (e.g. within the EU, or between India and Nepal). At least one such border includes a low-income country (India/Nepal — India’s per capita GDP is over twice that of Nepal’s), but as far as we are aware, there is no database of such borders.
• Ideas for studying this: we think valuable descriptive papers could gather information on the relative usage levels of different work visas (in HICs or MICs) that could be accessible to people from LMICs, or on migration paths that don’t have caps on work visas (such as India-Nepal). Limiting to the largest HICs for ease of initial study (e.g. US, Japan, Germany, France, UK) would probably still be very valuable.
• Why we care: education may be one of the best ways to increase long-run income. However, most education studies focus only on a small number of treated students; it is less clear what the general equilibrium effects are (that is, effects across an entire city/region/nation). These are important in understanding how valuable education is in raising wages — and if Open Philanthropy should consider education interventions as a cost-effective way of improving income.
• What we know: this question has been examined in both Indonesia and India , but re-examination of these findings has made them seem less robust . In addition, we continue to be surprised that there are so few studies on how large schooling expansions affect wages.
• Ideas for studying this: one might use other large-scale expansions of schooling, such as Ghana’s free senior high school program or the Kenyan schooling expansion studied in Mbiti & Lucas (2012) .
• Why we care: we think that economic growth is likely to be very important, but it isn’t clear how best to produce higher growth rates through philanthropic funding. One idea would be to increase the supply of highly trained policymakers, who might be able to influence policy that affects many people.
• What we know: we’re not aware of work trying to measure the impact of policy training programs, such as the masters program at the Williams Center for Development Economics or the MPA ID at Harvard.
• Ideas for studying this: if you could get access to the admissions data for a program like one of the above examples, you could compare people who were nearly admitted to those who were actually admitted to see whether the programs have an effect on career trajectories. This wouldn’t prove anything directly about growth, but would provide evidence that the programs have some counterfactual effect.

Science and Metascience

• Why we care: many of Open Philanthropy’s decisions are based on social scientific work. As such, we have a vested interest in this work being reliable and replicable. Unreliable or non-replicable work might lead us to make weaker, less impactful funding decisions.
• What we know: the peer review process does not seem to weed out papers with signs of p-hacking , but pre-registration may reduce publication bias .
• Ideas for studying this: one might consider the effects of efforts like the AEA pre-analysis plan registry or the Institute for Replication .
• Why we care: we think that scientific progress is hugely important to growth and health advances. One issue in current science is that scientists spend a huge amount of time on high-stakes grant applications instead of doing science (and that the applications may be excessively long relative to what’s necessary for identifying the best science). If this is true, advocating for changes to the grantmaking process might be a high-leverage opportunity for Open Philanthropy.
• What we know: descriptive data suggests that scientists now spend a huge amount of their time applying for grants, and that spending more time on a grant application does not increase the chance of success.
• Why we care: as above, we believe scientific progress is important to growth and health advances. Therefore, we are interested in making sure scientific funding processes work as well as possible to maximize the amount of impact per federal research dollar. If there are improvements that can be made to how science is funded, Open Philanthropy might fund advocacy for such improvements.
• What we know: Carson, Graff Zivin and Shrader (2023) find that reviewers would prefer to prioritize papers with more variance in review scores, and that if this preference were taken into account it would likely lead to different projects being funded. A review of the literature suggests that peer review of applications can identify some of the most promising ideas, but the level of signal is fairly weak.
• Ideas for studying this: one might look at data on past applications and see how the set of funded projects would have differed given the use of different selection criteria, such as max score or random selection (among projects over a certain level of quality). Alternatively, one could randomize within a specific RFP (so that some proposals are selected under different criteria) or randomize across RFPs (so that you can also see how various selection criteria affect the kinds of applications received). The Institute for Progress is currently studying this in collaboration with NSF.
• Why we care: a large share of the value of academic research comes from its ultimate impact on human decisions, but ultimate decision-makers are usually not academics who are well equipped to read and understand individual academic studies. Open Philanthropy would like to know how decision-makers use academic research, and whether there might be improvements to systematic reviews such that decision-makers could be better informed.
• What we know: We know remarkably little. This study argues that academic citation networks are significantly impacted by literature reviews, and suggests that they help to organize and orient fields. This study finds that policymakers respond more to sets of studies finding the same thing across multiple settings than to individual studies – but the results are mixed.
• Ideas for studying this: we think the rollout of evidence clearinghouses is likely pseudorandom across topics, such that measuring their impact may be tractable with difference-in-difference methods. For example, one could study outcomes across different disease categories as the Cochrane collective rolled out new systematic reviews, starting when it was founded in 1993.
• Why we care: Open Philanthropy has occasionally run prize competitions to try and generate useful knowledge. See, for example, our Cause Exploration Prizes and AI Worldviews Contest . We may run more prizes in the future; as such, we would like to know how likely a prize competition is to gather useful information and how to best attract talented entrants.
• What we know: a 2010 paper argues that proportional prize contests produce more total achievement, but another paper is less prescriptive about ideal prize structure.
• Ideas for studying this: Innocentive has done a lot of prize-like competitions; they might be able to share some useful retrospective data.
• Why we care: we believe that rigorous social scientific research is key to identifying the most impactful and cost-effective interventions and policies in developing countries, some of which we may go on to fund. We are interested in knowing cost-effective ways to produce more of said research. We have funded a new IPA office previously, and might fund more such work in the future if we had more evidence about its impact on research, both overall and specific to the target country.
• What we know: Matt Clancy, who leads our grantmaking in innovation policy , coauthored an article on the extent to which research done in one place can be usefully applied in other places. Obstacles to this include different places having different underlying conditions, as well as evidence that policymakers prefer research conducted in their own countries. The article’s bibliography includes many relevant sources.
• Ideas for studying this: Getcher and Meager (2021) collected data on the openings of developing-country offices for NGOs interested in conducting research within said countries. One could use difference-in-difference design to look at how research production (and RCT production in particular) changes when a new office opens – does it cause an increase in total research in those countries? Is there evidence of substitution from non-RCTs to RCTs? Substitution from neighboring countries to the country with a new office? Do new offices tend to produce research on different topics from existing offices (e.g. focusing more on financial inclusion instead of agriculture)?
• Why we care: Open Philanthropy is often interested in influencing policy. Therefore, we want to learn about what is most likely to influence policymakers’ decision-making. We are quite uncertain what types of evidence are most likely to influence policymakers, or in what venues this evidence is likely to be presented.
• What we know: Policy documents cite a relatively small number of scientific publications. In one study, policymakers do not seem to respond to strength of evidence in deciding what to implement; in another , policymakers cared more about external validity than internal validity; in another , policymakers cared substantially about sample size.
• Ideas for studying this: what evidence do central banks (and other governmental institutions) cite most often, and how does this differ from academic citation practices? Is there additional evidence on what types of evidence best persuade policymakers or are most likely to get cited as part of regulatory decisions? E.g. how do citations from a government agency (e.g. the FTC ) compare to citations in academic work on similar topics?
• Why we care: Open Philanthropy wants to raise income levels across society. Our previous work has suggested that public spending on R&D is one of the most effective ways for governments to increase their countries’ income levels. We are thus interested in knowing how the level of public spending on R&D is set, and if there are tractable ways that Open Philanthropy might advocate for this to be increased.
• What we know: there is relatively little information available about the process of setting national-level priorities, but there is some data available about agenda-setting within NIH.
• Ideas for studying this: we aren’t sure of the best approach. Focusing on particular periods of growth in R&D spending and producing case studies might yield evidence that could be explored in a quantitative way later.

Global Development

• Why we care: Open Philanthropy makes grants in global aid advocacy and is interested in increasing both the amount and efficacy of rich countries’ foreign aid. We are interested to know how much influence agency leadership has on the distribution of aid in order to benchmark how much change we should expect over different time frames.
• What we know: we’re not aware of any work addressing this.
• Ideas for studying this: when a new Administrator is appointed, how much does the distribution of aid change across different categories? Ideally, it would be interesting to compare USAID (which is known to have many Congressional earmarks) to other countries with more flexible aid budgets.
• Why we care: we believe that sustained economic growth is one of the best ways to improve health and income. We are interested in knowing how to obtain this. Growth diagnostics are a common tool for trying to select growth-friendly policies, but we are uncertain how valuable this tool is. We are interested in knowing what additional information is gained from using growth diagnostics – how useful they are, and the extent to which this suggests that countries face common vs. distinct growth challenges.
• What we know: while there are many papers on growth diagnostics, we are not aware of any evaluation of growth diagnostics across countries.
• Ideas for studying this: taking a large body of growth diagnostics from a common source (e.g. the World Bank or Harvard Growth Lab ); using automated methods to measure the similarity of recommendations, compare how similar they are, and determine whether that similarity varies by base GDP (e.g. do similarly rich/poor countries have similar diagnostics?) or region (e.g. do Central Asian countries have similar diagnostics?).
• Why we care: many social changes — such as encouraging migration or expanding one’s moral circle to include farmed animals — are often covered in widely-viewed media channels. We are interested in knowing if such coverage changes minds.
• What we know: media seems to be able to influence decision-making (as with fertility in Brazil ). Blackfish decreased attendance at Seaworld and decreased the value of the company that owned the park.
• Ideas for studying this: we think there is more scope to study individual documentaries or shows (did Waiting for Superman affect views on education? Did Bowling for Columbine affect views on guns?). One could also conduct meta-analyses, looking across a variety of documentaries or shows to look for common effects.
• Why we care: we believe that non-competes are likely to reduce labor mobility and decrease innovation .
• What we know: there are some surveys on the prevalence of non-competes outside the US, but few are recent or comprehensive. Outside of recent work in Italy , we have little information about how prevalent non-competes are, or how harmful they are in labor markets outside the US.
• Ideas for studying this: one could gather information on the prevalence of non-competes and their effects on wages in other large labor markets, like Germany, France, and Spain.

Footnotes [+] Footnotes [−]

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Regions & Countries

4. challenges in the classroom.

In addition to asking public K-12 teachers about issues they see at their school, we asked how much each of the following is a problem among students in their classroom :

• Showing little to no interest in learning (47% say this is a major problem)
• Being distracted by their cellphones (33%)
• Getting up and walking around when they’re not supposed to (21%)
• Being disrespectful toward the teacher (21%)

Some challenges are more common among high school teachers, while others are more common among those who teach elementary or middle school.

• Cellphones: 72% of high school teachers say students being distracted by their cellphones in the classroom is a major problem. A third of middle school teachers and just 6% of elementary school teachers say the same.
• Little to no interest in learning: A majority of high school teachers (58%) say students showing little to no interest in learning is a major problem. This compares with half of middle school teachers and 40% of elementary school teachers. 
• Getting up and walking around: 23% of elementary school teachers and 24% of middle school teachers see students getting up and walking around when they’re not supposed to as a major problem. A smaller share of high school teachers (16%) say the same.
• Being disrespectful: 23% of elementary school teachers and 27% of middle school teachers say students being disrespectful toward them is a major problem. Just 14% of high school teachers say this.

Policies around cellphone use

About eight-in-ten teachers (82%) say their school or district has policies regarding students’ use of cellphones in the classroom. Of those, 56% say these policies are at least somewhat easy to enforce, 30% say they’re difficult to enforce, and 14% say they’re neither easy nor difficult to enforce.

High school teachers are the least likely to say their school or district has policies regarding students’ use of cellphones in the classroom (71% vs. 84% of elementary school teachers and 94% of middle school teachers).

Among those who say there are such policies at their school, high school teachers are the most likely to say these are very or somewhat difficult to enforce. Six-in-ten high school teachers say this, compared with 30% of middle school teachers and 12% of elementary school teachers.

Verbal abuse and physical violence from students

Most teachers (68%) say they have experienced verbal abuse from their students, such as being yelled at or verbally threatened. About one-in-five (21%) say this happens at least a few times a month.

Physical violence is far less common, but about one-in-ten teachers (9%) say a student is physically violent toward them at least a few times a month. Four-in-ten say this has ever happened to them.

Differences by school level

Elementary school teachers (26%) are more likely than middle and high school teachers (18% and 16%) to say they experience verbal abuse from students a few times a month or more often.

And while relatively small shares across school levels say students are physically violent toward them a few times a month or more often, elementary school teachers (55%) are more likely than middle and high school teachers (33% and 23%) to say this has ever happened to them.

Differences by poverty level

Among teachers in high-poverty schools, 27% say they experience verbal abuse from students at least a few times a month. This is larger than the shares of teachers in medium- and low-poverty schools (19% and 18%) who say the same.

Experiences with physical violence don’t differ as much based on school poverty level.

Differences by gender

Teachers who are women are more likely than those who are men to say a student has been physically violent toward them. Some 43% of women teachers say this, compared with 30% of men.

There is also a gender difference in the shares of teachers who say they’ve experienced verbal abuse from students. But this difference is accounted for by the fact that women teachers are more likely than men to work in elementary schools.

Addressing behavioral and mental health challenges

Eight-in-ten teachers say they have to address students’ behavioral issues at least a few times a week, with 58% saying this happens every day .

A majority of teachers (57%) also say they help students with mental health challenges at least a few times a week, with 28% saying this happens daily.

Some teachers are more likely than others to say they have to address students’ behavior and mental health challenges on a daily basis. These include:

• Women: 62% of women teachers say they have to address behavior issues daily, compared with 43% of those who are men. And while 29% of women teachers say they have to help students with mental health challenges every day, a smaller share of men (19%) say the same.
• Elementary and middle school teachers: 68% each among elementary and middle school teachers say they have to deal with behavior issues daily, compared with 39% of high school teachers. A third of elementary and 29% of middle school teachers say they have to help students with mental health every day, compared with 19% of high school teachers.
• Teachers in high-poverty schools: 67% of teachers in schools with high levels of poverty say they have to address behavior issues on a daily basis. Smaller majorities of those in schools with medium or low levels of poverty say the same (56% and 54%). A third of teachers in high-poverty schools say they have to help students with mental health challenges every day, compared with about a quarter of those in medium- or low-poverty schools who say they have this experience (26% and 24%). 

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Table of contents, ‘back to school’ means anytime from late july to after labor day, depending on where in the u.s. you live, among many u.s. children, reading for fun has become less common, federal data shows, most european students learn english in school, for u.s. teens today, summer means more schooling and less leisure time than in the past, about one-in-six u.s. teachers work second jobs – and not just in the summer, most popular.

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

• COVID-19 and your mental health

Worries and anxiety about COVID-19 can be overwhelming. Learn ways to cope as COVID-19 spreads.

At the start of the COVID-19 pandemic, life for many people changed very quickly. Worry and concern were natural partners of all that change — getting used to new routines, loneliness and financial pressure, among other issues. Information overload, rumor and misinformation didn't help.

Worldwide surveys done in 2020 and 2021 found higher than typical levels of stress, insomnia, anxiety and depression. By 2022, levels had lowered but were still higher than before 2020.

Though feelings of distress about COVID-19 may come and go, they are still an issue for many people. You aren't alone if you feel distress due to COVID-19. And you're not alone if you've coped with the stress in less than healthy ways, such as substance use.

But healthier self-care choices can help you cope with COVID-19 or any other challenge you may face.

And knowing when to get help can be the most essential self-care action of all.

Recognize what's typical and what's not

Stress and worry are common during a crisis. But something like the COVID-19 pandemic can push people beyond their ability to cope.

In surveys, the most common symptoms reported were trouble sleeping and feeling anxiety or nervous. The number of people noting those symptoms went up and down in surveys given over time. Depression and loneliness were less common than nervousness or sleep problems, but more consistent across surveys given over time. Among adults, use of drugs, alcohol and other intoxicating substances has increased over time as well.

The first step is to notice how often you feel helpless, sad, angry, irritable, hopeless, anxious or afraid. Some people may feel numb.

Keep track of how often you have trouble focusing on daily tasks or doing routine chores. Are there things that you used to enjoy doing that you stopped doing because of how you feel? Note any big changes in appetite, any substance use, body aches and pains, and problems with sleep.

These feelings may come and go over time. But if these feelings don't go away or make it hard to do your daily tasks, it's time to ask for help.

Get help when you need it

If you're feeling suicidal or thinking of hurting yourself, seek help.

• Contact your healthcare professional or a mental health professional.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline , available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.

If you are worried about yourself or someone else, contact your healthcare professional or mental health professional. Some may be able to see you in person or talk over the phone or online.

You also can reach out to a friend or loved one. Someone in your faith community also could help.

And you may be able to get counseling or a mental health appointment through an employer's employee assistance program.

Another option is information and treatment options from groups such as:

• National Alliance on Mental Illness (NAMI).
• Substance Abuse and Mental Health Services Administration (SAMHSA).
• Anxiety and Depression Association of America.

Self-care tips

Some people may use unhealthy ways to cope with anxiety around COVID-19. These unhealthy choices may include things such as misuse of medicines or legal drugs and use of illegal drugs. Unhealthy coping choices also can be things such as sleeping too much or too little, or overeating. It also can include avoiding other people and focusing on only one soothing thing, such as work, television or gaming.

Unhealthy coping methods can worsen mental and physical health. And that is particularly true if you're trying to manage or recover from COVID-19.

Self-care actions can help you restore a healthy balance in your life. They can lessen everyday stress or significant anxiety linked to events such as the COVID-19 pandemic. Self-care actions give your body and mind a chance to heal from the problems long-term stress can cause.

Take care of your body

Healthy self-care tips start with the basics. Give your body what it needs and avoid what it doesn't need. Some tips are:

• Get the right amount of sleep for you. A regular sleep schedule, when you go to bed and get up at similar times each day, can help avoid sleep problems.
• Move your body. Regular physical activity and exercise can help reduce anxiety and improve mood. Any activity you can do regularly is a good choice. That may be a scheduled workout, a walk or even dancing to your favorite music.
• Choose healthy food and drinks. Foods that are high in nutrients, such as protein, vitamins and minerals are healthy choices. Avoid food or drink with added sugar, fat or salt.
• Avoid tobacco, alcohol and drugs. If you smoke tobacco or if you vape, you're already at higher risk of lung disease. Because COVID-19 affects the lungs, your risk increases even more. Using alcohol to manage how you feel can make matters worse and reduce your coping skills. Avoid taking illegal drugs or misusing prescriptions to manage your feelings.

Take care of your mind

Healthy coping actions for your brain start with deciding how much news and social media is right for you. Staying informed, especially during a pandemic, helps you make the best choices but do it carefully.

Set aside a specific amount of time to find information in the news or on social media, stay limited to that time, and choose reliable sources. For example, give yourself up to 20 or 30 minutes a day of news and social media. That amount keeps people informed but not overwhelmed.

For COVID-19, consider reliable health sources. Examples are the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

Other healthy self-care tips are:

• Relax and recharge. Many people benefit from relaxation exercises such as mindfulness, deep breathing, meditation and yoga. Find an activity that helps you relax and try to do it every day at least for a short time. Fitting time in for hobbies or activities you enjoy can help manage feelings of stress too.
• Stick to your health routine. If you see a healthcare professional for mental health services, keep up with your appointments. And stay up to date with all your wellness tests and screenings.
• Stay in touch and connect with others. Family, friends and your community are part of a healthy mental outlook. Together, you form a healthy support network for concerns or challenges. Social interactions, over time, are linked to a healthier and longer life.

Avoid stigma and discrimination

Stigma can make people feel isolated and even abandoned. They may feel sad, hurt and angry when people in their community avoid them for fear of getting COVID-19. People who have experienced stigma related to COVID-19 include people of Asian descent, health care workers and people with COVID-19.

Treating people differently because of their medical condition, called medical discrimination, isn't new to the COVID-19 pandemic. Stigma has long been a problem for people with various conditions such as Hansen's disease (leprosy), HIV, diabetes and many mental illnesses.

People who experience stigma may be left out or shunned, treated differently, or denied job and school options. They also may be targets of verbal, emotional and physical abuse.

Communication can help end stigma or discrimination. You can address stigma when you:

• Get to know people as more than just an illness. Using respectful language can go a long way toward making people comfortable talking about a health issue.
• Get the facts about COVID-19 or other medical issues from reputable sources such as the CDC and WHO.
• Speak up if you hear or see myths about an illness or people with an illness.

COVID-19 and health

The virus that causes COVID-19 is still a concern for many people. By recognizing when to get help and taking time for your health, life challenges such as COVID-19 can be managed.

• Mental health during the COVID-19 pandemic. National Institutes of Health. https://covid19.nih.gov/covid-19-topics/mental-health. Accessed March 12, 2024.
• Mental Health and COVID-19: Early evidence of the pandemic's impact: Scientific brief, 2 March 2022. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1. Accessed March 12, 2024.
• Mental health and the pandemic: What U.S. surveys have found. Pew Research Center. https://www.pewresearch.org/short-reads/2023/03/02/mental-health-and-the-pandemic-what-u-s-surveys-have-found/. Accessed March 12, 2024.
• Taking care of your emotional health. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coping/selfcare.asp. Accessed March 12, 2024.
• #HealthyAtHome—Mental health. World Health Organization. www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome/healthyathome---mental-health. Accessed March 12, 2024.
• Coping with stress. Centers for Disease Control and Prevention. www.cdc.gov/mentalhealth/stress-coping/cope-with-stress/. Accessed March 12, 2024.
• Manage stress. U.S. Department of Health and Human Services. https://health.gov/myhealthfinder/topics/health-conditions/heart-health/manage-stress. Accessed March 20, 2020.
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