research paper person pronouns

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Can You Use First-Person Pronouns (I/we) in a Research Paper?

Research writers frequently wonder whether the first person can be used in academic and scientific writing. In truth, for generations, we’ve been discouraged from using “I” and “we” in academic writing simply due to old habits. That’s right—there’s no reason why you can’t use these words! In fact, the academic community used first-person pronouns until the 1920s, when the third person and passive-voice constructions (that is, “boring” writing) were adopted–prominently expressed, for example, in Strunk and White’s classic writing manual “Elements of Style” first published in 1918, that advised writers to place themselves “in the background” and not draw attention to themselves.

In recent decades, however, changing attitudes about the first person in academic writing has led to a paradigm shift, and we have, however, we’ve shifted back to producing active and engaging prose that incorporates the first person.

Can You Use “I” in a Research Paper?

However, “I” and “we” still have some generally accepted pronoun rules writers should follow. For example, the first person is more likely used in the abstract , Introduction section , Discussion section , and Conclusion section of an academic paper while the third person and passive constructions are found in the Methods section and Results section .

In this article, we discuss when you should avoid personal pronouns and when they may enhance your writing.

It’s Okay to Use First-Person Pronouns to:

• clarify meaning by eliminating passive voice constructions;
• establish authority and credibility (e.g., assert ethos, the Aristotelian rhetorical term referring to the personal character);
• express interest in a subject matter (typically found in rapid correspondence);
• establish personal connections with readers, particularly regarding anecdotal or hypothetical situations (common in philosophy, religion, and similar fields, particularly to explore how certain concepts might impact personal life. Additionally, artistic disciplines may also encourage personal perspectives more than other subjects);
• to emphasize or distinguish your perspective while discussing existing literature; and
• to create a conversational tone (rare in academic writing).

The First Person Should Be Avoided When:

• doing so would remove objectivity and give the impression that results or observations are unique to your perspective;
• you wish to maintain an objective tone that would suggest your study minimized biases as best as possible; and
• expressing your thoughts generally (phrases like “I think” are unnecessary because any statement that isn’t cited should be yours).

Usage Examples

The following examples compare the impact of using and avoiding first-person pronouns.

Example 1 (First Person Preferred):

To understand the effects of global warming on coastal regions,  changes in sea levels, storm surge occurrences and precipitation amounts  were examined .

[Note: When a long phrase acts as the subject of a passive-voice construction, the sentence becomes difficult to digest. Additionally, since the author(s) conducted the research, it would be clearer to specifically mention them when discussing the focus of a project.]

We examined  changes in sea levels, storm surge occurrences, and precipitation amounts to understand how global warming impacts coastal regions.

[Note: When describing the focus of a research project, authors often replace “we” with phrases such as “this study” or “this paper.” “We,” however, is acceptable in this context, including for scientific disciplines. In fact, papers published the vast majority of scientific journals these days use “we” to establish an active voice.   Be careful when using “this study” or “this paper” with verbs that clearly couldn’t have performed the action.   For example, “we attempt to demonstrate” works, but “the study attempts to demonstrate” does not; the study is not a person.]

Example 2 (First Person Discouraged):

From the various data points  we have received ,  we observed  that higher frequencies of runoffs from heavy rainfall have occurred in coastal regions where temperatures have increased by at least 0.9°C.

[Note: Introducing personal pronouns when discussing results raises questions regarding the reproducibility of a study. However, mathematics fields generally tolerate phrases such as “in X example, we see…”]

Coastal regions  with temperature increases averaging more than 0.9°C  experienced  higher frequencies of runoffs from heavy rainfall.

[Note: We removed the passive voice and maintained objectivity and assertiveness by specifically identifying the cause-and-effect elements as the actor and recipient of the main action verb. Additionally, in this version, the results appear independent of any person’s perspective.] 

Example 3 (First Person Preferred):

In contrast to the study by Jones et al. (2001), which suggests that milk consumption is safe for adults, the Miller study (2005) revealed the potential hazards of ingesting milk.  The authors confirm  this latter finding.

[Note: “Authors” in the last sentence above is unclear. Does the term refer to Jones et al., Miller, or the authors of the current paper?]

In contrast to the study by Jones et al. (2001), which suggests that milk consumption is safe for adults, the Miller study (2005) revealed the potential hazards of ingesting milk.  We confirm  this latter finding.

[Note: By using “we,” this sentence clarifies the actor and emphasizes the significance of the recent findings reported in this paper. Indeed, “I” and “we” are acceptable in most scientific fields to compare an author’s works with other researchers’ publications. The APA encourages using personal pronouns for this context. The social sciences broaden this scope to allow discussion of personal perspectives, irrespective of comparisons to other literature.]

Other Tips about Using Personal Pronouns

• Avoid starting a sentence with personal pronouns. The beginning of a sentence is a noticeable position that draws readers’ attention. Thus, using personal pronouns as the first one or two words of a sentence will draw unnecessary attention to them (unless, of course, that was your intent).
• Be careful how you define “we.” It should only refer to the authors and never the audience unless your intention is to write a conversational piece rather than a scholarly document! After all, the readers were not involved in analyzing or formulating the conclusions presented in your paper (although, we note that the point of your paper is to persuade readers to reach the same conclusions you did). While this is not a hard-and-fast rule, if you do want to use “we” to refer to a larger class of people, clearly define the term “we” in the sentence. For example, “As researchers, we frequently question…”
• First-person writing is becoming more acceptable under Modern English usage standards; however, the second-person pronoun “you” is still generally unacceptable because it is too casual for academic writing.
• Take all of the above notes with a grain of salt. That is,  double-check your institution or target journal’s author guidelines .  Some organizations may prohibit the use of personal pronouns.
• As an extra tip, before submission, you should always read through the most recent issues of a journal to get a better sense of the editors’ preferred writing styles and conventions.

Wordvice Resources

For more general advice on how to use active and passive voice in research papers, on how to paraphrase , or for a list of useful phrases for academic writing , head over to the Wordvice Academic Resources pages . And for more professional proofreading services , visit our Academic Editing and P aper Editing Services pages.

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• Writing Tips

Can You Use I or We in a Research Paper?

4-minute read

• 11th July 2023

Writing in the first person, or using I and we pronouns, has traditionally been frowned upon in academic writing . But despite this long-standing norm, writing in the first person isn’t actually prohibited. In fact, it’s becoming more acceptable – even in research papers.

 If you’re wondering whether you can use I (or we ) in your research paper, you should check with your institution first and foremost. Many schools have rules regarding first-person use. If it’s up to you, though, we still recommend some guidelines. Check out our tips below!

When Is It Most Acceptable to Write in the First Person?

Certain sections of your paper are more conducive to writing in the first person. Typically, the first person makes sense in the abstract, introduction, discussion, and conclusion sections. You should still limit your use of I and we , though, or your essay may start to sound like a personal narrative .

 Using first-person pronouns is most useful and acceptable in the following circumstances.

When doing so removes the passive voice and adds flow

Sometimes, writers have to bend over backward just to avoid using the first person, often producing clunky sentences and a lot of passive voice constructions. The first person can remedy this. For example: 

Both sentences are fine, but the second one flows better and is easier to read.

When doing so differentiates between your research and other literature

When discussing literature from other researchers and authors, you might be comparing it with your own findings or hypotheses . Using the first person can help clarify that you are engaging in such a comparison. For example: 

 In the first sentence, using “the author” to avoid the first person creates ambiguity. The second sentence prevents misinterpretation.

When doing so allows you to express your interest in the subject

In some instances, you may need to provide background for why you’re researching your topic. This information may include your personal interest in or experience with the subject, both of which are easier to express using first-person pronouns. For example:

Expressing personal experiences and viewpoints isn’t always a good idea in research papers. When it’s appropriate to do so, though, just make sure you don’t overuse the first person.

When to Avoid Writing in the First Person

It’s usually a good idea to stick to the third person in the methods and results sections of your research paper. Additionally, be careful not to use the first person when:

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●  It makes your findings seem like personal observations rather than factual results.

●  It removes objectivity and implies that the writing may be biased .

●  It appears in phrases such as I think or I believe , which can weaken your writing.

Keeping Your Writing Formal and Objective

Using the first person while maintaining a formal tone can be tricky, but keeping a few tips in mind can help you strike a balance. The important thing is to make sure the tone isn’t too conversational.

 To achieve this, avoid referring to the readers, such as with the second-person you . Use we and us only when referring to yourself and the other authors/researchers involved in the paper, not the audience.

It’s becoming more acceptable in the academic world to use first-person pronouns such as we and I in research papers. But make sure you check with your instructor or institution first because they may have strict rules regarding this practice.

 If you do decide to use the first person, make sure you do so effectively by following the tips we’ve laid out in this guide. And once you’ve written a draft, send us a copy! Our expert proofreaders and editors will be happy to check your grammar, spelling, word choice, references, tone, and more. Submit a 500-word sample today!

Is it ever acceptable to use I or we in a research paper?

In some instances, using first-person pronouns can help you to establish credibility, add clarity, and make the writing easier to read.

How can I avoid using I in my writing?

Writing in the passive voice can help you to avoid using the first person.

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We Vs. They: Using the First & Third Person in Research Papers

Writing in the first , second , or third person is referred to as the author’s point of view . When we write, our tendency is to personalize the text by writing in the first person . That is, we use pronouns such as “I” and “we”. This is acceptable when writing personal information, a journal, or a book. However, it is not common in academic writing.

Some writers find the use of first , second , or third person point of view a bit confusing while writing research papers. Since second person is avoided while writing in academic or scientific papers, the main confusion remains within first or third person.

In the following sections, we will discuss the usage and examples of the first , second , and third person point of view.

First Person Pronouns

The first person point of view simply means that we use the pronouns that refer to ourselves in the text. These are as follows:

Can we use I or We In the Scientific Paper?

Using these, we present the information based on what “we” found. In science and mathematics, this point of view is rarely used. It is often considered to be somewhat self-serving and arrogant . It is important to remember that when writing your research results, the focus of the communication is the research and not the persons who conducted the research. When you want to persuade the reader, it is best to avoid personal pronouns in academic writing even when it is personal opinion from the authors of the study. In addition to sounding somewhat arrogant, the strength of your findings might be underestimated.

For example:

Based on my results, I concluded that A and B did not equal to C.

In this example, the entire meaning of the research could be misconstrued. The results discussed are not those of the author ; they are generated from the experiment. To refer to the results in this context is incorrect and should be avoided. To make it more appropriate, the above sentence can be revised as follows:

Based on the results of the assay, A and B did not equal to C.

Second Person Pronouns

The second person point of view uses pronouns that refer to the reader. These are as follows:

This point of view is usually used in the context of providing instructions or advice , such as in “how to” manuals or recipe books. The reason behind using the second person is to engage the reader.

You will want to buy a turkey that is large enough to feed your extended family. Before cooking it, you must wash it first thoroughly with cold water.

Although this is a good technique for giving instructions, it is not appropriate in academic or scientific writing.

Third Person Pronouns

The third person point of view uses both proper nouns, such as a person’s name, and pronouns that refer to individuals or groups (e.g., doctors, researchers) but not directly to the reader. The ones that refer to individuals are as follows:

• Hers (possessive form)
• His (possessive form)
• Its (possessive form)
• One’s (possessive form)

The third person point of view that refers to groups include the following:

• Their (possessive form)
• Theirs (plural possessive form)

Everyone at the convention was interested in what Dr. Johnson presented. The instructors decided that the students should help pay for lab supplies. The researchers determined that there was not enough sample material to conduct the assay.

The third person point of view is generally used in scientific papers but, at times, the format can be difficult. We use indefinite pronouns to refer back to the subject but must avoid using masculine or feminine terminology. For example:

A researcher must ensure that he has enough material for his experiment. The nurse must ensure that she has a large enough blood sample for her assay.

Many authors attempt to resolve this issue by using “he or she” or “him or her,” but this gets cumbersome and too many of these can distract the reader. For example:

A researcher must ensure that he or she has enough material for his or her experiment. The nurse must ensure that he or she has a large enough blood sample for his or her assay.

These issues can easily be resolved by making the subjects plural as follows:

Researchers must ensure that they have enough material for their experiment. Nurses must ensure that they have large enough blood samples for their assay.

Exceptions to the Rules

As mentioned earlier, the third person is generally used in scientific writing, but the rules are not quite as stringent anymore. It is now acceptable to use both the first and third person pronouns  in some contexts, but this is still under controversy.  

In a February 2011 blog on Eloquent Science , Professor David M. Schultz presented several opinions on whether the author viewpoints differed. However, there appeared to be no consensus. Some believed that the old rules should stand to avoid subjectivity, while others believed that if the facts were valid, it didn’t matter which point of view was used.

First or Third Person: What Do The Journals Say

In general, it is acceptable in to use the first person point of view in abstracts, introductions, discussions, and conclusions, in some journals. Even then, avoid using “I” in these sections. Instead, use “we” to refer to the group of researchers that were part of the study. The third person point of view is used for writing methods and results sections. Consistency is the key and switching from one point of view to another within sections of a manuscript can be distracting and is discouraged. It is best to always check your author guidelines for that particular journal. Once that is done, make sure your manuscript is free from the above-mentioned or any other grammatical error.

You are the only researcher involved in your thesis project. You want to avoid using the first person point of view throughout, but there are no other researchers on the project so the pronoun “we” would not be appropriate. What do you do and why? Please let us know your thoughts in the comments section below.

I am writing the history of an engineering company for which I worked. How do I relate a significant incident that involved me?

Hi Roger, Thank you for your question. If you are narrating the history for the company that you worked at, you would have to refer to it from an employee’s perspective (third person). If you are writing the history as an account of your experiences with the company (including the significant incident), you could refer to yourself as ”I” or ”My.” (first person) You could go through other articles related to language and grammar on Enago Academy’s website https://enago.com/academy/ to help you with your document drafting. Did you get a chance to install our free Mobile App? https://www.enago.com/academy/mobile-app/ . Make sure you subscribe to our weekly newsletter: https://www.enago.com/academy/subscribe-now/ .

Good day , i am writing a research paper and m y setting is a company . is it ethical to put the name of the company in the research paper . i the management has allowed me to conduct my research in thir company .

thanks docarlene diaz

Generally authors do not mention the names of the organization separately within the research paper. The name of the educational institution the researcher or the PhD student is working in needs to be mentioned along with the name in the list of authors. However, if the research has been carried out in a company, it might not be mandatory to mention the name after the name in the list of authors. You can check with the author guidelines of your target journal and if needed confirm with the editor of the journal. Also check with the mangement of the company whether they want the name of the company to be mentioned in the research paper.

Finishing up my dissertation the information is clear and concise.

How to write the right first person pronoun if there is a single researcher? Thanks

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Should I Use “I”?

What this handout is about.

This handout is about determining when to use first person pronouns (“I”, “we,” “me,” “us,” “my,” and “our”) and personal experience in academic writing. “First person” and “personal experience” might sound like two ways of saying the same thing, but first person and personal experience can work in very different ways in your writing. You might choose to use “I” but not make any reference to your individual experiences in a particular paper. Or you might include a brief description of an experience that could help illustrate a point you’re making without ever using the word “I.” So whether or not you should use first person and personal experience are really two separate questions, both of which this handout addresses. It also offers some alternatives if you decide that either “I” or personal experience isn’t appropriate for your project. If you’ve decided that you do want to use one of them, this handout offers some ideas about how to do so effectively, because in many cases using one or the other might strengthen your writing.

Expectations about academic writing

Students often arrive at college with strict lists of writing rules in mind. Often these are rather strict lists of absolutes, including rules both stated and unstated:

• Each essay should have exactly five paragraphs.
• Don’t begin a sentence with “and” or “because.”
• Never include personal opinion.
• Never use “I” in essays.

We get these ideas primarily from teachers and other students. Often these ideas are derived from good advice but have been turned into unnecessarily strict rules in our minds. The problem is that overly strict rules about writing can prevent us, as writers, from being flexible enough to learn to adapt to the writing styles of different fields, ranging from the sciences to the humanities, and different kinds of writing projects, ranging from reviews to research.

So when it suits your purpose as a scholar, you will probably need to break some of the old rules, particularly the rules that prohibit first person pronouns and personal experience. Although there are certainly some instructors who think that these rules should be followed (so it is a good idea to ask directly), many instructors in all kinds of fields are finding reason to depart from these rules. Avoiding “I” can lead to awkwardness and vagueness, whereas using it in your writing can improve style and clarity. Using personal experience, when relevant, can add concreteness and even authority to writing that might otherwise be vague and impersonal. Because college writing situations vary widely in terms of stylistic conventions, tone, audience, and purpose, the trick is deciphering the conventions of your writing context and determining how your purpose and audience affect the way you write. The rest of this handout is devoted to strategies for figuring out when to use “I” and personal experience.

Effective uses of “I”:

In many cases, using the first person pronoun can improve your writing, by offering the following benefits:

• Assertiveness: In some cases you might wish to emphasize agency (who is doing what), as for instance if you need to point out how valuable your particular project is to an academic discipline or to claim your unique perspective or argument.
• Clarity: Because trying to avoid the first person can lead to awkward constructions and vagueness, using the first person can improve your writing style.
• Positioning yourself in the essay: In some projects, you need to explain how your research or ideas build on or depart from the work of others, in which case you’ll need to say “I,” “we,” “my,” or “our”; if you wish to claim some kind of authority on the topic, first person may help you do so.

Deciding whether “I” will help your style

Here is an example of how using the first person can make the writing clearer and more assertive:

Original example:

In studying American popular culture of the 1980s, the question of to what degree materialism was a major characteristic of the cultural milieu was explored.

Better example using first person:

In our study of American popular culture of the 1980s, we explored the degree to which materialism characterized the cultural milieu.

The original example sounds less emphatic and direct than the revised version; using “I” allows the writers to avoid the convoluted construction of the original and clarifies who did what.

Here is an example in which alternatives to the first person would be more appropriate:

As I observed the communication styles of first-year Carolina women, I noticed frequent use of non-verbal cues.

Better example:

A study of the communication styles of first-year Carolina women revealed frequent use of non-verbal cues.

In the original example, using the first person grounds the experience heavily in the writer’s subjective, individual perspective, but the writer’s purpose is to describe a phenomenon that is in fact objective or independent of that perspective. Avoiding the first person here creates the desired impression of an observed phenomenon that could be reproduced and also creates a stronger, clearer statement.

Here’s another example in which an alternative to first person works better:

As I was reading this study of medieval village life, I noticed that social class tended to be clearly defined.

This study of medieval village life reveals that social class tended to be clearly defined.

Although you may run across instructors who find the casual style of the original example refreshing, they are probably rare. The revised version sounds more academic and renders the statement more assertive and direct.

Here’s a final example:

I think that Aristotle’s ethical arguments are logical and readily applicable to contemporary cases, or at least it seems that way to me.

Better example

Aristotle’s ethical arguments are logical and readily applicable to contemporary cases.

In this example, there is no real need to announce that that statement about Aristotle is your thought; this is your paper, so readers will assume that the ideas in it are yours.

Determining whether to use “I” according to the conventions of the academic field

Which fields allow “I”?

The rules for this are changing, so it’s always best to ask your instructor if you’re not sure about using first person. But here are some general guidelines.

Sciences: In the past, scientific writers avoided the use of “I” because scientists often view the first person as interfering with the impression of objectivity and impersonality they are seeking to create. But conventions seem to be changing in some cases—for instance, when a scientific writer is describing a project she is working on or positioning that project within the existing research on the topic. Check with your science instructor to find out whether it’s o.k. to use “I” in their class.

Social Sciences: Some social scientists try to avoid “I” for the same reasons that other scientists do. But first person is becoming more commonly accepted, especially when the writer is describing their project or perspective.

Humanities: Ask your instructor whether you should use “I.” The purpose of writing in the humanities is generally to offer your own analysis of language, ideas, or a work of art. Writers in these fields tend to value assertiveness and to emphasize agency (who’s doing what), so the first person is often—but not always—appropriate. Sometimes writers use the first person in a less effective way, preceding an assertion with “I think,” “I feel,” or “I believe” as if such a phrase could replace a real defense of an argument. While your audience is generally interested in your perspective in the humanities fields, readers do expect you to fully argue, support, and illustrate your assertions. Personal belief or opinion is generally not sufficient in itself; you will need evidence of some kind to convince your reader.

Other writing situations: If you’re writing a speech, use of the first and even the second person (“you”) is generally encouraged because these personal pronouns can create a desirable sense of connection between speaker and listener and can contribute to the sense that the speaker is sincere and involved in the issue. If you’re writing a resume, though, avoid the first person; describe your experience, education, and skills without using a personal pronoun (for example, under “Experience” you might write “Volunteered as a peer counselor”).

A note on the second person “you”:

In situations where your intention is to sound conversational and friendly because it suits your purpose, as it does in this handout intended to offer helpful advice, or in a letter or speech, “you” might help to create just the sense of familiarity you’re after. But in most academic writing situations, “you” sounds overly conversational, as for instance in a claim like “when you read the poem ‘The Wasteland,’ you feel a sense of emptiness.” In this case, the “you” sounds overly conversational. The statement would read better as “The poem ‘The Wasteland’ creates a sense of emptiness.” Academic writers almost always use alternatives to the second person pronoun, such as “one,” “the reader,” or “people.”

Personal experience in academic writing

The question of whether personal experience has a place in academic writing depends on context and purpose. In papers that seek to analyze an objective principle or data as in science papers, or in papers for a field that explicitly tries to minimize the effect of the researcher’s presence such as anthropology, personal experience would probably distract from your purpose. But sometimes you might need to explicitly situate your position as researcher in relation to your subject of study. Or if your purpose is to present your individual response to a work of art, to offer examples of how an idea or theory might apply to life, or to use experience as evidence or a demonstration of an abstract principle, personal experience might have a legitimate role to play in your academic writing. Using personal experience effectively usually means keeping it in the service of your argument, as opposed to letting it become an end in itself or take over the paper.

It’s also usually best to keep your real or hypothetical stories brief, but they can strengthen arguments in need of concrete illustrations or even just a little more vitality.

Here are some examples of effective ways to incorporate personal experience in academic writing:

• Anecdotes: In some cases, brief examples of experiences you’ve had or witnessed may serve as useful illustrations of a point you’re arguing or a theory you’re evaluating. For instance, in philosophical arguments, writers often use a real or hypothetical situation to illustrate abstract ideas and principles.
• References to your own experience can explain your interest in an issue or even help to establish your authority on a topic.
• Some specific writing situations, such as application essays, explicitly call for discussion of personal experience.

Here are some suggestions about including personal experience in writing for specific fields:

Philosophy: In philosophical writing, your purpose is generally to reconstruct or evaluate an existing argument, and/or to generate your own. Sometimes, doing this effectively may involve offering a hypothetical example or an illustration. In these cases, you might find that inventing or recounting a scenario that you’ve experienced or witnessed could help demonstrate your point. Personal experience can play a very useful role in your philosophy papers, as long as you always explain to the reader how the experience is related to your argument. (See our handout on writing in philosophy for more information.)

Religion: Religion courses might seem like a place where personal experience would be welcomed. But most religion courses take a cultural, historical, or textual approach, and these generally require objectivity and impersonality. So although you probably have very strong beliefs or powerful experiences in this area that might motivate your interest in the field, they shouldn’t supplant scholarly analysis. But ask your instructor, as it is possible that they are interested in your personal experiences with religion, especially in less formal assignments such as response papers. (See our handout on writing in religious studies for more information.)

Literature, Music, Fine Arts, and Film: Writing projects in these fields can sometimes benefit from the inclusion of personal experience, as long as it isn’t tangential. For instance, your annoyance over your roommate’s habits might not add much to an analysis of “Citizen Kane.” However, if you’re writing about Ridley Scott’s treatment of relationships between women in the movie “Thelma and Louise,” some reference your own observations about these relationships might be relevant if it adds to your analysis of the film. Personal experience can be especially appropriate in a response paper, or in any kind of assignment that asks about your experience of the work as a reader or viewer. Some film and literature scholars are interested in how a film or literary text is received by different audiences, so a discussion of how a particular viewer or reader experiences or identifies with the piece would probably be appropriate. (See our handouts on writing about fiction , art history , and drama for more information.)

Women’s Studies: Women’s Studies classes tend to be taught from a feminist perspective, a perspective which is generally interested in the ways in which individuals experience gender roles. So personal experience can often serve as evidence for your analytical and argumentative papers in this field. This field is also one in which you might be asked to keep a journal, a kind of writing that requires you to apply theoretical concepts to your experiences.

History: If you’re analyzing a historical period or issue, personal experience is less likely to advance your purpose of objectivity. However, some kinds of historical scholarship do involve the exploration of personal histories. So although you might not be referencing your own experience, you might very well be discussing other people’s experiences as illustrations of their historical contexts. (See our handout on writing in history for more information.)

Sciences: Because the primary purpose is to study data and fixed principles in an objective way, personal experience is less likely to have a place in this kind of writing. Often, as in a lab report, your goal is to describe observations in such a way that a reader could duplicate the experiment, so the less extra information, the better. Of course, if you’re working in the social sciences, case studies—accounts of the personal experiences of other people—are a crucial part of your scholarship. (See our handout on  writing in the sciences for more information.)

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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Use of Pronouns in Academic Writing

Published by Alvin Nicolas at August 17th, 2021 , Revised On August 24, 2023

Pronouns are words that make reference to both specific and nonspecific things and people. They are used in place of nouns.

First-person pronouns (I, We) are rarely used in academic writing. They are primarily used in a reflective piece, such as a reflective essay or personal statement. You should avoid using second-person pronouns such as “you” and “yours”. The use of third-person pronouns (He, She, They) is allowed, but it is still recommended to consider gender bias when using them in academic writing.

The antecedent of a pronoun is the noun that the pronoun represents. In English, you will see the antecedent appear both before and after the pronoun, even though it is usually mentioned in the text before the pronoun. The students could not complete the work on time because they procrastinated for too long. Before he devoured a big burger, Michael looked a bit nervous.

The Antecedent of a Pronoun

Make sure the antecedent is evident and explicit whenever you use a pronoun in a sentence. You may want to replace the pronoun with the noun to eliminate any vagueness.

• After the production and the car’s mechanical inspection were complete, it was delivered to the owner.

In the above sentence, it is unclear what the pronoun “it” is referring to.

• After the production and the car’s mechanical inspection was complete, the car was delivered to the owner.

Use of First Person Pronouns (I, We) in Academic Writing

The use of first-person pronouns, such as “I” and “We”, is a widely debated topic in academic writing.

While some style guides, such as ‘APA” and “Harvard”, encourage first-person pronouns when describing the author’s actions, many other style guides discourage their use in academic writing to keep the attention to the information presented within rather than who describes it.

Similarly, you will find some leniency towards the use of first-person pronouns in some academic disciplines, while others strictly prohibit using them to maintain an impartial and neutral tone.

It will be fair to say that first-person pronouns are increasingly regular in many forms of academic writing.  If ever in doubt whether or not you should use first-person pronouns in your essay or assignment, speak with your tutor to be entirely sure.

Avoid overusing first-person pronouns in academic papers regardless of the style guide used. It is recommended to use them only where required for improving the clarity of the text.

If you are writing about a situation involving only yourself or if you are the sole author of the paper, then use the singular pronouns (I, my). Use plural pronouns (We, They, Our) when there are coauthors to work.

Avoiding First Person Pronouns

You can avoid first-person pronouns by employing any of the following three methods.

There are advantages and disadvantages of each of these three strategies. For example, passive voice introduces dangling modifiers, which can make your text unclear and ambiguous. Therefore, it would be best to keep first-person pronouns in the text if you can use them.

In some forms of academic writing, such as a personal statement and reflective essay, it is completely acceptable to use first-person pronouns.

The Problem with the Editorial We

Avoid using the first person plural to refer to people in academic text, known as the “editorial we”. The use of the “editorial we” is quite common in newspapers when the author speaks on behalf of the people to express a shared experience or view.

Refrain from using broad generalizations in academic text. You have to be crystal clear and very specific about who you are making reference to. Use nouns in place of pronouns where possible.

• When we tested the data, we found that the hypothesis to be incorrect.
• When the researchers tested the data, they found the hypothesis to be incorrect.
• As we started to work on the project, we realized how complex the requirements were.
• As the students started to work on the project, they realized how complex the requirements were.

If you are talking on behalf of a specific group you belong to, then the use of “we” is acceptable.

• It is essential to be aware of our own
• It is essential for essayists to be aware of their own weaknesses.
• Essayists need to be aware of their own

Use of Second Person Pronouns (You) in Academic Writing

It is strictly prohibited to use the second-person pronoun “you” to address the audience in any form of academic writing. You can rephrase the sentence or introduce the impersonal pronoun “one” to avoid second-person pronouns in the text.

• To achieve the highest academic grade, you must avoid procrastination.
• To achieve the highest academic grade, one must avoid procrastination.
• As you can notice in below Table 2.1, all participants selected the first option.
• As shown in below Table 2.1, all participants selected the first option.

Use of Third Person Pronouns (He, She, They) in Academic Writing

Third-person pronouns in the English language are usually gendered (She/Her, He/Him). Educational institutes worldwide are increasingly advocating for gender-neutral language, so you should avoid using third-person pronouns in academic text.

In the older academic text, you will see gender-based nouns (Fishermen, Traitor) and pronouns (him, her, he, she) being commonly used. However, this style of writing is outdated and warned against in the present times.

You may also see some authors using both masculine and feminine pronouns, such as “he” or “she”, in the same text, but this generally results in unclear and inappropriate sentences.

Considering using gender-neutral pronouns, such as “they”, ‘there”, “them” for unknown people and undetermined people. The use of “they” in academic writing is highly encouraged. Many style guides, including Harvard, MLA, and APA, now endorse gender natural pronouns in academic writing.

On the other hand, you can also choose to avoid using pronouns altogether by either revising the sentence structure or pluralizing the sentence’s subject.

• When a student is asked to write an essay, he can take a specific position on the topic.
• When a student is asked to write an essay, they can take a specific position on the topic.
• When students are asked to write an essay, they are expected to take a specific position on the topic.
• Students are expected to take a specific position on the essay topic.
• The writer submitted his work for approval
• The writer submitted their work for approval.
• The writers submitted their work for approval.
• The writers’ work was submitted for approval.

Make sure it is clear who you are referring to with the singular “they” pronoun. You may want to rewrite the sentence or name the subject directly if the pronoun makes the sentence ambiguous.

For example, in the following example, you can see it is unclear who the plural pronoun “they” is referring to. To avoid confusion, the subject is named directly, and the context approves that “their paper” addresses the writer.

• If the writer doesn’t complete the client’s paper in time, they will be frustrated.
• The client will be frustrated if the writer doesn’t complete their paper in due time.

If you need to make reference to a specific person, it would be better to address them using self-identified pronouns. For example, in the following sentence, you can see that each person is referred to using a different possessive pronoun.

The students described their experience with different academic projects: Mike talked about his essay, James talked about their poster presentation, and Sara talked about her dissertation paper.

Ensure Consistency Throughout the Text

Avoid switching back and forth between first-person pronouns (I, We, Our) and third-person pronouns (The writers, the students) in a single piece. It is vitally important to maintain consistency throughout the text.

For example, The writers completed the work in due time, and our content quality is well above the standard expected. We completed the work in due time, and our content quality is well above the standard expected. The writers completed the work in due time, and the content quality is well above the standard expected.“

How to Use Demonstrative Pronouns (This, That, Those, These) in Academic Writing

Make sure it is clear who you are referring to when using demonstrative pronouns. Consider placing a descriptive word or phrase after the demonstrative pronouns to give more clarity to the sentence.

For example, The political relationship between Israel and Arab states has continued to worsen over the last few decades, contrary to the expectations of enthusiasts in the regional political sphere. This shows that a lot more needs to be done to tackle this.            The political relationship between Israel and Arab states has continued to worsen over the last few decades, contrary to the expectations of enthusiasts in the regional political sphere. This situation shows that a lot more needs to be done to tackle this issue.

Frequently Asked Questions

What are the 8 types of pronouns.

The 8 types of pronouns are:

• Personal: Refers to specific persons.
• Demonstrative: Points to specific things.
• Interrogative: Used for questioning.
• Possessive: Shows ownership.
• Reflexive: Reflects the subject.
• Reciprocal: Indicates mutual action.
• Relative: Introduces relative clauses.
• Indefinite: Refers vaguely or generally.

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Scholarly voice: point of view.

Personal pronouns are used to indicate point of view in most types of writing. Here are some common points of view:

• A paper using first-person point of view uses pronouns such as "I," "me," "we," and "us."
• A paper using second-person point of view uses the pronoun "you."
• A paper using third-person point of view uses pronouns such as "he," "she," "it," "they," "him," "her," "his," and "them."

In scholarly writing, first-person and third-person point of view are common, but second-person point of view is not. Read more about appropriate points of view on the following pages:

• First-Person Point of View
• Second-Person Point of View

Pronouns Video

• APA Formatting & Style: Pronouns (video transcript)

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Using “I” in Academic Writing

Traditionally, some fields have frowned on the use of the first-person singular in an academic essay and others have encouraged that use, and both the frowning and the encouraging persist today—and there are good reasons for both positions (see “Should I”).

I recommend that you not look on the question of using “I” in an academic paper as a matter of a rule to follow, as part of a political agenda (see webb), or even as the need to create a strategy to avoid falling into Scylla-or-Charybdis error. Let the first-person singular be, instead, a tool that you take out when you think it’s needed and that you leave in the toolbox when you think it’s not.

Examples of When “I” May Be Needed

• You are narrating how you made a discovery, and the process of your discovering is important or at the very least entertaining.
• You are describing how you teach something and how your students have responded or respond.
• You disagree with another scholar and want to stress that you are not waving the banner of absolute truth.
• You need “I” for rhetorical effect, to be clear, simple, or direct.

Examples of When “I” Should Be Given a Rest

• It’s off-putting to readers, generally, when “I” appears too often. You may not feel one bit modest, but remember the advice of Benjamin Franklin, still excellent, on the wisdom of preserving the semblance of modesty when your purpose is to convince others.
• You are the author of your paper, so if an opinion is expressed in it, it is usually clear that this opinion is yours. You don’t have to add a phrase like, “I believe” or “it seems to me.”

Works Cited

Franklin, Benjamin. The Autobiography of Benjamin Franklin . Project Gutenberg , 28 Dec. 2006, www.gutenberg.org/app/uploads/sites/3/20203/20203-h/20203-h.htm#I.

“Should I Use “I”?” The Writing Center at UNC—Chapel Hill , writingcenter.unc.edu/handouts/should-i-use-i/.

webb, Christine. “The Use of the First Person in Academic Writing: Objectivity, Language, and Gatekeeping.” ResearchGate , July 1992, doi: 10.1111/j.1365-2648.1992.tb01974.x.

J.S.Beniwal 05 August 2017 AT 09:08 AM

I have borrowed MLA only yesterday, did my MAEnglish in May 2017.MLA is of immense help for scholars.An overview of the book really enlightened​ me.I should have read it at bachelor's degree level.

Your e-mail address will not be published

Dr. Raymond Harter 25 September 2017 AT 02:09 PM

I discourage the use of "I" in essays for undergraduates to reinforce a conversational tone and to "self-recognize" the writer as an authority or at least a thorough researcher. Writing a play is different than an essay with a purpose.

Osayimwense Osa 22 March 2023 AT 05:03 PM

When a student or writer is strongly and passionately interested in his or her stance and argument to persuade his or her audience, the use of personal pronoun srenghtens his or her passion for the subject. This passion should be clear in his/her expression. However, I encourage the use of the first-person, I, sparingly -- only when and where absolutely necessary.

Eleanor 25 March 2023 AT 04:03 PM

I once had a student use the word "eye" when writing about how to use pronouns. Her peers did not catch it. I made comments, but I think she never understood what eye was saying!

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• Open access
• Published: 02 January 2024

Behavioral consequences of second-person pronouns in written communications between authors and reviewers of scientific papers

• Zhuanlan Sun 1   na1 ,
• C. Clark Cao   ORCID: orcid.org/0000-0002-4908-9240 2   na1 ,
• Sheng Liu 2   na1 ,
• Yiwei Li   ORCID: orcid.org/0000-0001-5358-9320 2 &
• Chao Ma   ORCID: orcid.org/0000-0003-0078-6755 3  

Nature Communications volume  15 , Article number:  152 ( 2024 ) Cite this article

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Pronoun usage’s psychological underpinning and behavioral consequence have fascinated researchers, with much research attention paid to second-person pronouns like “you,” “your,” and “yours.” While these pronouns’ effects are understood in many contexts, their role in bilateral, dynamic conversations (especially those outside of close relationships) remains less explored. This research attempts to bridge this gap by examining 25,679 instances of peer review correspondence with Nature Communications using the difference-in-differences method. Here we show that authors addressing reviewers using second-person pronouns receive fewer questions, shorter responses, and more positive feedback. Further analyses suggest that this shift in the review process occurs because “you” (vs. non-“you”) usage creates a more personal and engaging conversation. Employing the peer review process of scientific papers as a backdrop, this research reveals the behavioral and psychological effects that second-person pronouns have in interactive written communications.

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Introduction

In written communications, one can address the other conversational party using either second-person pronouns or their third-person counterparts. For instance, during the peer review process of a scientific paper, an academic may address the reviewers either using “you” (e.g., “the issue you brought up”) or a third-person reference instead (e.g., “the issue the reviewer brought up…”). Whether this choice matters, however, is less known. This question is embedded within the recent research investigating the behavioral and psychological consequences of personal pronoun usage 1 , 2 , 3 , which in turn falls under the broader research category of the social function of language usage 4 , 5 , 6 . Building upon this growing literature, the present research aims to investigate how the usage of second-person pronouns (“you,” “your,” and “yours”; hereinafter, we use the terms second-person pronoun usage and “you” usage interchangeably) impacts the outcome of written communications.

Currently, a wealth of research has investigated the impact of “you” usage on individuals’ mental state and/or behavior. For instance, “you” can draw the attention of a conversational party and hence evoke higher involvement 7 , 8 , 9 . Moreover, generic “you,” as in “you shall not murder,” signals normative behavior and hence impacts persuasion 10 , 11 , 12 , 13 . Furthermore, “you” usage in lyrics like “I will always love you” or movie quotes like “here’s looking at you, kid” can remind one of somebody in their own life (a loved one in these examples) 14 . Despite their important insights, however, most such investigations focus on one-way and one-off communications. While another body of literature does investigate “you” in two-way communications, it is largely limited to close relationships, mainly focusing on how pronoun usage reflects a party’s self- or other-focus 4 , 15 , 16 , 17 . Therefore, the field’s knowledge is still limited about the role of second-person pronouns in bilateral, dynamic, and interactive conversations, especially beyond close relationships.

To bridge this gap, in the present paper, we examine the behavioral and psychological consequences of second-person pronoun usage in interactive, conversational settings. Specifically, by analyzing 25,679 instances of revision correspondence with Nature Communications , we focus on how “you” (vs. non-“you”) usage in authors’ responses to reviewers may influence reviewers’ behavior. This dataset is ideal for our investigation, because the peer review process allows us to compare naturally occurring instances of both “you” and non-“you” responses.

The extant literature has shown that by directly addressing a conversational party, second-person pronouns can evoke the listener’s attention, personal relevance, and involvement in the communication 7 , 14 . Other personal pronouns do not possess this feature. For instance, in stark contrast to “you,” third-person pronouns often function to signal objectivity and minimize the involvement or even the existence of the speaker 18 , 19 , 20 . Building on this literature, we contend that in a communicative setting, addressing the other party as “you” (vs. not as “you”) should be associated with a more personal and engaging conversation, in contrast to an impersonal, businesslike exchange.

This feature of “you” usage may, in turn, lead to observable behavioral patterns in peer review outcomes. First, the personal and engaging conversational tone stimulated by “you” usage may in and of itself make the reviewer like the responses more, as individuals tend to favor things that are personally relevant 8 , 14 . Second, communicative norms that govern such conversations may call for greater politeness, civility, and embarrassment avoidance (“face-saving”) in communications 21 , 22 , 23 , 24 , making the comments more favorable (or less harsh) than they otherwise would be and resulting in greater positivity and fewer questions in reviewer comments.

Building on this perspective, here we show that when the authors use (vs. do not use) second-person pronouns to address the reviewers, they also see less lengthy reviewer comments, encounter fewer questions, and receive more positive and less negative feedback. We further link this shift in the review process to a more personal and engaging conversation prompted by “you” usage: First, when authors address reviewers using “you,” the reviewer responses tend to include fewer first-person singular pronouns, suggesting decreased self-focus 25 , 26 , 27 , 28 ; and to use less complex words, a staple feature of in-person conversation 29 , 30 , 31 , 32 . Second, thematic analyses conducted using Latent Dirichlet Allocation (LDA) show that second-person pronouns are indeed associated with increased reviewer engagement in their comments. Core findings from our dataset are also causally supported by a pre-registered behavioral experiment ( N  = 1601). Specifically, when participants assuming the role of reviewers are addressed in second person (vs. third person), they evaluate an otherwise identical author response as more positive. This effect is mediated by the extent to which the conversation is perceived as personal and engaging. Taken together, this research investigates the behavioral consequence and psychological underpinning of second-person pronoun usage employing field and lab data. In so doing, we contribute to the literature on language usage (and pronoun usage in particular) and shed light on the collegiate understanding of the peer review process and science of science in general.

Data and design

We analyzed revision correspondence of all papers published in Nature Communications between April 2016 (when the journal first began publishing reviewer reports) and April 2021. This dataset contains 13,359 published papers that account for a total of 29,144 rounds of review. In the present research, a “round” of review is defined as one exchange between the editorial/reviewer team (hereinafter simply “reviewers”) and the authors, with the reviewer comments being followed by the author responses. For instance, the “1st round of review” begins with the initial comments from the reviewers and the authors’ responses to those comments, the 2nd round of review consists of the next batch of reviewer comments and the authors’ responses to them, and so on. In our analysis, we focus on the authors’ usage of second-person pronouns in addressing the reviewer team in the first review-response-review process (i.e., reviewer comments in the 1st round, author responses in the 1st round, and reviewer comments in the 2nd round). We focus on this process because it constitutes most of our observations (25,679, or 88.11% of 29,144 review rounds) and, more importantly, affords a difference-in-differences (DID) design, which we elaborate below. Figure  1 illustrates our focal data and study design (full details regarding the number of papers and rounds of review can be found in Supplementary Note  1 ).

The treatment group and control group are defined by whether the authors responded to reviewers’ comments using second-person pronouns in the 1st round of review (i.e., between the 1st and 2nd round reviewer comments).

In examining the impact of “you” usage, it is important to consider some distinctive features of the peer review process. As an illustration, Fig.  2 shows the authors’ response to the reviewers in the 1st round of review (marked by the vertical dashed line), as well as the number of questions reviewers posed before and after this response (i.e., question counts in the 1st and 2nd review rounds). We then compare question counts following both “you” and non-“you” usage in a quasi-experimental fashion. Specifically, we categorize a paper into the treatment group if its authors used “you” in their 1st-round responses (which, in our context, can be considered as the treatment administered to reviewers), and the control group if they did not. Note that the treatment and control groups here are not in the strict experimental sense, as the papers are not randomly assigned to them.

Numbers herein represent mean values in the raw data and are not adjusted for any control variables or fixed effects. Supplementary Fig.  1 illustrates the distribution of the number of questions (and of words) across four scenarios as yielded by the (author “you” usage: yes vs. no) x 2 (round of review: before vs. after author response) DID design. We also direct interested readers to Supplementary Note  2 for further insights into data patterns related to “you” usage.

Importantly, as illustrated in Fig.  2 , to estimate the effect of “you” usage, it could be misleading to simply contrast the number of questions reviewers raised after the author responses with “you” (5.82) and without (4.25). This is because empirically, the treatment and control groups may begin with different question counts (which happens to be the case in our data—29.87 and 24.30, respectively, as per Fig.  2 ). To offset this initial discrepancy, we instead measure the decline in question count from the 1st to the 2nd round. Specifically, authors who used “you” saw a decrease of 24.05 questions in the subsequent round, while those who did not use “you” saw a decrease of 20.05.

Here, the control group reduction of 20.05 questions reflects a “natural” progression in our data, such that question count dwindles as the review process progresses, regardless of whether the author used “you” (see Fig.  2 ). On the other hand, the treatment group reduction of 24.05 also encompasses our focal effect of “you” usage, in addition to the overall trend. Therefore, the difference between the two reductions provides a relatively precise estimation of the effect of “you” usage. Specifically, compared to the control group, the treatment group experienced a steeper decline in question counts (by a margin of 4).

This approach to estimating the effect of “you” usage constitutes a DID framework, a quasi-experimental method widely used in observational data analysis. Specifically, the first “differences” here are the differences in question counts before and after author response, within both the treatment and control groups. These differences serve to offset initial discrepancies between the groups. The second “difference” then contrasts these two differences to estimate the effect of “you” usage—hence the name “difference-in-differences.”

As depicted in Fig.  1 , during the 1st round of review, authors of 5042 papers (37.74% of all 13,359 papers) used “you” in their responses to the reviewer comments (i.e., treatment group), whereas authors of 8317 (62.26%) papers did not use “you” (i.e., the control group). We then estimate the effect of “you” on various behavioral and psychological outcomes by comparing the average change in such outcomes before and after a response with “you” versus without “you”. In what follows, this DID model enables us to examine more closely the effect of “you” usage on total number of questions from the reviewers, total length of reviewer comments, and positivity/negativity of the 2nd-round reviewer comments.

In addition, we also employ this DID model to examine the impact of “you” usage on how personal and engaging the reviewer-author communication is. Measurements of interest include the subjectivity of the language used in the reviewer comments, the frequency of reviewers’ use of first-person pronouns, the complexity of the vocabulary used by the reviewers, and the extent to which the reviewers engage with the authors.

Equation ( 2 ) in the Methods section formulates the DID model summarized above. To ensure the robustness of our analysis, a variety of control variables are also included in this model. The summary statistics of our dependent and control variables are presented in Table  1 .

Reviewers wrote less and asked fewer questions following authors’ “you” (vs. non-“you”) usage

Table  2 summarizes the DID estimates on two review outcomes: the total number of questions the reviewer raised, and the total number of words the reviewer wrote. The first non-header row is of particular interest, as it reports the DID estimator, or the effect of the interaction between “you” usage and time (i.e., before vs. after the author’s response).

In Column (1), the significant, negative coefficient (−4.0019) indicates that “you” usage has a negative effect on the total number of questions the reviewer asked. Specifically, when exposed to “you” (vs. non-“you”) author response in the 1st round of review, reviewers raised fewer questions in the 2nd round ( t (25675) = −10.01, p  < 0.001, B = −4.00, 95% CI = [−4.79, −3.22]). This result remains robust when the control variables (see Table  1 ) and paper fixed effects are included in the DID model (“you” usage sees 3.34 fewer questions; t (12319) = −9.40, p  < 0.001, B = −3.34, 95% CI = [−4.03, −2.64]; Column (2)). Similarly, reviewers addressed by “you” (vs. non-“you”) language also wrote 172.15 fewer words as estimated by the basic DID model ( t (25675) = −9.54, p  < 0.001, B = −172.15, 95% CI = [−207.50, −136.79]; Column (3)), or 135.59 fewer words when the control variables and paper fixed effects are included ( t (12319) = −9.36, p  < 0.001, B = −135.59, 95% CI = [−163.98, −107.20]; Column (4)).

Reviewer Comments Are More Positive (and Less Negative) Following Authors’ “You” (vs. Non-“You”) Usage

In addition, we find that authors using “you” also receive more positive (and less negative) reviewer comments during the review process. To assess positivity in a reliable and robust manner, we employed multiple widely-adopted automated text analysis techniques to analyze the reviewer comments (see Sentiments of Reviewers’ Comments in the Methods section for more details on these measurements).

Table  3 summarizes the corresponding DID estimates, with control variables and paper fixed effects included. Columns (1) and (2) reflect the positivity of reviewer comments employing the Python package TextBlob and R package sentimentr, respectively. Columns (3) and (4), on the other hand, assess the negativity of reviewer comments employing the Python package NLTK and a hand-coded lexicon of common negative words, respectively. As indicated in the first non-header row of Table  3 , the findings are consistent across all measurements of review positivity/negativity, such that authors’ use of “you” in the 1st round is significantly associated with increased positivity and decreased negativity of the reviewer comments in the 2nd round.

To further validate these findings, we conducted six additional robustness checks, the detailed results of which are reported in the Supplementary Information for succinctness. To briefly summarize: First, we demonstrate that more “you” usage is associated with a stronger effect on the variables above (Supplementary Note  4 and Supplementary Table  3 ). Second, to construct a cleaner treatment group, we included a paper in the treatment group only when its “you” usage is conversational (as opposed to courteous; e.g., “thank you”). Of all 5042 “you” papers, 1847 (36.63%) contain only courteous “you,” and are thus excluded from analysis during this robustness check (Supplementary Note  4 and Supplementary Table  4 ). Third, to construct a cleaner control group, we only included a paper in the control condition if it explicitly addresses the reviewer in third person (e.g., “the reviewer”; Supplementary Note  4 and Supplementary Table  5 ). Fourth, we employed a matching technique (propensity score matching, PSM) to obtain matched treatment and control groups with comparable observable characteristics (Supplementary Note  4 ; Supplementary Tables  6 , 7 ; Supplementary Fig.  3 ). Fifth, we employed a two-stage Heckman model (Supplementary Note  4 ; Supplementary Tables  8 , 9 ) to capture authors’ “you” usage in response to the initial use of “you” by reviewers. In doing so, we allow for a more reciprocal, dynamic view of the impact of “you.” Sixth, to further account for the non-randomness in “you” usage, we employed placebo (non-parametric permutation) tests to validate that our DID findings are not spurious (Supplementary Note  4 and Supplementary Fig.  4 ). Our results remain robust to all these robust checks.

More personal and engaging conversation following “you” (vs. non-“you”) usage: “I” usage, word complexity, and reviewer engagement

Thus far, we have demonstrated that addressing reviewers as “you” is associated with fewer questions and less writing from the reviewers, as well as more positive and less negative reviewer comments. In postulating the underlying mechanism of the effect, we contend that addressing the other party in second person is also associated with a more personal and engaging conversation, which is in turn responsible for these marked effects on the review process. Below, we examine several potential indicators of personal and engaging conversations to test this hypothesis employing the same DID model.

A potential indicator is the subjectivity of reviewer comments—the extent to which comments reflect personal opinions rather than factual information 33 . High subjectivity in language indicates that the text or utterance is more opinionated and personal (as opposed to factual and unbiased) in nature. The usage of subjective languages is a marked feature of interpersonal conversations 34 , 35 , 36 , 37 . We assess language subjectivity using the Python package TextBlob 38 (see Supplementary Note  5 for method details, and Supplementary Fig.  5 for the most frequently used words in our data indicating subjectivity). However, our prediction that authors’ “you” usage is associated with increased subjectivity in reviewer responses does not reach the 0.05 level of significance (see Column (1) in Table  4 ).

One evidence of a more personal and engaging conversation involves first-person pronoun usage. In our data, authors’ “you” usage is associated with reviewers’ decreased usage of first-person singular pronouns (e.g., “I,” “me,” “my”; see Column (2) in Table  4 ), which can indicate self-focused attention 25 , 26 , 27 , 28 . On the other hand, there is no statistically significant difference for first-person plural pronouns (i.e., “we,” “us,” “our”), which often indicate a communal focus 39 (Supplementary Note  6 and Supplementary Table  12 ). This result suggests that following authors’ “you” usage, reviewer may show less self-focus, hence making fewer “I” statements.

Additional evidence of a more personal conversation is found in word complexity. A reviewer comment is more complex if the words in it contain more syllables on average. We find that authors’ second-person pronoun usage is associated with decreased word complexity in reviewer comments (see Column (3) in Table  4 ). This result suggests that the reviewers, when addressed using second-person pronouns, favored more plain, readable language over complex and formal written language, a choice often made to facilitate a conversation 29 , 30 , 31 , 40 , 41 .

Yet more evidence of personal, engaging conversation is found by employing the text mining technology Latent Dirichlet Allocation (LDA), which identifies the hidden topics in reviewer comments that may potentially indicate reviewers’ engagement with the authors. R package topicmodels was applied on reviewer comments of 1st and 2nd round, and revealed 40 hidden topics at optimal best model fit (see Supplementary Note  7 and Supplementary Fig.  6 ). Here, we focus on one topic (topic 11) that consists of numerous words reflecting communication and engagement during the review process (Fig.  3 ). All 40 identified topics and their top 10 marker words are displayed in Supplementary Note  7 and Supplementary Fig.  7 . The distribution of document-level topic proportions within the chosen topic (i.e., reviewer engagement) is presented in Supplementary Note  7 and Supplementary Fig.  8 .

Clustered into the engagement topic are words such as “address,” “revise,” “concern,” and so on.

We measure the engagement level of a review comment by the frequency of words associated with the identified engagement topic. This frequency is equal to the probability of a review containing the engagement topic, multiplied by the total word count of said review. We find that the topic of engagement appears significantly more frequently in reviewer comments if “you” was used (vs. not used) by the authors. This result again suggests that the use of “you” may have triggered greater engagement in the subject matter of the paper (see Column (4) in Table  4 ). We further experimented with alternative LDA models with 35 and 45 topics, as well as the use of a subset of “high-engagement” words (e.g., “exciting,” “interesting,” and “enjoy”; see all 116 words in Supplementary Note  8 and Supplementary Table  15 ) and the adoption of a structural topic model 42 , 43 . In all alternative models, we obtain results consistent with our predictions (see Supplementary Note  7 and Supplementary Table  13 ). However, no statistically significant difference was observed between the treatment and control groups when the selected topic of reviewer engagement was replaced with other, unrelated topics (see Supplementary Note  7 and Supplementary Table  14 ).

Effect of the usage of second-person pronouns by the reviewers on engagement measurements

If an author’s “you” usage can render conversations more personal and engaging, it follows that this effect should grow even stronger when both parties employ “you” to address each other. In this section, we examine how both parties’ “you” usage jointly impacts indicators of a personal and engaging conversation. This addition of reviewer usage of “you” into our analyses yields a difference-in-difference-in-differences (DDD) model. This DDD model is best viewed as splitting our original DID model into two separate yet comparable DIDs: one with reviewers who used “you” in the 1st round and the other without. This design thus allows us to examine the impact of reviewers’ “you” usage by contrasting the two separate DID models. Indeed, as demonstrated in Supplementary Note  9 , Supplementary Tables  16 , 17 , we find that when the reviewer initiates a “you” (vs. non-“you”) conversation in the first place, most of our DID (save for subjectivity) yields a larger effect size. In other words, the effect of “you” usage is the most evident when both parties use “you” language. Table  5 formally compares the effects of the two DIDs, forming a third differential impact based on reviewers’ initial “you” usage. The spirit of our analysis echoes that of Kenny and colleagues’ seminal work on dyadic data analysis, which factors the role of both parties into the analysis 44 , 45 .

Recall that author’s usage of “you” is sufficient to elicit significant behavioral consequences (i.e., question numbers, word counts, positivity, negativity), irrespective of whether the reviewer used “you” first or not (refer to Supplementary Note  9 ; Supplementary Tables  18 , 19 ). What we attempt to demonstrate here is the amplifying effect of mutual “you” usage on our mechanism—that is, creating a personal, engaging conversation.

Note that although the focus of this research lies in authors’ “you” usage, our DDD model, together with the previously discussed Heckman Model, affords a reciprocal perspective into how reviewers’ “you” usage also impacts the author. Specifically, reviewers’ “you” usage can not only stimulate authors’ “you” usage (Heckman Model) but also strengthen the contribution of “you” usage to boosted engagement (DDD). Also note that our DDD analysis can also cascade into the remaining rounds, and we direct interested readers to Supplementary Note  2 for more information.

Additionally, we report DDD results for number of questions, number of words, positivity, and negativity in Supplementary Tables  18 , 19 . Although the DID effect sizes are generally larger when reviewers used “you” in the 1st round, these DDD results are not statistically significant.

Behavioral experiment

The above analyses provide converging evidence that “you” usage is associated with more personal and engaging communication. However, secondary data have a limited capacity for establishing psychological mechanisms and, crucially, causality. To address this, we conducted a controlled, pre-registered ( https://aspredicted.org/9yw2f.pdf ) experiment to supplement our field data. In this study, 1601 participants were asked to play the role of reviewers and evaluate an author’s response. Of all participants, 901 (56.3%) self-identified as female, 676 (42.2%) as male, and 24 (1.5%) as non-binary or chose not to disclose their gender; M age  = 41.9 years.

Participants were randomly assigned to one of two conditions, in which they were addressed by the author using either “you” or non-“you” language. Participants then responded to a battery of questions regarding the author’s response. Detailed design and procedures are outlined in the Methods section. Key findings are summarized below, while secondary analyses are available in Supplementary Method  1 .

First, an ANOVA reveals that participants addressed with “you” rated the author’s response more positively ( M  = 5.77, SD = 0.98) than did those who were not (M = 5.61, SD = 1.01; F (1, 1599) = 10.62, p  = 0.001, Cohen’s d  = 0.16, 95% CI = [0.06, 0.26]). Furthermore, “you” (vs. non-“you”) usage also led participants to perceive their exchange with the author as more personal and engaging ( M  = 5.13, SD = 1.10 vs. M  = 4.76, SD = 1.24; F (1, 1599) = 40.78, p  < 0.001, Cohen’s d  = 0.32, 95% CI = [0.22, 0.42]). Figure  4 illustrates these findings.

a Participants addressed with “you” (vs. non-“you”) rated the author’s response more positively. b Participants addressed with “you” (vs. non-“you”) found their conversation with the author more personal and engaging. Individual data points are shown using overlaid dot plots. Error bar shows ±1 SE.

Second, a mediation analysis shows that the relationship between “you” usage and positivity is fully mediated by participants’ perception of an personal and engaging communication (unstandardized indirect effect = 0.19, SE = 0.03, 95% CI = [0.14, 0.26]; 5000 bootstrap resamples).

Taken together, “you” usage indeed makes the reviewer–author communication more personal and engaging, which in turn leads to more positive reviewer comments. To further validate these results, we also replicated the main effects and the mediation effect above in a separate sample ( N  = 1200) employing the same experimental design. In this second experiment, we also find that these findings cannot be attributed to alternative processes such as contention, personal connection, or obligation. Refer to Supplementary Method  2 for detailed results.

This work examines the correspondence in the peer review process and finds that when author responses use (vs. do not use) second-person pronouns (e.g., “you”), reviewers ask fewer questions, provide briefer responses, and offer more positive and fewer negative comments. Both lab and field evidence converge to demonstrate that this is the case because “you” (vs. non-“you”) usage fosters a more personal and engaging conversation.

An apparent practical implication of this work is, of course, that authors of academic papers can employ second-person pronouns strategically during the review process to their benefit. However, we believe that our findings extend beyond academic contexts and could be relevant for other forms of (formal) written communication. For example, businesses might utilize “you” in their marketing materials to nudge consumer attitude; likewise, professionals or politicians could use “you” to foster greater engagement. While the effectiveness of these applications requires further empirical validation, the real-world implications of our findings prove both intriguing and potentially impactful.

Conceptually, our study first contributes to the broad literature on language usage, particularly pronoun usage. Researchers have long known that nuances in language use matter. For example, the presence or absence of future tense in a language affects its users’ future orientation 6 , and word choice can signal political stance 46 . Within this field, pronoun usage has fascinated theorists for decades, as it can reflect individuals’ mental states such as narcissism 27 or lead to various mental processes or behaviors (such as introducing independence/interdependence self-construal) 47 , 48 . Recent technological advancements have significantly fueled research on pronoun usage, enabling the collection of large amounts of data from various online platforms 49 , 50 , 51 .

With respect to second-person pronouns, while their usage has been studied in unidirectional, one-off communication 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , understanding “you” usage in dynamic, bilateral, reciprocal contexts remains critical. Thus far, important work has explored the bilateral usage of “you” in close relationships 4 , 15 , 16 , 17 . Additionally, methods like the Actor-Partner Interdependence Model have further enriched our understanding of communications between comparable parties 44 , 45 . Nonetheless, current insights into mutual “you” usage are mostly confined to close relationships whose parties are of relative equal stations. Hence, there remains a need to explore more diverse contexts such as familial, professional, or adversarial communications, particularly those between unequal parties like superiors and subordinates, professors and students, or, in our case, reviewers and authors. Extant work has shown, for instance, that high-power individuals tend to use “I” less often, instead favoring more “we” and “you” usage 52 . In a similar vein, our study enriches our understanding of “you” usage in two-way communications that are both professional and hierarchical.

Moreover, by revealing the link between language and review outcomes, we contribute to the emerging field of science of science, which scientifically probes the practice of science itself 53 , 54 . Regarding the peer review process, several often-overlapping science of science sub-fields, such as bibliometrics, scientometrics, and metascience, have accumulated important insights into how scientific publication works, what potential biases exist, and how to ensure rigorous, transparent outcomes 55 , 56 , 57 . Through the present work, we underscore that perspectives and methods of language study can bear promising fruit in science of science, and we contribute to the few extant works that have already begun to explore this front (finding, e.g., that scientific papers often use generic, overgeneralized language that signals impact at the cost of precision) 5 .

Several limitations in our data should be noted. To begin, the lack of pre-1st-round reviewer comments prevents direct verification of the parallel trend assumption for DID analysis. As a result, the randomness of “you” and non-“you” usage poses a limitation in our data (we have, however, employed such methods to address this issue as PSM, Heckman model, permutation test, and behavioral experiment). Moreover, our dataset comprises only papers eventually published, leading to potential selection biases due to the absence of review reports from rejected submissions or those authors opted not to pursue. Additionally, since publishing review correspondence in Nature Communications was optional before November 2022, our data (April 2016 to April 2021) only include authors who opted for publication. These limitations could hinder our ability to analyze “you” usage in, say, more conflictual communications, despite its well-established potential to convey confrontation (e.g., challenging, blaming, or finger-pointing) 2 , 16 , 17 , 58 . Likewise, selection biases in our data also prevent us from comparing “you” usage in accepted versus rejected manuscripts, or between authors who did versus did not choose to publish their review records. Thus, we encourage future research to explore diverse datasets to expand on our findings.

Furthermore, in this study, we interpret the decreased “I” usage by reviewers following authors’ “you” usage as indicative of a reduction of self-focused attention. However, we recognize the complexities around this inference 59 , as “I” language may also signify language concreteness 1 and self-disclosure 15 , contributing to a more personal conversation. While this alternative account is unlikely to contradict our findings due to extensive triangulation, we nevertheless call on future research to delve deeper into first-person usage in written communication.

This research is approved by the Office of Research and Knowledge Transfer at Lingnan University and complies with all pertinent ethical regulations.

Peer review data

We sourced peer review data for all papers from April 2016 to April 2021 directly from Nature Communications . Each paper’s Supplementary Information section typically hosts its peer review file, which we downloaded using a custom Python (v3.7) script. These files, originally in PDF format, include both reviewer comments and author responses. To create a paper-level peer review dataset, we first separated reviewer comments from author responses for every review round and created separate TXT files for both. We then generated the variables used in our analysis for each paper by review round employing text mining techniques.

To construct the panel data for studying our proposed effects, we employed several automated text analysis techniques to generate desired variables. Specifically, we leveraged Python packages such as TextBlob and NLTK, as well as R packages including sentiments and topicmodels. These methods are well-established in the fields of natural language processing and computer science and are widely adopted in social science studies.

Sentiments of reviewers’ comments

We generated the following four sentiment metrics for reviewer comments. Two of these capture positivity, while the other two capture negativity.

Python-based positivity

Positivity is also known as “polarity” in Python and calculated by the TextBlob Python package. TextBlob calculates how positive a reviewer comment is on a scale ranging from −1.0 (highly negative) to 1.0 (highly positive). This calculation is enabled by TextBlob’s built-in lexicon, which contains a collection of words and their part-of-speech meanings.

R-based positivity

Using the sentimentr package in R, we gained an alternate metric of review positivity, which is also gauged on a −1.0 (highly negative) to 1.0 (highly positive) scale.

Python-based negativity

Utilizing Python’s NLTK package, we derived the negativity of a review. This approach leverages the VADER (Valence Aware Dictionary and Sentiment Reasoner) sentiment analyzer to evaluate each review’s negative emotion scores on a 0 (not negative at all) to 1 (very negative) scale.

Manually coded negativity

Following Delgado et al. 60 , we incorporated the 30 negative words most frequently employed by our sampled reviewers. We also introduced other negative words that recurrently appeared in our dataset, resulting in a compilation of 92 negative terms. To measure negativity, we determined the occurrence rate of these negative words (scaled by dividing by 100). The scale thus starts at 0 (not negative at all) and increases by 0.01 (or 1%) each time one of the 92 negative words is used.

Indicators of personal and engaging conversations

The following four variables serve as indicators of a personal and engaging conversations:

Subjectivity

Assessed using the TextBlob Python package, again using its built-in lexicon. This measure scales from 0 (very objective) to 1 (very subjective). For illustrative examples of varying subjectivity in reviewer comments, see Supplementary Note  5 and Supplementary Table  10 .

First-person singular pronoun usage

Quantified by counting occurrences of terms like “I,” “me,” “my,” and “mine” within a reviewer report.

Word complexity

Captured by the average number of syllables per word in a peer review report. More syllables per word indicates a more complex vocabulary. For examples of complex and simple words, refer to Supplementary Note  5 and Supplementary Table  11 .

Reviewer engagement

Deduced from the proportion of the “engagement topic” in a reviewer report. This proportion is obtained by employing the Latent Dirichlet Allocation (LDA) model, a well-established method in natural language processing that uncovers latent topics within a collection of texts.

In our context, the texts in question are the reviewer reports. The LDA model assumes that each report comprises several topics (with the combined probability of all topics being 1) and that every topic is a discrete probability distribution over all words. By implementing the LDA model with a predetermined number of topics, document–topic and topic–word pairs can be formed based on the words included in each reviewer report, allowing us to identify latent topics.

To implement the LDA model, we followed a data preprocessing approach similar to those used in recent studies 61 . Initial steps involved the removal of stop words (e.g., “and,” “or”), numbers, and punctuation. We also use stemmed and lower-case words for consistency. We then employed the R package topicmodels to assess the model performance and estimate an appropriate number of topics. Specifically, after experimenting with topic counts ranging from 10 to 100 (at 10-topic intervals), we determined 40 to be the optimal number in that it has the lowest perplexity score. With topic number set to 40, the engagement level was subsequently formulated as:

where % of engagement topic is the probability or proportion of the engagement-related topic in the review text calculated by the LDA analysis. Number of words in the reviewer report is the total word count in each review text.

We employ the difference-in-differences (DID) model to identify the impact of second-person pronouns on various outcome variables of interest. Specifically, we estimate the following model:

Where \({y}_{{it}}\) represents the outcome variable of paper i in round t . Response_with_you it denotes whether the author(s) of a paper responded with “you”, taking the value of 1 if the response includes “you” and 0 otherwise. After_response it denotes whether the observation period is after the response, taking the value of 1 if so and 0 otherwise. X it is a vector of controlling variables of a paper, including (1) the number of pages 62 ; (2) the number of references 63 ; (3) the title length; (4) the number of authors 64 ; (5) H-index of the first author 65 ; (6) the gender of the first author 61 ; (7) the last initial of the first author 66 ; (8) the positivity of authors in the 1 st round of review; (9) the friendliness of authors in the 1st round of review; (10) the positivity of reviewers in the 1st round of review; (11) the month the paper was published 67 ; (12) the year the paper was published 67 ; and (13) the discipline to which the paper belongs ( Nature Communications identifies five disciplines: biological sciences, physical sciences, health sciences, earth and environmental sciences, and scientific community and society). \({\delta }_{i}\) is the paper fixed effects, controlling for the potentially unobserved paper-level factors. \({\varepsilon }_{{it}}\) is a random error term. The coefficient β 1 is our coefficient of interest, examining the differential effects of responses with and without “you” (on various outcomes) before and after the response. We find that the residuals for DID models approximate a normal distribution, and the variance of the residuals is stable across different levels of the independent variables, as exemplified in Supplementary Fig.  9 .

Pre-registration

The behavioral experiment was pre-registered on April 28, 2023 (Pacific Time) with AsPredicted ( https://aspredicted.org/9yw2f.pdf ). Here, we disclose a total of two deviations from the pre-registration protocol. First, the reported mediation analysis was not originally included in the protocol and was added in response to a review comment. Second, the actual sample size exceeded the pre-registered target by one participant, as explained below.

Participants

We recruited 1601 Amazon Mechanical Turk panelists via the CloudResearch platform, who participated in the study for monetary compensation. No statistical method was used to predetermine sample size. All participants provided informed consent before participating in the study.

The pre-registered target sample size was 1600. However, due to CloudResearch’s process for determining sample size, which is outside our control, the study eventually yielded 1601 participants. This deviation was anticipated and noted in our pre-registration.

The participant gender distribution is as follows: Of all 1601 participants, 901 (56.3%) self-identified as female, 676 (42.2%) as male, and 24 (1.5%) as non-binary or chose not to disclose their gender. While we did not plan for a priori gender-based analysis, we have included the results of post hoc analyses in Supplementary Method  1 , in compliance with the editorial policies of the Nature Portfolio (as of November 12, 2023).

Data exclusion

Our pre-registration dictates that data would be excluded from analysis if flagged as fraudulent by Qualtrics, the survey platform used for our study. However, Qualtrics’ Expert Review function did not detect any fraud that would warrant data exclusion. Consequently, no data were excluded from the analyses.

After providing informed consent, all participants were asked to read a brief introduction to the peer review process. The introduction read “Peer review is a process all academics need to go through if they want to get their research work published. When a researcher submits a research paper to an academic journal, the paper is subject to an independent assessment by other field experts called the reviewers (whose role we ask you to play here).”

All participants were then asked to imagine that they had recently reviewed a manuscript for an academic journal. To provide sufficient realism, this hypothetical manuscript was very loosely adapted from a 2020 paper published in Nature Communications 68 , selected due to its subject matter being easily understandable for laypersons. Specifically, participants were told that “This work examines the possibility that people with more emotional experience (joy, anger, distress, etc.) also have richer emotional vocabulary (i.e., words describing states of emotions) in their language usage.”

All participants were then instructed to imagine that after reviewing the manuscript, they wrote the following comments to the author of the paper:

Overall, the paper presents an interesting theory and is well-written.

The studies included in the paper are well designed and the interpretation of data is generally convincing.

That being said, detailed criteria on what counts as “emotional vocabulary” are lacking. For instance, the usage of such words as “alone” or “bad” does not necessarily carry emotional connotations. As a result, the inclusion of such words in data analysis may prove problematic.

The contribution of the work is insufficiently elaborated. To this end, the paper needs to better explain why this work helps advance what the field already knows.

Note that no “you” language was presented in these comments.

All participants were then informed that they had now received the author’s responses. The responses were otherwise identical, save for how the participants (i.e., the reviewers) were addressed. By this design, participants were randomly assigned to one of the two conditions (i.e., “you” and non-“you”). Specifically, participants in the “you” [non-“you”] condition read:

We appreciate your [the reviewer’s] comments, which we find very useful. With regard to the questions you [the reviewer] raised:

You [The reviewer] advised us to provide details on how emotional vocabulary is determined. Building on your [the reviewer’s] advice, we now include a thorough discussion of your [the reviewer’s] concern over this issue, and lay out the selection procedure of those words in the manuscript.

In this discussion, we also address your [the reviewer’s] concern that some words are not applied solely to emotional experience.

You [The reviewer] suggested that the contribution of this work be differentiated from existing research. Following your [the reviewer’s] suggestion, we explain how this work advances the understanding of emotions and affective language.

As per your [the reviewer’s] recommendation, in this revision we also further elaborate the contribution of this work in the discussion section.

The participants were unaware of their assigned condition and were not cognizant of the existence of the alternate condition to which they were not assigned. The investigators, on the other hand, were not blinded to allocation during experiments and outcome assessment.

Participants were then prompted to evaluate the how personal and engaging they found the conversation to be on a 4-item, 7-point Likert scale (1 = strongly disagree; 7 = strongly agree; Cronbach’s α = 0.86): “In general, I find the conversation between the parties engaging,” “The author is engaging in a personal conversation with me,” “The correspondence between the reviewer and the author feels conversational,” and “I find the author personable.” Participants also rated the positivity of the author’s response on a single-item Likert scale “My overall impression of the author’s response is positive.”

Reporting summary

Further information on research design is available in the  Nature Portfolio Reporting Summary linked to this article.

Data availability

All data necessary for reproducing the results presented in this paper have been deposited in OSF ( https://doi.org/10.17605/OSF.IO/XWYS4 ) 69 .

Code availability

All code necessary to reproduce our analyses are available at OSF ( https://doi.org/10.17605/OSF.IO/XWYS4 ) 69 .

Yin, Y., Wakslak, C. J. & Joshi, P. D. “I” am more concrete than “we”: Linguistic abstraction and first-person pronoun usage. J. Pers. Soc. Psychol. 122 , 1004–1021 (2022).

Article   PubMed   Google Scholar  

Biesen, J. N., Schooler, D. E. & Smith, D. A. What a difference a pronoun makes: I/We versus you/me and worried couples’ perceptions of their interaction quality. J. Lang. Soc. Psychol. 35 , 180–205 (2016).

Article   Google Scholar  

Packard, G., Moore, S. G. & McFerran, B. (I’m) happy to help (you): the impact of personal pronoun use in customer-firm interactions. J. Mark. Res. 55 , 541–555 (2018).

Seraj, S., Blackburn, K. G. & Pennebaker, J. W. Language left behind on social media exposes the emotional and cognitive costs of a romantic breakup. Proc. Natl Acad. Sci. USA 118 , e2017154118 (2021).

Article   CAS   PubMed   PubMed Central   Google Scholar  

DeJesus, J. M., Callanan, M. A., Solis, G. & Gelman, S. A. Generic language in scientific communication. Proc. Natl Acad. Sci. USA 116 , 18370–18377 (2019).

Article   CAS   PubMed   PubMed Central   ADS   Google Scholar  

Chen, M. K. The effect of language on economic behavior: evidence from savings rates, health behaviors, and retirement assets. Am. Econ. Rev. 103 , 690–731 (2013).

Brunyé, T. T., Ditman, T., Mahoney, C. R., Augustyn, J. S. & Taylor, H. A. When you and I share perspectives: pronouns modulate perspective taking during narrative comprehension. Psychol. Sci. 20 , 27–32 (2009).

Escalas, J. E. Self-referencing and persuasion: narrative transportation versus analytical elaboration. J. Consum. Res. 33 , 421–429 (2007).

Mildorf, J. Reconsidering second-person narration and involvement. Lang. Lit. 25 , 145–158 (2016).

Orvell, A., Kross, E. & Gelman, S. A. “You” and “I” in a foreign land: the persuasive force of generic-you. J. Exp. Soc. Psychol . 85 , 103869 (2019).

Orvell, A., Kross, E. & Gelman, S. A. How “you” makes meaning. Science 355 , 1299–1302 (2017).

Article   CAS   PubMed   ADS   Google Scholar  

Orvell, A., Kross, E. & Gelman, S. A. Lessons learned: young children’s use of generic-you to make meaning from negative experiences. J. Exp. Psychol. Gen. 148 , 184–191 (2019).

Orvell, A., Kross, E. & Gelman, S. A. “You” speaks to me: effects of generic-you in creating resonance between people and ideas. Proc. Natl Acad. Sci. USA 117 , 31038–31045 (2020).

Packard, G. & Berger, J. Thinking of you: how second-person pronouns shape cultural success. Psychol. Sci. 31 , 397–407 (2020).

Slatcher, R. B., Vazire, S. & Pennebaker, J. W. Am “I” more important than “we”? Couples’ word use in instant messages. Pers. Relatsh. 15 , 407–424 (2008).

Simmons, R. A., Gordon, P. C. & Chambless, D. L. Pronouns in marital interaction: What do “you” and “I” say about marital health? Psychol. Sci. 16 , 932–936 (2005).

Williams-Baucom, K. J., Atkins, D. C., Sevier, M., Eldridge, K. A. & Christensen, A. “You” and “I” need to talk about “us”: Linguistic patterns in marital interactions. Pers. Relatsh. 17 , 41–56 (2010).

Smoke, T. A Writer’s Workbook: A Writing Text with Readings . (Cambridge University Press, 2005).

Webb, C. The use of the first person in academic writing: objectivity, language and gatekeeping. J. Adv. Nurs. 17 , 747–752 (1992).

Article   CAS   PubMed   Google Scholar  

Hinkel, E. Objectivity and credibility in L1 and L2 academic writing. in Culture in second language teaching and learning (ed Hinkel, E.) (Cambridge University Press, 1999).

Brown, P., Levinson, S. C. & Gumperz, J. J. Politeness: Some Universals Language Usage (Cambridge University Press, 1987).

Hwang, K. Face and favor: the Chinese power game. Am. J. Sociol. 92 , 944–974 (1987).

Watts, R. J., Ide, S. & Ehlich, K. Politeness in Language (De Gruyter, 1992).

DeBono, A., Shmueli, D. & Muraven, M. Rude and inappropriate: the role of self-control in following social norms. Pers. Soc. Psychol. B 37 , 136–146 (2011).

Martínez, I. A. Native and non-native writers’ use of first person pronouns in the different sections of biology research articles in English. J. Second Lang. Writ. 14 , 174–190 (2005).

Davis, D. & Brock, T. C. Use of first person pronouns as a function of increased objective self-awareness and performance feedback. J. Exp. Soc. Psychol. 11 , 381–388 (1975).

Raskin, R. & Shaw, R. Narcissism and the use of personal pronouns. J. Pers. 56 , 393–404 (1988).

Zimmermann, J., Wolf, M., Bock, A., Peham, D. & Benecke, C. The way we refer to ourselves reflects how we relate to others: associations between first-person pronoun use and interpersonal problems. J. Res. Pers. 47 , 218–225 (2013).

Lewis, M. L. & Frank, M. C. The length of words reflects their conceptual complexity. Cognition 153 , 182–195 (2016).

Koppen, K., Ernestus, M. & Van Mulken, M. The influence of social distance on speech behavior: formality variation in casual speech. Corpus Linguist. Ling. 15 , 139–165 (2019).

DuBay, W. H. The Principles of Readability (Impact Information, 2004).

Goel, V., Grafman, J., Tajik, J., Gana, S. & Danto, D. A study of the performance of patients with frontal lobe lesions in a financial planning task. Brain 120 , 1805–1822 (1997).

Bravo, G., Grimaldo, F., López-Iñesta, E., Mehmani, B. & Squazzoni, F. The effect of publishing peer review reports on referee behavior in five scholarly journals. Nat. Commun. 10 , 322 (2019).

Article   PubMed   PubMed Central   ADS   Google Scholar  

Bybee, J. L. & Hopper, P. J. Frequency and the Emergence of Linguistic Structure Vol 45 (John Benjamins Publishing Company, 2001).

Kärkkäinen, E. Stance taking in conversation: from subjectivity to intersubjectivity. Text. Talk. 26 , 699–731 (2006).

Du Bois, J. W. & Kärkkäinen, E. Taking a stance on emotion: affect, sequence, and intersubjectivity in dialogic interaction. Text. Talk. 32 , 433–451 (2012).

Google Scholar  

Baumgarten, N., House, J. & Du Bois, I. Subjectivity in Language and in Discourse (Brill, 2012).

Lorla, S. TextBlob Documentation Release 0.16.0. TextBlob (2020).

Pennebaker, J. W., Booth, R. J., Boyd, R. L. & Francis, M. E. Linguistic Inquiry and Word Count: LIWC2015 (Pennebaker Conglomerates, 2015).

Oppenheimer, D. M. Consequences of erudite vernacular utilized irrespective of necessity: Problems with using long words needlessly. Appl. Cogn. Psychol. 20 , 139–156 (2006).

Flesch, R. A new readability yardstick. J. Appl. Psychol. 32 , 221–233 (1948).

Roberts, M. E., Tingley, D., Stewart, B. M. & Airoldi, E. M. The structural topic model and applied social science. in Advances in neural information processing systems workshop on topic models: computation, application, and evaluation (2013).

Roberts, M. E., Stewart, B. M. & Tingley, D. stm: An R package for structural topic models. J. Stat. Softw. 91 , 1–40 (2019).

Kenny, D. A. Interpersonal Perception: The Foundation of Social Relationships (Guilford Press, 2019).

Kenny, D. A., Kashy, D. A. & Cook, W. L. Dyadic Data Analysis (Guilford Press, 2020).

Gentzkow, M., Shapiro, J. M. & Taddy, M. Measuring group differences in high‐dimensional choices: method and application to congressional speech. Econometrica 87 , 1307–1340 (2019).

Article   MathSciNet   Google Scholar  

Kühnen, U. & Oyserman, D. Thinking about the self influences thinking in general: cognitive consequences of salient self-concept. J. Exp. Soc. Psychol. 38 , 492–499 (2002).

Gardner, W. L., Gabriel, S. & Lee, A. Y. ‘I’ value freedom, but ‘we’ value relationships: Self-construal priming mirrors cultural differences in judgment. Psychol. Sci. 10 , 321–326 (1999).

Iliev, R., Dehghani, M. & Sagi, E. Automated text analysis in psychology: methods, applications, and future developments. Lang. Cogn. 7 , 265–290 (2015).

Pennebaker, J. W. & Chung, C. K. Counting little words in big data: the psychology of individuals, communities, culture, and history. in Social cognition and communication (eds Forgas, J. P., Vincze, O. & László, J.) 25–42 (Psychology Press, 2014).

Humphreys, A., Wang, R. J.-H., Fischer, E. & Price, L. Automated text analysis for consumer research. J. Consum. Res. 44 , 1274–1306 (2018).

Kacewicz, E., Pennebaker, J. W., Davis, M., Jeon, M. & Graesser, A. C. Pronoun use reflects standings in social hierarchies. J. Lang. Soc. Psychol. 33 , 125–143 (2014).

Fortunato, S. et al. Science of science. Science 359 , eaao0185 (2018).

Article   PubMed   PubMed Central   Google Scholar  

Wang, D. & Barabási, A.-L. The Science of Science (Cambridge University Press, 2021).

Belter, C. W. Bibliometric indicators: opportunities and limits. J. Med. Libr. Assoc. 103 , 219–221 (2015).

Huisman, J. & Smits, J. Duration and quality of the peer review process: the author’s perspective. Scientometrics 113 , 633–650 (2017).

Elson, M., Huff, M. & Utz, S. Metascience on peer review: testing the effects of a study’s originality and statistical significance in a field experiment. Adv. Methods Pract. Psychol. Sci. 3 , 53–65 (2020).

Rogers, S. L., Howieson, J. & Neame, C. I understand you feel that way, but I feel this way: the benefits of I-language and communicating perspective during conflict. PeerJ 6 , e4831 (2018).

Carey, A. L. et al. Narcissism and the use of personal pronouns revisited. J. Pers. Soc. Psychol. 109 , e1–e15 (2015).

Article   MathSciNet   PubMed   Google Scholar  

Delgado, A. F., Garretson, G. & Delgado, A. F. The language of peer review reports on articles published in the BMJ, 2014–2017: an observational study. Scientometrics 120 , 1225–1235 (2019).

Leung, F. F., Gu, F. F., Li, Y., Zhang, J. Z. & Palmatier, R. W. Influencer marketing effectiveness. J. Mark. 86 , 93–115 (2022).

Card, D. & DellaVigna, S. Page limits on economics articles: evidence from two journals. J. Econ. Perspect. 28 , 149–168 (2014).

Vieira, E. S. & Gomes, J. A. N. F. Citations to scientific articles: its distribution and dependence on the article features. J. Informetr. 4 , 1–13 (2010).

Freeman, R. B. & Huang, W. Collaborating with people like me: ethnic coauthorship within the United States. J. Labor Econ. 33 , S289–S318 (2015).

Hirsch, J. E. Does the h index have predictive power? Proc. Natl Acad. Sci. USA 104 , 19193–19198 (2007).

Huang, W. Do ABCs get more citations than XYZs? Econ. Inq. 53 , 773–789 (2015).

Ma, C., Li, Y., Guo, F. & Si, K. The citation trap: papers published at year-end receive systematically fewer citations. J. Econ. Behav. Organ. 166 , 667–687 (2019).

Vine, V., Boyd, R. L. & Pennebaker, J. W. Natural emotion vocabularies as windows on distress and well-being. Nat. Commun. 11 , 4525 (2020).

Cao, C. C. Behavioral consequences of second-person pronouns in written communications between authors and reviewers of scientific papers. OSF. https://doi.org/10.17605/OSF.IO/XWYS4 (2023).

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Acknowledgements

C.C. is supported by the Research Grants Council of Hong Kong (13501722) and the Lam Woo Research Fund (F871223) at Lingnan University. Y.L. is supported by the Research Grants Council of Hong Kong (13503323), the Lam Woo Research Fund (LWP20020) and Faculty Research Grant (DB23A5) at Lingnan University, and the National Natural Science Foundation of China (72271060). C.M. is supported by the General Project of National Natural Science Foundation of China (72074045).

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These authors contributed equally: Zhuanlan Sun, C. Clark Cao, Sheng Liu.

Authors and Affiliations

High-Quality Development Evaluation Institute, Nanjing University of Posts and Telecommunications, Nanjing, China

Zhuanlan Sun

Department of Marketing and International Business, Lingnan University, Hong Kong, China

C. Clark Cao, Sheng Liu & Yiwei Li

School of Economics and Management, Southeast University, Nanjing, China

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C.M., Y.L., Z.S. and C.C. designed research; Z.S., C.C., Y.L. and C.M. performed research; Z.S., C.C. and S.L. collected and analyzed data; and Z.S., C.C. and Y.L. wrote the paper. All authors wrote, edited, and revised the manuscript.

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Correspondence to Yiwei Li or Chao Ma .

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Sun, Z., Cao, C.C., Liu, S. et al. Behavioral consequences of second-person pronouns in written communications between authors and reviewers of scientific papers. Nat Commun 15 , 152 (2024). https://doi.org/10.1038/s41467-023-44515-1

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Using personal pronouns in research writing

15 October 2009

Should you use “I” or “we” or neither in your thesis or paper?

Thoughts on this have changed over the years. Traditionally, using personal pronouns like “I” and “we” was frowned on. Instead of saying “In Section 3, I have compared the results from method X with those of method Y”, you were expected to write “In section 3, the results from method X are compared with those from method Y”. This is known as writing in the “passive voice” , and for many years it has been considered the “academic” way of doing things. I think it is favoured because of the tone of detachment and impersonality that it helps establish.

Sometimes the passive voice is awkward. For example

In studying ARIMA models, the effect of the estimation method on forecast accuracy was explored.

This is easier to express using “I”:

In studying ARIMA models, I explored the effect of the estimation method on forecast accuracy.

In my exponential smoothing monograph , one of the coauthors preferred to write everything in the passive voice, which led to some rather awkward phrasing. (I edited all chapters to consistently use “we” before it went to print.)

There are still some journals and research supervisors who insist that research writing must be in the passive voice. However, the situation is slowly changing and now many journals accept, or even encourage, the use of personal pronouns. The International Journal of Forecasting which I edit allows authors to use whichever approach they prefer.

A related issue for research students writing a thesis is whether to use “I” or “we”, especially when the material has previously appeared in a co-authored paper. In general, I prefer students to use “I” when they mean the author, as it is their thesis. (The royal “we” should only be used by monarchs.) However, it is very important to include a statement at the front of the thesis clarifying the role of co-authors involved with any parts of the thesis. If a chapter is essentially a co-authored paper, many universities require a signed statement from all authors.

One area where “we” is useful is in referring to the reader and author together. For example,

In the following theorem, we see that …

This is particularly common in mathematics.

In summary:

• Write in the most natural way. It is ok if that means using “I”.
• Use “we” if you mean “the reader and I”, or if you are writing a coauthored paper.
• Don’t use “we” if you only mean yourself.

How to Use Pronouns Effectively While Writing Research Papers?

Usage of Pronouns in an Article

• Smooth: For the smooth flow of writing, pronouns are a necessary tool. Any article, book, or academic paper needs pronouns. If pronouns are replaced by nouns everywhere in a piece of writing, its readability would decrease, making it clumsy for the reader. However, the correct usage of pronouns is also required for the proper understanding of a subject.
• Simple to Read: In academic writing, it is important to use the accurate pronoun with the correct noun in the correct place of the sentence. If the pronouns make an article complicated instead of simple to read, they have not been used effectively.
• Singular/Plural, Person: When the pronoun that substitutes a noun agrees with the number and person of that noun, the writing becomes more meaningful. Here, the number implies whether the noun is singular or plural, and person implies whether the noun is in the first, second, or third person.
• Gender-Specific: Gender-specific pronouns bring clarity to the writing. If it is a feminine noun, the pronoun should be ‘she’, and for a masculine noun, it should be ‘he’. If the gender is not specified, both ‘he’ and ‘she’ should be used. In the case of plural nouns, ‘they’ should be used.
• Exceptions: Terms like ‘everyone’ and ‘everybody’ seem to be plural, but they carry singular pronouns. Singular pronouns are used for terms like ‘anybody’, ‘anyone’, ‘nobody’, ‘each’, and ‘someone’. These pronouns are also needed in academic writing.

Which Pronoun Should be Used Where?

• Personal Pronoun: If the author is writing from the first-person singular or plural point of view, then pronouns like ‘I’, ‘me’, ‘mine’, ‘my’, ‘we’, ‘our’, ‘ours’, and ‘us’ can be used. Academic writing considers these as personal pronouns. They make the author’s point of view and the results of the research immodest and opinionated. These pronouns should be avoided in academic writing as they understate the research findings. Authors must remember that their research and results should the focus, not themselves.
• First Person Plural Pronoun: Though sometimes ‘I’ can be used in the abstract, introduction, discussion, and conclusion sections, it should be avoided. It is advisable to use ‘we’ instead.
• Second Person Pronoun: The use of pronouns such as ‘you’, ‘your’, and ‘yours’ is also not appropriate in academic writing. They can be used to give instructions. It is better to use impersonal pronouns instead.
• Gender-Neutral Pronoun: Publications and study guides demand the writing to be gender-neutral which is why, either ‘s/he’ or ‘they’ is used.
• Demonstrative Pronoun: While using demonstrative pronouns such as this, that, these, or those, it should be clear who is being referred to.

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• Nouns and pronouns
• What Is a Pronoun? | Definition, Types & Examples

What Is a Pronoun? | Definition, Types & Examples

Published on October 17, 2022 by Jack Caulfield . Revised on March 2, 2023.

A pronoun is a word that stands in for a noun , often to avoid the need to repeat the same noun over and over. Like nouns, pronouns can refer to people, things, concepts, and places. Most sentences contain at least one noun or pronoun.

People tend to use “pronouns” to mean personal pronouns specifically, but there are many other kinds of pronouns that are just as important to English grammar. The words highlighted in bold below are all pronouns.

It might rain tomorrow, but there isn’t much we can do about that .

These are the days that I like best.

Table of contents

How are pronouns used in sentences, pronouns vs. nouns, pronouns vs. determiners, personal pronouns (first-, second-, and third-person).

• Demonstrative pronouns
• Interrogative pronouns
• Relative pronouns
• Indefinite pronouns
• Reciprocal pronouns
• Dummy pronouns (expletives)

Other interesting language articles

Frequently asked questions.

The main function of pronouns is to replace nouns. Because of this, they are used in sentences in similar ways to nouns.

Like nouns, pronouns commonly serve as the subject of a sentence, followed by a verb (a word expressing an action).

We have never been to Germany before.

A pronoun can also function as the object in a sentence—either a direct or indirect object:

• The direct object is something or someone that is directly acted upon by the verb.
• The indirect object is someone or something that receives the direct object.

Can you promise her this ? Note A noun phrase is a noun or pronoun in combination with any determiners applied to it. Despite the name, noun phrases can just as well consist of pronouns as of nouns.

Pronoun antecedents

The antecedent of a pronoun is the noun that it refers back to. It’s usually mentioned in the text before the pronoun, but sometimes it comes just after it in a sentence. The antecedent may also be something the person you’re speaking to said. Pronoun-antecedent agreement means ensuring that the pronoun you use matches its antecedent in number, person, and gender.

As they debated the point, the students became increasingly animated.

Person A: What do you think of Julian ?

When you use any type of pronoun, it’s important to ensure that the antecedent is clear and unambiguous. If there is any ambiguity, use the noun instead. For example, below, “it” would be unclear, as it could refer to either the interview or the test.

• After the interview and the written test were completed, it was checked for incomplete answers.
• After the interview and the written test were completed, the test was checked for incomplete answers.

Check for common mistakes

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While pronouns constitute a relatively small class of words that tends not to change over time, nouns are a much broader class that is constantly expanding. Like pronouns, nouns refer to things, people, places, and concepts, but they do so with much greater specificity.

Like pronouns, nouns can function as the head of a noun phrase and as the object or subject of a verb . A complete sentence may consist of just a noun and a verb (“Jeremy spoke.”), just as it could of a pronoun and a verb (“He spoke.”).

Unlike pronouns, nouns are fixed in form—they don’t change spellings depending on their grammatical role in a sentence. For example, while the third-person masculine pronoun “he” becomes “him” when used as an object, the noun “man” doesn’t change.

Many pronouns are closely related to determiners, being spelled similarly (or identically) and expressing related meanings. For example, possessive pronouns like “yours” are closely related to possessive determiners like “your”; and demonstrative pronouns like “that” are identical to the demonstrative determiners.

The grammatical distinction between the two is that pronouns stand on their own as the subject or object of a verb, whereas determiners are only used to modify nouns, not acting as subjects or objects in their own right.

Personal pronouns are words like “he” that refer to yourself, the person you’re addressing, or other people and things. They usually refer to an antecedent but may occur without one when the reference is self-evident (e.g., “I” always refers to the person saying or writing it).

Personal pronouns can change their form based on:

• Person ( first- , second- , or third-person )
• Number (singular or plural)
• Gender (masculine, feminine, neuter, or epicene)
• Case ( subject , object , possessive , or reflexive / intensive )

The impersonal pronoun “one” is used in general statements about no particular person. It has fewer forms than the personal pronouns but is otherwise used in the same way.

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The four demonstrative pronouns ( this , that , these , and those ) are used to indicate something previously mentioned or, in conversation, something that is clear from the context. For example, in the sentence “Take this,” “this” has no explicit antecedent, but it would be clear in context that it referred to whatever object you were being given.

The demonstrative pronouns give information about the relative closeness (literal or figurative) of the things they refer to, especially when they’re contrasted with each other:

• The “near” demonstrative this (singular) or these (plural) indicates something close to you.
• The “far” demonstrative that (singular) or those (plural) indicates something farther from you.

Interrogative pronouns are used (along with other types of interrogative words) to introduce questions. The interrogative pronouns are:

• What and which , used to ask questions about things
• Who and whom , used to ask about people
• Whose , used to ask about ownership

What were your favorite classes at school?

A relative pronoun is used to introduce a relative clause—a phrase that usually supplies more information about the preceding noun. They have a lot in common with interrogative pronouns. The relative pronouns are:

• Which(ever) , that , and what(ever) , used in relation to things
• Who(ever) and whom(ever) , used in relation to people
• Whose , used to indicate ownership

Relative pronouns are often omitted in practice (e.g., “the book [that] I read”). There’s nothing wrong with doing this as long as it doesn’t create ambiguity.

It doesn’t matter whose it was; it’s ours now!

Indefinite pronouns are words like “somebody” that refer to an unspecified person or thing. Many of them are formed using some combination of some- , any- , every- , or no- with -thing , -one , -where , or -body .

There are also various indefinite pronouns used to describe quantity, such as “little,” “many,” “none,” and “enough.” And there are distributive pronouns like “neither” and “each” that allow you to distinguish between options.

The impersonal pronoun “one” can also be regarded as indefinite.

No one likes him, and he doesn’t like anyone .

Some are born lucky, while others have to work hard for everything they get.

Reciprocal pronouns are used to indicate a reciprocal relationship between two people or things, where the members of a group each perform the same action relative to the other(s). The English reciprocal pronouns are each other and one another .

Some writers claim that “each other” should only be used to refer to groups of two and “one another” to groups of three or more. But this distinction is rejected by most style guides and not borne out in practice; you can use the two interchangeably.

A dummy pronoun (also called an expletive ) is a pronoun that doesn’t have any explicit meaning but is necessary to the sentence structure . Unlike other pronouns, dummy pronouns don’t actually replace a noun.

The two words used as dummy pronouns in English are it and there . Note that both words can also fulfill other grammatical roles. Dummy pronouns are commonly used to talk about the weather, to emphasize certain elements in a sentence, or to introduce the existence of something.

There are thousands of different species of birds in the world.

If you want to know more about nouns , pronouns, verbs , and other parts of speech , make sure to check out some of our other language articles with explanations and examples.

Nouns & pronouns

• Common nouns
• Proper nouns
• Collective nouns
• Personal pronouns
• Uncountable and countable nouns
• Verb tenses
• Phrasal verbs
• Types of verbs
• Active vs passive voice
• Subject-verb agreement
• Interjections
• Determiners
• Prepositions

The term preferred pronouns is used to mean the (third-person) personal pronouns a person identifies with and would like to be referred to by. People usually state the subject and object pronoun (e.g., “she/her”) but may also include the possessive (e.g., “she/her/hers”).

Most people go by the masculine “he/him,” the feminine “she/her,” the gender-neutral singular “they/them,” or some combination of these. There are also neopronouns used to express nonbinary gender identity, such as “xe/xem.” These are less common than the singular “they.”

The practice of stating one’s preferred pronouns (e.g., in a professional context or on a social media profile) is meant to promote inclusion for transgender and gender-nonconforming people. The first- and second-person pronouns (“I” and “you”) are not included, since they’re the same for everyone.

A pronoun is a word that stands in for a noun. Like nouns, pronouns refer to people, things, concepts, or places. Most sentences contain at least one noun or pronoun.

A pronoun can serve as the subject or object in a sentence, and it will usually refer back (or sometimes forward) to an antecedent—the noun that the pronoun stands in for. Pronouns are used to avoid the need to repeat the same nouns over and over.

Pronouns can be categorized into many types, all of which are very commonly used in English:

• Subject and object pronouns
• Possessive pronouns
• Reflexive pronouns and intensive pronouns
• Impersonal pronouns

Pronouns are words like “I,” “she,” and “they” that are used in a similar way to nouns . They stand in for a noun that has already been mentioned or refer to yourself and other people.

Pronouns can function just like nouns as the head of a noun phrase and as the subject or object of a verb . However, pronouns change their forms (e.g., from “I” to “me”) depending on the grammatical context they’re used in, whereas nouns usually don’t.

Sources in this article

We strongly encourage students to use sources in their work. You can cite our article (APA Style) or take a deep dive into the articles below.

Caulfield, J. (2023, March 02). What Is a Pronoun? | Definition, Types & Examples. Scribbr. Retrieved March 27, 2024, from https://www.scribbr.com/nouns-and-pronouns/pronouns/

Aarts, B. (2011).  Oxford modern English grammar . Oxford University Press.

Butterfield, J. (Ed.). (2015).  Fowler’s dictionary of modern English usage  (4th ed.). Oxford University Press.

Garner, B. A. (2016).  Garner’s modern English usage (4th ed.). Oxford University Press.

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• The Scientist University

The Fundamentals of Academic Science Writing

Writing is an essential skill for scientists, and learning how to write effectively starts with good fundamentals and lots of practice..

Nathan Ni holds a PhD from Queens University. He is a science editor for The Scientist’s Creative Services Team who strives to better understand and communicate the relationships between health and disease.

View full profile.

Learn about our editorial policies.

Writing is a big part of being a scientist, whether in the form of manuscripts, grants, reports, protocols, presentations, or even emails. However, many people look at writing as separate from science—a scientist writes, but scientists are not regarded as writers. 1 This outdated assertion means that writing and communication has been historically marginalized when it comes to training and educating new scientists. In truth, being a professional writer is part of being a scientist . 1 In today’s hypercompetitive academic environment, scientists need to be as proficient with the pen as they are with the pipette in order to showcase their work. 

Using the Active Voice

Stereotypical academic writing is rigid, dry, and mechanical, delivering prose that evokes memories of high school and undergraduate laboratory reports. The hallmark of this stereotype is passive voice overuse. In writing, the passive voice is when the action comes at the end of a clause—for example, “the book was opened”. In scientific writing, it is particularly prevalent when detailing methodologies and results. How many times have we seen something like “citric acid was added to the solution, resulting in a two-fold reduction in pH” rather than “adding citric acid to the solution reduced the pH two-fold”?

Scientists should write in the active voice as much as possible. However, the active voice tends to place much more onus on the writer’s perspective, something that scientists have historically been instructed to stay away from. For example, “we treated the cells with phenylephrine” places much more emphasis on the operator than “the cells were treated with phenylephrine.” Furthermore, pronoun usage in academic writing is traditionally discouraged, but it is much harder, especially for those with non-native English proficiency, to properly use active voice without them. 

Things are changing though, and scientists are recognizing the importance of giving themselves credit. Many major journals, including Nature , Science , PLoS One , and PNAS allow pronouns in their manuscripts, and prominent style guides such as APA even recommend using first-person pronouns, as traditional third-person writing can be ambiguous. 2 It is vital that a manuscript clearly and definitively highlights and states what the authors specifically did that was so important or novel, in contrast to what was already known. A simple “we found…” statement in the abstract and the introduction goes a long way towards giving readers the hook that they need to read further.

Keeping Sentences Simple

Writing in the active voice also makes it easier to organize manuscripts and construct arguments. Active voice uses fewer words than passive voice to explain the same concept. It also introduces argument components sequentially—subject, claim, and then evidence—whereas passive voice introduces claim and evidence before the subject. Compare, for example, “T cell abundance did not differ between wildtype and mutant mice” versus “there was no difference between wildtype and mutant mice in terms of T cell abundance.” T cell abundance, as the measured parameter, is the most important part of the sentence, but it is only introduced at the very end of the latter example.

The sequential nature of active voice therefore makes it easier to not get bogged down in overloading the reader with clauses and adhering to a general principle of “one sentence, one concept (or idea, or argument).” Consider the following sentence: 

Research on CysLT 2 R , expressed in humans in umbilical vein endothelial cells, macrophages, platelets, the cardiac Purkinje system, and coronary endothelial cells , had been hampered by a lack of selective pharmacological agents , the majority of work instead using the nonselective cysLT antagonist/partial agonist Bay-u9773 or genetic models of CysLT 2 R expression modulation) .

The core message of this sentence is that CysLT 2 R research is hampered by a lack of selective pharmacological agents, but that message is muddled by the presence of two other major pieces of information: where CysLT 2 R is expressed and what researchers used to study CysLT 2 R instead of selective pharmacological agents. Because this sentence contains three main pieces of information, it is better to break it up into three separate sentences for clarity.

In humans, CysLT 2 R is expressed in umbilical vein endothelial cells, macrophages, platelets, the cardiac Purkinje system, and coronary endothelial cells . CysLT 2 R research has been hampered by a lack of selective pharmacological agents . Instead, the majority of work investigating the receptor has used either the nonselective cysLT antagonist/partial agonist Bay-u9773 or genetic models of CysLT 2 R expression modulation.

The Right Way to Apply Jargon

There is another key advantage to organizing sentences in this simple manner: it lets scientists manage how jargon is introduced to the reader. Jargon—special words used within a specific field or on a specific topic—is necessary in scientific writing. It is critical for succinctly describing key elements and explaining key concepts. But too much jargon can make a manuscript unreadable, either because the reader does not understand the terminology or because they are bogged down in reading all of the definitions. 

The key to using jargon is to make it as easy as possible for the audience. General guidelines instruct writers to define new terms only when they are first used. However, it is cumbersome for a reader to backtrack considerable distances in a manuscript to look up a definition. If a term is first introduced in the introduction but not mentioned again until the discussion, the writer should re-define the term in a more casual manner. For example: “PI3K can be reversibly inhibited by LY294002 and irreversibly inhibited by wortmannin” in the introduction, accompanied by “when we applied the PI3K inhibitor LY294002” for the discussion. This not only makes things easier for the reader, but it also re-emphasizes what the scientist did and the results they obtained.

Practice Makes Better

Finally, the most important fundamental for science writing is to not treat it like a chore or a nuisance. Just as a scientist optimizes a bench assay through repeated trial and error, combined with literature reviews on what steps others have implemented, a scientist should practice, nurture, and hone their writing skills through repeated drafting, editing, and consultation. Do not be afraid to write. Putting pen to paper can help organize one’s thoughts, expose next steps for exploration, or even highlight additional experiments required to patch knowledge or logic gaps in existing studies. 

Looking for more information on scientific writing? Check out The Scientist’s TS SciComm  section. Looking for some help putting together a manuscript, a figure, a poster, or anything else? The Scientist’s Scientific Services  may have the professional help that you need.

• Schimel J. Writing Science: How to Write Papers That Get Cited And Proposals That Get Funded . Oxford University Press; 2012.
• First-person pronouns. American Psychological Association. Updated July 2022. Accessed March 2024. https://apastyle.apa.org/style-grammar-guidelines/grammar/first-person-pronouns  

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Gender Affirmation through Correct Pronoun Usage: Development and Validation of the Transgender Women’s Importance of Pronouns (TW-IP) Scale

Jae m. sevelius.

1 Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, CA 94158, USA; [email protected] (D.C.); [email protected] (S.E.D.); [email protected] (G.R.); [email protected] (T.B.N.)

2 Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, CA 94158, USA

Deepalika Chakravarty

Samantha e. dilworth, greg rebchook, torsten b. neilands.

Social interactions where a person is addressed by their correct name and pronouns, consistent with their gender identity, are widely recognized as a basic and yet critical aspect of gender affirmation for transgender people. Informed by the Model of Gender Affirmation, we developed a self-report measure of the importance of social gender affirmation, the Transgender Women’s Importance of Pronouns (TW-IP) scale, which measures gender affirmation through the usage of correct pronoun by others. Data were from self-administered surveys in two independent samples of transgender women living with HIV in the US (N1 = 278; N2 = 369). Using exploratory factor analysis with data from Study 1 and confirmatory factor analysis with data from Study 2, we obtained a four-item scale with a single-factor structure and strong reliability (α = 0.95). We present evidence of TW-IP’s convergent and discriminant validity through its correlations with select mental health and HIV-related measures. Further, scores on TW-IP were linked in expected directions to several hypothesized mental health and HIV care outcomes, demonstrating its predictive validity. The resulting brief measure of importance of pronouns among transgender women shows strong psychometric properties. Validation evidence offers highly promising opportunities for use of the measure in clinical and research settings.

1. Introduction

Gender affirmation, in its broadest sense, refers to an interpersonal process whereby a person receives social recognition and support for their gender identity and expression [ 1 ]. The term ‘gender affirmation’ has become widely used to specifically describe the process whereby transgender individuals affirm their gender through social, legal, and/or medical pathways [ 2 ]. The construct of gender affirmation is situated within the larger Model of Gender Affirmation, which is informed by multiple theoretical frameworks, including intersectionality, objectification theory, and the identity threat model of stigma [ 1 ]. The Model of Gender Affirmation emphasizes that health disparities experienced by transgender people are rooted in intersectional stigma and underscores the importance of increasing access to all forms of gender affirmation as a means of reducing these health disparities. The Model of Gender Affirmation includes a range of hypothesized influences of gender affirmation on resilience, risk behavior, and engagement in healthcare.

Gender affirmation as a social process is inherently interactive, where one’s gender identity is affirmed through social interactions with others [ 1 , 3 ]. For example, social interactions where a person is addressed by their correct name and pronouns, consistent with their gender identity, are widely recognized as a basic yet critical aspect of gender affirmation. Social affirmation processes occur for cisgender people as well as transgender people; however, the term ‘affirmation’ is often associated with transgender and gender diverse people because they more commonly have experiences that are disaffirming [ 4 ]. These disaffirming experiences include being misgendered (e.g., addressed in a way that is inconsistent with one’s gender identity) through incorrect pronoun usage, for example, referring to a transgender woman as “he” when the woman’s “preferred” pronoun is “she”. However, transgender communities and their advocates have increasingly emphasized that pronoun use goes beyond “preference”, since “preference” implies that using the correct pronoun is simply “preferred” by the person and therefore optional [ 4 ]. Addressing someone by the wrong name or misgendering them through use of incorrect pronouns can feel disrespectful, harmful, and even unsafe to the person being misgendered, since misgendering results in marginalization and communicates that a person’s identity is not being seen or respected [ 5 ].

Positive experiences of social gender affirmation are critical to the health and well-being of transgender and gender diverse people. Greater social gender affirmation is associated with improved mental health and well-being among diverse groups of transgender and gender diverse adults and youth [ 3 , 6 , 7 ]. Social gender affirmation, when combined with healthcare empowerment, was associated with viral suppression among a large national sample of transgender women of color living with HIV in the United States [ 8 ]. Disaffirming experiences in healthcare settings, such as being misgendered using incorrect pronouns, can result from overt or implicit biases and lack of training among healthcare providers and staff, often leading to anticipation of stigma and the avoidance of healthcare among transgender people [ 5 ].

A primary obstacle to further exploration of social gender affirmation is a lack of psychometrically sound measures of the construct. We sought to develop a measure of the importance of social gender affirmation in alignment with the Model of Gender Affirmation and within the context of HIV-related health outcomes. We chose this context because extensive research has shown that active engagement in clinical care and high levels of adherence to antiretroviral treatment (ART) are essential for those with HIV to live longer, healthier lives. Transgender women living with HIV are impacted by disparities at every stage of the HIV care continuum [ 9 , 10 ].

The purposes of the current paper are to use secondary data from two large quantitative studies to (a) describe the development of the Transgender Women’s Importance of Pronouns (TW-IP) scale, a brief, self-report measure of gender affirmation through correct pronoun usage among transgender women living with HIV and (b) present evidence of the TW-IP’s relationship to variables that are hypothesized correlates as suggested by the Model of Gender Affirmation. These hypothesized correlates were informed by previous research and included variables related to hormone use, affect, and engagement in HIV care [ 6 , 8 , 11 ].

Item development: The potential items for this scale were developed as part of a qualitative study conducted to generate theory around the construct of gender affirmation. The recruitment methodology for that study has been described elsewhere, and included individual interviews with 22 transgender women of color to explore the impact of intersections of racism and transphobia on experiences of gender affirmation [ 1 ]. Interview transcripts were analyzed with Atlas.ti [ 12 ] using template analysis, a standard qualitative technique for identifying and organizing themes through the development of a coding template [ 13 ]. This technique is useful for analysis of qualitative data when some a priori themes are defined based on theory and/or the research questions of interest. In this case, the a priori themes were based on the theoretical framework of the Model of Gender Affirmation. Initial analysis led to the identification of thematic categories such as the need for gender affirmation and the importance of correct pronoun use, which were relevant to item development for the current study. The themes were then broken down into codes and modified as needed to reflect the language that the participants used to describe the constructs of interest (e.g., need for gender affirmation) to ensure that the coding template included culturally relevant language. This coding process yielded multiple dimensions of gender affirmation and generated an initial list of candidate items. Five of those items were relevant to the importance of correct pronoun use, which is the focus of this investigation.

These initial items were then tested using an iterative process involving two rounds of cognitive interviewing with 10 transgender women in the first round and 9 in the second round (total N = 19 unique participants). Cognitive interviewing is a technique used to improve the development of surveys by administering draft items while eliciting further information from the participants about their responses to the items [ 14 ]. Participants were asked to describe their understanding of each item and provide recommendations for improvement of the appropriateness, wording, and/or the ordering of items in the scale, as these issues arose. After the first round of cognitive interviews, the initial items were modified based on participants’ feedback, and then were further refined using the same technique in the second round of interviews. These final items were administered to participants in two larger quantitative studies as described below. The resulting items, including the five used for the current measure development, were administered to participants in two larger quantitative studies as described below.

Samples for the current analyses: Data used in the present analyses were from two independent samples of transgender women living with HIV, who participated in two distinct studies (hereafter referred to as Study 1 and Study 2).

Study 1—Study 1 was a randomized controlled trial of a theory-driven, population-specific intervention (“Healthy Divas”) conducted in San Francisco and Los Angeles, CA to improve engagement in care for transgender women living with HIV (Unique Protocol ID: {"type":"clinical-trial","attrs":{"text":"NCT03081559","term_id":"NCT03081559"}} NCT03081559 ). Grounded in models of Gender Affirmation and Health Care Empowerment, the intent of the study was to test the efficacy of an intervention designed to systematically intervene on complex barriers to optimal engagement in HIV care for transgender women living with HIV. Participants ( N = 278) provided self-administered behavioral survey data at baseline and follow up visits. The current analysis utilizes the baseline data.

Study 2—As part of an initiative titled Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color, nine demonstration sites across four urban centers in the US—Chicago, New York, Los Angeles and San Francisco Bay Area—developed and implemented innovative interventions to engage and retain transgender women of color living with HIV, in quality HIV care; an additional site provided technical assistance to the sites and evaluated the interventions [ 15 ]. Participants completed a self-administered survey at baseline and follow-up visits. The current analysis utilizes the baseline data. Since the communities of transgender women are small and tightly knit, many participants within California were common to both studies. Therefore, to ensure that the two samples consisted of non-overlapping participants for these analyses, we excluded from Study 2 all the participants recruited at the California study sites. We also excluded participants ( n = 3) who did not respond to any of the items in the scale being developed, resulting in a final sample of 369 transgender women from Study 2.

Screening and Recruitment

Study 1—Between November 2016 and October 2019, participants were recruited from community-based organizations, social networks, and local venues frequented by transgender women. Participants were eligible if they were 18 years or older; were assigned male sex at birth but identified as transgender female, female, or another transfeminine identity; were confirmed to be living with HIV (either via medical documentation or an HIV rapid test); and were fluent in English or Spanish. After obtaining informed consent, we collected baseline data via a self-administered survey using CASIC data collection software [ 16 ]. Survey questions included detailed information on participants’ health care, sexual risk, and their attitudes and behaviors around HIV care, ART medication adherence, stigma, and gender affirmation. To compensate for their time, participants received USD 40 for the baseline study visit, including eligibility screening. All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the Institutional Review Board at the University of California, San Francisco (15-17910), and the Western Institutional Review Board (20181370).

Study 2—Between December 2013 and August 2016, participants were recruited using a variety of strategies including community outreach, networking, word-of-mouth, publicity materials, and referrals from clinics and other service providers. Participants were eligible if they were 16 years or older, assigned male sex at birth but identified as transgender or female, were living with HIV, and were fluent in English or Spanish. After obtaining informed consent, the participants completed a self-administered baseline survey in REDCap [ 17 ]. The survey covered topics such as their HIV care, health-related behaviors, and gender affirmation. To compensate for their time, participants received incentives between 25 and USD 50 across the sites. All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki. The study was approved by the local Institutional Review Board at each of the study sites, and the evaluation project was approved by the Institutional Review Board at the University of California, San Francisco (12-09622).

3. Measures

Candidate items for the new TW-IP scale: Both studies’ surveys contained these five questions: “How important is it to you that strangers call you ‘she’ when talking about you?”, “How important is it to you that family members call you ‘she’ when talking about you?”, “How important is it to you that your friends call you ‘she’ when talking about you?”, “How important is it to you that health care providers call you ‘she’ when talking about you?”, “How important is it to you to have a driver’s license or ID that says you are female?”. The five-point Likert-type response options were: Not at all important, Slightly important, Moderately important, Very important, Extremely important.

Sample characteristics: To characterize the two samples, we used the following data from the surveys: age, race-ethnicity, education, experiences of homelessness in the previous six months, engagement in sex work as a source of income in the previous six months, financial security (‘currently’ for Study 1, ‘in the previous six months’ for Study 2), and history of recent incarceration (‘in the previous twelve months’ in Study 1, ‘in the previous six months’ in Study 2).

Feminizing hormone therapy: Participants reported whether they had ever taken hormones (0 = No, 1 = Yes) and whether they were currently taking hormones (0 = No, 1 = Yes).

HIV diagnosis and care: Participants reported whether they had been newly diagnosed with HIV in the previous six months, whether they had ever taken ART for the treatment of HIV (0 = No, 1 = Yes), and whether they were currently on ART (0 = No, 1 = Yes).

Additionally, we used data on the following study-specific measures from the two studies:

3.1. Study 1

Positive and negative affect: Current positive and negative affect were measured using the 10-item International Positive and Negative Affect Schedule Short Form (I-PANAS-SF); the two subscales each utilized five items. Cronbach’s alphas for internal consistency were 0.88 and 0.84 for Positive and Negative Affect, respectively. Items asked the participant to rate the frequency of each emotion; five unipolar response choices spanned from 1 (Never) to 5 (Always). Sample item: “Thinking about yourself and how you normally feel, to what extent do you generally feel upset?”

HIV stigma: Stigma around HIV status was investigated using a 12-item scale that asked the participant to indicate the frequency of each feeling using one of four unipolar response choices ranging from 0 (Not at all) to 3 (Often). Cronbach’s alpha was 0.92. Sample item: “I’ve felt ashamed of my HIV”.

HIV treatment knowledge: Participant’s understanding of HIV treatment and medication was measured using the 16-item HIV Treatment Knowledge Scale [ 18 ]. The response choices were 1 (True), 0 (False), and 7 (Don’t know). The sum of the correct responses was used for analysis; Cronbach’s alpha was 0.89. Sample item: “Over-the-counter herbal pills (e.g., St. John’s Wort) could make HIV medications less effective.”

Treatment expectancies—Ease: One subscale—anticipated ease of taking ART—of a 13-item Treatment Expectancies scale [ 19 ], was investigated using the mean of four items asking participants to rate their agreement with each statement; Cronbach’s alpha was 0.74. Five Likert response choices ranged from ‘strongly disagree’ to ‘strongly agree’. Sample item: “Taking HIV medications on schedule would be easy for me”.

Experiences of traumatic events due to crime: Various experiences of having been a target of criminal acts, ex. Robbery, mugging were investigated. Endorsed experiences were summed for analysis. Sample item: “Has anyone ever tried to take something directly from you by using force or the threat of force, such as a stick-up or mugging?”

Perfect adherence to ART: Adherence to ART was measured by two items: (1) the Visual Analog scale (VAS) [ 20 ], where the participant was asked to estimate their ART medication adherence in the past 30 days on a line from 0 to 100%, and (2) Safren’s [ 21 ] Likert item, “Thinking back over the past 30 days, rate your ability to take all your medications as prescribed.” Six bipolar response choices for the Safren item span from 0 (Very poor) to 5 (Excellent). Adherence to ART was categorized as perfect if VAS adherence was equal to 100 and the participant responded with a 5 (Excellent) on the Safren item.

Number of sexual partners: Among detailed questions about sex behavior in the previous 3 months, participants were asked “How many sexual partners have you had in the past 3 months?”. Questions in this section were open ended.

3.2. Study 2

Depression: Depression during the previous week was measured using a 10-item version of the Center for Epidemiological Studies Depression (CES-D) scale [ 22 , 23 ]. The Likert-type response options ranged from 0 (Rarely or none of the time (less than 1 day)) to 3 (Most or all of the time (5–7 days)). The scale scores were dichotomized for use in the predictive model (0: score less than 10, not depressed; 1: score of 10 or greater, depressed) [ 24 ]. Cronbach’s alpha for the interval-level depression score was 0.87. Sample item: ‘During the past week, I felt that everything I did was an effort.’

Suppressed HIV viral load: Participants were considered to be virally suppressed if their HIV viral load had been tested in the previous six months and they had an undetectable viral load at their last test. Thus, viral suppression was a binary variable (1: virally suppressed; 0: not virally suppressed).

4. Data Analyses

First, we used SAS software version 9.4 (SAS Institute, Inc., Cary, NC, USA) [ 25 ] to compute the proportions, means and standard deviations to obtain the descriptive statistics for both study samples.

Exploratory Factor Analysis (EFA): Next, we used the data from Study 1 on the five potential items for the new scale to perform the EFA. In the initial item screening stage, M plus version 8.4 (Muthén & Muthén: Los Angeles, CA, USA) [ 26 ] was employed to determine the number of factors to keep using the scree plot as well as the following fit statistics: root mean square error of approximation (RMSEA ≤ 0.06), the comparative fit index (CFI ≥ 0.95), and the standardized root mean square residual (SRMR < 0.08) [ 27 ]. Item factor loadings as well as the underlying theory dictated their retention in the final EFA model. The Hull method available in FACTOR 10 was used to check the number of factors retained in the initial screening [ 28 ].

Confirmatory Factor Analysis (CFA): Next, we used the data from Study 2 and the factor structure from the Study 1′s EFA to perform the CFA using M plus version 8.4. In the Study 2 sample, 6.77% participants ( n = 25) had missing values on some but not all of the five candidate items for TW-IP. Therefore, while performing the CFA, we used multiple imputation within M plus with 250 imputed datasets [ 29 ]. We assessed the global model fit using the chi-square test of exact fit and the approximate fit using the following measures: the Root Mean Square Error of Approximation (RMSEA), Bentler’s Comparative Fit Index (CFI), and the Standardized Root Mean Square Residual (SRMR). Model-data fit is considered to be satisfactory if at least two of the following three conditions are met: RMSEA ≤ 0.06, CFI ≥ 0.95 and SRMR ≤ 0.08 [ 27 ]. Next, internal consistency reliability was estimated using Cronbach’s coefficient alpha using SAS PROC CORR (SAS Institute, Inc., Cary, NC, USA).

Convergent and discriminant validity: To evaluate these, we correlated the new scale with select measures of interest in the two studies. For convergent validity, we hypothesized that the new scale would be positively correlated with positive affect, negative affect, anticipated stigma for taking antiretroviral therapy (ART), and being on feminizing hormone therapy (ever and currently). On the other hand, for discriminant validity, we hypothesized that there would be no significant correlation of the new scale with knowledge of HIV treatment, anticipated ease of taking ART, experiences of traumatic events due to crime, and recent homelessness. These correlation analyses were conducted in M plus version 8.4.

Predictive validity: To evaluate this, we examined the bivariate association of the new scale with the following outcome variables from the two studies: being on ART (ever and currently), perfect adherence to ART, HIV viral suppression, depression, and the number of sexual partners. Since the number of sexual partners was a count variable, we performed negative binomial regression on it to obtain the incident rate ratio per unit change in the score of the new scale. The remaining outcomes were binary variables and we performed logistic regression on them to obtain the odds ratio per unit change in the score of the new scale. We hypothesized that higher scores on the new scale would be associated with greater odds (greater incident rate, in the case of number of sexual partners) of each of the outcomes. These analyses were conducted in SAS software V9.4.

Participant characteristics: The descriptive characteristics of the two study samples are shown in Table 1 . Participants in Study 1 were slightly older than those in Study 2 (mean age 43.5 years vs. 34 years in Study 2). Both studies were mostly composed of participants who were of Hispanic, Latina, or of Spanish origin (32.7% in Study 1 and 44.7% in Study 2) and participants who were non-Hispanic Black (45.3% in Study 1 and 51.2% in Study 2). The majority of participants in both studies had education levels that were grade 12 or lower, with similar levels of financial security and homelessness. Notably, a higher proportion of participants in Study 1 compared to those in Study 2 had ever taken ART (77.7% vs. 39.8%) and were currently on ART (68.7% vs. 37.4%).

Descriptive characteristics of participants in Study 1 ( N = 278) and Study 2 ( N = 369).

1 —Study 1: ‘Currently’, Study 2: ‘in the previous 6 months’; 2 —Study 1: ‘in the previous 12 months’, Study 2: ‘in the previous 6 months’; ART—Antiretroviral therapy for HIV.

Exploratory Factor Analysis of Study 1 data: The scree plot indicated one factor with an eigenvalue greater than 1.0, so the single-factor solution was chosen to model the items; two of the three fit statistics were achieved with one factor in M plus (CFI = 0.998, SRMR = 0.018) and the Hull method in FACTOR 10 also preferred one factor. All five items had factor loadings of 0.76 or greater and were retained (see Table 2 ).

Standardized factor loadings from factor analyses.

Notes: EFA factor loadings were estimated using FACTOR 10; CFA factor loadings and confidence intervals were estimated using M plus 8.4.

Confirmatory Factor Analysis of Study 2 data: On performing a CFA of the five-item factor structure indicated previously by the EFA using the 250 imputed datasets, the test of exact model-fit rejected the null hypothesis of exact model-data fit (χ 2 (5) = 14.09, p = 0.015). However, the approximate model-data fit met the criteria of two out of the three fit statistics being within desirable bounds (RMSEA = 0.07, CFI = 1.00, SRMR = 0.007). We noted the extremely high correlation (.988) between two items (“How important is it to you that your friends call you “she” when talking about you?” and “How important is it to you that health care providers call you “she” when talking about you?”). We therefore re-ran the CFA by dropping the first of these two items with the reasoning that one’s friends are usually most likely to use the correct pronouns and, as a result, retaining this item is unlikely to provide a high degree of additional useful information. During this second run, the fit statistics improved appreciably and indicated satisfactory exact and approximate model fit (χ 2 (2) = 1.43, p = 0.489; RMSEA = 0.008, CFI = 1.00, SRMR = 0.001). The final CFA factor loadings for the four items are presented in Table 2 ; the final scale is presented in the Appendix . The reliability was high for this four-item scale (α = 0.95).

Convergent and discriminant validity using Study 1 and Study 2 data: As hypothesized, the new scale was positively and significantly ( p < 0.05) correlated with positive affect, negative affect, anticipated stigma for taking ART, and being on feminizing hormone therapy both ever and currently ( Table 3 ). Further, as hypothesized, the new scale was not significantly correlated with knowledge of HIV treatment, anticipated ease of taking ART, experiences of traumatic events due to crime, and recent homelessness.

Correlations of Transgender Women’s Importance of Pronouns (TW-IP) with select study measures.

TW-IP—Scores on the Transgender Women’s Importance of Pronouns scale; ART—Antiretroviral therapy for HIV; Sample size: 278 (Study 1), 369 (Study 2). Correlations estimated using full information maximum likelihood (FIML) in M plus 8.4.

Predictive validity using Study 1 and Study 2 data: The results from the logistic regression of the new scale on select outcome variables showed a statistically significant positive association in each case ( Table 4 ). Specifically, higher scores on TW-IP were associated with higher odds of ever being on ART (OR = 1.28, p = 0.04), currently being on ART (OR = 1.25, p = 0.04), perfect adherence to ART (OR = 2.10, p = 0.02), HIV viral suppression (OR = 1.34, p = 0.003) and depression (OR = 1.26, p = 0.01). Similarly, the negative binomial regression demonstrated that higher scores on TW-IP were associated with a higher incident rate for the number of sexual partners (IRR = 2.27, p = 0.002).

Bivariate associations of TW-IP with select outcomes.

TW-IP—Scores on the Transgender Women’s Importance of Pronouns scale; ART—Antiretroviral therapy for HIV; Sample size: 278 (Study 1), 369 (Study 2). 1 —Calculated for participants on ART ( N = 191); 2 —Calculated for participants with non-missing scores for depression ( N = 343).

6. Discussion

The results of the factor analyses and convergent validity analysis suggest that a single-factor structure of TW-IP fit the data well in the two research samples, and that importance of pronouns can be measured with a parsimonious four-item measure (see Appendix A for the final scale). We began with a five-item measure and found that the scale performed better with the “friends” item dropped, suggesting that the importance of correct pronoun usage by strangers, family, and healthcare providers is sufficient to measure the TW-IP construct. This finding may be because interactions with one’s friends are less likely to be disaffirming. We also included one item related to the importance of having a legal document (e.g., driver’s license) that reflects one’s correct gender marker. While this item overlaps with the construct of legal gender affirmation, we found that it aligned conceptually with the pronoun use items designed to measure social gender affirmation. This alignment may be because legal documents, especially those such as a driver’s license, are often used to identify oneself to others and must be presented in various social situations (i.e., airports, entrances to venues), thereby having a significant impact on whether a person’s gender is socially affirmed in those interactions.

As predicted by the Model of Gender Affirmation, scores on the TW-IP were linked in expected directions to hormone use and positive affect. Gender affirmation for transgender people is often associated with access to transition-related medical care, such as hormones and surgery, so the positive correlation between scores on the TW-IP and hormone use was not surprising. It is clear though, that social gender affirmation and medical gender affirmation are distinct, reflecting the fact that not all transgender women who deem it important to be addressed by the correct pronouns use hormones and vice versa. These findings highlight how transgender women who deem it important to be addressed by correct pronouns are engaging in self-affirmation and self-advocating for being socially affirmed, which are important indicators of self-determination and empowerment.

Scores on the TW-IP were associated with negative affect and expected stigma from taking ART. While we typically think of positive and negative affect as inversely related, in fact they often vary independently [ 30 ]. Transgender women with high scores on the TW-IP may be particularly susceptible to the negative impacts of microaggressions related to gender disaffirming experiences of being addressed by incorrect pronouns, thus resulting in parallel increases in negative affect and anticipated stigma. Exploration of several factors that were not hypothesized by the Model of Gender Affirmation to be associated with scores on the TW-IP included HIV treatment knowledge, expected ease of taking ART, experiences of traumatic events due to crime, and experiences of homelessness in the prior 6 months. The lack of association between TW-IP scores and these measures contribute to the establishment of discriminant validity of the TW-IP scale. Further, the TW-IP scale demonstrated important associations with hypothesized health outcomes and HIV-related risk behaviors, including ever having taken ART, currently taking ART, perfect adherence to ART, being virally suppressed, and number of sex partners.

The Model of Gender Affirmation explicitly acknowledges that the experiences, identities, and preferences of transgender and gender diverse people are not homogeneous. Several studies have shown that correct pronoun use is critical to successful engagement and retention of transgender people in health care and that incorrect pronoun use can result in healthcare avoidance [ 31 , 32 , 33 , 34 ]. However, to the best of our knowledge, no quantitative measure exists to capture the importance of correct pronoun usage among transgender people, and further, no quantitative studies have explicitly looked at the impact of pronoun use on social gender affirmation or HIV-related health outcomes, which speaks to the novelty of our findings and the unique contribution of this measure. Transgender and gender diverse people use many different terms and pronouns to describe their identities, and these can evolve over one’s lifetime [ 35 ]. Further, the importance of the usage of particular pronouns varies among transgender people. For many, correct pronoun usage is a critical, respectful, and affirming form of communication that builds trust in settings such as healthcare [ 31 ]. Asserting one’s gender identity, correct name and pronoun, and insisting on the importance of having these respected by others may represent an important form of self-actualization and empowerment among transgender people, as well as a pathway to increase social gender affirmation [ 33 , 36 ].

6.1. Strengths and Limitations

This study was conducted among community- and clinic-based samples of transgender women living with HIV. Because these were not probability samples, our results may not generalize to all transgender women or transgender women not living with HIV. While development and initial validation of the TW-IP took place with transgender women living with HIV, the majority of whom were women of color, the scale is designed to be applicable across populations of transgender women regardless of HIV status or race.

The relatively moderate sample sizes and limited variability of age, race, and ethnicity preclude specific analysis of subgroups. However, in terms of population-specific research, these are two of the largest samples of transgender women living with HIV to date. Further, these samples were geographically diverse as they came from different regions of the US (West, East, and Midwest) and the majority of participants were women of color. Finally, an additional strength of this study is that our results were validated using two independent samples and we achieved consistent results across both samples.

6.2. Future Directions

The TW-IP was developed and tested with transgender women who were assigned ‘male’ sex at birth but identified as women, transgender women, or had another transfeminine identity. It is possible that some of our participants did not prefer “she” pronouns, as the diversity of pronoun preferences among transgender and gender diverse people has grown exponentially in the past few years. Future research should investigate how the importance of pronouns functions for other gender diverse people, such as transgender men and non-binary individuals. An adapted version of the TW-IP scale could also be explored with people who prefer non-standard pronouns, such as “ze/zir/zirs”, those who prefer no pronouns at all, and those who prefer that others vary the pronouns they use when addressing them. Future studies should also collect sufficiently large samples to permit testing the invariance of the measure’s performance across different demographic (e.g., age, race/ethnicity, education), psychographic (e.g., prefer non-standard pronouns vs. standard pronouns), and health status (e.g., HIV status) variables.

Future research should examine longitudinal patterns of TW-IP scores and predictive associations with engagement in healthcare, treatment adherence and persistence, and clinical outcomes, including health outcomes among transgender women not living with HIV. Among such outcomes are health-related quality of life, satisfaction with care, stigma resilience, and mental health. The availability of a psychometrically sound measure offers opportunities to investigate potential gender affirmation-related drivers of disparities in health-related outcomes experienced by transgender women. Additional research with sufficiently large and longitudinal samples is needed to evaluate the test–retest reliability of the measure and to test hypothesized determinants and consequences of TW-IP scores through associations with other constructs such as gender identity, socioeconomic status, and positive affect over time.

7. Conclusions

In summary, the TW-IP scale is a novel, brief measure of importance of pronouns among transgender women with strong psychometric properties, and preliminary validation evidence offers highly promising opportunities for use of the measure in clinical and research settings. The TW-IP scale has the potential to inform research that explores the impact of correct pronoun use as a critical form of gender affirmation on engagement in healthcare and other health outcomes among transgender women. That research can in turn serve to inform gender-affirming clinical practices that seek to address health disparities among transgender women, including HIV, mental health, and other health conditions that require active participation in health care.

Acknowledgments

We would like to thank the participants of both studies for contributing their time and information, along with all members of both study teams without whom participant recruitment and data collection would not have been possible.

Appendix A. The Transgender Women’s Importance of Pronouns (TW-IP) Scale

The following questions are about your attitudes regarding having your gender affirmed.

Response options for each question:

1 = Not at all important

2 = Slightly important

3 = Moderately important

4 = Very important

5 = Extremely important

• (1) How important is it to you that strangers call you “she” when talking about you?
• (2) How important is it to you that family members call you “she” when talking about you?
• (3) How important is it to you that health care providers call you “she” when talking about you?
• (4) How important is it to you to have a driver’s license or ID that says you are female?

Scoring: The scale is scored by calculating the mean of the four responses.

Permission: The TW-IP Scale is in the public domain and freely available to use.

Author Contributions

Conceptualization, J.M.S.; Data curation, D.C. and S.E.D.; Formal analysis, D.C., S.E.D. and T.B.N.; Funding acquisition, J.M.S. and G.R.; Methodology, J.M.S., D.C., S.E.D. and T.B.N.; Supervision, T.B.N.; Writing—original draft, J.M.S., D.C. and S.E.D.; Writing—review and editing, G.R. and T.B.N. All authors have read and agreed to the published version of the manuscript.

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health (NIH) under award number R01MH106373 (PI: Sevelius, Study 1) and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) Special Projects of National Significance (SPNS) Program under award number U90HA24973 (PI: Rebchook, Study 2). The publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH, HRSA, and the SPNS program.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Gender Pronouns

Using the right pronouns is an important part of respecting a person’s identity.  By asking and using a person’s pronouns, you show respect for the diversity of gender identities and promote awareness of transgender and gender nonconforming communities.

This also prevents assumptions from being made about a person’s gender identity, and, most importantly, fosters an affirming space for people's identities. In order to be a more welcoming campus, we are adding pronouns to class rosters and advising databases. By including their pronouns, asking questions when you are unsure, and learning about ways in which you can create these spaces in your own departments and classrooms, you become part of a welcoming environment. If there are questions or you do not see a pronoun with which you identify, please contact Paige Jennings, director of Gender and Sexuality/Women's Resource Center, [email protected]

Below, you will find some resources to help you get started. There are also some frequently asked questions about gender pronouns.  

• Gender Pronouns Guide
• Asking For and Using Pronouns: Making Spaces More Gender Inclusive
• Making Class Welcoming for Trans and Gender-Variant Students
• Adding Pronouns to Your Email Signature
• More Resources on Personal Pronouns

Frequently Asked Questions

• What are gender pronouns?
• Why is it important to respect people's pronouns?
• How do I ask someone what pronouns they use?
• What if I make a mistake?

What accommodations are available for Student-Athletes? 

What are gender pronouns? In English, whether we realize it or not, people frequently refer to one another using pronouns. Often, when speaking of a singular human in third person, these pronouns have a gender implied—“he” to refer to a man/boy or “she” to refer to a woman/girl.

Why is it important to respect people’s pronouns? Using someone’s correct personal pronouns is a way to respect them and create an inclusive environment. This is similar to using a person's name can be a way to respect them.  We all know it can be offensive or even harassing to make up a nickname for someone, and call them that nickname against their will. It can also be offensive or harassing to guess at someone's pronouns and refer to them using those pronouns if that is not how that person wants to be known.  

Even worse, actively choosing to ignore the pronouns someone has stated that they use could imply the oppressive notion that intersex, transgender, nonbinary, and gender nonconforming people do not or should not exist.

How do I ask someone what pronouns they use? First, make sure that you have shared your own pronouns. Doing so will help make other people more comfortable to share their pronouns with you.

If you are meeting someone new, you might say: “Hi, I’m Akeem, and I go by ‘they’ pronouns. How should I refer to you?” Of course, you may encounter someone who isn’t familiar with sharing personal pronouns. In that case, explain that people often assume that someone goes by “he” or “she” or another set of pronouns (e.g. “they” or “ze”) based on their appearance, but that the only way to really know how someone feels respected is to ask what pronouns they go by. Usually, offering up that the vast majority of people go by either “he” or “she” helps indicate to the other person the type of response they might give.

What if I make a mistake? It’s OK! Everyone slips up from time to time. The best thing to do if you use the wrong pronoun is to say something right away, such as, “Sorry, I meant [insert pronoun].”

If you realize your mistake after the fact, apologize in private and move on.

It can be tempting to go on and on about how bad you feel that you messed up, or how hard it is for you to get it right. Please don’t! It is inappropriate and makes the person who was misgendered feel awkward and responsible for comforting you. That is absolutely not their job.

Taking an active role in your classes, you may hear a student use the wrong pronoun for someone. In most cases, it is appropriate to gently correct the student without further embarrassing the individual who was misgendered. This means saying something like “Alex uses the pronoun she” and then moving on. If other students or faculty consistently use the wrong pronouns for someone, do not ignore it! It is important to let students know that you are their ally.

Varsity student-athletes can indicate changes to name or gender pronouns on athletic communications intake forms. The forms can be updated at any time  via online submission  to the Director of Athletic Communications. Department staff will work collaboratively with student-athletes to communicate changes to name or chosen pronouns to teammates, coaches, and other relevant parties, including to the media and in news stories and event recaps.

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

Published on 27.3.2024 in Vol 26 (2024)

Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients’ Experiences and Characteristics

Authors of this article:

Original Paper

• Stefanie C van den Bosch 1 * , MD, DDS   ; 
• Demi van Dalen 2 * , MD   ; 
• Marjan Meinders 3 , PhD   ; 
• Harry van Goor 2 , MD, PhD   ; 
• Stefaan Bergé 1 , MD, PhD, DDS   ; 
• Martijn Stommel 2 * , MD, PhD   ; 
• Sandra van Dulmen 4, 5, 6 * , PhD  

1 Department Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, Netherlands

2 Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands

3 IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands

4 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands

5 Faculty of Caring Science, Work Life and Social Welfare, University of Boras, Boras, Sweden

6 Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands

*these authors contributed equally

Corresponding Author:

Demi van Dalen, MD

Department of Surgery

Radboud University Medical Center

Geert Grooteplein Zuid 10

Nijmegen, 6525 GA

Netherlands

Phone: 31 243611111

Email: [email protected]

Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients’ experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation.

Objective: This study aims to examine patients’ experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible.

Methods: A cross-sectional survey study was conducted. Patients aged ≥18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients’ experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression.

Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often ( P= .001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P <.001).

Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better.

Introduction

In the Netherlands, the COVID-19 pandemic led to the first lockdown from March 2020 to June 2020 and the second lockdown from mid-December 2020 to April 2021. Throughout these periods, in-person visits were minimized to reduce the risk of potential virus transmission. As a substitute for in-person visits, the use of video visits significantly increased across many medical specialties.

Video visits were already in practice on a limited scale in a wide range of contexts: for speech evaluation in patients with cleft palate [ 1 ], genetic counseling [ 2 ], follow-up after facial plastic surgery [ 3 ], and postoperative wound assessment [ 4 ]. Video visits were found to be satisfactory for patients [ 5 ] and enabled empathetic patient-professional relationships remotely [ 1 , 6 , 7 ]. However, large-scale implementation in daily practice was found to be challenging owing to the multilevel complexity of implementation, where people, organizations, and technology continuously interconnect and develop [ 8 - 11 ]. For example, attitudes and beliefs of individual professionals have been shown to act as both facilitators and barriers in the implementation of eHealth applications [ 8 ]. Furthermore, video visits appeared to be particularly successful in follow-up appointments, when a preexisting relationship of trust is established between the patient and clinician [ 10 ]. For instance, video visits were more easily adopted in follow-up care after cancer surgery compared with a multidisciplinary context of antenatal diabetes care [ 10 ].

Owing to the pandemic-driven, accelerated application of video visits, many clinicians gained experience with this mode of health care delivery. This way of providing care offers several advantages, including saving travel time and costs for both patients and their companions and the efficient use of health care resources, such as outpatient clinic space and support [ 12 - 14 ]. As we move into the post–COVID-19 era, video visits are expected to persist as a routine practice, but large-scale use has seemed to stagnate, presumably owing to a lack of guidance, vision, and attention to patients’ needs, as observed in the United States [ 15 , 16 ]. The use and implementation of video visits are expected to be most successful when tailored to the needs of patients, clinicians, and health care organizations [ 17 , 18 ]. Therefore, it is crucial to understand patients’ perspectives and experiences with video visits and identify specific patient groups that show a greater or lesser degree of appreciation for and suitability to video visits [ 19 ]. Large studies with diverse patient populations covering all medical specialties need to be conducted to learn more about patients’ perspectives [ 16 , 18 ]. However, we are concerned that only a limited number of studies have been published that evaluated video visits for patients within large, diverse populations. Consequently, this study contributes significantly to the existing body of knowledge in this area [ 20 - 22 ].

The primary aim of this study was to examine patients’ evaluations of video visits in the context of the COVID-19 pandemic. The secondary aim was to identify patient groups for whom video visits are relatively more suitable, given their positive experiences. With these results, the first step toward patient-tailored choices for type of visit can be made.

Study Design and Population

A cross-sectional study was conducted from August 2020 to December 2020 at the Radboud University Medical Center (Radboudumc). Zaurus was used as the video visit app, which is compatible with all smartphones and tablets. Patients were invited via email to register and download the app.

Patients scheduled for a video visit were automatically selected based on the registered mode of visit. Links to the questionnaire were sent by an independent research firm (Expoints) on behalf of the Radboudumc. Selected patients received the survey within 8 days after their visit via email to evaluate the visit and collect their sociodemographic details. The survey had to be completed within 2 weeks, and a reminder was sent 1 week after the initial invitation. An incomplete survey could be saved to be completed later (within 2 weeks). No reminder for completion was sent.

All patients aged ≥18 years who received a video visit at an outpatient clinic at Radboudumc were eligible for inclusion. When a patient had multiple video visits in the selected period, the most recent video visit was selected.

Patients were excluded if they had cognitive problems; had difficulties with reading and understanding Dutch owing to a hindering language barrier; were deceased at the time of selection; completed a survey regarding video visits in the 180 days before the start of our study; completed a survey regarding their admission experience or experience with an in-person visit 30 days before the start of our study; or were admitted to the hospital, as priority was given to the patient experience survey regarding admission. In addition, when the video visit was a follow-up visit after giving birth or when the video visit was replaced with another visit modality, the patient was excluded.

Ethical Considerations

All patients participated voluntarily and anonymously in the survey and gave informed consent to use their data in accordance with the General Data Protection Regulation. Ethics approval was requested and waived by the local Medical Research Ethics Committee of Radboudumc (CMO [committee on research involving human subjects] Oost-Nederland; registration number 2021-8415).

A combined survey was used, which consisted of the Patient Experience Monitor (PEM) for adult outpatient experience [ 23 ], developed by the Dutch Federation of University Medical Centers, and the patient satisfaction survey for video visits created by Hanna et al [ 7 ]. This combined survey was constructed after extensive deliberation by an expert panel. In this process, a literature review of surveys specifically about video visits was performed. The experts found the survey by Hanna et al [ 7 ] to be the most suitable for the aim of our study.

The PEM survey was constructed by adapting a validated Picker Institute survey following a comprehensive theory-driven approach of item selection by an expert panel, cognitive interviews with patients, analysis of psychometric properties, and member checking. This survey of 14 items represents eight key domains of person-centered care: (1) fast access to reliable health care advice; (2) effective treatment delivered by trusted professionals; (3) continuity of care and smooth transitions; (4) involvement and support for family and caregivers; (5) clear information, communication, and support for self-care; (6) involvement in making decisions and respect for preferences; (7) emotional support, empathy, and respect; and (8) attention to physical and environmental needs [ 24 ]. The Picker Institute surveys are measures for evaluating patients’ experiences in outpatient and inpatient clinical care and have been validated and extensively used in university medical centers in the Netherlands since 2019 [ 25 ]. The PEM survey was adapted to the videoconferencing setting by rephrasing the questions. Overall, 2 items were open-ended questions ( Multimedia Appendix 1 ). Quantitative analyses of the PEM survey were based on individual survey items, whereas open-ended questions were analyzed using qualitative methods.

The 13-item survey by Hanna et al [ 7 ] is designed according to the principles of survey development for telemedicine to evaluate patients’ experiences with video visits in pain clinics [ 26 ]. This survey was translated into Dutch, and 1 item was removed, as it was already covered by the PEM survey ( Multimedia Appendix 1 , items 16-27). In total, 4 items were rephrased based on the advice of the patient communication experts. Analysis of the survey by Hanna et al [ 7 ] is based on an overall sum score, where a higher overall sum score represents greater satisfaction. For correct analysis and to calculate an overall sum score, the 3 negatively phrased questions (items 17, 21, and 23) were reversed (eg, “No, definitely not” was converted to “Yes, definitely”), according to protocol.

Finally, a question was added to assess the visit by assigning a score on a scale ranging from 1 to 10 (with 10 being most positive). The survey was conducted according to CHERRIES (Checklist for Reporting Results of Internet-Based e-Surveys; Multimedia Appendix 2 ) [ 27 ].

Statistical Analysis

Quantitative analysis.

Descriptive statistics were used for the closed-ended items ( Multimedia Appendix 1 , items 1-11 and 16-27). To identify patient and visit characteristics associated with positive evaluation of video visits, 4 authors found consensus upon the 3 key items from the survey by Hanna et al [ 7 ] that stood out the most (item 18: “the care I received by a video visit was just as good as with an in-person appointment”; item 22: “I was comfortable talking by video to the healthcare professional”; item 27: “I would recommend the video visit option to other patients”). Throughout the paper, these 3 items have been referred to as “crucial” components of the survey by Hanna et al [ 7 ], as they best displayed a positive experience.

Patient and visit characteristics were determined for the group answering the 3 crucial items positively. In this analysis, the following characteristics were included: sex, age category, level of education, self-rated health, type of visit (first vs follow-up), and medical specialty (surgical, nonsurgical, or other). High self-rated health was defined as a score that indicates “very well” or “excellent.”

Statistical analysis was performed using SPSS Statistics (version 25; IBM Corp). Binary logistic regression analysis was used to calculate differences in patient and visit characteristics between the patient subgroup that scored positively on all crucial items and the patient subgroup that did not score positively, as the dependent variable was not normally distributed.

Qualitative Analysis

Qualitative analysis was performed on the open-ended questions (items 13 and 14) to identify appreciated aspects and aspects for improvement for video visits. Overall, 2 authors (SCvdB and DD) independently categorized all the answers into six categories of factors that influence the implementation of innovations: (1) the innovation itself, (2) the individual professional, (3) the patient, (4) social context, (5) organizational context, and (6) economic and political context [ 28 ]. In case of conflicts in the categorization, consensus was reached through discussion between the authors. Responses including multiple levels within a single response were counted as individual items. Examples of answers for both aspects in each category have been cited in the Results section.

Quantitative Results

From August 2020 to December 2020, a total of 1244 surveys were completed, with a response rate of 28.32% (1244/4392). After excluding 15.27% (190/1244) of the patients who reported that the visit was either a telephone consultation or replaced by telephone after technical difficulties, 84.73% (1054/1244) of the surveys were used in the analysis.

Table 1 shows the patients’ demographics. An equal distribution across age categories was observed. Clinical genetics, neurology, and medical oncology accounted for 65.84% (694/1054) of the total number of evaluated video visits, whereas the distribution across the other medical specialties varied widely. The numbers of first and follow-up visits were equal, with most follow-up visits (480/1054, 45.54%) performed by a known clinician. After a video visit, 36.91% (389/1054) of the patients had to make an appointment for an additional in-person visit or medical examination. A follow-up visit via video was planned in 40.32% (425/1054) of the evaluated video visits. Clinicians from medical oncology and neurology more frequently scheduled an in-person follow-up visit for their patients—18.6% (40/215) and 23.3% (50/215), respectively. Moreover, in 39.7% (69/174) and 14.4% (25/174) of cases, the visits provided by clinical genetics and neurology respectively, were followed by a consecutive visit for additional (diagnostic) testing.

The overall grading for the video visit had a mean of 8.6 (SD 1.3; median 9) of 10. For 5 PEM items, >80% of the patients answered positively, that is, patients waited no longer than 5 minutes, clinicians had read their medical records well, patients received understandable answers, patients trusted the clinician, and patients had enough time to discuss their problems with the clinician. Refer to Table 2 for details about the responses of patients.

For the remaining 6 items, more than 21% stated that the item was either not applicable or answered positively. For instance, 80.25% (829/1033) indicated not receiving any new medication for the question about whether the professional explained the adverse effects of new medication. Analysis of the items in the survey by Hanna et al [ 7 ] showed that 91.46% (964/1054) of the patients was satisfied with their video visit, 66.98% (706/1054) found it to be just as good as an in-person visit, and 68.69% (724/1054) would recommend video visits to other patients, as shown in Table 3 .

Of 1054 patients, 574 (54.46%) answered all 3 crucial items on the survey by Hanna et al [ 7 ] positively, 234 (22.2%) answered 2 of 3 positively, 138 (13.09%) answered only 1 item positively, 72 (6.83%) patients answered “not applicable” or responded negatively, and 36 (3.42%) responses were missing. Patient and visit characteristics of patients who positively answered all 3 crucial Hanna [ 7 ] items versus the group who did not are shown in Multimedia Appendix 3 .

Results of the binary logistic regression are shown in Table 4 . Negative association was found between the positive evaluation of a visit and the surgical and “other” medical specialties (B=−0.64; P <.001). Positive evaluation was also associated with the patient category who described their health as “very well” (B=1.12; P =.01). Sex, age, and educational status had no influence on whether a patient rated the visit positively. In addition, the reason for the visit was not found to have any influence on the positive evaluation of a video visit.

a ENT: ear, nose, and throat.

b Includes trauma surgery, visceral surgery, surgical oncology, and vascular surgery.

c OMF: oral and maxillofacial surgery.

a The total in some sections is not 100% owing to missing responses.

a Nagelkerke R 2 =0.08.

b N/A: not applicable.

Qualitative Results

Table 5 displays the frequencies of appreciated aspects and aspects for improvement. Most patients (738/1054, 70.02%) cited appreciated aspects of the use of video visits in the open-ended questions. The most frequently cited appreciated aspects were expressed at the individual professional level, followed by the organizational context level and the innovation level. Few aspects were mentioned at the patient level, economic and political context level, and social context level. Approximately half of the patients (474/1054, 44.97%) cited aspects for improvement. Most were cited at the innovation, organizational context, and patient levels. In contrast, no improvable aspects were reported at the economic and political context level.

a Overall, 70.01% (738/1054) of the patients cited appreciated aspects.

b Responses including multiple levels within a single response were counted as individual items.

c Overall, 44.97% (474/1054) of the patients cited aspects for improvement.

The perceived ease of use and audio-visual quality were frequently mentioned as appreciated aspects. The intuitive character of the app was seen as valuable, as not all patients were familiar with using web-based apps. Patients appreciated the audio-visual quality, allowing the video visit to be a good alternative for an in-person visit. However, not all the patients experienced the same ease of use, as the most reported aspect for improvement was poor audio and video quality, sometimes clearly caused by an unstable internet connection. Although Zaurus is compatible with all electronic devices, users have reported issues with video size specifically on smartphones ( Textbox 1 ).

Appreciated aspect

“The application is straightforward and easy to understand. Conversation went well, the doctor even asked me if I could hear her well.” [Female; aged 18-34 y; clinical genetics]

Aspect for improvement

“The video connection was really bad. Almost immediately the app crashed, and the audio stuttered, so I could not understand what the doctor was saying. After two attempts, we continued the visit by telephone.” [Female; aged 65-79 y; excluded for further analysis; clinical genetics]

Individual Professional

Patients often mentioned what they valued in the clinician’s professional behavior, such as their attitude, and communicative style. In contrast, a lack of adequate or visible body language and lack of knowledge about someone’s medical history were mentioned as aspects for improvement ( Textbox 2 ).

“There is still a kind of personal touch in the contact, which is nice for the perception as well. The doctor radiated tranquility and was understanding, and she had read my personal record well. That gives me confidence.” [Female; aged 55-64 y; clinical genetics]

“The doctor did not look at us during the video visit. Both my daughter, who was also present, and I had noticed. That felt a little awkward. He was mainly looking down (I guess at a file or something like that, which was in front of him).” [Female; aged 80-99 y; clinical genetics]

The possibility to have face-to-face interactions remotely was often mentioned as valuable, as patients were able to watch the clinicians’ nonverbal reactions. It made video visits a safe alternative for patients with a weak immune system, for example, during the pandemic. Personal lack of experience with video visits was a hindering factor, as not all patients were familiar with the use of videoconferencing apps. Some of them preferred an in-person visit, as they felt uncomfortable owing to inexperience ( Textbox 3 ).

“It is nice to see the doctor, but for a first meeting, it is something I need to get used to. However, this feels safer regarding the coronavirus and a vulnerable immune status.” [Female; aged 35-54 y; neurology]

“I’d rather have the first visit in person. Maybe I’m old fashioned, but I prefer physical contact, even during this COVID pandemic. Feelings and emotions might be more difficult to pick up on screen.” [Male; aged 55-64 y; neurology]

Social Context

The possibility of the involvement of others, such as next of kin or other family members, was one of the mentioned appreciated aspects. Creating a culture in which a patient can share their preference or opt for a certain visit modality could stimulate the use of video visits. Patients expressed that they would like to have a say in choosing which visit modality they like, especially when the nature of the visit is sensitive ( Textbox 4 ).

“On time, pleasant conversation, space for questions, clear explanation. It was nice that my partner could join with his phone.” [Female; aged 18-34 y; reproductive medicine]

“It was a shame they communicated the results by a video visit. I was shocked and found they acted a bit indignant about my reaction. I was not capable anymore to follow the conversation.” [Female; aged 18-34 y; clinical genetics]

Organizational Context

Internet-based assistance, clear instructions, and time management by the clinician during the visit were often mentioned as appreciated aspects at this level. Many patients were called in advance of the visit to check for technical problems. However, patients were not always informed correctly if the visit would start later than scheduled, and in some cases, patients received the link for the video visit just before the visit started, which was an aspect for improvement ( Textbox 5 ).

“The support was really good, as I am not so technical and there was enough explanation. Great.” [Female; aged 55-64 y; clinical genetics]

“I would like to receive a notification when the doctor is held up, especially when it’s a first visit. Also, I would like to receive a heads up when I get another doctor than the one the appointment was originally scheduled with.” [Male; aged 55-64 y; medical oncology]

Economic and Political Context

Time and financial savings were identified as valuable aspects at the economic and political context level. Patients often cited less travel time and costs as beneficial. There were no improvable aspects reported at the economic and political context level ( Textbox 6 ).

“It is pleasant that there is no need for traveling to the hospital (regarding travel time and travel distance) and still have ‘personal’ contact with the doctor through a video connection.” [Male; aged 35-54 y; neurology]

Principal Findings

In this study, we comprehensively analyzed evaluations of visits via video to a tertiary clinic made by a large, diverse patient population, including appreciated aspects and aspects for improvement. Most patients (964/1054, 91.46%) evaluated the video visits positively, with significantly more positive evaluations when the visits were provided by a clinician from “other” medical specialties, as compared to surgical and nonsurgical specialties, or when the patient rated their health status as “very well.” The appreciated aspects were mostly at the individual professional level, whereas aspects for improvement were reported at the innovation level itself.

Comparison With Previous Studies

Our finding that high self-rated health of patients is an influencing patient characteristic for suitability of video visits echoes the finding that patients with less complex, more straightforward clinical needs are more suitable candidates for video visits than those with complex, high-risk diseases [ 10 , 29 ]. Similar findings were identified in an oncological study wherein telemedicine was received favorably for low-acuity cancer care [ 16 ]. In contrast to findings that video visits appear to be more appropriate when the clinician knows the patient beforehand and when it is a follow-up visit [ 10 ], we found that the reason for the visit did not have any influence on whether patients rated the video visit positively. Remarkably, the medical specialty providing the visit was found to be a significant associated factor. Nonsurgical visits were found to be most suitable for telemedicine. One can imagine that these visits are less dependent on physical examination, such as internal medicine or dermatology, for instance, as these specialties can easily review laboratory abnormalities or skin disorders on screen [ 30 ]. In addition to specific aspects of the visit that may depend on the medical specialty, other dimensions or elements during the visit could affect the patient experience, such as the communication strategy used by the clinician [ 31 ]. Nonetheless, more studies are needed to get a clear overview about whether medical specialty is a truly discriminative characteristic or whether it is more dependent on the attitude of certain clinicians and patient groups.

Qualitative analysis of the open-ended questions revealed both facilitating and hindering factors for broad implementation and upscaling of video visits. Following Grol and Wensing [ 28 ], these factors were categorized into innovation, professional, patient, social context, organizational context, and economic and political context levels. Appreciation was mostly centered on the professionals’ skill in adapting communication to the video setup; however, there was scope for improvement among some individuals, as they might benefit from investing additional effort in making visual contact. The way in which the video visits were organized was also highly valued, especially for the provision of technical support to patients as and when needed.

The attitude of the clinician during the video visit was one of the most frequently mentioned aspects for improvement. The bedside manner, which may be better described as the “webside” manner, of a clinician refers to how the clinician behaves, approaches the patient, and communicates during the visit. Clinicians sometimes seem to lack awareness of how their nonverbal behavior looks on screen, as was also shown by a study that analyzed a large data set of >5000 patients [ 32 ]. Patients prefer increased expression of nonverbal empathy from clinicians when they show signs of distress. Inadequate nonverbal communication and body language are often reported as barriers for telemedicine adoption [ 3 , 33 , 34 ]. Despite expert recommendations dating back several years to raise awareness for nonverbal and paraverbal communication, our study also indicates that there is still considerable scope for improvement and training at the clinician level [ 31 , 35 ].

In accordance with several survey studies conducted during the pandemic, our response rate was low. This might be explained by the questionnaire fatigue that was frequently observed during the COVID-19 pandemic, as patients received multiple questionnaires and messages from the outpatient clinic, apart from research [ 36 ].

Regarding future perspectives, clinicians should seek guidelines to assess the suitability of a video visit, and the following recommendations might be useful. The Dutch Center of Expertise on Health Disparities recommends checking the patients’ digital skills beforehand, providing digital support, and evaluating whether the information is correctly understood through techniques such as “teach back” at the end of the visit [ 37 ]. Video consulting guidelines advise considering several factors while deciding whether video visits may be suitable, such as whether there is an established relationship with the patient, whether it entails nonurgent care, whether there is a need for physical examination, and whether there are factors in favor of the patient staying at home [ 38 ].

Limitations

The findings of this study must be considered in the light of some limitations. First, our study might have been exposed to selection and sampling biases for several reasons. It was an “open” survey, where patients could decide voluntarily whether they would participate in the survey, which might have led to a sample of patients that is not representative of the entire population of the hospital. In addition, owing to the exclusion criteria, not all video visits were evaluated.

Second, the validity of the combined survey was not tested. As the analysis of our data was reported at the item level, calculating the internal consistency using Cronbach α was not applicable. PEM is known to be a validated survey; however, the psychometric properties of the survey by Hanna et al [ 7 ] are not known and should be determined. As the PEM items were rephrased to the videoconferencing setting, reliability of this new PEM survey will have to be reassessed.

The educational status of patients attending a university medical center is, in general, often higher than the mean educational status of the general population. In our study population, 44.4% (468/1054) of the patients were highly educated, compared with 30% in the Dutch population in 2018 [ 39 ]. As teaching hospitals and referring hospitals might serve different populations, the generalizability of our results might be limited, and further studies including different types of hospitals are recommended.

A total of 139 patients reported a failed video visit and noted that the visit was replaced by telephone. However, the exact number of times this occurred is not known, as not all patients might have reported this failure, which also may have resulted in selection bias.

In this evaluation, we deliberately focused on the patient evaluation of video visits. As it is known that patients and clinicians have different views about quality of information and visits [ 40 - 42 ], the clinicians’ point of view should also be explored for a comprehensive evaluation of the use of video visits. Health care providers, such as clinicians, might experience different barriers and facilitators compared with patients, thus influencing the successful implementation of video visits. Key barriers to successful implementation such as the lack of training and motivation to offer video visits need to be addressed [ 3 , 8 , 43 , 44 ].

Conclusions

Video visits were perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experiences reported by healthy participants and participants who scheduled a visit with a clinician outside the realms of surgical and nonsurgical medical specialties, such as clinical genetics or radiotherapy. Appreciated aspects were mainly at the individual professional level, organizational level, and at the level of the innovation itself. The mentioned aspects for improvement can be changed for the better.

The findings cannot be directly generalized as they were collected in a university medical center with a specific patient population, but they provide additional results for understanding the suitability of video visits in a broad patient population. To be able to truly tailor the use of video visits to patients’ needs, a patient-centered perspective involving both patients and health care professionals is needed.

Data Availability

The data used in this study will be made available by the authors upon reasonable request.

Authors' Contributions

SCvdB, MM, MS, and SvD contributed to the study’s conception and design. SCvdB and DvD performed the statistical analyses. SCvdB managed the project administration and data curation. SCvdB, DvD, MS, and SvD drafted the manuscript. HvG, SB, MS, and SvD supervised the research project. SCvdB and DvD contributed equally to this work and share first authorship. MS and SvD contributed equally to this work and share senior authorship. All authors interpreted the data, critically revised the paper, and approved the final version of the paper.

Conflicts of Interest

None declared.

Survey on video visits during the COVID-19 outbreak (August 2020 to December 2020).

CHERRIES (Checklist for Reporting Results of Internet-Based e-Surveys) checklist.

Patient and visit characteristics of those who positively answered all 3 crucial items in the checklist by Hanna et al [ 7 ] versus the group that did not answer positively.

• Whitehead E, Dorfman V, Tremper G, Kramer A, Sigler A, Gosman A. Telemedicine as a means of effective speech evaluation for patients with cleft palate. Ann Plast Surg. Apr 2012;68(4):415-417. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hilgart JS, Hayward JA, Coles B, Iredale R. Telegenetics: a systematic review of telemedicine in genetics services. Genet Med. Sep 2012;14(9):765-776. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Westra I, Niessen FB. Implementing real-time video consultation in plastic surgery. Aesthetic Plast Surg. Oct 2015;39(5):783-790. [ CrossRef ] [ Medline ]
• Stommel WJ, van Goor H, Stommel MW. The impact of video-mediated communication on closed wound assessments in postoperative consultations: conversation analytical study. J Med Internet Res. May 05, 2020;22(5):e17791. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Aneja J, Goyal T, Verma M, Kaur G, Mirza M, Gupta S. Client satisfaction with telemedicine services during COVID-19 pandemic: a cross-sectional survey from a teaching institute of North India. J Family Med Prim Care. Sep 2022;11(9):5187-5193. [ FREE Full text ] [ CrossRef ] [ Medline ]
• van Gurp J, van Selm M, Vissers K, van Leeuwen E, Hasselaar J. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study. PLoS One. 2015;10(4):e0124387. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hanna GM, Fishman I, Edwards DA, Shen S, Kram C, Liu X, et al. Development and patient satisfaction of a new telemedicine service for pain management at Massachusetts general hospital to the island of Martha’s vineyard. Pain Med. Sep 2016;17(9):1658-1663. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ross J, Stevenson F, Lau R, Murray E. Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update). Implement Sci. Oct 26, 2016;11(1):146. [ FREE Full text ] [ CrossRef ] [ Medline ]
• van Gemert-Pijnen JE, Nijland N, van Limburg M, Ossebaard HC, Kelders SM, Eysenbach G, et al. A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. Dec 05, 2011;13(4):e111. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Greenhalgh T, Shaw S, Wherton J, Vijayaraghavan S, Morris J, Bhattacharya S, et al. Real-world implementation of video outpatient consultations at macro, meso, and micro levels: mixed-method study. J Med Internet Res. Apr 17, 2018;20(4):e150. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Ossebaard HC, Van Gemert-Pijnen L. eHealth and quality in health care: implementation time. Int J Qual Health Care. Jun 2016;28(3):415-419. [ CrossRef ] [ Medline ]
• Bradford NK, Armfield NR, Young J, Smith AC. Paediatric palliative care by video consultation at home: a cost minimisation analysis. BMC Health Serv Res. Jul 28, 2014;14:328. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Versleijen M, Martin-Khan MG, Whitty JA, Smith AC, Gray LC. A telegeriatric service in a small rural hospital: a case study and cost analysis. J Telemed Telecare. Dec 2015;21(8):459-468. [ CrossRef ] [ Medline ]
• Andino J, Zhu A, Chopra Z, Daignault-Newton S, Ellimoottil C, Dupree JM. Video visits are practical for the follow-up and management of established male infertility patients. Urology. Aug 2021;154:158-163. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Assing Hvidt E, Atherton H, Keuper J, Kristiansen E, Lüchau EC, Lønnebakke Norberg B, et al. Low adoption of video consultations in post-COVID-19 general practice in Northern Europe: barriers to use and potential action points. J Med Internet Res. May 22, 2023;25:e47173. [ CrossRef ] [ Medline ]
• Mackwood M, Butcher R, Vaclavik D, Alford-Teaster JA, Curtis KM, Lowry M, et al. Adoption of telemedicine in a rural US cancer center amid the COVID-19 pandemic: qualitative study. JMIR Cancer. Aug 16, 2022;8(3):e33768. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Communication on enabling the digital transformation of health and care in the digital single market; empowering citizens and building a healthier society. European Commission. 2018. URL: https:/​/digital-strategy.​ec.europa.eu/​en/​library/​communication-enabling-digital-transformation-health-and-care-digital-single-market-empowering [accessed 2024-01-29]
• Wherton J, Greenhalgh T, Hughes G, Shaw SE. The role of information infrastructures in scaling up video consultations during COVID-19: mixed methods case study into opportunity, disruption, and exposure. J Med Internet Res. Nov 10, 2022;24(11):e42431. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Esber A, Teufel M, Jahre L, In der Schmitten J, Skoda EM, Bäuerle A. Predictors of patients' acceptance of video consultation in general practice during the coronavirus disease 2019 pandemic applying the unified theory of acceptance and use of technology model. Digit Health. 2023;9:20552076221149317. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Rasmussen B, Perry R, Hickey M, Hua X, Wong ZW, Guy L, et al. Patient preferences using telehealth during the COVID-19 pandemic in four Victorian tertiary hospital services. Intern Med J. May 2022;52(5):763-769. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Splinter MJ, Ikram MK, Helsper CW, Bindels PJ, de Schepper EI, Licher S. Patient perspectives on telemedicine during the COVID-19 pandemic: a mixed-methods community-based study. BMC Health Serv Res. Jul 27, 2023;23(1):803. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Farrer LM, Batterham PJ, Gulliver A, Morse A, Calear AL, McCallum S, et al. The factors associated with telehealth use and avoidance during the COVID-19 pandemic: longitudinal survey. J Med Internet Res. Feb 08, 2023;25:e43798. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Nieuwe patiëntervaringsmonitor helpt zorg te verbeteren. Netherlands Federation of University Medical Centres. URL: https://www.nfu.nl/themas/kwaliteit-van-zorg/patientervaringen-en-uitkomsten-van-zorg [accessed 2024-01-29]
• Principles of person-centered care. Picker Institute Europe. URL: https://picker.org/who-we-are/the-picker-principles-of-person-centred-care/ [accessed 2024-01-29]
• Bastemeijer CM, Boosman H, Zandbelt L, Timman R, de Boer D, Hazelzet JA. Patient experience monitor (PEM): the development of new short-form picker experience questionnaires for hospital patients with a wide range of literacy levels. Patient Relat Outcome Meas. 2020;11:221-230. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Demiris G. Principles of survey development for telemedicine applications. J Telemed Telecare. 2006;12(3):111-115. [ CrossRef ] [ Medline ]
• Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res. Sep 29, 2004;6(3):e34. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust. Mar 15, 2004;180(S6):S57-S60. [ CrossRef ] [ Medline ]
• James HM, Papoutsi C, Wherton J, Greenhalgh T, Shaw SE. Spread, scale-up, and sustainability of video consulting in health care: systematic review and synthesis guided by the NASSS framework. J Med Internet Res. Jan 26, 2021;23(1):e23775. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jaklitsch E, Shah VK, Smith B, Agarwal A, Chen J, Sweeney A, et al. Melanoma detected through teledermatology versus in-person visits. Telemed J E Health (Forthcoming). Oct 17, 2023. [ CrossRef ] [ Medline ]
• Mazouri-Karker S, Braillard O, Lüchinger R, Bajwa N, Achab S, Hudelson P, et al. Patients preferences for communication during video consultations. Patient Educ Couns. Oct 2023;115:107894. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Chandrasekaran R, Bapat P, Venkata PJ, Moustakas E. Face time with physicians: how do patients assess providers in video-visits? Heliyon. Jun 2023;9(6):e16883. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Demiris G, Speedie SM, Finkelstein S. Change of patients' perceptions of TeleHomeCare. Telemed J E Health. 2001;7(3):241-248. [ CrossRef ] [ Medline ]
• Armfield N, Bradford N, White MM, Spitzer P, Smith AC. Humour sans frontieres: the feasibility of providing clown care at a distance. Telemed J E Health. May 2011;17(4):316-318. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jiménez-Rodríguez D, Ruiz-Salvador D, Rodríguez Salvador MD, Pérez-Heredia M, Muñoz Ronda FJ, Arrogante O. Consensus on criteria for good practices in video consultation: a Delphi study. Int J Environ Res Public Health. Jul 27, 2020;17(15):5396. [ FREE Full text ] [ CrossRef ] [ Medline ]
• de Koning R, Egiz A, Kotecha J, Ciuculete AC, Ooi SZ, Bankole ND, et al. Survey fatigue during the COVID-19 pandemic: an analysis of neurosurgery survey response rates. Front Surg. Aug 12, 2021;8:690680. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Checklist beeldbellen. Pharos. URL: https://www.pharos.nl/kennisbank/stappenplan-laagdrempelig-toegankelijk-beeldbellen/ [accessed 2024-01-29]
• Gilbert AW, Billany JC, Adam R, Martin L, Tobin R, Bagdai S, et al. Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative. BMJ Open Qual. May 2020;9(2):e000985. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Imlach F, McKinlay E, Middleton L, Kennedy J, Pledger M, Russell L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract. Dec 13, 2020;21(1):269. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Barsom EZ, Meijer HA, Blom J, Schuuring MJ, Bemelman WA, Schijven MP. Emergency upscaling of video consultation during the COVID-19 pandemic: contrasting user experience with data insights from the electronic health record in a large academic hospital. Int J Med Inform. Jun 2021;150:104463. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kim J, Kim S. Physicians' perception of the effects of Internet health information on the doctor-patient relationship. Inform Health Soc Care. Sep 2009;34(3):136-148. [ CrossRef ] [ Medline ]
• Murray E, Lo B, Pollack L, Donelan K, Catania J, Lee K, et al. The impact of health information on the internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians. J Med Internet Res. 2003;5(3):e17. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Smith WR, Atala AJ, Terlecki RP, Kelly EE, Matthews CA. Implementation guide for rapid integration of an outpatient telemedicine program during the COVID-19 pandemic. J Am Coll Surg. Aug 2020;231(2):216-2.e2. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Jiménez-Rodríguez D, Santillán García A, Montoro Robles J, Rodríguez Salvador MD, Muñoz Ronda FJ, Arrogante O. Increase in video consultations during the COVID-19 pandemic: healthcare professionals' perceptions about their implementation and adequate management. Int J Environ Res Public Health. Jul 15, 2020;17(14):5112. [ FREE Full text ] [ CrossRef ] [ Medline ]

Abbreviations

Edited by T Leung; submitted 16.05.23; peer-reviewed by AW Zahoor, J Hayden; comments to author 25.10.23; revised version received 08.12.23; accepted 31.01.24; published 27.03.24.

©Stefanie C van den Bosch, Demi van Dalen, Marjan Meinders, Harry van Goor, Stefaan Bergé, Martijn Stommel, Sandra van Dulmen. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.03.2024.

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

• The Buzz on Florida Politics

Is Biden in trouble with young voters? Some in Florida are concerned.

• Kirby Wilson Times staff

Cat Margaux, the vice president of the University of South Florida College Democrats, is getting worried.

As the 21-year-old senior drums up support for President Joe Biden ahead of his 2024 reelection contest, they see their peers less interested in voting than they were four years ago. The war in Gaza has eroded support for Biden among young progressives, Margaux said — as has abortion rights getting rolled back on the president’s watch.

“I’m concerned that people are giving up,” Margaux said. “I don’t want people to give up.”

It may not be an exaggeration to say that voters like Margaux delivered Biden the presidency in 2020. In a contest decided by just tens of thousands of votes across key swing states, Biden won the 18-to-29 age group by 24 points nationally in 2020, according to the Pew Research Center . Young voters turned out at a rate 11 percentage points higher than in 2016, according to Tufts University researchers . Biden may be the oldest-ever president, but his strongest demographic was 18-29.

With seven months until Election Day, there are signs Biden is in trouble with young voters. Some in the demographic say he’s too old to get results. Some are dissatisfied with Biden’s policies. And some, Biden supporters fear, are simply unmotivated to vote.

A March USA Today/Suffolk University survey of 233 registered voters found that Biden’s 2024 opponent, Donald Trump, was winning the 18-to-34 demographic by six points. That would be a catastrophe for Biden.

Tyler Tone, 25, the president of the USF College Democrats in Tampa, is worried about the enthusiasm issue. Young voters perceive Biden’s approach to be compromise-first, and that can be frustrating to those who want sweeping change — and fast, Tone said.

“His age is kind of like a symbol for all sorts of other things that drive down enthusiasm,” Tone said.

There’s also the issue of perspective. Some of this year’s first-time voters were 9 when Trump first declared his candidacy in 2015. Biden’s arguments that Trump presents a unique threat to democracy might not motivate voters who don’t know any other political reality, Tone said.

Ethan Vaubel, the president of the College Republicans at USF, said plenty of young voters chose Biden in 2020 because they saw him as the “lesser of two evils.” After seeing his record in office for four years, some of those voters will be less reluctant to vote for Trump, Vaubel said.

A poll released in November by Tufts University’s Center for Information and Research on Civic Learning and Engagement of more than 2,000 U.S. citizens aged 18-34 found reasons for Biden to be optimistic about the youth vote. Nearly three in five of those surveyed told researchers they were “extremely likely” to vote in 2024. Of those voters, 51% said they’d back the Democratic candidate, 30% said they’d back a Republican and 16% are undecided.

On many of the issues that resonate with young voters, Biden is clearly preferable to Trump, his supporters say.

For example, abortion ranked as the top priority among young voters during the 2022 midterm elections , according to Tufts researchers. The vast majority of young voters believe abortion should be legal in most or all cases, the researchers found. Biden has emphasized the issue on the campaign trail so far, bashing Republicans during events for restricting access to the procedure. Trump appointed three of the five Supreme Court justices who decided federal abortion protections should go away.

But there are reasons for Democrats to be concerned. The top issue for young voters in 2024 was inflation/affordability, according to the Tufts University researchers. Although inflation has come down to less than half of its 2021 peak , Republicans routinely hammer Biden on his economic record.

Nikki Fried, the chairperson of the Florida Democratic Party, said her party could be better at making young voters excited about what she called Democratic wins: an improving economy, billions in student debt forgiveness, movement toward legalizing marijuana.

“As Democrats, we are humble and to our detriment, don’t go around bragging about all the accomplishments,” Fried said. “We’re not always great communicators.”

Fried noted that the party has set up a youth council to help the Democrats take the temperature of this all-important demographic. The party plans to make a renewed effort to organize on college campuses this year.

Alexa Matos, 19, the president of the University of South Florida-St. Petersburg College Democrats, will be part of that organizing effort. She met Biden in person once before at an event at the University of Tampa. He’s quick on his feet in person, and funny, she said.

“He’s like your cool grandpa,” Matos said.

During a get-together at a campus library in early March, Matos and about a dozen college Democrats crowded in front of a TV to watch Biden deliver his State of the Union address.

It was a big moment for Biden. Days before the speech, the New York Times released a survey showing that a majority of his own supporters from 2020 think he’s too old to be effective. Some Republicans previewing the speech called it Biden’s “State of Confusion.” He went into the night needing to show the American public that he was still with it.

Matos and the other young Democrats made a game of the evening.

On a custom-made bingo board, the group wrote terms like “Biden winks ;)” and “‘My fellow Americans.’” They spent the evening checking off squares.

One of the squares was “youth vote.”

Biden never mentioned it.

Correction: An earlier version version of this story misidentified Cat Margaux. They use the pronouns they/them.

Kirby Wilson is a politics reporter, covering the leaders of Florida and explaining the political landscape. Reach him at [email protected].

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