research conclusion paper

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

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

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

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

Table of Contents

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

• How to write a research paper conclusion with Paperpal? 

Frequently Asked Questions

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

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

Types of conclusions for research papers

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

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

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

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

Align your conclusion’s tone with the rest of your research paper. Start Writing with Paperpal Now!  

The conclusion in a research paper serves several important purposes:

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

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

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

Write your research paper conclusion 2x faster with Paperpal. Try it now!

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

How to write a research paper conclusion with Paperpal?

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

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

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

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

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

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

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

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

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

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

Paperpal is a comprehensive AI writing toolkit that helps students and researchers achieve 2x the writing in half the time. It leverages 21+ years of STM experience and insights from millions of research articles to provide in-depth academic writing, language editing, and submission readiness support to help you write better, faster.  

Get accurate academic translations, rewriting support, grammar checks, vocabulary suggestions, and generative AI assistance that delivers human precision at machine speed. Try for free or upgrade to Paperpal Prime starting at US$19 a month to access premium features, including consistency, plagiarism, and 30+ submission readiness checks to help you succeed.  

Experience the future of academic writing – Sign up to Paperpal and start writing for free!  

Related Reads:

• 5 Reasons for Rejection After Peer Review
• Ethical Research Practices For Research with Human Subjects

7 Ways to Improve Your Academic Writing Process

• Paraphrasing in Academic Writing: Answering Top Author Queries

Preflight For Editorial Desk: The Perfect Hybrid (AI + Human) Assistance Against Compromised Manuscripts

You may also like, ai in education: it’s time to change the..., is it ethical to use ai-generated abstracts without..., what are journal guidelines on using generative ai..., quillbot review: features, pricing, and free alternatives, what is an academic paper types and elements , should you use ai tools like chatgpt for..., publish research papers: 9 steps for successful publications , what are the different types of research papers, how to make translating academic papers less challenging, self-plagiarism in research: what it is and how....

• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

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

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

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

Importance of a Good Conclusion

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

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

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

Structure and Writing Style

I.  General Rules

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

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

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

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

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

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

II.  Developing a Compelling Conclusion

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

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

III. Problems to Avoid

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

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

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

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

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

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

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

Writing Tip

Don't Belabor the Obvious!

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

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

Another Writing Tip

New Insight, Not New Information!

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

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

• << Previous: Limitations of the Study
• Next: Appendices >>
• Last Updated: Apr 5, 2024 1:38 PM
• URL: https://libguides.usc.edu/writingguide

• Privacy Policy

Buy Me a Coffee

Home » Research Paper Conclusion – Writing Guide and Examples

Research Paper Conclusion – Writing Guide and Examples

Table of Contents

Research Paper Conclusion

Definition:

A research paper conclusion is the final section of a research paper that summarizes the key findings, significance, and implications of the research. It is the writer’s opportunity to synthesize the information presented in the paper, draw conclusions, and make recommendations for future research or actions.

The conclusion should provide a clear and concise summary of the research paper, reiterating the research question or problem, the main results, and the significance of the findings. It should also discuss the limitations of the study and suggest areas for further research.

Parts of Research Paper Conclusion

The parts of a research paper conclusion typically include:

Restatement of the Thesis

The conclusion should begin by restating the thesis statement from the introduction in a different way. This helps to remind the reader of the main argument or purpose of the research.

Summary of Key Findings

The conclusion should summarize the main findings of the research, highlighting the most important results and conclusions. This section should be brief and to the point.

Implications and Significance

In this section, the researcher should explain the implications and significance of the research findings. This may include discussing the potential impact on the field or industry, highlighting new insights or knowledge gained, or pointing out areas for future research.

Limitations and Recommendations

It is important to acknowledge any limitations or weaknesses of the research and to make recommendations for how these could be addressed in future studies. This shows that the researcher is aware of the potential limitations of their work and is committed to improving the quality of research in their field.

Concluding Statement

The conclusion should end with a strong concluding statement that leaves a lasting impression on the reader. This could be a call to action, a recommendation for further research, or a final thought on the topic.

How to Write Research Paper Conclusion

Here are some steps you can follow to write an effective research paper conclusion:

• Restate the research problem or question: Begin by restating the research problem or question that you aimed to answer in your research. This will remind the reader of the purpose of your study.
• Summarize the main points: Summarize the key findings and results of your research. This can be done by highlighting the most important aspects of your research and the evidence that supports them.
• Discuss the implications: Discuss the implications of your findings for the research area and any potential applications of your research. You should also mention any limitations of your research that may affect the interpretation of your findings.
• Provide a conclusion : Provide a concise conclusion that summarizes the main points of your paper and emphasizes the significance of your research. This should be a strong and clear statement that leaves a lasting impression on the reader.
• Offer suggestions for future research: Lastly, offer suggestions for future research that could build on your findings and contribute to further advancements in the field.

Remember that the conclusion should be brief and to the point, while still effectively summarizing the key findings and implications of your research.

Example of Research Paper Conclusion

Here’s an example of a research paper conclusion:

Conclusion :

In conclusion, our study aimed to investigate the relationship between social media use and mental health among college students. Our findings suggest that there is a significant association between social media use and increased levels of anxiety and depression among college students. This highlights the need for increased awareness and education about the potential negative effects of social media use on mental health, particularly among college students.

Despite the limitations of our study, such as the small sample size and self-reported data, our findings have important implications for future research and practice. Future studies should aim to replicate our findings in larger, more diverse samples, and investigate the potential mechanisms underlying the association between social media use and mental health. In addition, interventions should be developed to promote healthy social media use among college students, such as mindfulness-based approaches and social media detox programs.

Overall, our study contributes to the growing body of research on the impact of social media on mental health, and highlights the importance of addressing this issue in the context of higher education. By raising awareness and promoting healthy social media use among college students, we can help to reduce the negative impact of social media on mental health and improve the well-being of young adults.

Purpose of Research Paper Conclusion

The purpose of a research paper conclusion is to provide a summary and synthesis of the key findings, significance, and implications of the research presented in the paper. The conclusion serves as the final opportunity for the writer to convey their message and leave a lasting impression on the reader.

The conclusion should restate the research problem or question, summarize the main results of the research, and explain their significance. It should also acknowledge the limitations of the study and suggest areas for future research or action.

Overall, the purpose of the conclusion is to provide a sense of closure to the research paper and to emphasize the importance of the research and its potential impact. It should leave the reader with a clear understanding of the main findings and why they matter. The conclusion serves as the writer’s opportunity to showcase their contribution to the field and to inspire further research and action.

When to Write Research Paper Conclusion

The conclusion of a research paper should be written after the body of the paper has been completed. It should not be written until the writer has thoroughly analyzed and interpreted their findings and has written a complete and cohesive discussion of the research.

Before writing the conclusion, the writer should review their research paper and consider the key points that they want to convey to the reader. They should also review the research question, hypotheses, and methodology to ensure that they have addressed all of the necessary components of the research.

Once the writer has a clear understanding of the main findings and their significance, they can begin writing the conclusion. The conclusion should be written in a clear and concise manner, and should reiterate the main points of the research while also providing insights and recommendations for future research or action.

Characteristics of Research Paper Conclusion

The characteristics of a research paper conclusion include:

• Clear and concise: The conclusion should be written in a clear and concise manner, summarizing the key findings and their significance.
• Comprehensive: The conclusion should address all of the main points of the research paper, including the research question or problem, the methodology, the main results, and their implications.
• Future-oriented : The conclusion should provide insights and recommendations for future research or action, based on the findings of the research.
• Impressive : The conclusion should leave a lasting impression on the reader, emphasizing the importance of the research and its potential impact.
• Objective : The conclusion should be based on the evidence presented in the research paper, and should avoid personal biases or opinions.
• Unique : The conclusion should be unique to the research paper and should not simply repeat information from the introduction or body of the paper.

Advantages of Research Paper Conclusion

The advantages of a research paper conclusion include:

• Summarizing the key findings : The conclusion provides a summary of the main findings of the research, making it easier for the reader to understand the key points of the study.
• Emphasizing the significance of the research: The conclusion emphasizes the importance of the research and its potential impact, making it more likely that readers will take the research seriously and consider its implications.
• Providing recommendations for future research or action : The conclusion suggests practical recommendations for future research or action, based on the findings of the study.
• Providing closure to the research paper : The conclusion provides a sense of closure to the research paper, tying together the different sections of the paper and leaving a lasting impression on the reader.
• Demonstrating the writer’s contribution to the field : The conclusion provides the writer with an opportunity to showcase their contribution to the field and to inspire further research and action.

Limitations of Research Paper Conclusion

While the conclusion of a research paper has many advantages, it also has some limitations that should be considered, including:

• I nability to address all aspects of the research: Due to the limited space available in the conclusion, it may not be possible to address all aspects of the research in detail.
• Subjectivity : While the conclusion should be objective, it may be influenced by the writer’s personal biases or opinions.
• Lack of new information: The conclusion should not introduce new information that has not been discussed in the body of the research paper.
• Lack of generalizability: The conclusions drawn from the research may not be applicable to other contexts or populations, limiting the generalizability of the study.
• Misinterpretation by the reader: The reader may misinterpret the conclusions drawn from the research, leading to a misunderstanding of the findings.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

How to Cite Research Paper – All Formats and...

Data Collection – Methods Types and Examples

Delimitations in Research – Types, Examples and...

Research Paper Format – Types, Examples and...

Research Process – Steps, Examples and Tips

Research Design – Types, Methods and Examples

• Link to facebook
• Link to linkedin
• Link to twitter
• Link to youtube
• Writing Tips

How to Write a Conclusion for a Research Paper

3-minute read

• 29th August 2023

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

·   Reword your thesis statement

·   Highlight the significance of your research

·   Discuss limitations

·   Connect to the introduction

·   End with a thought-provoking statement

Rewording Your Thesis Statement

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

Find this useful?

Subscribe to our newsletter and get writing tips from our editors straight to your inbox.

Highlighting the Significance of Your Research

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

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

Discussing Limitations

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

Connecting to the Introduction

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

Ending With a Thought-Provoking Statement

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

Expert Proofreading Services

Ensure that your essay ends on a high note by having our experts proofread your research paper. Our team has experience with a wide variety of academic fields and subjects and can help make your paper stand out from the crowd – get started today and see the difference it can make in your work.

Share this article:

Post A New Comment

Got content that needs a quick turnaround? Let us polish your work. Explore our editorial business services.

What is a content editor.

Are you interested in learning more about the role of a content editor and the...

4-minute read

The Benefits of Using an Online Proofreading Service

Proofreading is important to ensure your writing is clear and concise for your readers. Whether...

2-minute read

6 Online AI Presentation Maker Tools

Creating presentations can be time-consuming and frustrating. Trying to construct a visually appealing and informative...

What Is Market Research?

No matter your industry, conducting market research helps you keep up to date with shifting...

8 Press Release Distribution Services for Your Business

In a world where you need to stand out, press releases are key to being...

How to Get a Patent

In the United States, the US Patent and Trademarks Office issues patents. In the United...

Make sure your writing is the best it can be with our expert English proofreading and editing.

In a short paper—even a research paper—you don’t need to provide an exhaustive summary as part of your conclusion. But you do need to make some kind of transition between your final body paragraph and your concluding paragraph. This may come in the form of a few sentences of summary. Or it may come in the form of a sentence that brings your readers back to your thesis or main idea and reminds your readers where you began and how far you have traveled.

So, for example, in a paper about the relationship between ADHD and rejection sensitivity, Vanessa Roser begins by introducing readers to the fact that researchers have studied the relationship between the two conditions and then provides her explanation of that relationship. Here’s her thesis: “While socialization may indeed be an important factor in RS, I argue that individuals with ADHD may also possess a neurological predisposition to RS that is exacerbated by the differing executive and emotional regulation characteristic of ADHD.”

In her final paragraph, Roser reminds us of where she started by echoing her thesis: “This literature demonstrates that, as with many other conditions, ADHD and RS share a delicately intertwined pattern of neurological similarities that is rooted in the innate biology of an individual’s mind, a connection that cannot be explained in full by the behavioral mediation hypothesis.”  

Highlight the “so what”  

At the beginning of your paper, you explain to your readers what’s at stake—why they should care about the argument you’re making. In your conclusion, you can bring readers back to those stakes by reminding them why your argument is important in the first place. You can also draft a few sentences that put those stakes into a new or broader context.

In the conclusion to her paper about ADHD and RS, Roser echoes the stakes she established in her introduction—that research into connections between ADHD and RS has led to contradictory results, raising questions about the “behavioral mediation hypothesis.”

She writes, “as with many other conditions, ADHD and RS share a delicately intertwined pattern of neurological similarities that is rooted in the innate biology of an individual’s mind, a connection that cannot be explained in full by the behavioral mediation hypothesis.”  

Leave your readers with the “now what”  

After the “what” and the “so what,” you should leave your reader with some final thoughts. If you have written a strong introduction, your readers will know why you have been arguing what you have been arguing—and why they should care. And if you’ve made a good case for your thesis, then your readers should be in a position to see things in a new way, understand new questions, or be ready for something that they weren’t ready for before they read your paper.

In her conclusion, Roser offers two “now what” statements. First, she explains that it is important to recognize that the flawed behavioral mediation hypothesis “seems to place a degree of fault on the individual. It implies that individuals with ADHD must have elicited such frequent or intense rejection by virtue of their inadequate social skills, erasing the possibility that they may simply possess a natural sensitivity to emotion.” She then highlights the broader implications for treatment of people with ADHD, noting that recognizing the actual connection between rejection sensitivity and ADHD “has profound implications for understanding how individuals with ADHD might best be treated in educational settings, by counselors, family, peers, or even society as a whole.”

To find your own “now what” for your essay’s conclusion, try asking yourself these questions:

• What can my readers now understand, see in a new light, or grapple with that they would not have understood in the same way before reading my paper? Are we a step closer to understanding a larger phenomenon or to understanding why what was at stake is so important?  
• What questions can I now raise that would not have made sense at the beginning of my paper? Questions for further research? Other ways that this topic could be approached?  
• Are there other applications for my research? Could my questions be asked about different data in a different context? Could I use my methods to answer a different question?  
• What action should be taken in light of this argument? What action do I predict will be taken or could lead to a solution?  
• What larger context might my argument be a part of?  

What to avoid in your conclusion  

• a complete restatement of all that you have said in your paper.  
• a substantial counterargument that you do not have space to refute; you should introduce counterarguments before your conclusion.  
• an apology for what you have not said. If you need to explain the scope of your paper, you should do this sooner—but don’t apologize for what you have not discussed in your paper.  
• fake transitions like “in conclusion” that are followed by sentences that aren’t actually conclusions. (“In conclusion, I have now demonstrated that my thesis is correct.”)
• picture_as_pdf Conclusions

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

• PLOS Biology
• PLOS Climate
• PLOS Complex Systems
• PLOS Computational Biology
• PLOS Digital Health
• PLOS Genetics
• PLOS Global Public Health
• PLOS Medicine
• PLOS Mental Health
• PLOS Neglected Tropical Diseases
• PLOS Pathogens
• PLOS Sustainability and Transformation
• PLOS Collections
• How to Write Discussions and Conclusions

The discussion section contains the results and outcomes of a study. An effective discussion informs readers what can be learned from your experiment and provides context for the results.

What makes an effective discussion?

When you’re ready to write your discussion, you’ve already introduced the purpose of your study and provided an in-depth description of the methodology. The discussion informs readers about the larger implications of your study based on the results. Highlighting these implications while not overstating the findings can be challenging, especially when you’re submitting to a journal that selects articles based on novelty or potential impact. Regardless of what journal you are submitting to, the discussion section always serves the same purpose: concluding what your study results actually mean.

A successful discussion section puts your findings in context. It should include:

• the results of your research,
• a discussion of related research, and
• a comparison between your results and initial hypothesis.

Tip: Not all journals share the same naming conventions.

You can apply the advice in this article to the conclusion, results or discussion sections of your manuscript.

Our Early Career Researcher community tells us that the conclusion is often considered the most difficult aspect of a manuscript to write. To help, this guide provides questions to ask yourself, a basic structure to model your discussion off of and examples from published manuscripts. 

Questions to ask yourself:

• Was my hypothesis correct?
• If my hypothesis is partially correct or entirely different, what can be learned from the results? 
• How do the conclusions reshape or add onto the existing knowledge in the field? What does previous research say about the topic? 
• Why are the results important or relevant to your audience? Do they add further evidence to a scientific consensus or disprove prior studies? 
• How can future research build on these observations? What are the key experiments that must be done? 
• What is the “take-home” message you want your reader to leave with?

How to structure a discussion

Trying to fit a complete discussion into a single paragraph can add unnecessary stress to the writing process. If possible, you’ll want to give yourself two or three paragraphs to give the reader a comprehensive understanding of your study as a whole. Here’s one way to structure an effective discussion:

Writing Tips

While the above sections can help you brainstorm and structure your discussion, there are many common mistakes that writers revert to when having difficulties with their paper. Writing a discussion can be a delicate balance between summarizing your results, providing proper context for your research and avoiding introducing new information. Remember that your paper should be both confident and honest about the results! 

• Read the journal’s guidelines on the discussion and conclusion sections. If possible, learn about the guidelines before writing the discussion to ensure you’re writing to meet their expectations. 
• Begin with a clear statement of the principal findings. This will reinforce the main take-away for the reader and set up the rest of the discussion. 
• Explain why the outcomes of your study are important to the reader. Discuss the implications of your findings realistically based on previous literature, highlighting both the strengths and limitations of the research. 
• State whether the results prove or disprove your hypothesis. If your hypothesis was disproved, what might be the reasons? 
• Introduce new or expanded ways to think about the research question. Indicate what next steps can be taken to further pursue any unresolved questions. 
• If dealing with a contemporary or ongoing problem, such as climate change, discuss possible consequences if the problem is avoided. 
• Be concise. Adding unnecessary detail can distract from the main findings. 

Don’t

• Rewrite your abstract. Statements with “we investigated” or “we studied” generally do not belong in the discussion. 
• Include new arguments or evidence not previously discussed. Necessary information and evidence should be introduced in the main body of the paper. 
• Apologize. Even if your research contains significant limitations, don’t undermine your authority by including statements that doubt your methodology or execution. 
• Shy away from speaking on limitations or negative results. Including limitations and negative results will give readers a complete understanding of the presented research. Potential limitations include sources of potential bias, threats to internal or external validity, barriers to implementing an intervention and other issues inherent to the study design. 
• Overstate the importance of your findings. Making grand statements about how a study will fully resolve large questions can lead readers to doubt the success of the research. 

Snippets of Effective Discussions:

Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach

Identifying reliable indicators of fitness in polar bears

• How to Write a Great Title
• How to Write an Abstract
• How to Write Your Methods
• How to Report Statistics
• How to Edit Your Work

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

• PRO Courses Guides New Tech Help Pro Expert Videos About wikiHow Pro Upgrade Sign In
• EDIT Edit this Article
• EXPLORE Tech Help Pro About Us Random Article Quizzes Request a New Article Community Dashboard This Or That Game Popular Categories Arts and Entertainment Artwork Books Movies Computers and Electronics Computers Phone Skills Technology Hacks Health Men's Health Mental Health Women's Health Relationships Dating Love Relationship Issues Hobbies and Crafts Crafts Drawing Games Education & Communication Communication Skills Personal Development Studying Personal Care and Style Fashion Hair Care Personal Hygiene Youth Personal Care School Stuff Dating All Categories Arts and Entertainment Finance and Business Home and Garden Relationship Quizzes Cars & Other Vehicles Food and Entertaining Personal Care and Style Sports and Fitness Computers and Electronics Health Pets and Animals Travel Education & Communication Hobbies and Crafts Philosophy and Religion Work World Family Life Holidays and Traditions Relationships Youth
• Browse Articles
• Learn Something New
• Quizzes Hot
• This Or That Game New
• Train Your Brain
• Explore More
• Support wikiHow
• About wikiHow
• Log in / Sign up
• Education and Communications
• College University and Postgraduate
• Academic Writing
• Research Papers

How to Write a Conclusion for a Research Paper

Last Updated: June 29, 2023 Approved

This article was co-authored by Christopher Taylor, PhD . Christopher Taylor is an Adjunct Assistant Professor of English at Austin Community College in Texas. He received his PhD in English Literature and Medieval Studies from the University of Texas at Austin in 2014. wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 42 testimonials and 82% of readers who voted found it helpful, earning it our reader-approved status. This article has been viewed 2,256,383 times.

The conclusion of a research paper needs to summarize the content and purpose of the paper without seeming too wooden or dry. Every basic conclusion must share several key elements, but there are also several tactics you can play around with to craft a more effective conclusion and several you should avoid to prevent yourself from weakening your paper's conclusion. Here are some writing tips to keep in mind when creating a conclusion for your next research paper.

Sample Conclusions

Writing a basic conclusion.

• Do not spend a great amount of time or space restating your topic.
• A good research paper will make the importance of your topic apparent, so you do not need to write an elaborate defense of your topic in the conclusion.
• Usually a single sentence is all you need to restate your topic.
• An example would be if you were writing a paper on the epidemiology of infectious disease, you might say something like "Tuberculosis is a widespread infectious disease that affects millions of people worldwide every year."
• Yet another example from the humanities would be a paper about the Italian Renaissance: "The Italian Renaissance was an explosion of art and ideas centered around artists, writers, and thinkers in Florence."

• A thesis is a narrowed, focused view on the topic at hand.
• This statement should be rephrased from the thesis you included in your introduction. It should not be identical or too similar to the sentence you originally used.
• Try re-wording your thesis statement in a way that complements your summary of the topic of your paper in your first sentence of your conclusion.
• An example of a good thesis statement, going back to the paper on tuberculosis, would be "Tuberculosis is a widespread disease that affects millions of people worldwide every year. Due to the alarming rate of the spread of tuberculosis, particularly in poor countries, medical professionals are implementing new strategies for the diagnosis, treatment, and containment of this disease ."

• A good way to go about this is to re-read the topic sentence of each major paragraph or section in the body of your paper.
• Find a way to briefly restate each point mentioned in each topic sentence in your conclusion. Do not repeat any of the supporting details used within your body paragraphs.
• Under most circumstances, you should avoid writing new information in your conclusion. This is especially true if the information is vital to the argument or research presented in your paper.
• For example, in the TB paper you could summarize the information. "Tuberculosis is a widespread disease that affects millions of people worldwide. Due to the alarming rate of the spread of tuberculosis, particularly in poor countries, medical professionals are implementing new strategies for the diagnosis, treatment, and containment of this disease. In developing countries, such as those in Africa and Southeast Asia, the rate of TB infections is soaring. Crowded conditions, poor sanitation, and lack of access to medical care are all compounding factors in the spread of the disease. Medical experts, such as those from the World Health Organization are now starting campaigns to go into communities in developing countries and provide diagnostic testing and treatments. However, the treatments for TB are very harsh and have many side effects. This leads to patient non-compliance and spread of multi-drug resistant strains of the disease."

• Note that this is not needed for all research papers.
• If you already fully explained what the points in your paper mean or why they are significant, you do not need to go into them in much detail in your conclusion. Simply restating your thesis or the significance of your topic should suffice.
• It is always best practice to address important issues and fully explain your points in the body of your paper. The point of a conclusion to a research paper is to summarize your argument for the reader and, perhaps, to call the reader to action if needed.

• Note that a call for action is not essential to all conclusions. A research paper on literary criticism, for instance, is less likely to need a call for action than a paper on the effect that television has on toddlers and young children.
• A paper that is more likely to call readers to action is one that addresses a public or scientific need. Let's go back to our example of tuberculosis. This is a very serious disease that is spreading quickly and with antibiotic-resistant forms.
• A call to action in this research paper would be a follow-up statement that might be along the lines of "Despite new efforts to diagnose and contain the disease, more research is needed to develop new antibiotics that will treat the most resistant strains of tuberculosis and ease the side effects of current treatments."

• For example, if you are writing a history paper, then you might discuss how the historical topic you discussed matters today. If you are writing about a foreign country, then you might use the conclusion to discuss how the information you shared may help readers understand their own country.

Making Your Conclusion as Effective as Possible

• Since this sort of conclusion is so basic, you must aim to synthesize the information rather than merely summarizing it.
• Instead of merely repeating things you already said, rephrase your thesis and supporting points in a way that ties them all together.
• By doing so, you make your research paper seem like a "complete thought" rather than a collection of random and vaguely related ideas.

• Ask a question in your introduction. In your conclusion, restate the question and provide a direct answer.
• Write an anecdote or story in your introduction but do not share the ending. Instead, write the conclusion to the anecdote in the conclusion of your paper.
• For example, if you wanted to get more creative and put a more humanistic spin on a paper on tuberculosis, you might start your introduction with a story about a person with the disease, and refer to that story in your conclusion. For example, you could say something like this before you re-state your thesis in your conclusion: "Patient X was unable to complete the treatment for tuberculosis due to severe side effects and unfortunately succumbed to the disease."
• Use the same concepts and images introduced in your introduction in your conclusion. The images may or may not appear at other points throughout the research paper.

• Include enough information about your topic to back the statement up but do not get too carried away with excess detail.
• If your research did not provide you with a clear-cut answer to a question posed in your thesis, do not be afraid to indicate as much.
• Restate your initial hypothesis and indicate whether you still believe it or if the research you performed has begun swaying your opinion.
• Indicate that an answer may still exist and that further research could shed more light on the topic at hand.

• This may not be appropriate for all types of research papers. Most research papers, such as one on effective treatment for diseases, will have the information to make the case for a particular argument already in the paper.
• A good example of a paper that might ask a question of the reader in the ending is one about a social issue, such as poverty or government policy.
• Ask a question that will directly get at the heart or purpose of the paper. This question is often the same question, or some version of it, that you may have started with when you began your research.
• Make sure that the question can be answered by the evidence presented in your paper.
• If desired you can briefly summarize the answer after stating the question. You could also leave the question hanging for the reader to answer, though.

• Even without a call to action, you can still make a recommendation to your reader.
• For instance, if you are writing about a topic like third-world poverty, you can various ways for the reader to assist in the problem without necessarily calling for more research.
• Another example would be, in a paper about treatment for drug-resistant tuberculosis, you could suggest donating to the World Health Organization or research foundations that are developing new treatments for the disease.

Avoiding Common Pitfalls

• These sayings usually sound stiff, unnatural, or trite when used in writing.
• Moreover, using a phrase like "in conclusion" to begin your conclusion is a little too straightforward and tends to lead to a weak conclusion. A strong conclusion can stand on its own without being labeled as such.

• Always state the main argument or thesis in the introduction. A research paper is an analytical discussion of an academic topic, not a mystery novel.
• A good, effective research paper will allow your reader to follow your main argument from start to finish.
• This is why it is best practice to start your paper with an introduction that states your main argument and to end the paper with a conclusion that re-states your thesis for re-iteration.

• All significant information should be introduced in the body of the paper.
• Supporting evidence expands the topic of your paper by making it appear more detailed. A conclusion should narrow the topic to a more general point.
• A conclusion should only summarize what you have already stated in the body of your paper.
• You may suggest further research or a call to action, but you should not bring in any new evidence or facts in the conclusion.

• Most often, a shift in tone occurs when a research paper with an academic tone gives an emotional or sentimental conclusion.
• Even if the topic of the paper is of personal significance for you, you should not indicate as much in your paper.
• If you want to give your paper a more humanistic slant, you could start and end your paper with a story or anecdote that would give your topic more personal meaning to the reader.
• This tone should be consistent throughout the paper, however.

• Apologetic statements include phrases like "I may not be an expert" or "This is only my opinion."
• Statements like this can usually be avoided by refraining from writing in the first-person.
• Avoid any statements in the first-person. First-person is generally considered to be informal and does not fit with the formal tone of a research paper.

Community Q&A

You Might Also Like

• ↑ http://owl.english.purdue.edu/owl/resource/724/04/
• ↑ http://www.crlsresearchguide.org/18_Writing_Conclusion.asp
• ↑ http://writing.wisc.edu/Handbook/PlanResearchPaper.html#conclusion
• ↑ http://writingcenter.unc.edu/handouts/conclusions/
• ↑ http://writing2.richmond.edu/writing/wweb/conclude.html

About This Article

To write a conclusion for a research paper, start by restating your thesis statement to remind your readers what your main topic is and bring everything full circle. Then, briefly summarize all of the main points you made throughout your paper, which will help remind your readers of everything they learned. You might also want to include a call to action if you think more research or work needs to be done on your topic by writing something like, "Despite efforts to contain the disease, more research is needed to develop antibiotics." Finally, end your conclusion by explaining the broader context of your topic and why your readers should care about it, which will help them understand why your topic is relevant and important. For tips from our Academic co-author, like how to avoid common pitfalls when writing your conclusion, scroll down! Did this summary help you? Yes No

• Send fan mail to authors

Reader Success Stories

Ummay Aimen

Sep 30, 2016

Did this article help you?

Oct 22, 2017

Sally Larrin

Mar 17, 2018

Maya Loeven

Jun 4, 2017

Sep 26, 2016

Featured Articles

Trending Articles

Watch Articles

• Terms of Use
• Privacy Policy
• Do Not Sell or Share My Info
• Not Selling Info

wikiHow Tech Help Pro:

Develop the tech skills you need for work and life

• Walden University
• Faculty Portal

Writing a Paper: Conclusions

Writing a conclusion.

A conclusion is an important part of the paper; it provides closure for the reader while reminding the reader of the contents and importance of the paper. It accomplishes this by stepping back from the specifics in order to view the bigger picture of the document. In other words, it is reminding the reader of the main argument. For most course papers, it is usually one paragraph that simply and succinctly restates the main ideas and arguments, pulling everything together to help clarify the thesis of the paper. A conclusion does not introduce new ideas; instead, it should clarify the intent and importance of the paper. It can also suggest possible future research on the topic.

An Easy Checklist for Writing a Conclusion

It is important to remind the reader of the thesis of the paper so he is reminded of the argument and solutions you proposed.

Think of the main points as puzzle pieces, and the conclusion is where they all fit together to create a bigger picture. The reader should walk away with the bigger picture in mind.

Make sure that the paper places its findings in the context of real social change.

Make sure the reader has a distinct sense that the paper has come to an end. It is important to not leave the reader hanging. (You don’t want her to have flip-the-page syndrome, where the reader turns the page, expecting the paper to continue. The paper should naturally come to an end.)

No new ideas should be introduced in the conclusion. It is simply a review of the material that is already present in the paper. The only new idea would be the suggesting of a direction for future research.

Conclusion Example

As addressed in my analysis of recent research, the advantages of a later starting time for high school students significantly outweigh the disadvantages. A later starting time would allow teens more time to sleep--something that is important for their physical and mental health--and ultimately improve their academic performance and behavior. The added transportation costs that result from this change can be absorbed through energy savings. The beneficial effects on the students’ academic performance and behavior validate this decision, but its effect on student motivation is still unknown. I would encourage an in-depth look at the reactions of students to such a change. This sort of study would help determine the actual effects of a later start time on the time management and sleep habits of students.

Related Webinar

Didn't find what you need? Search our website or email us .

Read our website accessibility and accommodation statement .

• Previous Page: Thesis Statements
• Next Page: Writer's Block
• Office of Student Disability Services

Walden Resources

Departments.

• Academic Residencies
• Academic Skills
• Career Planning and Development
• Customer Care Team
• Field Experience
• Military Services
• Student Success Advising
• Writing Skills

Centers and Offices

• Center for Social Change
• Office of Academic Support and Instructional Services
• Office of Degree Acceleration
• Office of Research and Doctoral Services
• Office of Student Affairs

Student Resources

• Doctoral Writing Assessment
• Form & Style Review
• Quick Answers
• ScholarWorks
• SKIL Courses and Workshops
• Walden Bookstore
• Walden Catalog & Student Handbook
• Student Safety/Title IX
• Legal & Consumer Information
• Website Terms and Conditions
• Cookie Policy
• Accessibility
• Accreditation
• State Authorization
• Net Price Calculator
• Contact Walden

Walden University is a member of Adtalem Global Education, Inc. www.adtalem.com Walden University is certified to operate by SCHEV © 2024 Walden University LLC. All rights reserved.

• Affiliate Program

• UNITED STATES
• 台灣 (TAIWAN)
• TÜRKIYE (TURKEY)
• Academic Editing Services
• - Research Paper
• - Journal Manuscript
• - Dissertation
• - College & University Assignments
• Admissions Editing Services
• - Application Essay
• - Personal Statement
• - Recommendation Letter
• - Cover Letter
• - CV/Resume
• Business Editing Services
• - Business Documents
• - Report & Brochure
• - Website & Blog
• Writer Editing Services
• - Script & Screenplay
• Our Editors
• Client Reviews
• Editing & Proofreading Prices
• Wordvice Points
• Partner Discount
• Plagiarism Checker
• APA Citation Generator
• MLA Citation Generator
• Chicago Citation Generator
• Vancouver Citation Generator
• - APA Style
• - MLA Style
• - Chicago Style
• - Vancouver Style
• Writing & Editing Guide
• Academic Resources
• Admissions Resources

How to Write a Research Paper Conclusion Section

What is a conclusion in a research paper?

The conclusion in a research paper is the final paragraph or two in a research paper. In scientific papers, the conclusion usually follows the Discussion section , summarizing the importance of the findings and reminding the reader why the work presented in the paper is relevant.

However, it can be a bit confusing to distinguish the conclusion section/paragraph from a summary or a repetition of your findings, your own opinion, or the statement of the implications of your work. In fact, the conclusion should contain a bit of all of these other parts but go beyond it—but not too far beyond! 

The structure and content of the conclusion section can also vary depending on whether you are writing a research manuscript or an essay. This article will explain how to write a good conclusion section, what exactly it should (and should not) contain, how it should be structured, and what you should avoid when writing it.  

Table of Contents:

What does a good conclusion section do, what to include in a research paper conclusion.

• Conclusion in an Essay
• Research Paper Conclusion 
• Conclusion Paragraph Outline and Example
• What Not to Do When Writing a Conclusion

The conclusion of a research paper has several key objectives. It should:

• Restate your research problem addressed in the introduction section
• Summarize your main arguments, important findings, and broader implications
• Synthesize key takeaways from your study

The specific content in the conclusion depends on whether your paper presents the results of original scientific research or constructs an argument through engagement with previously published sources.

You presented your general field of study to the reader in the introduction section, by moving from general information (the background of your work, often combined with a literature review ) to the rationale of your study and then to the specific problem or topic you addressed, formulated in the form of the statement of the problem in research or the thesis statement in an essay.

In the conclusion section, in contrast, your task is to move from your specific findings or arguments back to a more general depiction of how your research contributes to the readers’ understanding of a certain concept or helps solve a practical problem, or fills an important gap in the literature. The content of your conclusion section depends on the type of research you are doing and what type of paper you are writing. But whatever the outcome of your work is, the conclusion is where you briefly summarize it and place it within a larger context. It could be called the “take-home message” of the entire paper.

What to summarize in the conclusion

Your conclusion section needs to contain a very brief summary of your work , a very brief summary of the main findings of your work, and a mention of anything else that seems relevant when you now look at your work from a bigger perspective, even if it was not initially listed as one of your main research questions. This could be a limitation, for example, a problem with the design of your experiment that either needs to be considered when drawing any conclusions or that led you to ask a different question and therefore draw different conclusions at the end of your study (compared to when you started out).

Once you have reminded the reader of what you did and what you found, you need to go beyond that and also provide either your own opinion on why your work is relevant (and for whom, and how) or theoretical or practical implications of the study , or make a specific call for action if there is one to be made.   

How to Write an Essay Conclusion

Academic essays follow quite different structures than their counterparts in STEM and the natural sciences. Humanities papers often have conclusion sections that are much longer and contain more detail than scientific papers. There are three main types of academic essay conclusions.

Summarizing conclusion

The most typical conclusion at the end of an analytical/explanatory/argumentative essay is a summarizing conclusion . This is, as the name suggests, a clear summary of the main points of your topic and thesis. Since you might have gone through a number of different arguments or subtopics in the main part of your essay, you need to remind the reader again what those were, how they fit into each other, and how they helped you develop or corroborate your hypothesis.

For an essay that analyzes how recruiters can hire the best candidates in the shortest time or on “how starving yourself will increase your lifespan, according to science”, a summary of all the points you discussed might be all you need. Note that you should not exactly repeat what you said earlier, but rather highlight the essential details and present those to your reader in a different way. 

Externalizing conclusion

If you think that just reminding the reader of your main points is not enough, you can opt for an externalizing conclusion instead, that presents new points that were not presented in the paper so far. These new points can be additional facts and information or they can be ideas that are relevant to the topic and have not been mentioned before.

Such a conclusion can stimulate your readers to think about your topic or the implications of your analysis in a whole new way. For example, at the end of a historical analysis of a specific event or development, you could direct your reader’s attention to some current events that were not the topic of your essay but that provide a different context for your findings.

Editorial conclusion

In an editorial conclusion , another common type of conclusion that you will find at the end of papers and essays, you do not add new information but instead present your own experiences or opinions on the topic to round everything up. What makes this type of conclusion interesting is that you can choose to agree or disagree with the information you presented in your paper so far. For example, if you have collected and analyzed information on how a specific diet helps people lose weight, you can nevertheless have your doubts on the sustainability of that diet or its practicability in real life—if such arguments were not included in your original thesis and have therefore not been covered in the main part of your paper, the conclusion section is the place where you can get your opinion across.    

How to Conclude an Empirical Research Paper

An empirical research paper is usually more concise and succinct than an essay, because, if it is written well, it focuses on one specific question, describes the method that was used to answer that one question, describes and explains the results, and guides the reader in a logical way from the introduction to the discussion without going on tangents or digging into not absolutely relevant topics.

Summarize the findings

In a scientific paper, you should include a summary of the findings. Don’t go into great detail here (you will have presented your in-depth  results  and  discussion  already), but do clearly express the answers to the  research questions  you investigated.

Describe your main findings, even if they weren’t necessarily the ones anticipated, and explain the conclusion they led you to. Explain these findings in as few words as possible.

Instead of beginning with “ In conclusion, in this study, we investigated the effect of stress on the brain using fMRI …”, you should try to find a way to incorporate the repetition of the essential (and only the essential) details into the summary of the key points. “ The findings of this fMRI study on the effect of stress on the brain suggest that …” or “ While it has been known for a long time that stress has an effect on the brain, the findings of this fMRI study show that, surprisingly… ” would be better ways to start a conclusion. 

You should also not bring up new ideas or present new facts in the conclusion of a research paper, but stick to the background information you have presented earlier, to the findings you have already discussed, and the limitations and implications you have already described. The one thing you can add here is a practical recommendation that you haven’t clearly stated before—but even that one needs to follow logically from everything you have already discussed in the discussion section.

Discuss the implications

After summing up your key arguments or findings, conclude the paper by stating the broader implications of the research , whether in methods , approach, or findings. Express practical or theoretical takeaways from your paper. This often looks like a “call to action” or a final “sales pitch” that puts an exclamation point on your paper.

If your research topic is more theoretical in nature, your closing statement should express the significance of your argument—for example, in proposing a new understanding of a topic or laying the groundwork for future research.

Future research example

Future research into education standards should focus on establishing a more detailed picture of how novel pedagogical approaches impact young people’s ability to absorb new and difficult concepts. Moreover, observational studies are needed to gain more insight into how specific teaching models affect the retention of relationships and facts—for instance, how inquiry-based learning and its emphasis on lateral thinking can be used as a jumping-off point for more holistic classroom approaches.

Research Conclusion Example and Outline

Let’s revisit the study on the effect of stress on the brain we mentioned before and see what the common structure for a conclusion paragraph looks like, in three steps. Following these simple steps will make it easy for you to wrap everything up in one short paragraph that contains all the essential information: 

One: Short summary of what you did, but integrated into the summary of your findings:

While it has been known for a long time that stress has an effect on the brain, the findings of this fMRI study in 25 university students going through mid-term exams show that, surprisingly, one’s attitude to the experienced stress significantly modulates the brain’s response to it. 

Note that you don’t need to repeat any methodological or technical details here—the reader has been presented with all of these before, they have read your results section and the discussion of your results, and even (hopefully!) a discussion of the limitations and strengths of your paper. The only thing you need to remind them of here is the essential outcome of your work. 

Two: Add implications, and don’t forget to specify who this might be relevant for: 

Students could be considered a specific subsample of the general population, but earlier research shows that the effect that exam stress has on their physical and mental health is comparable to the effects of other types of stress on individuals of other ages and occupations. Further research into practical ways of modulating not only one’s mental stress response but potentially also one’s brain activity (e.g., via neurofeedback training) are warranted.

This is a “research implication”, and it is nicely combined with a mention of a potential limitation of the study (the student sample) that turns out not to be a limitation after all (because earlier research suggests we can generalize to other populations). If there already is a lot of research on neurofeedback for stress control, by the way, then this should have been discussed in your discussion section earlier and you wouldn’t say such studies are “warranted” here but rather specify how your findings could inspire specific future experiments or how they should be implemented in existing applications. 

Three: The most important thing is that your conclusion paragraph accurately reflects the content of your paper. Compare it to your research paper title , your research paper abstract , and to your journal submission cover letter , in case you already have one—if these do not all tell the same story, then you need to go back to your paper, start again from the introduction section, and find out where you lost the logical thread. As always, consistency is key.    

Problems to Avoid When Writing a Conclusion 

• Do not suddenly introduce new information that has never been mentioned before (unless you are writing an essay and opting for an externalizing conclusion, see above). The conclusion section is not where you want to surprise your readers, but the take-home message of what you have already presented.
• Do not simply copy your abstract, the conclusion section of your abstract, or the first sentence of your introduction, and put it at the end of the discussion section. Even if these parts of your paper cover the same points, they should not be identical.
• Do not start the conclusion with “In conclusion”. If it has its own section heading, that is redundant, and if it is the last paragraph of the discussion section, it is inelegant and also not really necessary. The reader expects you to wrap your work up in the last paragraph, so you don’t have to announce that. Just look at the above example to see how to start a conclusion in a natural way.
• Do not forget what your research objectives were and how you initially formulated the statement of the problem in your introduction section. If your story/approach/conclusions changed because of methodological issues or information you were not aware of when you started, then make sure you go back to the beginning and adapt your entire story (not just the ending). 

Consider Receiving Academic Editing Services

When you have arrived at the conclusion of your paper, you might want to head over to Wordvice AI’s AI Writing Assistant to receive a free grammar check for any academic content. 

After drafting, you can also receive English editing and proofreading services , including paper editing services for your journal manuscript. If you need advice on how to write the other parts of your research paper , or on how to make a research paper outline if you are struggling with putting everything you did together, then head over to the Wordvice academic resources pages , where we have a lot more articles and videos for you.

How to Write Conclusion in Research Paper (With Example)

Writing a strong conclusion is a crucial part of any research paper. It provides a final opportunity to summarize your key findings, restate your thesis, and leave a lasting impression on your reader. However, many students struggle with how to effectively write a conclusion that ties everything together.

In this article, we’ll provide some tips and strategies for writing a compelling conclusion, along with an example to help illustrate the process. By following these guidelines, you can ensure that your research paper ends on a high note and leaves a lasting impact on your audience.

Why Conclusion is Important in Research Paper

The conclusion is the final chapter of your research paper journey, sealing the deal on all your hard work. After thoroughly laying out your main points and arguments in the body paragraphs, the conclusion gives you a chance to tie everything together into a neat, cohesive package.

More than just summarizing your key ideas, an effective conclusion shows readers the bigger picture of your research and why it matters. It highlights the significance of your findings , explains how your work contributes to the field, and points to potential future directions stemming from your study.

The conclusion is your last chance to leave a lasting impact and compel readers to seriously consider your perspective. With the right phrasing and tone, you can amplify the power of your work. Choose your words wisely, be persuasive yet diplomatic, and guide readers to walk away feeling satisfied by your reasoning and conclusions.

Approach the conclusion thoughtfully, reflect deeply on the larger meaning of your research, and craft impactful final sentences that linger in the reader’s mind. Wield your conclusion skillfully to make your research paper transformative and memorable. A powerful, thoughtful conclusion inspires action, sparks curiosity, and showcases the valuable insights you bring to the academic conversation.

How to Write Conclusion for a Research Paper

Crafting an effective conclusion in research paper requires thoughtful consideration and deliberate effort. After presenting your findings and analysis, the conclusion allows you to close your work with a flourish.

Begin by briefly summarizing the main points of your paper, provide a quick recap of your thesis, methodology, and key findings without repeating too much details from the body. Use this as an opportunity to reinforce your main argument and position within the field.

Next, highlight the significance and implications of your research. What new insights or perspectives does your work contribute? Discuss how your findings can inform future studies or practical applications. Convey why your research matters and how it moves the needle forward in your discipline.

Address any limitations of the current study and propose potential next steps that could be taken by you or other scholars to further the research. This shows readers you have critically considered ways to continue expanding knowledge in this area.

Finally, close with a memorable statement that captures the essence of your work and leaves a lasting impression. This could be an apt metaphor, a call to action, or a thought provoking question for readers to ponder. Choose words that will resonate with your audience and demonstrate the impact of your research.

With care and creativity, your conclusion can elevate your paper and cement your scholarly authority. Revisit often as you write to ensure your conclusion accomplishes its purpose, to convince readers of the value of your study and ignite further progress in your field.

What Not to Include in a Research Paper Conclusion

1. New Data: In a research paper conclusion, avoid presenting new data or evidence that wasn’t discussed earlier in the paper. It’s the time to summarize, analyze, or explain the significance of data already provided, not to introduce new material.

2. Irrelevant Details: The conclusion is not the spot for extraneous details not directly related to your research or its findings. Be focused and concise, tying up the paper neatly without going off-target.

3. Personal Opinions: Try not to include personal beliefs or subjective opinions unless your paper calls for it. Stick to empirical evidence, facts, and objective interpretation of your research.

4. Vague Summarization: While summarizing is the essence of a conclusion, too much of a broad or vague narrative should be avoided. Your conclusion shouldn’t be a generalization of the research but should specifically state your significant findings and their implications.

5. Overstating Results: No matter how exhilarating your research may be, don’t exaggerate its implications or general applications. Remember to acknowledge limitations or potential areas for future exploration.

6. Procrastinating: Refrain from leaving unresolved issues for future research. The conclusion is meant to tie up loose ends, not create more.

7. Repetition: While some reiteration is necessary, completely repeating the same phrases and points made previously can make your conclusion sound boring and redundant. Instead, try to look at your argument from a fresh, summarized perspective.

8. Apologies: Do not apologize or discredit your research efforts. Avoid phrases like, “This research was only” or “Although the study wasn’t able to prove”. A conclusion should confidently present your research results even if they’re unexpected or differ from your hypothesis.

9. Impractical Recommendations: While it’s often good to suggest directions for future research, don’t go overboard by proposing impractical or unachievable goals. Keep your recommendations relevant to your findings and within the realm of possibility.

10. Too Much Jargon: While it’s appropriate to use technical language throughout your research paper, remember the conclusion might be what a layman reads. Stick with a happy medium of professional lingo intermixed with understandable, plain language.

Also Check:   Conclusion for Internship Report

Conclusion in research Example

Research: Impact of Social Media Use on Adolescent Mental Health.

In conclusion, this study has demonstrated the significant impact of social media use on adolescent mental health. Our findings indicate that frequent social media use is associated with higher levels of anxiety and depression, particularly among girls. These results underscore the need for continued research in this area, as well as the development of interventions and strategies to promote healthy social media use among young people. By addressing this issue, we can help to ensure the well-being and success of the next generation.

Conclusion in Research Paper Example

Research: Impact of climate change on coral reefs in Florida.

In conclusion, the effect of climate change on Florida’s coral reefs presents a significant concern for the state’s ecosystem and economy. The data collected during this investigation reveal a direct correlation between rising ocean temperatures and coral bleaching events. This pattern has increased over the past decade, indicating that coral reefs’ health directly correlates with climate change effects.

Example Conclusion in Research

Research: The Influence of Social Media on Consumer Buying Behavior

Social media significantly shapes consumer buying behavior. Its power to influence is seen through peer opinions, online advertising, and brand communication. However, with the potential for misinformation, the reliability and quality of information are areas for further study. Despite these concerns, businesses leveraging social media can effectively boost their market reach and sales.

Research Paper Conclusion

Research: Impacts of Remote Work on Employee Productivity

Remote work has been found to notably enhance employee productivity. The elimination of commuting time, flexible scheduling, and comforting environment contribute to this increase. However, factors like home distractions and technological difficulties offer room for further research. Yet, integrating remote work can be a strategic pathway towards improved efficiency and workforce satisfaction.

These examples demonstrate techniques for crafting an effective conclusion in a research paper, providing your thesis with a powerful final statement. Now it is your turn to compose a strong concluding paragraph that summarizes your findings, reinforces your central argument, and leaves readers with a memorable takeaway.

Remember to restate your thesis without repeating it verbatim, highlight your main points without introducing new evidence, and end on a note that conveys the significance of your research. With a clear structure and purpose, proper grammar, and impactful writing, you can give your paper the persuasive conclusion it deserves.

Writing an effective conclusion takes practice, but by honing these skills you will elevate your academic writing to new heights. Use the strategies outlined here as a guide, believe in your capabilities, and soon you will be adept at concluding research papers powerfully. The final paragraph is your last chance to impress readers, so make it count!

You May Also Like

Conclusion of yoga and meditation, conclusion of social media, conclusion of waste management, conclusion for assignment, conclusion of artificial intelligence | how to write | with example, conclusion for internship report, leave a reply cancel reply.

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Research Paper Guide

Research Paper Conclusion

Writing a Research Paper Conclusion - Step-by-Step Guide

People also read

Research Paper Writing - A Step by Step Guide

Research Paper Examples - Free Sample Papers for Different Formats!

Guide to Creating Effective Research Paper Outline

Interesting Research Paper Topics for 2024

Research Proposal Writing - A Step-by-Step Guide

How to Start a Research Paper - 7 Easy Steps

How to Write an Abstract for a Research Paper - A Step by Step Guide

Writing a Literature Review For a Research Paper - A Comprehensive Guide

Qualitative Research - Methods, Types, and Examples

8 Types of Qualitative Research - Overview & Examples

Qualitative vs Quantitative Research - Learning the Basics

200+ Engaging Psychology Research Paper Topics for Students in 2024

Learn How to Write a Hypothesis in a Research Paper: Examples and Tips!

20+ Types of Research With Examples - A Detailed Guide

Understanding Quantitative Research - Types & Data Collection Techniques

230+ Sociology Research Topics & Ideas for Students

How to Cite a Research Paper - A Complete Guide

Excellent History Research Paper Topics- 300+ Ideas

A Guide on Writing the Method Section of a Research Paper - Examples & Tips

How To Write an Introduction Paragraph For a Research Paper: Learn with Examples

Crafting a Winning Research Paper Title: A Complete Guide

Writing a Thesis For a Research Paper - A Comprehensive Guide

How To Write A Discussion For A Research Paper | Examples & Tips

How To Write The Results Section of A Research Paper | Steps & Examples

Writing a Problem Statement for a Research Paper - A Comprehensive Guide

Finding Sources For a Research Paper: A Complete Guide

A Guide on How to Edit a Research Paper

200+ Ethical Research Paper Topics to Begin With (2024)

300+ Controversial Research Paper Topics & Ideas - 2024 Edition

150+ Argumentative Research Paper Topics For You - 2024

How to Write a Research Methodology for a Research Paper

Finishing a research paper feels great, but getting to the end—especially the conclusion—can be a bit tricky. 

People often wonder, "How do I wrap up my findings nicely?" or "What tone should I use in the conclusion?" 

If you're dealing with these questions, you're not alone! Many researchers find writing a good conclusion a bit challenging since it's a crucial part that is meant to leave a strong impression on your readers.

No need to worry! 

In this guide, we'll show you how to write a conclusion that not only ties up your research paper neatly but also leaves a strong impression. We'll cover everything from summarizing effectively to creating the right feeling. 

So, let’s get started. 

• 1. What is a Research Paper Conclusion?
• 2. How to Write a Research Paper Conclusion: 7 Steps
• 3. Research Paper Conclusion Examples
• 4. Things to Avoid While Writing the Research Paper Conclusion

What is a Research Paper Conclusion?

A research paper conclusion is like the final chapter of your paper. It's where you bring everything together and leave a lasting impression on your readers. 

In simple terms, it's the last part where you sum up what you found during your research and explain why it matters. 

The conclusion isn't just a summary; it's a chance to make your research memorable and show its importance.

Types of Research Paper Conclusions

When it comes to writing the conclusion of your research paper, there isn't a one-size-fits-all approach. Different types of research papers call for different types of conclusions. Here are some common types:

• Summarizing Conclusion

This type recaps the key points and findings of your research. It's like giving your readers a quick overview of what you discovered without introducing new information. Summarizing conclusions works well for straightforward research papers.

• Reflective Conclusion

A reflective conclusion allows you to share your personal thoughts on the research process, challenges faced, and lessons learned. It adds a human touch to your paper, giving readers insight into your journey as a researcher.

• Open-ended Conclusion

Some research papers benefit from an open-ended conclusion that leaves room for further exploration. This type invites readers to think critically, ask questions, or even conduct additional research on the same topic.

How to Write a Research Paper Conclusion: 7 Steps

Writing an effective conclusion for your research paper involves more than just summarizing your findings. Follow these six essential steps to ensure your conclusion leaves a lasting impact:

Step 1: Restate the Research Problem

Start wrapping up your paper by going back to the main research question or issue you were investigating. 

Remind your readers about what you were trying to find out or understand. This gives your conclusion a clear connection to the original goal of your research, helping readers see the bigger picture.

Step 2: Revisit Your Thesis Statement

Go back to the main idea or argument you had in your paper—this is called your thesis statement. Double-check that your conclusion matches and supports what you wanted to prove or talk about in the beginning. 

This step is important because it keeps your conclusion connected to the main point of your research, making everything fit together nicely.

Step 3: Summarize Key Points

Give a short and clear recap of the most important things you found in your research. Keep it simple and stick to what you've already talked about—don't bring in new details now. 

The goal is to remind your readers of the important stuff you covered earlier. This helps to underline why your research is important and what you want them to take away from it.

Step 4: Discuss the Implications

Address the broader implications of your research. Explain why your findings matter and how they contribute to the existing body of knowledge in your field. 

Discuss the practical applications of your research and highlight any potential areas for further exploration.

Step 5: Connect with the Introduction

Create a seamless connection between your conclusion and the introduction. Referencing key elements from the introduction helps to create a cohesive narrative for your paper. 

This connection gives your research a sense of completeness and unity.

Step 6: Consider the "So What?" Factor

Ask yourself the question, "So what?" Why should readers care about your research? Clearly articulate the significance of your findings and their relevance to the broader academic or real-world context. 

Demonstrating the impact of your research adds depth to your conclusion.

Step 7: End with a Strong Closing Statement:

Conclude your research paper with a memorable closing statement. This could be a thought-provoking reflection, a call to action, or a suggestion for future research.

A strong closing leaves a lasting impression on your readers and emphasizes the importance of your work.

Research Paper Conclusion Examples

When it comes to writing a conclusion for your research paper, examining examples can offer valuable insights. Let’s take a look at this comprehensive example given below:

Still wondering how to write the conclusion for your research paper? Check out these examples for better understanding:

Conclusion For A Research Paper APA

Conclusion For A Research Paper Example Pdf

Conclusion For A Research Paper Pdf

Conclusion For A Research Paper Middle School

Conclusion For A Scientific Paper

Conclusion For A Research Paper Sample

Things to Avoid While Writing the Research Paper Conclusion

While crafting a conclusion for your research paper, it's crucial to steer clear of common pitfalls that can diminish the impact of your final remarks. 

Here are some things to avoid:

• Repetition: Avoid rehashing the exact language used in the introduction or body of your paper. A conclusion should summarize key points without duplicating content.
• Introducing New Information: Resist the temptation to introduce new ideas or data in the conclusion. This section is for summarizing existing content and reinforcing key findings.
• Overly Complex Language: Keep your conclusion clear and accessible. Avoid introducing overly complex or technical language that might confuse your readers.
• Lack of Connection to Introduction: Ensure that your conclusion ties back to the introduction. Failing to connect these sections can make your paper feel disjointed.
• Vague Statements: Steer clear of vague statements that lack substance. Clearly articulate the significance of your findings and their broader implications.
• Apologies or Excuses: Avoid including apologies or excuses for limitations in your research. While acknowledging limitations is important, the conclusion is not the place to dwell on them.
• New Arguments or Debates: The conclusion is not the space to introduce new debates or arguments. Keep the focus on summarizing your research and its implications.
• Abrupt Endings: A conclusion should not end abruptly. Instead, provide a thoughtful and well-rounded closing statement about the results of your study.

To sum it up, we've gone through important steps to make your research paper conclusion strong. We covered things like going back to your main question, talking about the most important points, and thinking about why your research matters in the real world.

Remember, a good ending is more than just a summary; it captures the heart of your research and answers the big "So what?" question. 

Remember, don't say the same things too much, don't add new details at the end, and keep your language simple!

If you ever need help with your academic writing, MyPerfectWords.com is here for you. Our expert writers are committed to helping you excel in your research papers and beyond. 

Take the next step towards academic success with MyPerfectWords.com, and hire our essay writing service today!

Write Essay Within 60 Seconds!

Dr. Barbara is a highly experienced writer and author who holds a Ph.D. degree in public health from an Ivy League school. She has worked in the medical field for many years, conducting extensive research on various health topics. Her writing has been featured in several top-tier publications.

Paper Due? Why Suffer? That’s our Job!

Keep reading

How to Write a Conclusion for a Research Paper: Examples & Tips

You might be wondering about how to write a conclusion paragraph for a research paper. It may seem like your readers should understand your main arguments by the end, so there is no need for it. However, there are several aspects that prove the importance of a conclusion section in research.

Our specialists will write a custom essay specially for you!

Its first and primary function is, of course, a summary of all the main ideas and evidence in the paper. Sometimes research can be quite lengthy so putting all the thoughts you want to share in one place is very handy. Moreover, the conclusion shows how important your work is and suggests new ways of looking at the problem.

Our guide and research paper conclusion example are here to help you with your assignment!

• ❗ Importance of a Conclusion
• 👣 Writing Steps
• 📑 Conclusion Types & Examples
• ❌ Common Mistakes

🔗 References

❗ importance of a conclusion in a research paper.

A conclusion intends to remind the readers about the main arguments and findings of the whole paper. However, it also highlights the significance of the work. Both these functions help create a long-lasting, memorable impression from your research paper , so always include this part and try to think of the ways to make it even more effective.

Since having a strong concluding paragraph is so crucial for the overall success, you might want to check out a step-by-step guide on writing it. It can assure you don’t miss any vital moments. Moreover, you need to find out what conclusion type would be the best!

👣 How to Write a Conclusion for a Research Paper Step by Step

Below are only a few simple steps that can allow you to write the most persuasive research paper.

Just in 1 hour! We will write you a plagiarism-free paper in hardly more than 1 hour

📑 Types & Examples of Research Paper Conclusions

You may be assigned to write a persuasive or argumentative paper. Or your professor might ask you to develop an analytical or comparative research paper.

Should you write their conclusions in the same way? The answer is “No”. When you write different types of assignments, you need different conclusions.

Argumentative Research Paper Conclusion

To write an excellent argumentative paper conclusion, you need to highlight the most persuasive and strong arguments you have — no need to add many details. In addition, don’t forget you should include the essential components of the conclusion, such as paraphrasing your thesis statement, which points out your opinion on the chosen topic. If you used a strong thesis statement generator , it won’t be hard to do.

Argumentative Research Paper Conclusion Example

Right now, Earth is facing the issue of the sixth extinction, which causes numerous species to fade every day. There are at least three ideas people might use to prevent their total extinction in the next fifty years. More ways of recycling, new approaches to plastic production, and conservation of species could be life-saving.

Analytical Research Paper Conclusion

First, you should restate your thesis statement and summarize the critical points of your arguments. The main difference between the analytical research paper conclusion and other types is that there should definitely be a highlight of a broader context. It means you can add some meaning to the findings.

Analytical Research Paper Conclusion Example

Elon Musk has made a revolution in the way we pay, drive, and even fly. His ideas come only from the desire to make things easier, but eventually, they change the world. Musk first thought about PayPal when he was a student, and now it’s one of the most popular online payment systems. The same with Tesla cars.

Comparative Research Paper Conclusion

An effective comparative paper conclusion requires some analytical skills. You need to be very careful in looking through facts to clearly formulate your findings. Moreover, the sources need to be trustworthy. And, as usual, you need to add a paraphrased thesis statement and a few words about the importance of your study research.

Receive a plagiarism-free paper tailored to your instructions. Cut 20% off your first order!

Comparative Research Paper Conclusion Example

Electric cars are proven to be more efficient and effective than gas cars. Not only do they produce fewer emissions, but the drivers reach their destination point faster. Moreover, gas cars are more expensive to maintain. It all derives from the specifics of the electric cars’ engines, which are much simpler.

❌ Common Mistakes You Should Avoid

Are you ready to pass your writing? Wait! Have you checked it for the most common mistakes? If no, below are several general errors you should avoid.

• The Conclusion – Organizing Academic Research Papers
• Conclusions – UNC Writing Center
• Conclusions // Purdue Writing Lab
• Writing the conclusion – Research & Learning Online
• Writing a Research Paper – The Writing Center – UW–Madison
• How to Structure & Organize Your Paper
• Writing Conclusions: Writing Guides
• Ending the Essay: Conclusions
• Tips for Writing Policy Papers – Stanford Law School
• A Process Approach to Writing Research Papers
• Share to Facebook
• Share to Twitter
• Share to LinkedIn
• Share to email

American Antiquity is a professional quarterly journal, which contains various papers on the American archeology. It is incredibly popular among archeologists and the students majoring in history. The organization adopted the rules of The Society for American Archaeology (SAA) citation style. As a result: The journal includes numerous references that...

The most tedious and time-consuming part of any school or college written assignment is the bibliography. Sometimes, it can even be challenging! For example, if you’re confused by the variety of citation styles. This is probably when the most students wonder “Is there someone who could complete my assignment?” That...

An appendix is the part of the paper that contains supplementary material. The information from an appendix in paper writing is not essential. If the readers ignore this part, they still have to get the paper’s idea. Appendices help the readers to understand the research better. They might be useful...

Writing an abstract is one of the skills you need to master to succeed in your studies. An abstract is a summary of an academic text. It contains information about the aims and the outcomes of the research. The primary purpose of an abstract is to help readers understand what...

So you have to write a literature review. You find your favorite novel and then start analyzing it. This is how it’s usually done, right? It’s not. You have to learn the elements of literature review and how to deal with them.

Looking for relevant sources of information for your research is already a tiring process, but when you also need to pay attention to their credibility, it becomes almost impossible! However, it’s still a quite critical aspect to pay attention to. Using unreliable sites like Wikipedia, even if it’s a two-page...

A research proposal is a text that suggests a topic or research problem, justifies the need to study it, and describes the ways and methods of conducting the study. Scholars usually write proposals to get funding for their research. In their turn, students might have to do that to get...

It’s longer than your Bachelor’s thesis. It’s more stressful. It’s more important. And you have no clue how to write it. We understand that a lot comes with the responsibility of creating a Master’s thesis from scratch. But no need to stress out; you can get all the help you...

Students struggle with academic writing rules. Mastering them takes longer than writing the paper. But when the conventions become a normal state of things, the process becomes faster and easier than before. The less you think about the form, the more time you have to think about the contents.

Few students fully get the meaning and the importance of a research proposal. If you have a good research proposal, it means that you are going to carry out adequate research. A low-quality research proposal may be the reason your research will never start.

A lab report is quite a serious piece of paper that has a massive value in your research. And don’t be deceived by the name as the lab report is not a form you just need to fill in. There is an impressive list of components you need to describe...

A literature review is an update on the status of current research related to the issue in question. Its purpose is to provide the reader with a guide to a particular research topic. And for the writer, a well-written literature review is the best way to show their competence in...

Very, very useful website for students. I appreciate people who kindly share brilliant writing tips with others! Thanks a lot!

Great article! It helped me to complete my research papers conclusion that was a real nightmare for me! Thank you so much for it!

I was on my way to completing my research paper and going to finish the conclusion by copy-pasting the introduction. Thank God, I wanted to read some articles on conclusion writing. After reading your post on this question, I completed my conclusion following your instructions. Believe my research paper is worth an excellent mark!

In response to a comment from Lynn: Thank you for noting this unfortunate mistake in the text. Obviously, we spend a lot of time compiling, writing, and editing materials, but there’s always room for a simple human error! Thanks again, and have a great day! 🙂

This helped a lot, thanks =)

This helped me so much! Thank you!

You are required to submit an essay in the Personal Comments Essay section. You must complete two additional essays if you apply to an MD-PhD program: the MD-PhD Essay and the Significant Research Experience Essay.  This essay should reflect your personal perspective and experiences accurately. Make sure you proofread carefully because no changes may be made after you submit your application.

Personal Comments Essay

Consider and write your Personal Comments Essay carefully; many admissions committees place significant weight on the essay. Here are some questions you may want to consider while writing the essay:

• Why have you selected the field of medicine?
• What motivates you to learn more about medicine?
• What do you want medical schools to know about you that has not been disclosed in other sections of the application?

In addition, you may wish to include information such as:

• Unique hardships, challenges, and obstacles that may have influenced your educational pursuits.
• Comments on significant fluctuations in your academic record not explained elsewhere in your application.

Formatting Your Essay:  Medical schools receive all text-entry responses as plain text. This means that formatting options such as bulleted lists, indented paragraphs, and bold and italic fonts do not appear for reviewers and are not available in the AMCAS application. You may want to include an extra space between paragraphs because the essay does not permit indentation.

To avoid formatting issues, we recommend typing your essay directly into your AMCAS application; copying formatted text into the application may result in formatting problems that can’t be edited after your application is submitted. If you do cut and paste your essay(s) into the application, you should draft your essay(s) in a plain text format, such as Microsoft Notepad or Mac TextEdit.

Please keep the following in mind:

• Proofread carefully! No changes (including corrections to grammatical or typographical errors) may be made to your essay after you submit your application to the AMCAS program.
• You can’t run a spell check in the AMCAS application, but most browsers have built-in spell checking that you can enable. Use English (United States) characters; other characters may not be accurately recognized.
• Medical schools prefer to receive applications that follow normal writing practices regarding the case of letters. You should avoid using all uppercase or all lowercase letters for the text responses in your application.
• Plagiarism or misrepresentations may result in an investigation. You may use artificial intelligence tools for brainstorming, proofreading, or editing your essays. However, it's essential to ensure that the final submission reflects your own work and accurately represents your experiences.
• It isn’t necessary to repeat information reported elsewhere on your application.
• The essay will be sent to all the medical schools you apply to.
• The space allotted for the essay is 5,300 characters, or about one page. Spaces are counted as characters. You will receive an error message if you exceed the character limit.

MD-PhD Essay

If you’re applying to MD-PhD programs, you’re required to provide two additional essays, the MD-PhD Essay and the Significant Research Experience Essay. Use the MD-PhD Essay to state your reasons for pursuing the combined MD-PhD degree. Your essay will be forwarded only to your designated MD-PhD programs. This essay is limited to 3,000 characters.

Below the MD-PhD Essay, you will be asked to enter your total hours of research experience.

Significant Research Experience Essay

If you’re applying to MD-PhD programs, you’re also required to write an essay that describes your significant research experiences. In this essay, please specify your research supervisor’s name and affiliation, the duration of the experience, the nature of the problem you studied, and your contributions to the research effort. This essay is limited to 10,000 characters.

If you were an author of a publication about your research, please enter the full citation in the Work/Activities section of your application.

Please note: If you change the program type to a Combined MD-PhD Program at a designated school after you submit your application to the AMCAS program, you will need to complete the MD-PhD and Significant Research Experience Essays before you can resubmit your application.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• My Account Login
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 25 March 2024

The evolutionary drivers and correlates of viral host jumps

• Cedric C. S. Tan   ORCID: orcid.org/0000-0003-3536-8465 1 , 2 ,
• Lucy van Dorp   ORCID: orcid.org/0000-0002-6211-2310 1   na1 &
• Francois Balloux   ORCID: orcid.org/0000-0003-1978-7715 1   na1  

Nature Ecology & Evolution ( 2024 ) Cite this article

11k Accesses

2409 Altmetric

Metrics details

• Molecular evolution
• Viral evolution

Most emerging and re-emerging infectious diseases stem from viruses that naturally circulate in non-human vertebrates. When these viruses cross over into humans, they can cause disease outbreaks, epidemics and pandemics. While zoonotic host jumps have been extensively studied from an ecological perspective, little attention has gone into characterizing the evolutionary drivers and correlates underlying these events. To address this gap, we harnessed the entirety of publicly available viral genomic data, employing a comprehensive suite of network and phylogenetic analyses to investigate the evolutionary mechanisms underpinning recent viral host jumps. Surprisingly, we find that humans are as much a source as a sink for viral spillover events, insofar as we infer more viral host jumps from humans to other animals than from animals to humans. Moreover, we demonstrate heightened evolution in viral lineages that involve putative host jumps. We further observe that the extent of adaptation associated with a host jump is lower for viruses with broader host ranges. Finally, we show that the genomic targets of natural selection associated with host jumps vary across different viral families, with either structural or auxiliary genes being the prime targets of selection. Collectively, our results illuminate some of the evolutionary drivers underlying viral host jumps that may contribute to mitigating viral threats across species boundaries.

Similar content being viewed by others

Diversity and evolution of the animal virome

Erin Harvey & Edward C. Holmes

Epidemiological hypothesis testing using a phylogeographic and phylodynamic framework

Simon Dellicour, Sebastian Lequime, … Philippe Lemey

Predicting the global mammalian viral sharing network using phylogeography

Gregory F. Albery, Evan A. Eskew, … Kevin J. Olival

The majority of emerging and re-emerging infectious diseases in humans are caused by viruses that have jumped from wild and domestic animal populations into humans (that is, zoonoses) 1 . Zoonotic viruses have caused countless disease outbreaks ranging from isolated cases to pandemics and have taken a major toll on human health throughout history. There is a pressing need to develop better approaches to pre-empt the emergence of viral infectious diseases and mitigate their effects. As such, there is an immense interest in understanding the correlates and mechanisms of zoonotic host jumps 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 .

Most studies thus far have primarily investigated the ecological and phenotypic risk factors contributing to viral host range through the use of host–virus association databases constructed mainly on the basis of systematic literature reviews and online compendiums, including VIRION 11 and CLOVER 12 . For example, ‘generalist’ viruses that can infect a broader range of hosts have typically been shown to be associated with greater zoonotic potential 2 , 3 , 5 . In addition, factors such as increasing human population density 1 , alterations in human-related land use 4 , ability to replicate in the cytoplasm or being vector-borne 3 are positively associated with zoonotic risk. However, despite global efforts to understand how viral infectious diseases emerge as a result of host jumps, our current understanding remains insufficient to effectively predict, prevent and manage imminent and future infectious disease threats. This may partly stem from the lack of integration of genomics into these ecological and phenotypic analyses.

One challenge for predicting viral disease emergence is that only a small fraction of the viral diversity circulating in wild and domestic vertebrates has been characterized so far. Due to resource and logistical constraints, surveillance studies of novel pathogens in animals often have sparse geographical and/or temporal coverage 13 , 14 and focus on selected host and pathogen taxa. Further, many of these studies do not perform downstream characterization of the novel viruses recovered and may lack sensitivity due to the use of PCR pre-screening to prioritize samples for sequencing 15 . As such, our knowledge of which viruses can, or are likely to emerge and in which settings, is poor. In addition, while genomic analyses are important for investigating the drivers of viral host jumps 16 , most studies do not incorporate genomic data into their analyses. Those that did have mostly focused on measures of host 2 or viral 3 diversity as predictors of zoonotic risk. As such, despite the limited characterization of global viral diversity thus far, existing genomic databases remain a rich, largely untapped resource to better understand the evolutionary processes surrounding viral host jumps.

Further, humans are just one node in a large and complex network of hosts in which viruses are endlessly exchanged, with viral zoonoses representing probably only rare outcomes of this wider ecological network. While research efforts have rightfully focused on zoonoses, viral host jumps between non-human animals remain relatively understudied. Another important process that has received less attention is human-to-animal (that is, anthroponotic) spillover, which may impede biodiversity conservation efforts and could also negatively impact food security. For example, human-sourced metapneumovirus has caused fatal respiratory outbreaks in captive chimpanzees 17 . Anthroponotic events may also lead to the establishment of wild animal reservoirs that may reseed infections in the human population, potentially following the acquisition of animal-specific adaptations that could increase the transmissibility or pathogenicity of a virus in humans 13 . Uncovering the broader evolutionary processes surrounding host jumps across vertebrate species may therefore enhance our ability to pre-empt and mitigate the effects of infectious diseases on both human and animal health.

A major challenge for understanding macroevolutionary processes through large-scale genomic analyses is the traditional reliance on physical and biological properties of viruses to define viral taxa, which is largely a vestige of the pre-genomic era 18 . As a result, taxon names may not always accurately reflect the evolutionary relatedness of viruses, precluding robust comparative analyses involving diverse viral taxa. Notably, the International Committee on Taxonomy of Viruses (ICTV) has been strongly advocating for taxon names to also reflect the evolutionary history of viruses 18 , 19 . However, the increasing use of metagenomic sequencing technologies has resulted in a large influx of newly discovered viruses that have not yet been incorporated into the ICTV taxonomy. Furthermore, it remains challenging to formally assess genetic relatedness through multiple sequence alignments of thousands of sequences comprising diverse viral taxa, particularly for those that experience a high frequency of recombination or reassortment.

In this study, we leverage the ~12 million viral sequences and associated host metadata hosted on NCBI to assess the current state of global viral genomic surveillance. We additionally analyse ~59,000 viral sequences isolated from various vertebrate hosts using a bespoke approach that is agnostic to viral taxonomy to understand the evolutionary processes surrounding host jumps. We ascertain overall trends in the directionality of viral host jumps between human and non-human vertebrates and quantify the amount of detectable adaptation associated with putative host jumps. Finally, we examine, for a subset of viruses, signatures of adaptive evolution detected in specific categories of viral proteins associated with facilitating or sustaining host jumps. Together, we provide a comprehensive assessment of potential genomic correlates underpinning host jumps in viruses across humans and other non-human vertebrates.

An incomplete picture of global vertebrate viral diversity

Global genomic surveillance of viruses from different hosts is key to preparing for emerging and re-emerging infectious diseases in humans and animals 13 , 16 . To identify the scope of viral genomic data collected thus far, we downloaded the metadata of all viral sequences hosted on NCBI Virus ( n  = 11,645,803; accessed 22 July 2023; Supplementary Data 1 ). Most (68%) of these sequences were associated with SARS-CoV-2, reflecting the intense sequencing efforts during the COVID-19 pandemic. In addition, of these sequences, 93.6%, 3.3%, 1.5%, 1.1% and 0.6% were of viruses with single-stranded (ss)RNA, double-stranded (ds)DNA, dsRNA, ssDNA and unspecified genome compositions, respectively. The dominance of ssRNA viruses is not entirely explained by the high number of SARS-CoV-2 genomes, as ssRNA viruses still represent 80% of all viral genomes if SARS-CoV-2 is discounted.

Vertebrate-associated viral sequences represent 93% of this dataset, of which 93% were human associated. The next four most-sequenced viruses are associated with domestic animals ( Sus , Gallus , Bos and Anas ) and, after excluding SARS-CoV-2, represent 15% of vertebrate viral sequences, while viruses isolated from the remaining vertebrate genera occupy a mere 9% (Fig. 1a and Extended Data Fig. 1a ), highlighting the human-centric nature of viral genomic surveillance. Further, only a limited number of non-human vertebrate families have at least ten associated viral genome sequences deposited (Fig. 1b ), reinforcing the fact that a substantial proportion of viral diversity in vertebrates remains uncharacterized. Viral sequences obtained from non-human vertebrates thus far also display a strong geographic bias, with most samples collected from the United States of America and China, whereas countries in Africa, Central Asia, South America and Eastern Europe are highly underrepresented (Fig. 1c ). This geographical bias varies among the four most-sequenced non-human host genera Sus , Gallus , Anas and Bos (Extended Data Fig. 1b ). Finally, the user-submitted host metadata associated with viral sequences, which is key to understanding global trends in the evolution and spread of viruses in wildlife, remains poor, with 45% and 37% of non-human viral sequences having no associated host information provided at the genus level, or sample collection year, respectively. The proportion of missing metadata also varies extensively between viral families and between countries (Extended Data Fig. 2 ). Overall, these results highlight the massive gaps in the genomic surveillance of viruses in wildlife globally and the need for more conscientious reporting of sample metadata.

a , Proportion of non-SARS-CoV-2, vertebrate-associated viral sequences deposited in public sequence databases ( n  = 2,874,732), stratified by host. Viral sequences associated with humans and the next four most-sampled vertebrate hosts are shown. Sequences with no host metadata resolved at the genus level are denoted as ‘missing’. b , Proportion of host families represented by at least 10 associated viral sequences for the five major vertebrate host groups. c , Global heat map of sequencing effort, generated from all viral sequences deposited in public sequence databases that are not associated with human hosts ( n  = 1,599,672). d , Number of vertebrate viral species on NCBI Virus used for the genomic analyses in this study, stratified by viral family. The 32 vertebrate-associated viral families considered in this study are shown and the remaining 21 families that were not considered are denoted as ‘others’.

Humans give more viruses to animals than they do to us

To investigate the relative frequency of anthroponotic and zoonotic host jumps, we retrieved 58,657 quality-controlled viral genomes spanning 32 viral families, associated with 62 vertebrate host orders and representing 24% of all vertebrate viral species on NCBI Virus ( https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/ ) (Fig. 1d ). We found that the user-submitted species identifiers of these viral genomes are poorly ascribed, with only 37% of species names consistent with those in the ICTV viral taxonomy 20 . In addition, the genetic diversity represented by different viral species is highly variable since they are conventionally defined on the basis of the genetic, phenotypic and ecological attributes of viruses 18 . Thus, we implemented a species-agnostic approach based on network theory to define ‘viral cliques’ that represent discrete taxonomic units with similar degrees of genetic diversity, similar to the concept of operational taxonomic units 21 (Fig. 2a and Methods ). A similar approach was previously shown to effectively partition the genomic diversity of plasmids in a biologically relevant manner 22 . Using this approach, we identified 5,128 viral cliques across the 32 viral families that were highly concordant with ICTV-defined species (median adjusted Rand index, ARI = 83%; adjusted mutual information, AMI = 75%) and of which 95% were monophyletic (Fig. 2a ). Some clique assignments aggregated multiple viral species identifiers, while others disaggregated species into multiple cliques (Fig. 2b ; clique assignments for Coronaviridae illustrated in Extended Data Fig. 3 ). Despite the human-centric nature of genomic surveillance, viral cliques involving only animals represent 62% of all cliques, highlighting the extensive diversity of animal viruses in the global viral-sharing network (Extended Data Fig. 4a ).

a , Workflow for taxonomy-agnostic clique assignments. Briefly, the alignment-free Mash 53 distances between complete viral genomes in each viral family are computed and dense networks where nodes and edges representing viral genomes and the pairwise Mash distances, respectively, are constructed. From these networks, edges representing Mash distances >0.15 are removed to produce sparse networks, on which the community-detection algorithm, Infomap 54 , is applied to identify viral cliques. Concordance with the ICTV taxonomy was assessed using ARI and AMI. b , Sparse networks of representative viral cliques identified within the Coronaviridae (ssRNA), Picobirnaviridae (dsRNA), Genomoviridae (ssDNA) and Adenoviridae (dsDNA). Some viral clique assignments aggregated multiple viral species, while others disaggregated species into multiple cliques. Nodes, node shapes and edges represent individual genomes, their associated host and their pairwise Mash distances, respectively. The list of viral families considered in our analysis are shown on the bottom-left corner of each panel. Silhouettes were sourced from Flaticon.com and Adobe Stock Images ( https://stock.adobe.com ) with a standard licence.

We then identified putative host jumps within these viral cliques by producing curated whole-genome alignments to which we applied maximum-likelihood phylogenetic reconstruction. For segmented viruses, we instead used single-gene alignments as the high frequency of reassortment 23 precludes robust phylogenetic reconstruction using whole genomes. Phylogenetic trees were rooted with suitable outgroups identified using metrics of alignment-free distances (see Methods ). We subsequently reconstructed the host states of all ancestral nodes in each tree, allowing us to determine the most probable direction of a host jump for each viral sequence (approach illustrated in Fig. 3a ). To minimize the uncertainty in the ancestral reconstructions, we considered only host jumps where the likelihood of the ancestral host state was twofold higher than alternative host states (Fig. 3a and Supplementary Methods ). Varying the stringency of this likelihood threshold yielded highly consistent results (Extended Data Fig. 5a ), indicating that the inferred host jumps are robust to our choice of threshold. In total, we identified 12,676 viral lineages comprising 2,904 putative vertebrate host jumps across 174 of these viral cliques.

a , Illustration of ancestral host reconstruction approach used to infer the directionality of putative host jumps. Putative host jumps are identified if the ancestral host state has a twofold higher likelihood than alternative host states. The mutational distance (substitutions per site) represents the sum of the branch lengths between the tip sequence and the ancestral node for which the first host state transition occurred in a tip-to-root traverse. b , Number of distinct putative host jumps involving humans across all viral families considered ( n  = 32). Black dots represent the observed point estimates for each type of host jump. The violin plots show the bootstrap distributions of these estimates, where the host jumps within each viral clique were resampled with replacement for 1,000 iterations. Black lines show the 95% confidence intervals associated with these bootstrap distributions. Silhouettes were sourced from Flaticon.com and Adobe Stock Images ( https://stock.adobe.com ) with a standard licence. A two-tailed paired t -test was performed to test for a difference in the zoonotic and anthroponotic bootstrap distributions.

Among the putative host jumps inferred to involve human hosts (599/2,904; 21%), we found a much higher frequency of anthroponotic compared with zoonotic host jumps (64% vs 36%, respectively; Fig. 3b ). This finding was statistically significant as assessed via a bootstrap paired t -test ( t  = 227, d.f. = 999, P  < 0.0001) and a permutation test ( P  = 0.035; see Methods ). In addition, this result was robust to our choice of likelihood thresholds used during ancestral reconstruction (Extended Data Fig. 5b ), the tree depth at which the host jump was identified (Extended Data Fig. 5c ), and to sampling bias ( Supplementary Notes and Fig. 1 ). The highest number of anthroponotic jumps was contributed by the cliques representing SARS-CoV-2 (132/383; 34%), MERS-CoV (39/383; 10%) and influenza A (37/383; 10%). This is concordant with the repeated independent anthroponotic spillovers into farmed, captive and wild animals described for SARS-CoV-2 (refs. 13 , 24 , 25 , 26 , 27 ) and influenza A 28 , 29 . Meanwhile, there has only been circumstantial evidence for human-to-camel transmission of MERS-CoV 30 , 31 , 32 . Noting the disproportionate number of anthroponotic jumps contributed by these viral cliques, we reperformed the analysis without them and found a significantly higher frequency of anthroponotic than zoonotic jumps (53.5% vs 46.5%; bootstrap paired t -test, t  = 40, d.f. = 999, P  < 0.0001), suggesting that our results are not driven solely by these cliques. Further, 16/21 of the viral families were involved in more anthroponotic than zoonotic jumps (Extended Data Fig. 5d ), indicating that this finding is generalizable across most viruses. Overall, our results highlight the high but largely underappreciated frequency of anthroponotic jumps among vertebrate viruses.

Host jumps of multihost viruses require fewer adaptations

Before jumping to a new host, a virus in its natural reservoir may fortuitously acquire pre-adaptive mutations that facilitate its transition to a new host. This may be followed by the further acquisition of adaptive mutations as the virus adapts to its new host environment 16 .

For each host jump inferred, we estimated the extent of both pre-jump and post-jump adaptations through the sum of branch lengths from the observed tip to the ancestral node where the host transition occurred (Fig. 3a ). However, in practice, the degree of adaptation inferred may vary on the basis of different factors, including sampling intensity and the time interval between when the host jump occurred and when the virus was isolated from its new host. As such, for each viral clique, we considered only the minimum mutational distance associated with a host jump.

We first examined whether the minimum mutational distance associated with a host jump for each viral clique was higher than the minimum for a random selection of viral lineages not involved in host jumps (Fig. 3a and Methods ). Indeed, the minimum mutational distance for a putative host jump within each clique was significantly higher than that for non-host jumps (Fig. 4a ; two-tailed Mann–Whitney U -test, U  = 6,767, P  < 0.0001). Noting that both sampling intensity and the different mutation rates of viral families may confound these results, we corrected for these confounders using a logistic regression model but found a similar effect (odds ratio, OR host jump  = 1.31; two-tailed Z -test for slope = 0, Z  = 6.58, d.f. = 289, P  < 0.0001).

a , b , Distributions (Gaussian kernel densities and boxplots) of ( a ) minimum mutational distance and ( b ) minimum dN/dS for inferred host jump events and non-host jump controls on the logarithmic scale. Differences in distributions were assessed using two-sided Mann–Whitney U -tests. c , d , Scatterplots of the ( c ) minimum mutational distance and ( d ) minimum dN/dS for host jump and non-host jumps. Lines represent univariate linear regression smooths fitted on the data. We corrected for the effects of sequencing effort and viral family membership using Poisson regression models. The parameter estimates in these Poisson models and their statistical significance, as assessed using two-tailed Z -tests, after performing these corrections are annotated. For all panels, each data point represents the minimum distance or minimum dN/dS across all host jump or randomly selected non-host jump lineages in a single clique. Boxplot elements are defined as follows: centre line, median; box limits, upper and lower quartiles; whiskers, 1.5× interquartile range.

We then considered the commonly used measure of directional selection acting on genomes, the ratio of non-synonymous mutations per non-synonymous site (dN) to the number of synonymous mutations per synonymous site (dS). Comparing the minimum dN/dS for host jumps within each clique, we observed that minimum dN/dS was also significantly higher for host jumps compared with non-host jumps (Fig. 4b ; OR host jump  = 2.39; Z  = 4.84, d.f. = 263, P  < 0.0001). Finally, after correcting for viral clique membership, there were no significant differences in log-transformed mutational distance ( F (1,528)  = 2.23, P  = 0.136) or dN/dS estimates ( F (1,338)  = 1.66, P  = 0.198) between zoonotic and anthroponotic jumps, or between forward and reverse cross-species jumps (mutational distance: F (1,1588)  = 0.538, P  = 0.463; dN/dS: F (1,1168)  = 0.0311, P  = 0.860), indicating that there are no direction-specific biases in these measures of adaptation. Overall, these results are consistent with the hypothesized heightened selection following a change in host environment and additionally provide confidence in our ancestral-state reconstruction method for assigning host jump status.

However, the extent of adaptive change required for a viral host jump may vary. For instance, some zoonotic viruses may require minimal adaptation to infect new hosts while in other cases, more substantial genetic changes might be necessary for the virus to overcome barriers that prevent efficient infection or transmission in the new host. We therefore tested the hypothesis that the strength of selection associated with a host jump decreases for viruses that tend to have broader host ranges. To do so, we compared the minimum mutational distance between ancestral and observed host states to the number of host genera sampled for each viral clique. We found that the observed host range for each viral clique is positively associated with greater sequencing intensity (that is, the number of viral genomes in each clique; Pearson’s r  = 0.486; two-tailed t -test for r  = 0, t  = 34.9, d.f. = 3,932, P  < 0.0001), in line with the strong positive correlation between per-host viral diversity and surveillance effort reported in previous studies 2 , 3 , 8 . After correcting for both sequencing effort and viral family membership, we found that the mutational distance for host jumps tends to decrease with broader host ranges (Poisson regression, slope = −0.113; two-tailed Z -test for slope = 0, Z  = −9.40, d.f. = 129, P  < 0.0001). In contrast, the relationship between mutational distance and host range for viral lineages that have not experienced host jumps is only weakly positive (slope = 0.0843; Z  = 7.16, d.f. = 127, P  < 0.0001) (Fig. 4c ). Similarly, the minimum dN/dS for a host jump decreases more substantially for viral cliques with broader host ranges (slope = −0.427; Z  = −9.18, d.f. = 116, P  < 0.0001) than for non-host jump controls (slope = 0.143; Z  = 3.08, d.f. = 116, P  < 0.01) (Fig. 4d ). These trends in mutational distance and dN/dS were consistent when the same analysis was performed for ssDNA, dsDNA, +ssRNA and −ssRNA viruses separately (Extended Data Fig. 6 ). These results indicate that, on average, ‘generalist’ multihost viruses experience lower degrees of adaptation when jumping into new vertebrate hosts.

Host jump adaptations are gene and family specific

We next examined whether genes with different established functions displayed distinctive patterns of adaptive evolution linked to host jump events. Since gene function remains poorly characterized in the large and complex genomes of dsDNA viruses, we focused on the shorter ssRNA and ssDNA viral families. We selected for analysis the four non-segmented viral families with the greatest number of host jump lineages in our dataset: Coronaviridae (+ssRNA; n  = 2,537), Rhabdoviridae (−ssRNA; n  = 1,097), Paramyxoviridae (−ssRNA; n  = 787) and Circoviridae (ssDNA; n  = 695). For these viral families, we extracted all annotated protein-coding regions from their genomes and categorized them as either being associated with cell entry (termed ‘entry’), viral replication (‘replication-associated’) or virion formation (‘structural’), and classifying the remaining genes as ‘auxiliary’ genes.

For the Coronaviridae , Paramyxoviridae and Rhabdoviridae , the entry genes encode surface glycoproteins that could also be considered structural but were not categorized as such given their important role in mediating cell entry. The capsid gene of circoviruses, however, encodes the sole structural protein that is also the key mediator of cell entry and was therefore categorized as structural. To estimate putative signatures of adaptation in relation to lineages that have experienced host jumps for the different gene categories, we modelled the change in log 10 (dN/dS) in host jumps versus non-host jumps using a linear model, while correcting for the effects of clique membership (see Methods ). Contrary to our expectation that entry genes would generally be under the strongest adaptive pressures during a host jump, we found that the strength of adaptation signals for each gene category varied by family. Indeed, the strongest signals were observed for structural proteins in coronaviruses (effect = 0.375, two-tailed t -test for difference in parameter estimates, t  = 4.35, d.f. = 10,121, P  < 0.0001) and auxiliary proteins in paramyxoviruses (effect = 0.439, t  = 2.15, d.f. = 4,225, P  = 0.02) (Fig. 5 ). Meanwhile, no significant adaptive signals were observed in the entry genes of all families (minimum P  = 0.3), except for the capsid gene in circoviruses (effect = 0.325, t  = 2.68, d.f. = 1,367, P  = 0.004) (Fig. 5 ). These findings suggest that selective pressures acting on viral genomes in relation to host jumps are likely to differ by gene function and viral family.

The strength of adaptation signals in genes associated with host jump and non-host jump lineages were estimated using linear models for Coronaviridae ( n  = 10,129), Paramyxoviridae ( n  = 4,233), Rhabdoviridae ( n  = 3,321), and Circoviridae ( n  = 1,373). We modelled the effects of gene type and host jump status on log(dN/dS) while correcting for viral clique membership and, for each gene type, inferred the strength of adaptive signal (denoted ‘effect’) as the difference in parameter estimates for host jumps versus non-host jumps. Points and lines represent the parameter estimates and their standard errors, respectively. Differences in parameter estimates were tested against zero using a one-tailed t -test. Subpanels for each gene type were ordered from left to right with increasing effect estimates.

Given the lack of adaptive signals in the entry proteins, we further hypothesized that within each gene, adaptative changes are likely to be localized to regions of functional importance and/or that are under relatively stronger selective pressures exerted by host immunity. To test this, we focused on the spike gene (entry) of viral cliques within the Coronaviridae since the key region involved in viral entry is well characterized (that is, the receptor-binding domain (RBD)) 33 . We found that dN/dS estimates consistent with adaptive evolution were indeed localized to the RBDs, but also to the N-terminal domains (NTD), of SARS-CoV-2 (genus Betacoronavirus ), avian infectious bronchitis virus (IBV; Gammacoronavirus ) and MERS (genus Alphacoronavirus ) (Extended Data Fig. 7 ). This is consistent with the strong immune pressures exerted on these regions of the spike protein 34 , 35 and the central role of the RBD in host-cell recognition and entry 36 , 37 , 38 . Overall, our results indicate that the extent of adaptation associated with a host jump likely varies by gene function, gene region and viral family.

The post-genomic era has opened opportunities to advance our understanding of the diversity of viruses in circulation and the macroevolutionary principles of viral host range. Leveraging ~59,000 publicly available viral sequences isolated from vertebrate hosts, we inferred that humans give more viruses to other vertebrates than they give to us across the 32 viral families we considered. We further demonstrated that host jumps are associated with heightened signals of adaptive evolution that tend to decrease in viruses with broader host ranges. This indicates that there may be a minimum mutational threshold necessary for viruses to expand their host range. Finally, we showed that adaptive evolution linked to host jumps may vary by gene function and may be localized to specific gene regions of functional importance.

To bypass the limitations of existing viral taxonomies, we used a taxonomy-agnostic approach to define roughly equivalent units of viral diversity, which formed the basis for most of the analyses presented in this study. The use of operational taxonomic units rather than traditional taxonomic species names further allowed us to perform like-for-like analyses across the entire diversity of viruses. Our approach identified cliques that were largely concordant with traditional viral species nomenclature but also highlighted inconsistencies, where in some cases, single viral species appear to form distinct taxonomic groups while other groups of species seem to form a single group solely based on their genetic relatedness (Fig. 2 and Extended Data Fig. 3 ). However, we do not claim that our approach should supersede existing taxonomic classification systems, especially since a robust and meaningful species definition requires the integration of viral properties with finer-scale evolutionary analyses that was not necessary for our purposes. Nevertheless, we anticipate that the development and use of similar network-based approaches may pave the way for the development of efficient classification frameworks that can rapidly incorporate novel, metagenomically derived viruses into existing taxonomies.

Harnessing cliques as a mechanism of identifying clusters of related viruses for phylogenetic inspection allowed us to quantify the number and sources of recent host jump events. One important caveat to this approach is that the viral cliques involved in putative host jumps represent only a fraction of the viral diversity sequenced thus far (Extended Data Fig. 4b ) and the patterns we observed may change as more viruses are discovered. However, we consistently found higher frequencies of anthroponotic than zoonotic jumps across 16 of the 21 viral families (Extended Data Fig. 5d ). Since each of these families are associated with varying viral discovery effort, the consistency of this pattern makes it highly unlikely that surveillance biases are driving the excess of anthroponotic jumps we inferred. Another caveat is that our clique assignment approach clusters viruses within ~15% sequence divergence, which limits our analyses to relatively recent host jump events. However, the limited divergence of the sequences within each clique also allowed us to produce more robust alignments and hence evolutionary inferences.

Of the 599 recent host jumps identified, 64% were inferred as anthroponotic (Fig. 3b ). While the relative importance of anthroponotic versus zoonotic events has been speculated 13 , 29 , 39 , 40 , we provide a formal evaluation of the zoonotic-to-anthroponotic ratio in vertebrates, showing that anthroponoses are equally, if not more, critical to consider than zoonoses when assessing viral spillover dynamics. It stands to reason that the substantial global human population size and ubiquitous spatial distribution position us as a major source for viral exchange. However, it is also likely that behavioural factors might amplify the risk of anthroponotic transmission, for example, through changes in land use, agricultural methods or heightened interactions between humans and wildlife 4 . Overall, our results highlight the importance of surveying and monitoring human-to-animal transmission of viruses, and its impacts on human and animal health.

We observed heightened evolution and adaptive signals in association with host jumps (Fig. 4 ). This result is largely intuitive, since a virus jumping into a new host is likely to be under different selective pressures exerted directly by the novel host environment and indirectly by changes in host-to-host transmission dynamics. The evolutionary signals we captured may include pre-requisite adaptations that enable a virus to infect the new host. In addition, they probably also represent the burst of adaptive mutations which may be acquired following a host jump, which has been demonstrated for multiple viral systems 24 , 41 , 42 , 43 . Further, these signals could potentially reflect a relaxation of previous selective pressures no longer present in the novel host. We note that these signals of heightened evolution could also, in principle, be inflated by sampling bias, where two viruses circulating in the same host are more often drawn from the same population. However, this was largely controlled for in our analysis through comparisons to representative non-host jump lineages that are expected to be affected by the same sampling bias.

We observed lower mutational and adaptive signals associated with host jumps for viruses that infect a broader range of hosts (Fig. 4c,d ). The most likely explanation for this pattern is that some viruses are intrinsically more capable of infecting a diverse range of hosts, possibly by exploiting host-cell machinery that are conserved across different hosts. For example, sarbecoviruses (the subgenus comprising SARS-CoV-2) target the ACE2 host-cell receptor, which is conserved across vertebrates 44 , 45 , and the high structural conservation of the sarbecovirus spike protein 15 may explain the observation that single mutations can enable sarbecoviruses to expand their host tropism 46 . In other words, multihost viruses may have evolved to target more conserved host machinery that reduces the mutational barrier for them to productively infect new hosts. This may provide a mechanistic explanation for previous observations that viruses with broad host range have a higher risk of emerging as zoonotic diseases 2 , 3 , 5 .

Our approach to identifying putative host jumps hinges on ancestral-state reconstruction (Fig. 3a ), which has been shown to be affected by sampling biases 47 , 48 . However, we accounted for this, at least in part, by including sequencing effort as a measure of sampling bias in our statistical models, allowing us to draw inferences that were robust to disproportionate sampling of viruses in different hosts. Our approach also does not consider the epidemiology or ecology of viral transmission, as this is largely dependent on host features such as population size, social structure and behaviour for which comprehensive datasets at this scale are not currently available. We anticipate that future datasets that integrate ecology, epidemiology and genomics may allow more granular investigations of these patterns in specific host and viral systems. In addition, the patterns we described are broad and do not capture the idiosyncrasies of individual host–pathogen associations. These include a variety of biological features— intrinsic ones, such as the molecular adaptations required for receptor binding, as well as more complex ones including cross-immunity and interference with other viral pathogens circulating in a host population.

Overall, our work highlights the large scope of genomic data in the public domain and its utility in exploring the evolutionary mechanisms of viral host jumps. However, the large gaps in the genomic surveillance of viruses thus far suggest that we have only just scratched the surface of the true viral diversity in nature. In addition, despite the strong anthropocentric bias in viral surveillance, 81% of the putative host jumps identified in this study do not involve humans, emphasizing the large underappreciated scale of the global viral-sharing network (Extended Data Fig. 8 ). Widening our field of view beyond zoonoses and investigating the flow of viruses within this larger network could yield valuable insights that may help us better prepare for and manage infectious disease emergence at the human–animal interface.

Data acquisition, curation and quality control

The metadata of all partial and complete viral genomes were downloaded from NCBI Virus ( https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/ ) on 22 July 2023, with filters excluding sequences isolated from environmental sources, lab hosts, or associated with vaccine strains or proviruses ( n  = 11,645,803). Where possible, host taxa names in the metadata were resolved in accordance with the NCBI taxonomy 49 using the ‘taxizedb’ v.0.3.1 package in R. User-submitted viral species names were compared to the ICTV master species list version ‘MSL38.V2’ dated 6 July 2023.

To generate a candidate list of viral sequences for further genomic analysis, the metadata were filtered to include 53 viral families known to infect vertebrate hosts on the basis of information provided in the 2022 release of the ICTV taxonomy ( https://ictv.global/taxonomy ) 50 and with reference to that provided by ViralZone ( https://viralzone.expasy.org/ ) 51 . We then retained only sequences from viral families comprising at least 100 sequences of greater than 1,000 nt in length. Since the sequences of segmented viral families are rarely deposited as whole genomes and since the high frequency of reassortment 23 precludes robust phylogenetic reconstruction, we identified sequences for single genes conserved within each of these families for further analysis ( Arenaviridae : L segment; Birnaviridae : ORF1/RdRP/VP1/Segment B; Peribunyaviridae : L segment; Orthomyxoviridae : PB1; Picobirnaviridae : RdRP; Sedoreoviridae : VP1/Segment 1/RdRP; Spinareoviridae : Segment 1/RdRP/Lambda 3). These sequences were retrieved by applying text-based pattern matching (that is, ‘grepl’ in R) to query the GenBank sequence titles. For non-segmented genomes, we retained all non-human-associated sequences and subsampled the human-associated sequences as follows: we selected a random subsample of 1,000 SARS-CoV-2 genomes of greater than 28,000 nt from distinct countries, isolation sources and with distinct collection dates. For influenza B, we retained only human sequences with distinct country of origins, sample types and collection dates, and hosts of isolation. For other human-associated sequences, we retained viruses with distinct species, country, isolation source and collection date information. We then downloaded the final candidate list of viral sequences ( n  = 92,973) using ‘ncbi-acc-download’ v.0.2.8 ( https://github.com/kblin/ncbi-acc-download ). Further quality control of the genomes downloaded was performed using ‘CheckV’ (v.1.0.1) 52 , retaining sequences with more than 95% completeness (for non-segmented viruses) and less than 5% contamination (for all sequences). This resulted in a final genomic dataset comprising 58,657 observations (Supplementary Table 1 ) composed of gene sequences for segmented viruses and complete genomes for non-segmented viruses. For simplicity, we will henceforth refer to the gene sequences and complete genomes as ‘genomes’.

Taxonomy-agnostic identification of viral cliques

To identify viral cliques, we calculated the pairwise alignment-free Mash distances of genomes within each viral family via ‘Mash’ (v.1.1) 53 with a k -mer size of 13. This k -mer size ensures that the probability of observing a k -mer by chance, given the median genome length for each clique, is less than 0.01. Given a genome length, l , alphabet, Σ  = {A, T, G, C}, and the desired probability of observing a k -mer by chance, q  = 0.01, this was computed using the formula described previously 53 :

We then constructed undirected graphs for each viral family with nodes and edges representing genomes and Mash distances, respectively. From these networks, we removed edges with Mash distance values greater than a certain threshold, t , before we applied the community-detection algorithm, Infomap 54 . This community-detection algorithm performs well in both large (>1,000 nodes) and small (≤1,000 nodes) undirected graphs 55 and seeks to identify subgraphs within these undirected graphs that minimize the information required to constrain the movement of a random walker 54 . We refer to the subgraphs identified through this algorithm as ‘viral cliques’. Here we forced the community-detection algorithm to identify taxonomically relevant cliques by removing edges with Mash distance values greater than t , which resulted in sparser graphs with closely related genomes (for example, from the same species) being more densely connected than more distantly related genomes (for example, different species). The value of t was selected by maximizing the proportion of monophyletic cliques identified and the concordance of the viral cliques identified with the viral species names from the NCBI taxonomy, based on the commonly used clustering performance metrics, AMI and ARI (Supplementary Fig. 2 ). These metrics were computed using the ‘AMI’ and ‘ARI’ functions in ‘Aricode’ v.1.0.2. To assess whether the viral cliques identified fulfil the species definition criterion of being monophyletic 18 , we reconstructed the phylogenies of each viral family by applying the neighbour-joining algorithm 56 implemented in the ‘Ape’ v.5.7.1 R package on their pairwise Mash distance matrices. We then computed the proportion of monophyletic viral cliques using the ‘is.monophyletic’ function in Ape v.5.7.1 across the various values of t . Given the discordance between the NCBI and ICTV taxonomies, we applied the above optimization protocol to t using the viral species names in the ICTV taxonomy. Using the NCBI viral species names, t  = 0.15 maximized both the median AMI and ARI across all families (Supplementary Fig. 2a ), with 94.3% of the cliques identified being monophyletic (Supplementary Fig. 2b ). Using the ICTV viral species names, t  = 0.2 and t  = 0.25 maximized the median AMI and median ARI across families (Supplementary Fig. 2c ), with 93.7% and 87.8% of the cliques being monophyletic (Supplementary Fig. 2b ), respectively. Since t  = 0.15 produced the highest proportion of monophyletic clades that were approximately concordant with existing viral taxonomies, we used this threshold to generate the final viral clique assignments for downstream analyses (Supplementary Table 1 ).

Identification of putative host jumps

We retrieved all viral cliques that were associated with at least two distinct host genera and comprised at least 10 genomes ( n  = 215). We then generated clique-level genome alignments using the ‘FFT-NS-2’ algorithm in ‘MAFFT’ (v.7.490) 57 , 58 . We masked regions of the alignments that were poorly aligned or prone to sequencing error by replacing alignment sites that had more than 10% of gaps or ambiguous nucleotides with Ns. Clique-level genome alignments that had more than 20% of the median genome length masked were considered to be poorly aligned and thus removed from further analysis ( n  = 6; Supplementary Fig. 3 ). Following this procedure, we reconstructed maximum-likelihood phylogenies for each viral clique with ‘IQ-Tree’ (v.2.1.4-beta) 59 , using 1,000 ultrafast bootstrap (UFBoot) 60 replicates. The optimal substitution model for each tree was automatically determined using the ‘ModelFinder’ 61 utility native to IQ-Tree. To estimate the root position for each clique tree, we reconstructed neighbour-joining Mash trees for each viral clique, including 10 additional genomes whose minimum pairwise Mash distance to the genomes in each tree was 0.3–0.5, as potential outgroups. The most basal tips in these neighbour-joining Mash trees were identified and used to root the maximum-likelihood clique trees. This approach, as opposed to using maximum-likelihood phylogenetic reconstruction involving the outgroups, was used as it is difficult to reliably align clique sequences with highly divergent outgroups.

To identify putative host jumps, we performed ancestral-state reconstruction on the resultant rooted maximum-likelihood phylogenies with host as a discrete trait using the ‘ace’ function in Ape v.5.7.1. Traversing from a tip to the root node, a putative host jump is identified if the reconstructed host state of an ancestral node is different from the observed tip state, has a twofold greater likelihood compared with alternative states and is different from the host state of the sampled tip. Where the tip and ancestral host states were of different taxonomic ranks, we excluded putative host jumps where the ancestral host state is nested within the tip host state, or vice versa (for example, ‘ Homo ’ and ‘Hominidae’). Missing host metadata were encoded as ‘unknown’ and included in the ancestral-state reconstruction analysis. Host jumps involving unknown or non-vertebrate host states were excluded from further analysis. Separately, we extracted non-host jump lineages to control for any biases in our analysis approach. To do so, we randomly selected an ancestral node where the reconstructed host state is the same as the observed tip state and has a twofold greater likelihood than alternative host states, for each viral genome that is not involved in any putative host jumps. For the mutational distance and dN/dS analyses, we retained only viral cliques where non-host jump lineages could be identified. An analysis exploring the robustness of this host jump inference approach to sampling biases (Supplementary Fig. 1 ) and a more detailed description of the inference algorithm (Supplementary Fig. 4 ) are provided in Supplementary Information .

Implementation of this algorithm yielded a list of all viral lineages involving a host jump (Supplementary Table 2 ). Since multiple lineages may involve a host transition at the same ancestral node, we calculated the number of unique host jump events as the number of distinct nodes for each unique host pair. For example, the three lineages Node1 (host A)→Tip1 (host B), Node1 (host A)→Tip2 (host B) and Node1 (host A)→Tip3 (host C) would be considered as two distinct host jump events, one between hosts A and B and the other between hosts A and C. This counting approach was used for Fig. 3a and Extended Data Fig. 5 . The list of all 2,904 distinct host jumps is provided in Supplementary Table 3 .

Calculating mutational distances and dN/dS

Mutational distance and dN/dS estimates may be lineage specific and may depend on sampling intensity. In addition, there is a nonlinear relationship between dN/dS and branch length, that is, the estimated dN/dS decreases with increasing evolutionary distance 62 . Therefore, we opted to compare the minimum adaptive signal (that is, minimum dN/dS) associated with a host jump for each clique. For host jump lineages, mutational distances were calculated as the sum of the branch lengths between the tip sequence and the ancestral node for which the first host state transition occurred (in substitutions per site) using the ‘get_pairwise_distances’ function in the ‘Castor’ (v.1.7.10) 63 R package; this was then multiplied by the alignment length to obtain the estimated number of substitutions (Fig. 3a ). To calculate the dN/dS estimates, we reconstructed the ancestral sequences of ancestral nodes using the ‘-asr’ flag in IQ-Tree, which is based on an empirical Bayesian algorithm ( http://www.iqtree.org/doc/Command-Reference ). We then extracted coding regions from the clique-level masked alignments based on the user-submitted gene annotations on NCBI GenBank (in ‘gff’ format) of each viral genome. We then computed the dN/dS estimates using the method of ref. 64 implemented in the ‘dnastring2kaks’ function of the ‘MSA2dist’ v.1.4.0 R package ( https://github.com/kullrich/MSA2dist ). We calculated the minimum mutational distance and dN/dS across all host jump events in each clique for our downstream statistical analyses, which, in principle, represents the minimum evolutionary signal associated with a host jump in each viral clique. For non-host jump lineages, we similarly computed the minimum mutational distance and dN/dS across the randomly selected lineages. Estimates where dN = 0 or dS = 0 were removed. The list of all minimum mutational distance and minimum dN/dS estimates is provided in Supplementary Tables 4 and 5 , respectively. The dN/dS estimates for the analysis shown in Fig. 5 are provided in Supplementary Table 6 .

For the coronavirus spike gene analysis (Extended Data Fig. 7 ), spike sequences were extracted from the clique-level multiple sequence alignments, with gaps trimmed to the reference sequences (avian infectious bronchitis virus, EU714028.1; SARS-CoV-2, MN908947.3; MERS, JX869059.2). The genomic coordinates for the functional domains of the spike proteins were derived from previous studies 33 , 37 , 65 . Estimates where dN = 0 or dS = 0 were removed. The dN/dS estimates are provided in Supplementary Table 7 .

Statistical analyses

All statistical analyses were performed using the ‘stats’ package native to R v.4.3.1. To generate the bootstrapped distributions shown in Fig. 3b , we randomly resampled the host jumps within each clique with replacement (1,000 iterations) and performed two-tailed paired t -tests using the ‘t.test’ function. Mann–Whitney U -tests, analysis of variance (ANOVA), linear regressions, and Poisson and logistic regressions were implemented using ‘wilcox.test’, ‘anova’, ‘lm’ and ‘glm’ functions, respectively.

A permutation test was performed to assess whether the higher proportion of anthroponotic versus zoonotic jumps was statistically significant. We randomly permuted the host states in each clique for 500 iterations while preserving the number of host-jump and non-host-jump lineages (illustrated in Supplementary Fig. 5 ). The P value was calculated as the number of iterations where the permutated anthroponotic/zoonotic ratio was greater than or equal to the observed ratio.

To assess the relationship between host range and adaptative signals (Fig. 4 ), we used Poisson regressions to model the expected number of host genera observed in each viral clique, λ host range . We corrected for the number of genomes in each clique, g , as a measure of sampling effort, and viral family membership, v , by including them as fixed effects in these models. These models can be formalized for mutational distance or dN/dS, d , with some p number of viral families and residual error, ε , as:

We tested whether the parameter estimates were non-zero by performing two-tailed Z -tests implemented within the ‘summary’ function in R.

To estimate the strength of adaptive signals for coronaviruses, paramyxoviruses, rhabdoviruses and circoviruses (Fig. 5 ) by gene type, we implemented two linear regression models for each viral family. Since the overall adaptive signal may differ for each viral clique, we corrected for this effect by using an initial linear model where the number of viral cliques, viral clique membership and residual are given by q , c and ε , respectively, as follows:

Subsequently, we used the corrected log(dN/dS) estimates represented by the residuals of model 1, ε model 1 , in a second linear model partitioning the effects of gene type by host jump status, j . Given r number of gene types, this model can be formalized as follows:

The estimated effects shown in Fig. 5 , representative of the difference in adaptive signals associated with jump and non-host jump lineages for each gene type, were then computed as:

To test whether this effect is statistically significant, we used a one-tailed t -test, with the t statistic computed using the standard error of the parameter estimates in model 2:

The residuals of model 2 were confirmed to be approximately normal by visual inspection (Supplementary Fig. 6 ).

Data analysis and visualization

All data analyses were performed using R v.4.3.1. All visualizations were performed using ggplot (v.3.4.2) 66 or ggtree (v.3.8.2) 67 . UpSet plots were created using the R package, UpSetR (v.1.4.0) 68 .

Reporting summary

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

Data availability

The full list of accessions considered in this study is provided in Supplementary Data 1 . The data used for the main analyses are provided in Supplementary Tables 2–7 . All reconstructed maximum-likelihood trees and ancestral sequences used for the analyses are hosted on Zenodo ( https://doi.org/10.5281/zenodo.10214868 ) 69 .

Code availability

All custom code used to perform the analyses reported here are hosted on GitHub ( https://github.com/cednotsed/vertebrate_host_jumps ).

Jones, K. E. et al. Global trends in emerging infectious diseases. Nature 451 , 990–993 (2008).

Article   ADS   CAS   PubMed   PubMed Central   Google Scholar  

Shaw, L. P. et al. The phylogenetic range of bacterial and viral pathogens of vertebrates. Mol. Ecol. 29 , 3361–3379 (2020).

Article   PubMed   Google Scholar  

Olival, K. J. et al. Host and viral traits predict zoonotic spillover from mammals. Nature 546 , 646–650 (2017).

Gibb, R. et al. Zoonotic host diversity increases in human-dominated ecosystems. Nature 584 , 398–402 (2020).

Article   ADS   CAS   PubMed   Google Scholar  

Woolhouse, M. E. J. & Gowtage-Sequeria, S. Host range and emerging and reemerging pathogens. Emerg. Infect. Dis. 11 , 1842–1847 (2005).

Article   PubMed   PubMed Central   Google Scholar  

Albery, G. F., Eskew, E. A., Ross, N. & Olival, K. J. Predicting the global mammalian viral sharing network using phylogeography. Nat. Commun. 11 , 2260 (2020).

Taylor, L. H., Latham, S. M. & Woolhouse, M. E. J. Risk factors for human disease emergence. Phil. Trans. R. Soc. Lond. B 356 , 983–989 (2001).

Article   CAS   Google Scholar  

Albery, G. F. et al. Urban-adapted mammal species have more known pathogens. Nat. Ecol. Evol. 6 , 794–801 (2022).

Karesh, W. B. et al. Ecology of zoonoses: natural and unnatural histories. Lancet 380 , 1936–1945 (2012).

Cleaveland, S., Laurenson, M. K. & Taylor, L. H. Diseases of humans and their domestic mammals: pathogen characteristics, host range and the risk of emergence. Phil. Trans. R. Soc. Lond. B 356 , 991–999 (2001).

Carlson, C. J. et al. The Global Virome in One Network (VIRION): an atlas of vertebrate–virus associations. mBio 13 , e02985-21 (2022).

Gibb, R. et al. Data proliferation, reconciliation, and synthesis in viral ecology. BioScience 71 , 1148–1156 (2021).

Article   Google Scholar  

Kuchipudi, S. V. et al. Coordinated surveillance is essential to monitor and mitigate the evolutionary impacts of SARS-CoV-2 spillover and circulation in animal hosts. Nat. Ecol. Evol. https://doi.org/10.1038/s41559-023-02082-0 (2023).

Watsa, M. & Wildlife Disease Surveillance Focus Group. Rigorous wildlife disease surveillance. Science 369 , 145–147 (2020).

Tan, C. C. et al. Genomic screening of 16 UK native bat species through conservationist networks uncovers coronaviruses with zoonotic potential. Nat. Commun. 14 , 3322 (2023).

Pepin, K. M., Lass, S., Pulliam, J. R. C., Read, A. F. & Lloyd-Smith, J. O. Identifying genetic markers of adaptation for surveillance of viral host jumps. Nat. Rev. Microbiol. 8 , 802–813 (2010).

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kaur, T. et al. Descriptive epidemiology of fatal respiratory outbreaks and detection of a human‐related metapneumovirus in wild chimpanzees ( Pan troglodytes ) at Mahale Mountains National Park, Western Tanzania. Am. J. Primatol. 70 , 755–765 (2008).

Simmonds, P. et al. Four principles to establish a universal virus taxonomy. PLoS Biol. 21 , e3001922 (2023).

Adams, M. J. et al. 50 years of the International Committee on Taxonomy of Viruses: progress and prospects. Arch. Virol. 162 , 1441–1446 (2017).

Article   CAS   PubMed   Google Scholar  

Walker, P. J. et al. Recent changes to virus taxonomy ratified by the International Committee on Taxonomy of Viruses (2022). Arch. Virol. 167 , 2429–2440 (2022).

Blaxter, M. et al. Defining operational taxonomic units using DNA barcode data. Phil. Trans. R. Soc. B 360 , 1935–1943 (2005).

Acman, M., van Dorp, L., Santini, J. M. & Balloux, F. Large-scale network analysis captures biological features of bacterial plasmids. Nat. Commun. 11 , 2452 (2020).

McDonald, S. M., Nelson, M. I., Turner, P. E. & Patton, J. T. Reassortment in segmented RNA viruses: mechanisms and outcomes. Nat. Rev. Microbiol. 14 , 448–460 (2016).

Tan, C. C. S. et al. Transmission of SARS-CoV-2 from humans to animals and potential host adaptation. Nat. Commun. 13 , 2988 (2022).

Kuchipudi, S. V. et al. Multiple spillovers from humans and onward transmission of SARS-CoV-2 in white-tailed deer. Proc. Natl Acad. Sci. USA 119 , e2121644119 (2022).

Munnink, B. B. O. et al. Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans. Science 371 , 172–177 (2021).

Article   ADS   Google Scholar  

McAloose, D. et al. From people to Panthera: natural SARS-CoV-2 infection in tigers and lions at the Bronx Zoo. mBio 11 , e02220-20 (2020).

Short, K. R. et al. One health, multiple challenges: the inter-species transmission of influenza A virus. One Health 1 , 1–13 (2015).

Nelson, M. I. & Vincent, A. L. Reverse zoonosis of influenza to swine: new perspectives on the human–animal interface. Trends Microbiol. 23 , 142–153 (2015).

Samara, E. M. & Abdoun, K. A. Concerns about misinterpretation of recent scientific data implicating dromedary camels in epidemiology of Middle East respiratory syndrome (MERS). mBio 5 , e01430-14 (2014).

Du, L. & Han, G.-Z. Deciphering MERS-CoV evolution in dromedary camels. Trends Microbiol. 24 , 87–89 (2016).

Zhang, Z., Shen, L. & Gu, X. Evolutionary dynamics of MERS-CoV: potential recombination, positive selection and transmission. Sci. Rep. 6 , 25049 (2016).

Huang, Y., Yang, C., Xu, X., Xu, W. & Liu, S. Structural and functional properties of SARS-CoV-2 spike protein: potential antivirus drug development for COVID-19. Acta Pharmacol. Sin. 41 , 1141–1149 (2020).

Carabelli, A. M. et al. SARS-CoV-2 variant biology: immune escape, transmission and fitness. Nat. Rev. Microbiol. 21 , 162–177 (2023).

CAS   PubMed   PubMed Central   Google Scholar  

Wang, N. et al. Structural definition of a neutralization-sensitive epitope on the MERS-CoV S1-NTD. Cell Rep. 28 , 3395–3405 (2019).

Shang, J. et al. Structural basis of receptor recognition by SARS-CoV-2. Nature 581 , 221–224 (2020).

Shang, J. et al. Cryo-EM structure of infectious bronchitis coronavirus spike protein reveals structural and functional evolution of coronavirus spike proteins. PLoS Pathog. 14 , e1007009 (2018).

Yuan, Y. et al. Cryo-EM structures of MERS-CoV and SARS-CoV spike glycoproteins reveal the dynamic receptor binding domains. Nat. Commun. 8 , 15092 (2017).

Messenger, A. M., Barnes, A. N. & Gray, G. C. Reverse zoonotic disease transmission (zooanthroponosis): a systematic review of seldom-documented human biological threats to animals. PLoS ONE 9 , e89055 (2014).

Article   ADS   PubMed   PubMed Central   Google Scholar  

Edwards, S. J., Chatterjee, H. J. & Santini, J. M. Anthroponosis and risk management: a time for ethical vaccination of wildlife? Lancet Microbe 2 , e230–e231 (2021).

Schrauwen, E. J. & Fouchier, R. A. Host adaptation and transmission of influenza A viruses in mammals. Emerg. Microbes Infect. 3 , e9 (2014).

Villordo, S. M., Carballeda, J. M., Filomatori, C. V. & Gamarnik, A. V. RNA structure duplications and flavivirus host adaptation. Trends Microbiol. 24 , 270–283 (2016).

Urbanowicz, R. A. et al. Human adaptation of Ebola virus during the West African outbreak. Cell 167 , 1079–1087 (2016).

Damas, J. et al. Broad host range of SARS-CoV-2 predicted by comparative and structural analysis of ACE2 in vertebrates. Proc. Natl Acad. Sci. USA 117 , 22311–22322 (2020).

Lam, S. D. et al. SARS-CoV-2 spike protein predicted to form complexes with host receptor protein orthologues from a broad range of mammals. Sci. Rep. 10 , 16471 (2020).

Starr, T. N. et al. ACE2 binding is an ancestral and evolvable trait of sarbecoviruses. Nature 603 , 913–918 (2022).

Wright, A. M., Lyons, K. M., Brandley, M. C. & Hillis, D. M. Which came first: the lizard or the egg? Robustness in phylogenetic reconstruction of ancestral states. J. Exp. Zool. B 324 , 504–516 (2015).

Liu, P., Song, Y., Colijn, C. & MacPherson, A. The impact of sampling bias on viral phylogeographic reconstruction. PLoS Glob. Public Health 2 , e0000577 (2022).

Schoch, C. L. et al. NCBI Taxonomy: a comprehensive update on curation, resources and tools. Database 2020 , baaa062 (2020).

Lefkowitz, E. J. et al. Virus taxonomy: the database of the International Committee on Taxonomy of Viruses (ICTV). Nucleic Acids Res. 46 , D708–D717 (2018).

Hulo, C. et al. ViralZone: a knowledge resource to understand virus diversity. Nucleic Acids Res. 39 , D576–D582 (2011).

Nayfach, S. et al. CheckV assesses the quality and completeness of metagenome-assembled viral genomes. Nat. Biotechnol. 39 , 578–585 (2021).

Ondov, B. D. et al. Mash: fast genome and metagenome distance estimation using MinHash. Genome Biol. 17 , 132 (2016).

Rosvall, M. & Bergstrom, C. T. Maps of random walks on complex networks reveal community structure. Proc. Natl Acad. Sci. USA 105 , 1118–1123 (2008).

Yang, Z., Algesheimer, R. & Tessone, C. J. A comparative analysis of community detection algorithms on artificial networks. Sci. Rep. 6 , 30750 (2016).

Saitou, N. & Nei, M. The neighbor-joining method: a new method for reconstructing phylogenetic trees. Mol. Biol. Evol. 4 , 406–425 (1987).

CAS   PubMed   Google Scholar  

Katoh, K., Misawa, K., Kuma, K. & Miyata, T. MAFFT: a novel method for rapid multiple sequence alignment based on fast Fourier transform. Nucleic Acids Res. 30 , 3059–3066 (2002).

Katoh, K. & Standley, D. M. MAFFT multiple sequence alignment software version 7: improvements in performance and usability. Mol. Biol. Evol. 30 , 772–780 (2013).

Minh, B. Q. et al. IQ-TREE 2: new models and efficient methods for phylogenetic inference in the genomic era. Mol. Biol. Evol. 37 , 1530–1534 (2020).

Minh, B. Q., Nguyen, M. A. T. & von Haeseler, A. Ultrafast approximation for phylogenetic bootstrap. Mol. Biol. Evol. 30 , 1188–1195 (2013).

Kalyaanamoorthy, S., Minh, B. Q., Wong, T. K., von Haeseler, A. & Jermiin, L. S. ModelFinder: fast model selection for accurate phylogenetic estimates. Nat. Methods 14 , 587–589 (2017).

Wolf, J. B., Künstner, A., Nam, K., Jakobsson, M. & Ellegren, H. Nonlinear dynamics of nonsynonymous (d N) and synonymous (d S) substitution rates affects inference of selection. Genome Biol. Evol. 1 , 308–319 (2009).

Louca, S. & Doebeli, M. Efficient comparative phylogenetics on large trees. Bioinformatics 34 , 1053–1055 (2018).

Li, W.-H. Unbiased estimation of the rates of synonymous and nonsynonymous substitution. J. Mol. Evol. 36 , 96–99 (1993).

Lu, G. et al. Molecular basis of binding between novel human coronavirus MERS-CoV and its receptor CD26. Nature 500 , 227–231 (2013).

Wickham, H. ggplot2. Wiley Interdiscip. Rev. Comput. Stat. 3 , 180–185 (2011).

Yu, G., Smith, D. K., Zhu, H., Guan, Y. & Lam, T. T. ggtree: an R package for visualization and annotation of phylogenetic trees with their covariates and other associated data. Methods Ecol. Evol. 8 , 28–36 (2017).

Conway, J. R., Lex, A. & Gehlenborg, N. UpSetR: an R package for the visualization of intersecting sets and their properties. Bioinformatics 33 , 2938–2940 (2017).

Tan, C. C. S. Supplementary data for ‘Crossing host boundaries: the evolutionary drivers and correlates of viral host jumps’ [Data set]. Zenodo https://doi.org/10.5281/zenodo.10497734 (2023).

Download references

Acknowledgements

We thank R. J. Gibbs, G. Murray and L. P. Shaw for helpful feedback and discussions. C.C.S.T. was funded by the National Science Scholarship from the Agency for Science, Technology and Research (A*STAR), Singapore. F.B. and L.v.D. were funded by the European Commission (Horizon 2021–2024, END-VOC Project). L.v.D. was also funded by the UCL Excellence Fellowship. Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency. For the purpose of open access, the corresponding author has applied a ‘Creative Commons Attribution’ (CC BY) licence to any author-accepted version of the manuscript. The authors acknowledge the use of the UCL Myriad High Performance Computing Facility (Myriad@UCL), the UCL Department of Computer Science High Performance Computing Cluster and associated support services in the completion of this work.

Author information

These authors contributed equally: Lucy van Dorp, Francois Balloux.

Authors and Affiliations

UCL Genetics Institute, University College London, London, UK

Cedric C. S. Tan, Lucy van Dorp & Francois Balloux

The Francis Crick Institute, London, UK

Cedric C. S. Tan

You can also search for this author in PubMed   Google Scholar

Contributions

C.C.S.T. performed all analyses. L.v.D. and F.B. jointly supervised the study. C.C.S.T., L.v.D. and F.B. wrote the manuscript.

Corresponding author

Correspondence to Cedric C. S. Tan .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Peer review

Peer review information.

Nature Ecology & Evolution thanks the anonymous reviewers for their contribution to the peer review of this work. Peer reviewer reports are available.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Extended data

Extended data fig. 1 host and geographical distribution of viral sequences..

( a ) Number of viral sequences, excluding SARS-CoV-2, associated with the top 50 vertebrate hosts observed in the ‘others’ category as shown in main text Fig. 1a . ( b ) Number of viral sequences stratified by the four most-sequenced non-human animals, excluding SARS-CoV-2. The number of viral sequences for the top 10 countries are shown as bar plots. The percentage of viral sequences for the top three most sequenced viral species for each host are annotated.

Extended Data Fig. 2 Distribution of missing metadata for viral sequences.

(Top) Proportion of all viral sequences associated to non-human vertebrates ( n  = 1,599,672) with missing genus information or (bottom) sample collection year, stratified by viral family or country of origin. Countries with no associated sequences are denoted ‘NA’.

Extended Data Fig. 3 Viral cliques for Coronaviridae .

Sparse networks of viral cliques identified (see Methods) and their corresponding user-submitted species names for the Coronaviridae , similar to main text Fig. 2 . Nodes, node shapes, and edges represent individual genomes, their associated host and their pairwise Mash (alignment-free) distances, respectively.

Extended Data Fig. 4 Summary of viral cliques identified.

( a ) Number of viral cliques identified stratified by viral family. Cliques with only animal-associated sequences, human-associated sequences, or both are annotated. ( b ) Percentage of viral cliques involving at least one of the 2,904 putative host jumps inferred, stratified by viral family.

Extended Data Fig. 5 Robustness of host jump inference.

( a ) UpSet plot providing the intersecting host jumps identified via ancestral reconstruction when using a two-fold, five-fold or ten-fold likelihood threshold. ( b ) Bar plot showing the number of anthroponotic and zoonotic events inferred using various likelihood thresholds, ( c ) at different ancestral node depths, and ( d ) stratified by viral family. For (b), the number of anthroponotic and zoonotic host jumps were stratified by the depth of the ancestral node in the tip-to-node traversal. Since multiple host jump lineages can involve the same ancestral node, the tip-to-node depths may vary depending on which lineage is selected. As such, we randomly selected a viral lineage for each distinct host jump event for this analysis.

Extended Data Fig. 6 Adaptation analysis for viral groups.

Analysis of relationships between host range and estimated adaptive signals, similar to Fig. 3 , but only considering ssDNA, dsDNA, +ssRNA or -ssRNA viruses. Distributions of minimum ( a ) mutational distance and ( b ) dN/dS for host jump and non-host jumps on the logarithmic scale. We corrected for the effects of sequencing effort and viral family membership using Poisson regression models. The estimated effects of patristic distance on host range after these corrections are annotated. We tested whether the estimated effects were non-zero using two-tailed Z-tests. For all panels, each data point represents the minimum distance or dN/dS across all host jump or randomly selected non-host jump lineages in a single clique. Line segments represent linear regression smooths without correction.

Extended Data Fig. 7 Adaptive signals in the Coronaviridae spike gene.

Analysis of the log10(dN/dS) estimates associated to different functional domains encoded by the coronavirus spike gene: N-terminal domain (NTD), receptor-binding domain (RBD), fusion peptide (FP), heptad repeats 1 and 2 (HR1 and HR2), central helix (CH), transmembrane (TM), C-terminal domains (CT). Estimates with dN=0 or dS=0 were removed and the remaining number of sequences for each domain and viral clique are annotated. Differences in distributions were tested for using two-sided Mann-Whitney U tests and the corresponding p-values are annotated. Boxplot elements are defined as follows: centre line, median; box limits, upper and lower quartiles; whiskers, 1.5x interquartile range.

Extended Data Fig. 8 The global viral host jump network.

Directed network of the vertebrate viral-sharing network, where nodes and edges represent host genera and the number of viral cliques shared. Edge widths and colour are indicative of the number of viral cliques shared.

Supplementary information

Supplementary information.

Supplementary Note, Methods and Figs. 1–6.

Reporting Summary

Peer review file, supplementary data 1., supplementary tables 1–9., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ .

Reprints and permissions

About this article

Cite this article.

Tan, C.C.S., van Dorp, L. & Balloux, F. The evolutionary drivers and correlates of viral host jumps. Nat Ecol Evol (2024). https://doi.org/10.1038/s41559-024-02353-4

Download citation

Received : 11 January 2024

Accepted : 29 January 2024

Published : 25 March 2024

DOI : https://doi.org/10.1038/s41559-024-02353-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

• Open access
• Published: 02 April 2022

A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access

• Nicholas C. Coombs 1 ,
• Duncan G. Campbell 2 &
• James Caringi 1  

BMC Health Services Research volume  22 , Article number:  438 ( 2022 ) Cite this article

22k Accesses

19 Citations

10 Altmetric

Metrics details

Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution.

We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings.

Five key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US.

Conclusions

Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.

Peer Review reports

Unequal access to healthcare services is an important element of health disparities in the United States [ 1 ], and there remains much about access that is not fully understood. The lack of understanding is attributable, in part, to the lack of uniformity in how access is defined and evaluated, and the extent to which access is often oversimplified in research [ 2 ]. Subsequently, attempts to address population-level barriers to healthcare access are insufficient, and access remains an unresolved, complex health challenge [ 3 , 4 , 5 ]. This paper presents a study that aims to explore some of the less well studied barriers to healthcare access, particularly those that influence healthcare acceptability and appropriateness.

In truth, healthcare access entails a complicated calculus that combines characteristics of individuals, their households, and their social and physical environments with characteristics of healthcare delivery systems, organizations, and healthcare providers. For one to fully ‘access’ healthcare, they must have the means to identify their healthcare needs and have available to them care providers and the facilities where they work. Further, patients must then reach, obtain, and use the healthcare services in order to have their healthcare needs fulfilled. Levesque and colleagues critically examined access conceptualizations in 2013 and synthesized all ways in which access to healthcare was previously characterized; Levesque et al. proposed five dimensions of access: approachability, acceptability, availability, affordability and appropriateness [ 2 ]. These refer to the ability to perceive, seek, reach, pay for, and engage in services, respectively.

According to Levesque et al.’s framework, the five dimensions combine to facilitate access to care or serve as barriers. Approachability indicates that people facing health needs understand that healthcare services exist and might be helpful. Acceptability represents whether patients see healthcare services as consistent or inconsistent with their own social and cultural values and worldviews. Availability indicates that healthcare services are reached both physically and in a timely manner. Affordability simplifies one’s capacity to pay for healthcare services without compromising basic necessities, and finally, appropriateness represents the fit between healthcare services and a patient’s specific healthcare needs [ 2 ]. This study focused on the acceptability and appropriateness dimensions of access.

Before the novel coronavirus (SARS-CoV-2; COVID-19) pandemic, approximately 13.3% of adults in the US did not have a usual source of healthcare [ 6 ]. Millions more did not utilize services regularly, and close to two-thirds reported that they would be debilitated by an unexpected medical bill [ 7 , 8 , 9 ]. Findings like these emphasized a fragility in the financial security of the American population [ 10 ]. These concerns were exacerbated by the pandemic when a sudden surge in unemployment increased un- and under-insurance rates [ 11 ]. Indeed, employer-sponsored insurance covers close to half of Americans’ total cost of illness [ 12 ]. Unemployment linked to COVID-19 cut off the lone outlet to healthcare access for many. Health-related financial concerns expanded beyond individuals, as healthcare organizations were unequipped to manage a simultaneous increase in demand for specialized healthcare services and a steep drop off for routine revenue-generating healthcare services [ 13 ]. These consequences of the COVID-19 pandemic all put additional, unexpected pressure on an already fragmented US healthcare system.

Other structural barriers to healthcare access exist in relation to the rural–urban divide. Less than 10% of US healthcare resources are located in rural areas where approximately 20% of the American population resides [ 14 ]. In a country with substantially fewer providers per capita compared to many other developed countries, persons in rural areas experience uniquely pressing healthcare provider shortages [ 15 , 16 ]. Rural inhabitants also tend to have lower household income, higher rates of un- or under-insurance, and more difficulty with travel to healthcare clinics than urban dwellers [ 17 ]. Subsequently, persons in rural communities use healthcare services at lower rates, and potentially preventable hospitalizations are more prevalent [ 18 ]. This disparity often leads rural residents to use services primarily for more urgent needs and less so for routine care [ 19 , 20 , 21 ].

The differences in how rural and urban healthcare systems function warranted a federal initiative to focus exclusively on rural health priorities and serve as counterpart to Healthy People objectives [ 22 ]. The rural determinants of health, a more specific expression of general social determinants, add issues of geography and topography to the well-documented social, economic and political factors that influence all Americans’ access to healthcare [ 23 ]. As a result, access is consistently regarded as a top priority in rural areas, and many research efforts have explored the intersection between access and rurality, namely within its less understood dimensions (acceptability and appropriateness) [ 22 ].

Acceptability-related barriers to care

Acceptability represents the dimension of healthcare access that affects a patient’s ability to seek healthcare, particularly linked to one’s professional values, norms and culture [ 2 ]. Access to health information is an influential factor for acceptable healthcare and is essential to promote and maintain a healthy population [ 24 ]. According to the Centers for Disease Control and Prevention, health literacy or a high ‘health IQ’ is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others, which impacts healthcare use and system navigation [ 25 ]. The literature indicates that lower levels of health literacy contribute to health disparities among rural populations [ 26 , 27 , 28 ]. Evidence points to a need for effective health communication between healthcare organizations and patients to improve health literacy [ 24 ]. However, little research has been done in this area, particularly as it relates to technologically-based interventions to disseminate health information [ 29 ].

Stigma, an undesirable position of perceived diminished status in an individual’s social position, is another challenge that influences healthcare acceptability [ 30 ]. Those who may experience stigma fear negative social consequences in relation to care seeking. They are more likely to delay seeking care, especially among ethnic minority populations [ 31 , 32 ]. Social media presents opportunities for the dissemination of misleading medical information; this runs further risk for stigma [ 33 ]. Stigma is difficult to undo, but research has shown that developing a positive relationship with a healthcare provider or organization can work to reduce stigma among patients, thus promoting healthcare acceptability [ 34 ].

A provider’s attempts to engage patients and empower them to be active decision-makers regarding their treatment has also been shown to improve healthcare acceptability. One study found that patients with heart disease who completed a daily diary of weight and self-assessment of symptoms, per correspondence with their provider, had better care outcomes than those who did not [ 35 ]. Engaging with household family members and involved community healers also mitigates barriers to care, emphasizing the importance of a team-based approach that extends beyond those who typically provide healthcare services [ 36 , 37 ]. One study, for instance, explored how individuals closest to a pregnant woman affect the woman’s decision to seek maternity care; partners, female relatives, and community health-workers were among the most influential in promoting negative views, all of which reduced a woman’s likelihood to access care [ 38 ].

Appropriateness-related barriers to care

Appropriateness marks the dimension of healthcare access that affects a patient’s ability to engage, and according to Levesque et al., is of relevance once all other dimensions (the ability to perceive, seek, reach and pay for) are achieved [ 2 ]. The ability to engage in healthcare is influenced by a patient’s level of empowerment, adherence to information, and support received by their healthcare provider. Thus, barriers to healthcare access that relate to appropriateness are often those that indicate a breakdown in communication between a patient with their healthcare provider. Such breakdown can involve a patient experiencing miscommunication, confrontation, and/or a discrepancy between their provider’s goals and their own goals for healthcare. Appropriateness represents a dimension of healthcare access that is widely acknowledged as an area in need of improvement, which indicates a need to rethink how healthcare providers and organizations can adapt to serve the healthcare needs of their communities [ 39 ]. This is especially true for rural, ethnic minority populations, which disproportionately experience an abundance of other barriers to healthcare access. Culturally appropriate care is especially important for members of minority populations [ 40 , 41 , 42 ]. Ultimately, patients value a patient-provider relationship characterized by a welcoming, non-judgmental atmosphere [ 43 , 44 ]. In rural settings especially, level of trust and familiarity are common factors that affect service utilization [ 45 ]. Evidence suggests that kind treatment by a healthcare provider who promotes patient-centered care can have a greater overall effect on a patient’s experience than a provider’s degree of medical knowledge or use of modern equipment [ 46 ]. Of course, investing the time needed to nurture close and caring interpersonal connections is particularly difficult in under-resourced, time-pressured rural health systems [ 47 , 48 ].

The most effective way to evaluate access to healthcare largely depends on which dimensions are explored. For instance, a population-based survey can be used to measure the barrier of healthcare affordability. Survey questions can inquire directly about health insurance coverage, care-related financial burden, concern about healthcare costs, and the feared financial impacts of illness and/or disability. Many national organizations have employed such surveys to measure affordability-related barriers to healthcare. For example, a question may ask explicitly about financial concerns: ‘If you get sick or have an accident, how worried are you that you will not be able to pay your medical bills?’ [ 49 ]. Approachability and availability dimensions of access are also studied using quantitative analysis of survey questions, such as ‘Is there a place that you usually go to when you are sick or need advice about your health?’ or ‘Have you ever delayed getting medical care because you couldn’t get through on the telephone?’ In contrast, the remaining two dimensions–acceptability and appropriateness–require a qualitative approach, as the social and cultural factors that determine a patient’s likelihood of accepting aspects of the services that are to be received (acceptability) and the fit between those services and the patient’s specific healthcare needs (appropriateness) can be more abstract [ 50 , 51 ]. In social science, qualitative methods are appropriate to generate knowledge of what social events mean to individuals and how those individuals interact within them; these methods allow for an exploration of depth rather than breadth [ 52 , 53 ]. Qualitative methods, therefore, are appropriate tools for understanding the depth of healthcare providers’ experiences in the inherently social context of seeking and engaging in healthcare.

In sum, acceptability- and appropriateness-related barriers to healthcare access are multi-layered, complex and abundant. Ensuring access becomes even more challenging if structural barriers to access are factored in. In this study, we aimed to explore barriers to healthcare access among persons in Montana, a historically underserved, under-resourced, rural region of the US. Montana is the fourth largest and third least densely populated state in the country; more than 80% of Montana counties are classified as non-core (the lowest level of urban/rural classification), and over 90% are designated as health professional shortage areas [ 54 , 55 ]. Qualitative methods supported our inquiry to explore barriers to healthcare access related to acceptability and appropriateness.

Participants

Qualitative methods were utilized for this interpretive, exploratory study because knowledge regarding barriers to healthcare access within Montana’s rural health systems is limited. We chose Montana healthcare providers, rather than patients, as the population of interest so we may explore barriers to healthcare access from the perspective of those who serve many persons in rural settings. Inclusion criteria required study participants to provide direct healthcare to patients at least one-half of their time. We defined ‘provider’ as a healthcare organization employee with clinical decision-making power and the qualifications to develop or revise patients’ treatment plans. In an attempt to capture a group of providers with diverse experience, we included providers across several types and specialties. These included advanced practice registered nurses (APRNs), physicians (MDs and DOs), and physician assistants (PAs) who worked in critical care medicine, emergency medicine, family medicine, hospital medicine, internal medicine, pain medicine, palliative medicine, pediatrics, psychiatry, and urgent care medicine. We also included licensed clinical social workers (LCSWs) and clinical psychologists who specialize in behavioral healthcare provision.

Recruitment and Data Collection

We recruited participants via email using a snowball sampling approach [ 56 ]. We opted for this approach because of its effectiveness in time-pressured contexts, such as the COVID-19 pandemic, which has made healthcare provider populations hard to reach [ 57 ]. Considering additional constraints with the pandemic and the rural nature of Montana, interviews were administered virtually via Zoom video or telephone conferencing with Zoom’s audio recording function enabled. All interviews were conducted by the first author between January and September 2021. The average length of interviews was 50 min, ranging from 35 to 70 min. There were occasional challenges experienced during interviews (poor cell phone reception from participants, dropped calls), in which case the interviewer remained on the line until adequate communication was resumed. All interviews were included for analysis and transcribed verbatim into NVivo Version 12 software. All qualitative data were saved and stored on a password-protected University of Montana server. Hard-copy field notes were securely stored in a locked office on the university’s main campus.

Data analysis included a deductive followed by an inductive approach. This dual analysis adheres to Levesque’s framework for qualitative methods, which is discussed in the Definition of Analytic Domains sub-section below. Original synthesis of the literature informed the development of our initial deductive codebook. The deductive approach was derived from a theory-driven hypothesis, which consisted of synthesizing previous research findings regarding acceptability- and appropriateness-related barriers to care. Although the locations, patient populations and specific type of healthcare services varied by study in the existing literature, several recurring barriers to healthcare access were identified. We then operationalized three analytic domains based on these findings: cultural considerations, patient-provider communication, and provider-provider communication. These domains were chosen for two reasons: 1) the terms ‘culture’ and ‘communication’ were the most frequently documented characteristics across the studies examined, and 2) they each align closely with the acceptability and appropriateness dimensions of access to healthcare, respectively. In addition, ‘culture’ is included in the definition of acceptability and ‘communication’ is a quintessential aspect of appropriateness. These domains guided the deductive portion of our analysis, which facilitated the development of an interview guide used for this study.

Interviews were semi-structured to allow broad interpretations from participants and expand the open-ended characterization of study findings. Data were analyzed through a flexible coding approach proposed by Deterding and Waters [ 58 ]. Qualitative content analysis was used, a method particularly beneficial for analyzing large amounts of qualitative data collected through interviews that offers possibility of quantifying categories to identify emerging themes [ 52 , 59 ]. After fifty percent of data were analyzed, we used an inductive approach as a formative check and repeated until data saturation, or the point at which no new information was gathered in interviews [ 60 ]. At each point of inductive analysis, interview questions were added, removed, or revised in consideration of findings gathered [ 61 ]. The Standards for Reporting Qualitative Research (SRQR) was used for reporting all qualitative data for this study [ 62 ]. The first and third authors served as primary and secondary analysts of the qualitative data and collaborated to triangulate these findings. An audit approach was employed, which consisted of coding completed by the first author and then reviewed by the third author. After analyses were complete, member checks ensured credibility and trustworthiness of findings [ 63 ]. Member checks consisted of contacting each study participant to explain the study’s findings; one-third of participants responded and confirmed all findings. All study procedures were reviewed and approved by the Human Subjects Committee of the authors’ institution’s Institutional Review Board.

Definitions of Analytic Domains

Cultural considerations.

Western health systems often fail to consider aspects of patients’ cultural perspectives and histories. This can manifest in the form of a providers’ lack of cultural humility. Cultural humility is a process of preventing imposition of one’s worldview and cultural beliefs on others and recognizing that everyone’s conception of the world is valid. Humility cultivates sensitive approaches in treating patients [ 64 ]. A lack of cultural humility impedes the delivery of acceptable and appropriate healthcare [ 65 ], which can involve low empathy or respect for patients, or dismissal of culture and traditions as superstitions that interfere with standard treatments [ 66 , 67 ]. Ensuring cultural humility among all healthcare employees is a step toward optimal healthcare delivery. Cultural humility is often accomplished through training that can be tailored to particular cultural- or gender-specific populations [ 68 , 69 ]. Since cultural identities and humility have been marked as factors that can heavily influence patients’ access to care, cultural considerations composed our first analytic domain. To assess this domain, we asked participants how they address the unique needs of their patients, how they react when they observe a cultural behavior or attitude from a patient that may not directly align with their treatment plan, and if they have received any multicultural training or training on cultural considerations in their current role.

Patient-provider communication

Other barriers to healthcare access can be linked to ineffective patient-provider communication. Patients who do not feel involved in healthcare decisions are less likely to adhere to treatment recommendations [ 70 ]. Patients who experience communication difficulties with providers may feel coerced, which generates disempowerment and leads patients to employ more covert ways of engagement [ 71 , 72 ]. Language barriers can further compromise communication and hinder outcomes or patient progress [ 73 , 74 ]. Any miscommunication between a patient and provider can affect one’s access to healthcare, namely affecting appropriateness-related barriers. For these reasons, patient-provider communication composed our second analytic domain. We asked participants to highlight the challenges they experience when communicating with their patients, how those complications are addressed, and how communication strategies inform confidentiality in their practice. Confidentiality is a core ethical principle in healthcare, especially in rural areas that have smaller, interconnected patient populations [ 75 ].

Provider-Provider Communication

A patient’s journey through the healthcare system necessitates sufficient correspondence between patients, primary, and secondary providers after discharge and care encounters [ 76 ]. Inter-provider and patient-provider communication are areas of healthcare that are acknowledged to have some gaps. Inconsistent mechanisms for follow up communication with patients in primary care have been documented and emphasized as a concern among those with chronic illness who require close monitoring [ 68 , 77 ]. Similar inconsistencies exist between providers, which can lead to unclear care goals, extended hospital stays, and increased medical costs [ 78 ]. For these reasons, provider-provider communication composed our third analytic domain. We asked participants to describe the approaches they take to streamline communication after a patient’s hospital visit, the methods they use to ensure collaborative communication between primary or secondary providers, and where communication challenges exist.

Healthcare provider characteristics

Our sample included 12 providers: four in family medicine (1 MD, 1 DO, 1 PA & 1 APRN), three in pediatrics (2 MD with specialty in hospital medicine & 1 DO), three in palliative medicine (2 MDs & 1 APRN with specialty in wound care), one in critical care medicine (DO with specialty in pediatric pulmonology) and one in behavioral health (1 LCSW with specialty in trauma). Our participants averaged 9 years (range 2–15) as a healthcare provider; most reported more than 5 years in their current professional role. The diversity of participants extended to their patient populations as well, with each participant reporting a unique distribution of age, race and level of medical complexity among their patients. Most participants reported that a portion of their patients travel up to five hours, sometimes across county- or state-lines, to receive care.

Theme 1: A friction exists between aspects of patients’ rural identities and healthcare systems

Our participants comprised a collection of medical professions and reported variability among health-related reasons their patients seek care. However, most participants acknowledged similar characteristics that influence their patients’ challenges to healthcare access. These identified factors formed categories from which the first theme emerged. There exists a great deal of ‘rugged individualism’ among Montanans, which reflects a self-sufficient and self-reliant way of life. Stoicism marked a primary factor to characterize this quality. One participant explained:

True Montanans are difficult to treat medically because they tend to be a tough group. They don’t see doctors. They don’t want to go, and they don’t want to be sick. That’s an aspect of Montana that makes health culture a little bit difficult.

Another participant echoed this finding by stating:

The backwoods Montana range guy who has an identity of being strong and independent probably doesn’t seek out a lot of medical care or take a lot of medications. Their sense of vitality, independence and identity really come from being able to take care and rely on themselves. When that is threatened, that’s going to create a unique experience of illness.

Similar responses were shared by all twelve participants; stoicism seemed to be heavily embedded in many patient populations in Montana and serves as a key determinant of healthcare acceptability. There are additional factors, however, that may interact with stoicism but are multiply determined. Stigma is an example of this, presented in this context as one’s concern about judgement by the healthcare system. Respondents were openly critical of this perception of the healthcare system as it was widely discussed in interviews. One participant stated:

There is a real perception of a punitive nature in the medical community, particularly if I observe a health issue other than the primary reason for one’s hospital visit, whether that may be predicated on medical neglect, delay of care, or something that may warrant a report to social services. For many of the patients and families I see, it’s not a positive experience and one that is sometimes an uphill barrier that I work hard to circumnavigate.

Analysis of these factors suggest that low use of healthcare services may link to several characteristics, including access problems. Separately, a patient’s perceived stigma from healthcare providers may also impact a patient’s willingness to receive services. One participant put it best by stating

Sometimes, families assume that I didn’t want to see them because they will come in for follow up to meet with me but end up meeting with another provider, which is frustrating because I want to maintain patients on my panel but available time and resource occasionally limits me from doing so. It could be really hard adapting to those needs on the fly, but it’s an honest miss.

When a patient arrives for a healthcare visit and experiences this frustration, it may elicit a patient’s perceptions of neglect or disorganization. This ‘honest miss’ may, in turn, exacerbate other acceptable-related barriers to care.

Theme 2: Facilitating access to healthcare requires application of and respect for cultural differences

The biomedical model is the standard of care utilized in Western medicine [ 79 , 80 ]. However, the US comprises people with diverse social and cultural identities that may not directly align with Western conceptions of health and wellness. Approximately 11.5% of the Montana population falls within an ethnic minority group. 6.4% are of American Indian or Alaska Native origin, 0.5% are of Black or African American origin, 0.8% are of Asian origin and 3.8% are of multiple or other origins. [ 81 ]. Cultural insensitivity is acknowledged in health services research as an active deterrent for appropriate healthcare delivery [ 65 ]. Participants for this study were asked how they react when a patient brings up a cultural attitude or behavior that may impact the proposed treatment plan. Eight participants noted a necessity for humility when this occurs. One participant conceptualized this by stating:

When this happens, I learn about individuals and a way of life that is different to the way I grew up. There is a lot of beauty and health in a non-patriarchal, non-dominating, non-sexist framework, and when we can engage in such, it is really expansive for my own learning process.

The participants who expressed humility emphasized that it is best to work in tandem with their patient, congruently. Especially for those with contrasting worldviews, a provider and a patient working as a team poses an opportunity to develop trust. Without it, a patient can easily fall out of the system, further hindering their ability to access healthcare services in the future. One participant stated:

The approach that ends up being successful for a lot of patients is when we understand their modalities, and they have a sense we understand those things. We have to show understanding and they have to trust. From there, we can make recommendations to help get them there, not decisions for them to obey, rather views based on our experiences and understanding of medicine.

Curiosity was another reaction noted by a handful of participants. One participant said:

I believe patients and their caregivers can be engaged and loving in different ways that don’t always follow the prescribed approach in the ways I’ve been trained, but that doesn’t necessarily mean that they are detrimental. I love what I do, and I love learning new things or new approaches, but I also love being surprised. My style of medicine is not to predict peoples’ lives, rather to empower and support what makes life meaningful for them.

Participants mentioned several other characteristics that they use in practice to prevent cultural insensitivity and support a collaborative approach to healthcare. Table 1 lists these facilitating characteristics and quotes to explain the substance of their benefit.

Consensus among participants indicated that the use of these protective factors to promote cultural sensitivity and apply them in practice is not standardized. When asked, all but two participants said they had not received any culturally-based training since beginning their practice. Instead, they referred to developing skills through “on the job training” or “off the cuff learning.” The general way of medicine, one participant remarked, was to “throw you to the fire.” This suggested that use of standardized cultural humility training modules for healthcare providers was not common practice. Many attributed this to time constraints.

Individual efforts to gain culturally appropriate skills or enhance cultural humility were mentioned, however. For example, three participants reported that they attended medical conferences to discuss cultural challenges within medicine, one participant sought out cultural education within their organization, and another was invited by Native American community members to engage in traditional peace ceremonies. Participants described these additional efforts as uncommon and outside the parameters of a provider’s job responsibilities, as they require time commitments without compensation.

Additionally, eight participants said they share their personal contact information with patients so they may call them directly for medical needs. The conditions and frequency with which this is done was variable and more common among providers in specialized areas of medicine or those who described having a manageable patient panel. All who reported that they shared their personal contact information described it as an aspect of rural health service delivery that is atypical in other, non-rural healthcare systems.

Theme 3: Communication between healthcare providers is systematically fragmented

Healthcare is complex and multi-disciplinary, and patients’ treatment is rarely overseen by a single provider [ 82 ]. The array of provider types and specialties is vast, as is the range of responsibilities ascribed to providers. Thus, open communication among providers both within and between healthcare systems is vital for the success of collaborative healthcare [ 83 ]. Without effective communication achieved between healthcare providers, the appropriate delivery of healthcare services may be become compromised. Our participants noted that they face multiple challenges that complicate communication with other providers. Miscommunication between departments, often implicating the Emergency Department (ED), was a recurring point noted among participants. One participant who is a primary care physician said:

If one of my patients goes to the ER, I don’t always get the notes. They’re supposed to send them to the patient’s primary care doc. The same thing happens with general admissions, but again, I often find out from somebody else that my patient was admitted to the hospital.

This failure to communicate can negatively impact the patient, particularly if time sensitivity or medical complexity is essential to treatment. A patient’s primary care physician is the most accurate source of their medical history; without an effective way to obtain and synthesize a patient’s health information, there may be increased risk of medical error. One participant in a specialty field stated:

One of the biggest barriers I see is obtaining a concise description of a patient’s history and needs. You can imagine if you’re a mom and you’ve got a complicated kid. You head to the ER. The ER doc looks at you with really wide eyes, not knowing how to get information about your child that’s really important.

This concern was highlighted with a specific example from a different participant:

I have been unable to troubleshoot instances when I send people to the ER with a pretty clear indication for admission, and then they’re sent home. For instance, I had an older fellow with pretty severe chronic kidney disease. He presented to another practitioner in my office with shortness of breath and swelling and appeared to have newly onset decompensated heart failure. When I figured this out, I sent him to the ER, called and gave my report. The patient later came back for follow up to find out not only that they had not been admitted but they lost no weight with outpatient dialysis . I feel like a real opportunity was missed to try to optimize the care of the patient simply because there was poor communication between myself and the ER. This poor guy… He ended up going to the ER four times before he got admitted for COVID-19.

In some cases, communication breakdown was reported as the sole cause of a poor outcome. When communication is effective, each essential member of the healthcare team is engaged and collaborating with the same information. Some participants called this process ‘rounds’ when a regularly scheduled meeting is staged between a group of providers to ensure access to accurate patient information. Accurate communication may also help build trust and improve a patient’s experience. In contrast, ineffective communication can result in poor clarity regarding providers’ responsibilities or lost information. Appropriate delivery of healthcare considers the fit between providers and a patient’s specific healthcare needs; the factors noted here suggest that provider-provider miscommunication can adversely affect this dimension of healthcare access.

Another important mechanism of communication is the sharing of electronic medical records (EMRs), a process that continues to shift with technological advances. Innovation is still recent enough, however, for several of our study participants to be able to recall a time when paper charts were standard. Widespread adoption and embrace of the improvements inherent in electronic medical records expanded in the late 2000’s [ 84 ]. EMRs vastly improved the ability to retain, organize, safeguard, and transfer health information. Every participant highlighted EMRs at one point or another and often did so with an underlying sense of anger or frustration. Systematic issues and problems with EMRs were discussed. One participant provided historical context to such records:

Years back, the government aimed to buy an electronic medical record system, whichever was the best, and a number of companies created their own. Each were a reasonable system, so they all got their checks and now we have four completely separate operating systems that do not talk to each other. The idea was to make a router or some type of relay that can share information back and forth. There was no money in that though, so of course, no one did anything about it. Depending on what hospital, clinic or agency you work for, you will most likely work within one of these systems. It was a great idea; it just didn’t get finished.

Seven participants confirmed these points and their impacts on making coordination more difficult, relying on outdated communication strategies more often than not. Many noted this even occurs between facilities within the same city and in separate small metropolitan areas across the state. One participant said:

If my hospital decides to contract with one EMR and the hospital across town contracts with another, correspondence between these hospitals goes back to traditional faxing. As a provider, you’re just taking a ‘fingered crossed’ approach hoping that the fax worked, is picked up, was put in the appropriate inbox and was actually looked at. Information acquisition and making sure it’s timely are unforeseen between EMRs.

Participants reported an “astronomic” number of daily faxes and telephone calls to complete the communication EMRs were initially designed to handle. These challenges are even more burdensome if a patient moves from out of town or out of state; obtaining their medical records was repeatedly referred to as a “chore” so onerous that it often remains undone. Another recurring concern brought up by participants regarded accuracy within EMRs to lend a false sense of security. They are not frequently updated, not designed to be family-centered and not set up to do anything automatically. One participant highlighted these limitations by stating:

I was very proud of a change I made in our EMR system [EPIC], even though it was one I never should have had to make. I was getting very upset because I would find out from my nursing assistant who read the obituary that one of my patients had died. There was a real problem with the way the EMR was notifying PCP’s, so I got an EPIC-level automated notification built into our EMR so that any time a patient died, their status would be changed to deceased and a notification would be sent to their PCP. It’s just really awful to find out a week later that your patient died, especially when you know these people and their families really well. It’s not good care to have blind follow up.

Whether it be a physical or electronic miscommunication between healthcare providers, the appropriate delivery of healthcare can be called to question

Theme 4: Time and resource constraints disproportionately harm rural health systems

Several measures of system capacity suggest the healthcare system in the US is under-resourced. There are fewer physicians and hospital beds per capita compared to most comparable countries, and the growth of healthcare provider populations has stagnated over time [ 15 ]. Rural areas, in particular, are subject to resource limitations [ 16 ]. All participants discussed provider shortages in detail. They described how shortages impact time allocation in their day-to-day operations. Tasks like patient intakes, critical assessments, and recovering information from EMRs take time, of which most participants claimed to not have enough of. There was also a consensus in having inadequate time to spend on medically complex cases. Time pressures were reported to subsequently influence quality of care. One participant stated:

With the constant pace of medicine, time is not on your side. A provider cannot always participate in an enriching dialogue with their patients, so rather than listen and learn, we are often coerced into the mindset of ‘getting through’ this patient so we can move on. This echoes for patient education during discharge, making the whole process more arduous than it otherwise could be if time and resources were not as sparse.

Depending on provider type, specialty, and the size of patient panels, four participants said they have the luxury of extending patient visits to 40 + minutes. Any flexibility with patient visits was regarded as just that: a luxury. Very few providers described the ability to coordinate their schedules as such. This led some study participants to limit the number of patients they serve. One participant said:

We simply don’t have enough clinicians, which is a shame because these people are really skilled, exceptional, brilliant providers but are performing way below their capacity. Because of this, I have a smaller case load so I can engage in a level of care that I feel is in the best interest of my patients. Everything is a tradeoff. Time has to be sacrificed at one point or another. This compromise sets our system up to do ‘ok’ work, not great work.

Of course, managing an overly large number of patients with high complexity is challenging. Especially while enduring the burden of a persisting global pandemic, participants reflected that the general outlook of administering healthcare in the US is to “do more with less.” This often forces providers to delegate responsibilities, which participants noted has potential downsides. One participant described how delegating patient care can cause problems.

Very often will a patient schedule a follow up that needs to happen within a certain time frame, but I am unable to see them myself. So, they are then placed with one of my mid-level providers. However, if additional health issues are introduced, which often happens, there is a high-risk of bounce-back or need to return once again to the hospital. It’s an inefficient vetting process that falls to people who may not have specific training in the labs and imaging that are often included in follow up visits. Unfortunately, it’s a forlorn hope to have a primary care physician be able to attend all levels of a patient’s care.

Several participants described how time constraints stretch all healthcare staff thin and complicate patient care. This was particularly important among participants who reported having a patient panel exceeding 1000. There were some participants, however, who praised the relationships they have with their nurse practitioners and physician’s assistants and mark transparency as the most effective way to coordinate care. Collectively, these clinical relationships were built over long standing periods of time, a disadvantage to providers at the start of their medical career. All but one participant with over a decade of clinical experience mentioned the usefulness of these relationships. The factors discussed in Theme 4 are directly linked to the Availability dimension of access to healthcare. A patient’s ability to reach care is subject to the capacity of their healthcare provider(s). Additionally, further analysis suggests these factors also link to the Appropriateness dimension because the quality of patient-provider relationships may be negatively impacted if a provider’s time is compromised.

Theme 5: Profits are prioritized over addressing barriers to healthcare access in the US.

The US healthcare system functions partially for-profit in the public and private sectors. The federal government provides funding for national programs such as Medicare, but a majority of Americans access healthcare through private employer plans [ 85 ]. As a result, uninsurance rates influence healthcare access. Though the rate of the uninsured has dropped over the last decade through expansion of the Affordable Care Act, it remains above 8 percent [ 86 ]. Historically, there has been ethical criticism in the literature of a for-profit system as it is said to exacerbate healthcare disparities and constitute unfair competition against nonprofit institutions. Specifically, the US healthcare system treats healthcare as a commodity instead of a right, enables organizational controls that adversely affect patient-provider relationships, undermines medical education, and constitutes a medical-industrial complex that threatens influence on healthcare-related public policy [ 87 ]. Though unprompted by the interviewer, participants raised many of these concerns. One participant shared their views on how priorities stand in their practice:

A lot of the higher-ups in the healthcare system where I work see each patient visit as a number. It’s not that they don’t have the capacity to think beyond that, but that’s what their role is, making sure we’re profitable. That’s part of why our healthcare system in the US is as broken as it is. It’s accentuated focus on financially and capitalistically driven factors versus understanding all these other barriers to care.

Eight participants echoed a similar concept, that addressing barriers to healthcare access in their organizations is largely complicated because so much attention is directed on matters that have nothing to do with patients. A few other participants supported this by alluding to a “cherry-picking” process by which those at the top of the hierarchy devote their attention to the easiest tasks. One participant shared an experience where contrasting work demands between administrators and front-line clinical providers produces adverse effects:

We had a new administrator in our hospital. I had been really frustrated with the lack of cultural awareness and curiosity from our other leaders in the past, so I offered to meet and take them on a tour of the reservation. This was meant to introduce them to kids, families and Tribal leaders who live in the area and their interface with healthcare. They declined, which I thought was disappointing and eye-opening.

Analysis of these factors suggest that those who work directly with patients understand patient needs better than those who serve in management roles. This same participant went on to suggest an ulterior motive for a push towards telemedicine, as administrators primarily highlight the benefit of billing for virtual visits instead of the nature of the visits themselves.

This study explored barriers and facilitators to healthcare access from the perspective of rural healthcare providers in Montana. Our qualitative analysis uncovered five key themes: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. Themes 2 and 3 were directly supported by earlier qualitative studies that applied Levesque’s framework, specifically regarding healthcare providers’ poor interpersonal quality and lack of collaboration with other providers that are suspected to result from a lack of provider training [ 67 , 70 ]. This ties back to the importance of cultural humility, which many previous culture-based trainings have referred to as cultural competence. Cultural competence is achieved through a plethora of trainings designed to expose providers to different cultures’ beliefs and values but induces risk of stereotyping and stigmatizing a patient’s views. Therefore, cultural humility is the preferred idea, by which providers reflect and gain open-ended appreciation for a patient’s culture [ 88 ].

Implications for Practice

Perhaps the most substantial takeaway is how embedded rugged individualism is within rural patient populations and how difficult that makes the delivery of care in rural health systems. We heard from participants that stoicism and perceptions of stigma within the system contribute to this, but other resulting factors may be influential at the provider- and organizational-levels. Stoicism and perceived stigma both appear to arise, in part, from an understandable knowledge gap regarding the care system. For instance, healthcare providers understand the relations between primary and secondary care, but many patients may perceive both concepts as elements of a single healthcare system [ 89 ]. Any issue experienced by a patient when tasked to see both a primary and secondary provider may result in a patient becoming confused [ 90 ]. This may also overlap with our third theme, as a disjointed means of communication between healthcare providers can exacerbate patients’ negative experiences. One consideration to improve this is to incorporate telehealth programs into an existing referral framework to reduce unnecessary interfacility transfers; telehealth programs have proven effective in rural and remote settings [ 91 ].

In fact, telehealth has been rolled out in a variety of virtual platforms throughout its evolution, its innovation matched with continued technological advancement. Simply put, telehealth allows health service delivery from a distance; it allows knowledge and practice of clinical care to be in a different space than a patient. Because of this, a primary benefit of telehealth is its impact on improving patient-centered outcomes among those living in rural areas. For instance, text messaging technology improves early infant diagnosis, adherence to recommended diagnostic testing, and participant engagement in lifestyle change interventions [ 92 , 93 , 94 ]. More sophisticated interventions have found their way into smartphone-based technology, some of which are accessible even without an internet connection [ 95 , 96 ]. Internet accessibility is important because a number of study participants noted internet connectivity as a barrier for patients who live in low resource communities. Videoconferencing is another function of telehealth that has delivered a variety of health services, including those which are mental health-specific [ 97 ], and mobile health clinics have been used in rural, hard-to-reach settings to show the delivery of quality healthcare is both feasible and acceptable [ 98 , 99 , 100 ]. While telehealth has potential to reduce a number of healthcare access barriers, it may not always address the most pressing healthcare needs [ 101 ]. However, telehealth does serve as a viable, cost-effective alternative for rural populations with limited physical access to specialized services [ 102 ]. With time and resource limitations acknowledged as a key theme in our study, an emphasis on expanding telehealth services is encouraged as it will likely have significant involvement on advancing healthcare in the future, especially as the COVID-19 pandemic persists [ 103 ].

Implications for Policy

One could argue that most of the areas of fragmentation in the US healthcare system can be linked to the very philosophy on which it is based: an emphasis on profits as highest priority. Americans are, therefore, forced to navigate a health service system that does not work solely in their best interests. It is not surprising to observe lower rates of healthcare usage in rural areas, which may be a result from rural persons’ negative views of the US healthcare system or a perception that the system does not exist to support wellness. These perceptions may interact with ‘rugged individualism’ to squelch rural residents’ engagement in healthcare. Many of the providers we interviewed for this study appeared to understand this and strived to improve their patients’ experiences and outcomes. Though these efforts are admirable, they may not characterize all providers who serve in rural areas of the US. From a policy standpoint, it is important to recognize these expansive efforts from providers. If incentives were offered to encourage maximum efforts be made, it may lessen burden due to physician burnout and fatigue. Of course, there is no easy fix to the persisting limit of time and resources for providers, problems that require workforce expansion. Ultimately, though, the current structure of the US healthcare system is failing rural America and doing little to help the practice of rural healthcare providers.

Implications for Future Research

It is important for future health systems research efforts to consider issues that arise from both individual- and system-level access barriers and where the two intersect. Oftentimes, challenges that appear linked to a patient or provider may actually stem from an overarching system failure. If failures are critically and properly addressed, we may refine our understanding of what we can do in our professional spaces to improve care as practitioners, workforce developers, researchers and advocates. This qualitative study was exploratory in nature. It represents a step forward in knowledge generation regarding challenges in access to healthcare for rural Americans. Although mental health did not come up by design in this study, future efforts exploring barriers to healthcare access in rural systems should focus on access to mental healthcare. In many rural areas, Montana included, rates of suicide, substance use and other mental health disorders are highly prevalent. These characteristics should be part of the overall discussion of access to healthcare in rural areas. Optimally, barriers to healthcare access should continue to be explored through qualitative and mixed study designs to honor its multi-dimensional stature.

Strengths and Limitations

It is important to note first that this study interviewed healthcare providers instead of patients, which served as both a strength and limitation. Healthcare providers were able to draw on numerous patient-provider experiences, enabling an account of the aggregate which would have been impossible for a patient population. However, accounts of healthcare providers’ perceptions of barriers to healthcare access for their patients may differ from patients’ specific views. Future research should examine acceptability- and appropriateness-related barriers to healthcare access in patient populations. Second, study participants were recruited through convenience sampling methods, so results may be biased towards healthcare providers who are more invested in addressing barriers to healthcare access. Particularly, the providers interviewed for this study represented a subset who go beyond expectations of their job descriptions by engaging with their communities and spending additional uncompensated time with their patients. It is likely that a provider who exhibits these behavioral traits is more likely to participate in research aimed at addressing barriers to healthcare access. Third, the inability to conduct face-to-face interviews for our qualitative study may have posed an additional limitation. It is possible, for example, that in-person interviews might have resulted in increased rapport with study participants. Notwithstanding this possibility, the remote interview format was necessary to accommodate health risks to the ongoing COVID-19 pandemic. Ultimately, given our qualitative approach, results from our study cannot be generalizable to all rural providers’ views or other rural health systems. In addition, no causality can be inferred regarding the influence of aspects of rurality on access. The purpose of this exploratory qualitative study was to probe research questions for future efforts. We also acknowledge the authors’ roles in the research, also known as reflexivity. The first author was the only author who administered interviews and had no prior relationships with all but one study participant. Assumptions and pre-dispositions to interview content by the first author were regularly addressed throughout data analysis to maintain study integrity. This was achieved by conducting analysis by unique interview question, rather than by unique participant, and recoding the numerical order of participants for each question. Our commitment to rigorous qualitative methods was a strength for the study for multiple reasons. Conducting member checks with participants ensured trustworthiness of findings. Continuing data collection to data saturation ensured dependability of findings, which was achieved after 10 interviews and confirmed after 2 additional interviews. We further recognize the heterogeneity in our sample of participants, which helped generate variability in responses. To remain consistent with appropriate means of presenting results in qualitative research however, we shared minimal demographic information about our study participants to ensure confidentiality.

The divide between urban and rural health stretches beyond a disproportionate allocation of resources. Rural health systems serve a more complicated and hard-to-reach patient population. They lack sufficient numbers of providers to meet population health needs. These disparities impact collaboration between patients and providers as well as the delivery of acceptable and appropriate healthcare. The marker of rurality complicates the already cumbersome challenge of administering acceptable and appropriate healthcare and impediments stemming from rurality require continued monitoring to improve patient experiences and outcomes. Our qualitative study explored rural healthcare providers’ views on some of the social, cultural, and programmatic factors that influence access to healthcare among their patient populations. We identified five key themes: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US. This study provides implications that may shift the landscape of a healthcare provider’s approach to delivering healthcare. Further exploration is required to understand the effects these characteristics have on measurable patient-centered outcomes in rural areas.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to individual privacy could be compromised but are available from the corresponding author on reasonable request.

Ethics approval and consent to participate.

All study procedures and methods were carried out in accordance with relevant guidelines and regulations from the World Medical Association Declaration of Helsinki. Ethics approval was given by exempt review from the Institutional Review Board (IRB) at the University of Montana (IRB Protocol No.: 186–20). Participants received oral and written information about the study prior to interview, which allowed them to provide informed consent for the interviews to be recorded and used for qualitative research purposes. No ethical concerns were experienced in this study pertaining to human subjects.

Consent for publication.

The participants consented to the publication of de-identified material from the interviews.

Riley WJ. Health Disparities: Gaps in Access, Quality and Affordability of Medical Care. Trans Am Clin Climatol Assoc. 2012;123:167–74.

PubMed   PubMed Central   Google Scholar  

Levesque J, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18. https://doi.org/10.1186/1475-9276-12-18 .

Article   PubMed   PubMed Central   Google Scholar  

Serban N. A Multidimensional Framework for Measuring Access. In: Serban N. Healthcare System Access: Measurement, Inference, and Intervention. New Jersey: John Wiley & Sons; 2019. p. 13–59.

Google Scholar  

Roncarolo F, Boivin A, Denis JL, et al. What do we know about the needs and challenges of health systems? A scoping review of the international literature. BMC Health Serv Res. 2017;17:636. https://doi.org/10.1186/s12913-017-2585-5 .

Cabrera-Barona P, Blaschke T. Kienberger S. Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach. Soc Indic Res. 2017;133,719–739. https://doi.org/10.1007/s11205-016-1371-9 .

Coombs NC, Meriwether WE, Caringi J, Newcomer SR. Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study. SSM Popul Health. 2021;15:100847. https://doi.org/10.1016/j.ssmph.2021.100847 .

Farietta TP, Lu B, Tumin R. Ohio’s Medicaid Expansion and Unmet Health Needs Among Low-Income Women of Reproductive Age. Matern Child Health. 2018;22(12):1771–9. https://doi.org/10.1007/s10995-018-2575-1 .

Article   Google Scholar  

Sommers BD, Blendon RJ, Orav EJ, Epstein AM. Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Intern Med. 2016;1;176(10):1501–1509. https://doi.org/10.1001/jamainternmed.2016.4419 .

National Alliance on Mental Illness: The Doctor is Out. Continuing Disparities in Access to Mental and Physical Health Care. 2017. https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out . Accessed 29 Aug 2021.

Pollitz K, Lopes L, Kearney A, Rae M, Cox C, Fehr F, Rousseau D, Kaiser Family Foundation. US Statistics on Surprise Medical Billing. JAMA. 2020;323(6):498. https://doi.org/10.1001/jama.2020.0065 .

Kahraman C, Orobello C, Cirella GT. hanging Dynamics with COVID-19: Future Outlook. In: XX Cirella GT, editor. Human Settlements: Urbanization, Smart Sector Development, and Future Outlook. Singapore: Springer; 2022. p. 235–52.

Book   Google Scholar  

Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19 — Implications for the Health Care System. N Engl J Med. 2020;383(15):1483–8. https://doi.org/10.1056/NEJMsb2021088 .

Article   CAS   PubMed   Google Scholar  

Defêche J, Azarzar S, Mesdagh A, Dellot P, Tytgat A, Bureau F, Gillet L, Belhadj Y, Bontems S, Hayette M-P, Schils R, Rahmouni S, Ernst M, Moutschen M, Darcis G. In-Depth Longitudinal Comparison of Clinical Specimens to Detect SARS-CoV-2. Pathogens. 2021;10(11):1362. https://doi.org/10.3390/pathogens10111362 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Rosenblatt RA, Hart LG. Physicians and rural America. West J Med. 2000;173(5):348–51. https://doi.org/10.1136/ewjm.173.5.348 .

Kaiser Family Foundation Analysis of OECD Data. 2020. https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-physicians-density-per-1000-population-2000-2018 . Accessed 31 Oct 2021.

Government Accounting Office. Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs. 2017. https://www.gao.gov/assets/gao-17-411.pdf . Accessed 31 Oct 2021.

The Kaiser Family Foundation: The Uninsured in Rural America. 2003. https://www.kff.org/wp-content/uploads/2013/01/the-uninsured-in-rural-america-update-pdf.pdf . Accessed 15 Sept 2021.

Wright B, Potter AJ, Trivedi AN, Mueller KJ. The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries. J Rural Health. 2018;34(4):423–30. https://doi.org/10.1111/jrh.12253 .

Article   PubMed   Google Scholar  

Weichelt B, Bendixsen C, Patrick T. A Model for Assessing Necessary Conditions for Rural Health Care’s Mobile Health Readiness: Qualitative Assessment of Clinician-Perceived Barriers. JMIR Mhealth Uhealth. 2019;7(11): e11915. https://doi.org/10.2196/11915 .

Mangundu M, Roets L, Janse van Rensberg E. Accessibility of healthcare in rural Zimbabwe: The perspective of nurses and healthcare users. Afr J Prim Health Care Fam Med. 2020;12(1):e1-e7. https://doi.org/10.4102/phcfm.v12i1.2245 .

Rahayu YYS, Araki T, Rosleine D. Factors affecting the use of herbal medicines in the universal health coverage system in Indonesia. J Ethnopharmacol. 2020;260: 112974. https://doi.org/10.1016/j.jep.2020.112974 .

Bolin JN, Bellamy GR, Ferdinand AO, et al. Rural Healthy People 2020: New Decade, Same Challenges. Journal of Rural Health. 2015;31(3):326–33.

Reid S. The rural determinants of health: using critical realism as a theoretical framework. Rural Remote Health. 2019;19(3):5184. https://doi.org/10.22605/RRH5184 .

Wynia MK, Osborn CY. Health literacy and communication quality in health care organizations. J Health Commun. 2010;15 Suppl 2(Suppl 2):102–115. https://doi.org/10.1080/10810730.2010.499981 .

Centers for Disease Control and Prevention. What is Health Literacy? 2022. https://www.cdc.gov/healthliteracy/learn/index.html . Accessed 25 Feb 2022.

Davis TC, Arnold CL, Rademaker A, et al. Differences in barriers to mammography between rural and urban women. J Womens Health (Larchmt). 2012;21(7):748–55. https://doi.org/10.1089/jwh.2011.3397 .

Halverson J, Martinez-Donate A, Trentham-Dietz A, et al. Health literacy and urbanicity among cancer patients. J Rural Health. 2013;29(4):392–402. https://doi.org/10.1111/jrh.12018 .

Zahnd WE, Scaife SL, Francis ML. Health literacy skills in rural and urban populations. Am J Health Behav. 2009;33(5):550–7. https://doi.org/10.5993/ajhb.33.5.8 .

Dogba MJ, Dossa AR, Breton E, Gandonou-Migan R. Using information and communication technologies to involve patients and the public in health education in rural and remote areas: a scoping review. BMC Health Serv Res. 2019;19(1):128. https://doi.org/10.1186/s12913-019-3906-7 .

Committee on the Science of Changing Behavioral Health Social Norms, Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. In: Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington: National Academics Press; 2016. p. 33–52.

Wu Y, Zhou H, Wang Q, Cao M, Medina A, Rozelle S. Use of maternal health services among women in the ethnic rural areas of western China. BMC Health Serv Res. 2019;19(1):179. https://doi.org/10.1186/s12913-019-3996-2 .

Meyer E, Hennink M, Rochat R, et al. Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia. Matern Child Health J. 2016;20(7):1358–65. https://doi.org/10.1007/s10995-016-1997-x .

Heinrich S. Medical science faces the post-truth era: a plea for the grassroot values of science. Curr Opin Anaesthesiol. 2020;33(2):198–202. https://doi.org/10.1097/ACO.0000000000000833 .

Esquivel MM, Chen JC, Woo RK, et al. Why do patients receive care from a short-term medical mission? Survey study from rural Guatemala. J Surg Res. 2017;215:160–6. https://doi.org/10.1016/j.jss.2017.03.056 .

Park LG, Dracup K, Whooley MA, et al. Symptom Diary Use and Improved Survival for Patients With Heart Failure [published correction appears in Circ Heart Fail. 2017 Dec;10(12):]. Circ Heart Fail. 2017;10(11):e003874. https://doi.org/10.1161/CIRCHEARTFAILURE.117.003874 .

Taleb F, Perkins J, Ali NA, et al. Transforming maternal and newborn health social norms and practices to increase utilization of health services in rural Bangladesh: a qualitative review. BMC Pregnancy Childbirth. 2015;15:75. https://doi.org/10.1186/s12884-015-0501-8 .

Billah SM, Hoque DE, Rahman M, et al. Feasibility of engaging “Village Doctors” in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh. J Glob Health. 2018;8(2): 020413. https://doi.org/10.7189/jogh.08.020413 .

Kaiser JL, Fong RM, Hamer DH, et al. How a woman’s interpersonal relationships can delay care-seeking and access during the maternity period in rural Zambia: An intersection of the Social Ecological Model with the Three Delays Framework. Soc Sci Med. 2019;220:312–21. https://doi.org/10.1016/j.socscimed.2018.11.011 .

Rao KD, Sheffel A. Quality of clinical care and bypassing of primary health centers in India. Soc Sci Med. 2018;207:80–8. https://doi.org/10.1016/j.socscimed.2018.04.040 .

Lee YT, Lee YH, Kaplan WA. Is Taiwan’s National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships. Int J Health Plann Manage. 2019;34(1):e6–10. https://doi.org/10.1002/hpm.2653 .

Lyford M, Haigh MM, Baxi S, Cheetham S, Shahid S, Thompson SC. An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia. Int J Environ Res Public Health. 2018;15(2):337. https://doi.org/10.3390/ijerph15020337 .

Article   PubMed Central   Google Scholar  

Rohr JM, Spears KL, Geske J, Khandalavala B, Lacey MJ. Utilization of Health Care Resources by the Amish of a Rural County in Nebraska. J Community Health. 2019;44(6):1090–7. https://doi.org/10.1007/s10900-019-00696-9 .

Johnston K, Harvey C, Matich P, et al. Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers. Aust J Rural Health. 2015;23(5):257–64. https://doi.org/10.1111/ajr.12186 .

Legido-Quigley H, Naheed A, de Silva HA, et al. Patients’ experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study. PLoS ONE. 2019;14(1): e0211100. https://doi.org/10.1371/journal.pone.0211100 .

Shaw B, Amouzou A, Miller NP, Bryce J, Surkan PJ. A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia. BMC Health Serv Res. 2017;17(1):184. https://doi.org/10.1186/s12913-017-2123-5 .

Larson E, Vail D, Mbaruku GM, Kimweri A, Freedman LP, Kruk ME. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women. PLoS ONE. 2015;10(8): e0135621. https://doi.org/10.1371/journal.pone.0135621 .

Spleen AM, Lengerich EJ, Camacho FT, Vanderpool RC. Health care avoidance among rural populations: results from a nationally representative survey. J Rural Health. 2014;30(1):79–88. https://doi.org/10.1111/jrh.12032 .

Weisgrau S. Issues in rural health: access, hospitals, and reform. Health Care Financ Rev. 1995;17(1):1–14.

CAS   PubMed   PubMed Central   Google Scholar  

National Center for Health Statistics. 2018. https://www.cdc.gov/nchs/surveys.htm . Accessed 29 Aug 2021.

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. https://doi.org/10.1186/s12913-017-2031-8 .

Dyer TA, Owens J, Robinson PG. The acceptability of healthcare: from satisfaction to trust. Community Dent Health. 2016;33(4):242–51. https://doi.org/10.1922/CDH_3902Dyer10 .

Padgett DK. Qualitative and Mixed Methods in Public Health. Thousand Oaks, California: SAGE Publications Inc.; 2012.

Tolley EE, Ulin PR, Mack N, Robinson ET, Succop SM. Qualitative Methods in Public Health: A Field Guide for Applied Research. 2nd ed. San Francisco, California: John Wiley & Sons, Inc.; 2016.

Ingram DD, Franco SJ. 2013 NCHS urban-rural classification scheme for counties. In: National Center for Health Statistics: Vital Health Statistics. 2014. https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf . Accessed 31 Oct 2021.

Health Resources & Services Administration. Health Professional Shortage Area Find. 2021. https://data.hrsa.gov/tools/shortage-area/hpsa-find . Accessed 31 Oct 2021.

Shaghaghi A, Bhopal RS, Sheikh A. Approaches to Recruiting “Hard-To-Reach” Populations into Re-search: A Review of the Literature. Health Promot Perspect. 2011;1(2):86–94. https://doi.org/10.5681/hpp.2011.009 .

Sadler GR, Lee HC, Lim RS, Fullerton J. Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy. Nurs Health Sci. 2010;12(3):369–74. https://doi.org/10.1111/j.1442-2018.2010.00541.x .

Deterding NM, Waters MC. Flexible Coding of In-depth Interviews: A Twenty-first-century Approach. Sociological Methods & Research. 2021;50(2):708–39. https://doi.org/10.1177/0049124118799377 .

Schreier M, Stamann C, Janssen M, Dahl T, Whittal A. Qualitative Content Analysis: Conceptualizations and Challenges in Research Practice-Introduction to the FQS Special Issue" Qualitative Content Analysis I". InForum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2019;20:26 DEU.

Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE. 2020;15(5): e0232076. https://doi.org/10.1371/journal.pone.0232076 .

Mayring P. Qualitative Content Analysis. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research. 2000;1(2). https://doi.org/10.17169/fqs-1.2.1089 .

O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine, Vol. 89, No. 9 / Sept 2014. https://doi.org/10.1097/ACM.0000000000000388 .

Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545–7. https://doi.org/10.1188/14.ONF.545-547 .

Miller S. Cultural humility is the first step to becoming global care providers. J Obstet Gynecol Neonatal Nurs. 2009;38(1):92–3. https://doi.org/10.1111/j.1552-6909.2008.00311.x .

Prasad SJ, Nair P, Gadhvi K, Barai I, Danish HS, Philip AB. Cultural humility: treating the patient, not the illness. Med Educ Online. 2016;21:30908. https://doi.org/10.3402/meo.v21.30908 .

George MS, Davey R, Mohanty I, Upton P. “Everything is provided free, but they are still hesitant to access healthcare services”: why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare? Int J Equity Health. 2020;19(1):105. https://doi.org/10.1186/s12939-020-01216-1 .

Romanelli M, Hudson KD. Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. Am J Orthopsychiatry. 2017;87(6):714–28. https://doi.org/10.1037/ort0000306 .

Bailie J, Schierhout G, Laycock A, et al. Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians. BMJ Open. 2015;5(11): e008103. https://doi.org/10.1136/bmjopen-2015-008103 .

Reeve C, Humphreys J, Wakerman J, Carter M, Carroll V, Reeve D. Strengthening primary health care: achieving health gains in a remote region of Australia. Med J Aust. 2015;202(9):483–7. https://doi.org/10.5694/mja14.00894 .

Swan LET, Auerbach SL, Ely GE, Agbemenu K, Mencia J, Araf NR. Family Planning Practices in Appalachia: Focus Group Perspectives on Service Needs in the Context of Regional Substance Abuse. Int J Environ Res Public Health. 2020;17(4):1198. https://doi.org/10.3390/ijerph17041198 .

Kabia E, Mbau R, Oyando R, et al. “We are called the et cetera”: experiences of the poor with health financing reforms that target them in Kenya. Int J Equity Health. 2019;18(1):98. https://doi.org/10.1186/s12939-019-1006-2 .

Ho JW, Kuluski K, Im J. “It’s a fight to get anything you need” - Accessing care in the community from the perspectives of people with multimorbidity. Health Expect. 2017;20(6):1311–9. https://doi.org/10.1111/hex.12571 .

Latif A, Mandane B, Ali A, Ghumra S, Gulzar N. A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups. Pharmacy (Basel). 2020;8(2):73. https://doi.org/10.3390/pharmacy8020073 .

Tschirhart N, Diaz E, Ottersen T. Accessing public healthcare in Oslo, Norway: the experiences of Thai immigrant masseuses. BMC Health Serv Res. 2019;19(1):722. https://doi.org/10.1186/s12913-019-4560-9 .

Ireland S, Belton S, Doran F. “I didn’t feel judged”: exploring women’s access to telemedicine abortion in rural Australia. J Prim Health Care. 2020;12(1):49–56. https://doi.org/10.1071/HC19050 .

Stokes T, Tumilty E, Latu ATF, et al. Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients. BMJ Open. 2019;9(11): e033524. https://doi.org/10.1136/bmjopen-2019-033524 .

Jafar TH, Ramakrishnan C, John O, et al. Access to CKD Care in Rural Communities of India: a qualitative study exploring the barriers and potential facilitators. BMC Nephrol. 2020;21(1):26. https://doi.org/10.1186/s12882-020-1702-6 .

Doetsch J, Pilot E, Santana P, Krafft T. Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: a qualitative case study in Lisbon, Portugal. Int J Equity Health. 2017;16(1):184. https://doi.org/10.1186/s12939-017-0679-7 .

Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36. https://doi.org/10.1126/science.847460 .

Risberg G, Hamberg K, Johansson E.E. Gender perspective in medicine: a vital part of medical scientific rationality. A useful model for comprehending structures and hierarchies within medical science. BMC Med. 2006;4(1):1.

Montana Census & Economic Information Center. 2021. https://ceic.mt.gov/ . Accessed 18 Sept 2021.

Smith M, Saunders R, Stuckhardt L, McGinnis JM, Committee on the Learning Health Care System in America, Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington: National Academies Press; 2013.

O’Daniel M, Rosenstein AH, Professional Communication and Team Collaboration. In: Hughes RG, editor. Chapter 33: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality: Rockville; 2008.

Evans RS. Electronic Health Records: Then, Now, and in the Future. Yearb Med Inform. 2016;Suppl 1(Suppl 1):S48-S61. https://doi.org/10.15265/IYS-2016-s006 .

Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton GA. International Health Care System Profiles: United States. The Commonwealth Fund. 2020. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states . Accessed 19 Sept 2021.

Berchick ER, Barnett JC, Upton RD. Health Insurance Coverage in the United States. Washington: United States Census Bureau; 2018.

Brock DW, Buchanan A. Ethical Issues in For-Profit Health Care. In: Gray BH, editor. For-Profit Enterprise in Health Care. Washington: National Academics Press; 1986.

Lekas HM, Pahl K, Fuller Lewis C. Rethinking Cultural Competence: Shifting to Cultural Humility. Health Serv Insights. 2020;13:1178632920970580. https://doi.org/10.1177/1178632920970580 .

Beaulieu MD. Primary and secondary care: Breaking down barriers for our patients with chronic diseases. Can Fam Physician. 2013;59(2):221.

Crafford L, Jenkins LS. Why seek a second consultation at an emergency centre? A qualitative study. Afr J Prim Health Care Fam Med. 2017;9(1):e1–8. https://doi.org/10.4102/phcfm.v9i1.1397 .

Sorensen MJ, von Recklinghausen FM, Fulton G, et al. Secondary overtriage: The burden of unnecessary interfacility transfers in a rural trauma system. JAMA Surg. 2013;148:763–8.

Sutcliffe CG, Thuma PE, van Dijk JH, et al. Use of mobile phones and text messaging to decrease the turnaround time for early infant HIV diagnosis and notification in rural Zambia: an observational study. BMC Pediatr. 2017;17(1):66. https://doi.org/10.1186/s12887-017-0822-z .

Baldwin LM, Morrison C, Griffin J, et al. Bidirectional Text Messaging to Improve Adherence to Recommended Lipid Testing. J Am Board Fam Med. 2017;30(5):608–14. https://doi.org/10.3122/jabfm.2017.05.170088 .

Albright K, Krantz MJ, Backlund Jarquín P, DeAlleaume L, Coronel-Mockler S, Estacio RO. Health Promotion Text Messaging Preferences and Acceptability Among the Medically Underserved. Health Promot Pract. 2015;16(4):523–32. https://doi.org/10.1177/1524839914566850 .

Cramer ME, Mollard EK, Ford AL, Kupzyk KA, Wilson FA. The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth. Public Health Nurs. 2018;35(6):508–16. https://doi.org/10.1111/phn.12543 .

Gbadamosi SO, Eze C, Olawepo JO, et al. A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study. J Med Internet Res. 2018;20(1): e18. https://doi.org/10.2196/jmir.8716 .

Trondsen MV, Tjora A, Broom A, Scambler G. The symbolic affordances of a video-mediated gaze in emergency psychiatry. Soc Sci Med. 2018;197:87–94. https://doi.org/10.1016/j.socscimed.2017.11.056 .

Schwitters A, Lederer P, Zilversmit L, et al. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned mobile health clinics for ART. Glob Health Sci Pract. 2015;3(1):109–16. https://doi.org/10.9745/GHSP-D-14-00145 .

Kojima N, Krupp K, Ravi K, et al. Implementing and sustaining a mobile medical clinic for prenatal care and sexually transmitted infection prevention in rural Mysore, India. BMC Infect Dis. 2017;17(1):189. https://doi.org/10.1186/s12879-017-2282-3 .

Gorman SE, Martinez JM, Olson J. An assessment of HIV treatment outcomes among utilizers of semi-mobile clinics in rural Kenya. AIDS Care. 2015;27(5):665–8. https://doi.org/10.1080/09540121.2014.986053 .

Lee S, Black D, Held ML. Factors Associated with Telehealth Service Utilization among Rural Populations. J Health Care Poor Underserved. 2019;30(4):1259–72. https://doi.org/10.1353/hpu.2019.0104 .

Agha Z, Schapira RM, Maker AH. Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population. Telemed J E Health. 2002;8(3):281–91. https://doi.org/10.1089/15305620260353171 .

Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of Telehealth During the COVID-19 Pandemic: Scoping Review. J Med Internet Res. 2020;22(12): e24087. https://doi.org/10.2196/24087 .

Download references

Acknowledgements

This research was supported by the Center for Biomedical Research Excellence award (P20GM130418) from the National Institute of General Medical Sciences of the National Institute of Health. The first author was also supported by the University of Montana Burnham Population Health Fellowship. We would like to thank Dr. Christopher Dietrich, Dr. Jennifer Robohm and Dr. Eric Arzubi for their contributions on determining inclusion criteria for the healthcare provider population used for this study.

 This research did not receive any specific grant from funding agencies in the public, commercial, and not-for-profit sectors. 

Author information

Authors and affiliations.

School of Public & Community Health Sciences, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA

Nicholas C. Coombs & James Caringi

Department of Psychology, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA

Duncan G. Campbell

You can also search for this author in PubMed   Google Scholar

Contributions

The authors confirm contribution to the paper as follows: study conception and design: NC and JC; data collection: NC; analysis and interpretation of results: NC and JC; draft manuscript preparation: NC, DC and JC; and manuscript editing: NC, DC and JC. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Nicholas C. Coombs .

Ethics declarations

Competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Coombs, N.C., Campbell, D.G. & Caringi, J. A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Serv Res 22 , 438 (2022). https://doi.org/10.1186/s12913-022-07829-2

Download citation

Received : 11 January 2022

Accepted : 21 March 2022

Published : 02 April 2022

DOI : https://doi.org/10.1186/s12913-022-07829-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Access to healthcare
• Rural health
• Qualitative methods

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Publications — Over 100 years of publishing excellence

• Book Author Resources
• Submit a Book Proposal
• AMS Rights, Licensing, and Permissions
• Open Math Notes
• Frequently asked questions
• Member Journals
• Research Journals
• Translation Journals
• Distributed Journals
• Open Access Journals
• Guidelines and Policies
• Journal Author Resources

Librarian Resources

• eBook Collections
• COUNTER Usage Statistics
• My Subscriptions
• Subscription Information
• Licensing Information

Mathematical Reviews/MathSciNet®

• MathSciNet ®
• Reviewer Home
• MathSciNet ® Subscriptions

Membership — Welcome to your membership center

Join the ams, renew your membership, give a membership, individual membership.

• Member Benefits
• Member Directory
• Reciprocating Societies
• Members in Developing Countries

Institutional Membership

• Domestic Institutions
• International Institutions
• Two-Year Institutions
• Graduate Student Chapter Program

Other Member Types

• Corporate Memberships
• Associate Memberships

Meetings & Conferences — Engage with colleagues and the latest research

National meetings.

• Joint Mathematics Meetings
• Upcoming JMMs
• Previous JMMs
• Special Lectures
• Professional Enhancement Programs (PEPs)

Sectional Meetings

• Upcoming Sectionals
• Previous Sectionals
• Presenting Papers
• Hosting Sectionals

Other Meetings, Conferences & Workshops

• Mathematics Research Communities
• Education Mini-conference
• International Meetings
• Mathematics Calendar
• Short Courses
• Workshop for Department Chairs and Leaders

Meetings Resources

• Suggest a Speaker
• AMS Meetings Grants
• Submitting Abstracts
• Welcoming Environment Policy
• MathSafe – supporting safe meetings

News & Outreach — Explore news, images, posters, and mathematical essays

News from the ams.

• AMS News Releases
• Feature Stories
• Information for Journalists
• In Memory Of

Math Voices

• Feature Column
• Math in the Media
• Column on Teaching and Learning

Explorations

• Recognizing Diverse Mathematicians
• AMS Posters
• Mathematics & Music
• Mathematical Imagery
• Mathematical Moments

Professional Programs — Resources and opportunities to further your mathematical pursuits

Professional development.

• Employment Services
• Mathjobs.org
• BEGIN Career Initiative
• Mathprograms.org
• Mathematical Opportunities Database
• Research Seminars

Institutional Information and Data

• Annual Survey of the Mathematical and Statistical Sciences
• CBMS Survey
• Other Sources of Data
• Directory of Institutions in the Mathematical Sciences
• Professional Directory

Grants & Support

• AMS-Simons Grants for PUI Faculty
• Travel Grants
• Fellowships & Scholarships
• Epsilon Fund
• Child Care Grants

Awards & Recognition

• AMS Prizes & Awards
• Fellows of the AMS

Education — Resources to support advanced mathematics teaching and learning

For students.

• Information for Undergraduate and High School Students
• Research Experiences for Undergraduates (REUs)
• Considering Grad School
• Find Grad Programs
• Applying to Grad School
• What do Mathematicians Do?

For Teachers

• Teaching Online
• Teaching Resources
• Inclusive Classrooms
• Assessing Student Learning
• Education Webinars

For Department Leaders & Mentors

• Information for Department Leaders
• paraDIGMS (Diversity in Graduate Mathematical Sciences)

Government Relations — Advocating for the mathematical sciences

Elevating mathematics in congress.

• Our Mission
• Letters, Statements, & Legislation
• Congressional Briefings

Legislative Priorities

• Federal Issues of Concern
• Federal Budget Process

Get Involved

• Advocacy Resources
• Take Action

DC-Based Fellowships

• Congressional Fellowship
• Mass Media Fellowship
• Catalyzing Advocacy in Science & Engineering (CASE) Fellowship

Giving to the AMS — Your gifts make great things happen for mathematics   Make a Gift

What you can support.

• The 2020 Fund
• Next Generation Fund
• Birman Fellowship for Women Scholars
• JMM Child Care Grants
• MathSciNet for Developing Countries

Create a Legacy

• Make a Tribute Gift
• Create a Permanent Fund
• Establish a Prize, Award or Fellowship
• Bequests and Charitable Estate Planning

Honoring Your Gift

• Donor Stories
• Donor Wall of Honor
• Thomas S. Fiske Society
• AMS Contributors Society
• AMS Gardens

Giving Resources

• AMS Development Committee
• AMS Gift Acceptance Policy

About the AMS — Advancing research. Connecting the mathematics community.

Our organization.

• Executive Staff
• Equity, Diversity, & Inclusion
• Jobs at AMS
• Customer Service

Our Governance

• Board of Trustees
• Executive Committee

Governance Operations

• Calendar of Meetings
• Policy Statements & Guidelines

Bulletin of the American Mathematical Society

The Bulletin publishes expository articles on contemporary mathematical research, written in a way that gives insight to mathematicians who may not be experts in the particular topic. The Bulletin also publishes reviews of selected books in mathematics and short articles in the Mathematical Perspectives section, both by invitation only.

ISSN 1088-9485 (online) ISSN 0273-0979 (print)

The 2020 MCQ for Bulletin of the American Mathematical Society is 0.84 . What is MCQ? The Mathematical Citation Quotient (MCQ) measures journal impact by looking at citations over a five-year period. Subscribers to MathSciNet may click through for more detailed information.

• Articles in press
• Recently published
• All issues : 1891 – Present

Contents of Volume 61, Number 2 HTML articles powered by AMS MathViewer View front and back matter from the print issue

Frequently asked questions

What should i include in a research paper conclusion.

The conclusion of a research paper has several key elements you should make sure to include:

• A restatement of the research problem
• A summary of your key arguments and/or findings
• A short discussion of the implications of your research

Frequently asked questions: Writing a research paper

A research project is an academic, scientific, or professional undertaking to answer a research question . Research projects can take many forms, such as qualitative or quantitative , descriptive , longitudinal , experimental , or correlational . What kind of research approach you choose will depend on your topic.

The best way to remember the difference between a research plan and a research proposal is that they have fundamentally different audiences. A research plan helps you, the researcher, organize your thoughts. On the other hand, a dissertation proposal or research proposal aims to convince others (e.g., a supervisor, a funding body, or a dissertation committee) that your research topic is relevant and worthy of being conducted.

Formulating a main research question can be a difficult task. Overall, your question should contribute to solving the problem that you have defined in your problem statement .

However, it should also fulfill criteria in three main areas:

• Researchability
• Feasibility and specificity
• Relevance and originality

Research questions anchor your whole project, so it’s important to spend some time refining them.

In general, they should be:

• Focused and researchable
• Answerable using credible sources
• Complex and arguable
• Feasible and specific
• Relevant and original

All research questions should be:

• Focused on a single problem or issue
• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly

A research aim is a broad statement indicating the general purpose of your research project. It should appear in your introduction at the end of your problem statement , before your research objectives.

Research objectives are more specific than your research aim. They indicate the specific ways you’ll address the overarching aim.

Once you’ve decided on your research objectives , you need to explain them in your paper, at the end of your problem statement .

Keep your research objectives clear and concise, and use appropriate verbs to accurately convey the work that you will carry out for each one.

I will compare …

Your research objectives indicate how you’ll try to address your research problem and should be specific:

Research objectives describe what you intend your research project to accomplish.

They summarize the approach and purpose of the project and help to focus your research.

Your objectives should appear in the introduction of your research paper , at the end of your problem statement .

The main guidelines for formatting a paper in Chicago style are to:

• Use a standard font like 12 pt Times New Roman
• Use 1 inch margins or larger
• Apply double line spacing
• Indent every new paragraph ½ inch
• Include a title page
• Place page numbers in the top right or bottom center
• Cite your sources with author-date citations or Chicago footnotes
• Include a bibliography or reference list

To automatically generate accurate Chicago references, you can use Scribbr’s free Chicago reference generator .

The main guidelines for formatting a paper in MLA style are as follows:

• Use an easily readable font like 12 pt Times New Roman
• Set 1 inch page margins
• Include a four-line MLA heading on the first page
• Center the paper’s title
• Use title case capitalization for headings
• Cite your sources with MLA in-text citations
• List all sources cited on a Works Cited page at the end

To format a paper in APA Style , follow these guidelines:

• Use a standard font like 12 pt Times New Roman or 11 pt Arial
• If submitting for publication, insert a running head on every page
• Apply APA heading styles
• Cite your sources with APA in-text citations
• List all sources cited on a reference page at the end

No, it’s not appropriate to present new arguments or evidence in the conclusion . While you might be tempted to save a striking argument for last, research papers follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the results and discussion sections if you are following a scientific structure). The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

Don’t feel that you have to write the introduction first. The introduction is often one of the last parts of the research paper you’ll write, along with the conclusion.

This is because it can be easier to introduce your paper once you’ve already written the body ; you may not have the clearest idea of your arguments until you’ve written them, and things can change during the writing process .

The way you present your research problem in your introduction varies depending on the nature of your research paper . A research paper that presents a sustained argument will usually encapsulate this argument in a thesis statement .

A research paper designed to present the results of empirical research tends to present a research question that it seeks to answer. It may also include a hypothesis —a prediction that will be confirmed or disproved by your research.

The introduction of a research paper includes several key elements:

• A hook to catch the reader’s interest
• Relevant background on the topic
• Details of your research problem

and your problem statement

• A thesis statement or research question
• Sometimes an overview of the paper

Ask our team

Want to contact us directly? No problem.  We  are always here for you.

• Email [email protected]
• Start live chat
• Call +1 (510) 822-8066
• WhatsApp +31 20 261 6040

Our team helps students graduate by offering:

• A world-class citation generator
• Plagiarism Checker software powered by Turnitin
• Innovative Citation Checker software
• Professional proofreading services
• Over 300 helpful articles about academic writing, citing sources, plagiarism, and more

Scribbr specializes in editing study-related documents . We proofread:

• PhD dissertations
• Research proposals
• Personal statements
• Admission essays
• Motivation letters
• Reflection papers
• Journal articles
• Capstone projects

Scribbr’s Plagiarism Checker is powered by elements of Turnitin’s Similarity Checker , namely the plagiarism detection software and the Internet Archive and Premium Scholarly Publications content databases .

The add-on AI detector is powered by Scribbr’s proprietary software.

The Scribbr Citation Generator is developed using the open-source Citation Style Language (CSL) project and Frank Bennett’s citeproc-js . It’s the same technology used by dozens of other popular citation tools, including Mendeley and Zotero.

You can find all the citation styles and locales used in the Scribbr Citation Generator in our publicly accessible repository on Github .

A Solar Eclipse Means Big Science

By Katrina Miller April 1, 2024

• Share full article

On April 8, cameras all over North America will make a “megamovie” of the sun’s corona, like this one from the 2017 eclipse. The time lapse will help scientists track the behavior of jets and plumes on the sun’s surface.

There’s more science happening along the path of totality →

An app named SunSketcher will help the public take pictures of the eclipse with their phones.

Scientists will use these images to study deviations in the shape of the solar surface , which will help them understand the sun’s churning behavior below.

The sun right now is approaching peak activity. More than 40 telescope stations along the eclipse’s path will record totality.

By comparing these videos to what was captured in 2017 — when the sun was at a lull — researchers can learn how the sun’s magnetism drives the solar wind, or particles that stream through the solar system.

Students will launch giant balloons equipped with cameras and sensors along the eclipse’s path.

Their measurements may improve weather forecasting , and also produce a bird’s eye view of the moon’s shadow moving across the Earth.

Ham radio operators will send signals to each other across the path of totality to study how the density of electrons in Earth’s upper atmosphere changes .

This can help quantify how space weather produced by the sun disrupts radar communication systems.

(Animation by Dr. Joseph Huba, Syntek Technologies; HamSCI Project, Dr. Nathaniel Frissell, the University of Scranton, NSF and NASA.)

NASA is also studying Earth’s atmosphere, but far from the path of totality.

In Virginia, the agency will launch rockets during the eclipse to measure how local drops in sunlight cause ripple effects hundreds of miles away . The data will clarify how eclipses and other solar events affect satellite communications, including GPS.

Biologists in San Antonio plan to stash recording devices in beehives to study how bees orient themselves using sunlight , and how the insects respond to the sudden atmospheric changes during a total eclipse.

Two researchers in southern Illinois will analyze social media posts to understand tourism patterns in remote towns , including when visitors arrive, where they come from and what they do during their visits.

Results can help bolster infrastructure to support large events in rural areas.

Read more about the eclipse:

Our Coverage of the Total Solar Eclipse

Dress for the Occasion:  What should you wear for the eclipse? Our fashion critic weighs the options , including an unexpected suggestion from scientists.

Free to View:  Six inmates in upstate New York prisons who sued the state won their lawsuit to view the eclipse , arguing it “is a religious event.” But a statewide prison lockdown during the eclipse will remain in place.

Hearing the Eclipse:  A device called LightSound is being distributed to help the blind and visually impaired experience what they can’t see .

Sky-High Hotel Prices: One Super 8 hotel in the eclipse’s path is charging $949 a night . Its normal rate is $95.

Animal Reactions : Researchers will watch if animals at zoos, homes and farms act strangely  when day quickly turns to night.

A Rare Return:  A total solar eclipse happens twice in the same place every 366 years on average. But people in certain areas will encounter April 8’s eclipse  about seven years after they were near the middle of the path of the “Great American Eclipse.”

 No Power Outages:  When the sky darkens during the eclipse, electricity production in some parts of the country will drop so sharply that it could theoretically leave tens of millions of homes in the dark. In practice, hardly anyone will notice  a sudden loss of energy.

Advertisement