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How to Write a Research Paper Introduction (with Examples)

How to Write a Research Paper Introduction (with Examples)

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

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

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

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

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

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Table of Contents

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

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

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

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

What are the parts of introduction in the research?

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

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

How to write a research paper introduction?

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

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

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

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

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

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

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

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

Write a Research Paper Introduction in Minutes with Paperpal

Paperpal Copilot is a generative AI-powered academic writing assistant. It’s trained on millions of published scholarly articles and over 20 years of STM experience. Paperpal Copilot helps authors write better and faster with:

  • Real-time writing suggestions
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With Paperpal Copilot, create a research paper introduction effortlessly. In this step-by-step guide, we’ll walk you through how Paperpal transforms your initial ideas into a polished and publication-ready introduction.

what is the content of the introduction part of a research paper

How to use Paperpal to write the Introduction section

Step 1: Sign up on Paperpal and click on the Copilot feature, under this choose Outlines > Research Article > Introduction

Step 2: Add your unstructured notes or initial draft, whether in English or another language, to Paperpal, which is to be used as the base for your content.

Step 3: Fill in the specifics, such as your field of study, brief description or details you want to include, which will help the AI generate the outline for your Introduction.

Step 4: Use this outline and sentence suggestions to develop your content, adding citations where needed and modifying it to align with your specific research focus.

Step 5: Turn to Paperpal’s granular language checks to refine your content, tailor it to reflect your personal writing style, and ensure it effectively conveys your message.

You can use the same process to develop each section of your article, and finally your research paper in half the time and without any of the stress.

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

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

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

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

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

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

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

To summarize, the research paper introduction section should be brief yet informative. It should convince the reader the need to conduct the study and motivate him to read further. If you’re feeling stuck or unsure, choose trusted AI academic writing assistants like Paperpal to effortlessly craft your research paper introduction and other sections of your research article.

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

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

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

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

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  • USC Libraries
  • Research Guides

Organizing Your Social Sciences Research Paper

  • 4. The Introduction
  • 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
  • Applying Critical Thinking
  • 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 introduction leads the reader from a general subject area to a particular topic of inquiry. It establishes the scope, context, and significance of the research being conducted by summarizing current understanding and background information about the topic, stating the purpose of the work in the form of the research problem supported by a hypothesis or a set of questions, explaining briefly the methodological approach used to examine the research problem, highlighting the potential outcomes your study can reveal, and outlining the remaining structure and organization of the paper.

Key Elements of the Research Proposal. Prepared under the direction of the Superintendent and by the 2010 Curriculum Design and Writing Team. Baltimore County Public Schools.

Importance of a Good Introduction

Think of the introduction as a mental road map that must answer for the reader these four questions:

  • What was I studying?
  • Why was this topic important to investigate?
  • What did we know about this topic before I did this study?
  • How will this study advance new knowledge or new ways of understanding?

According to Reyes, there are three overarching goals of a good introduction: 1) ensure that you summarize prior studies about the topic in a manner that lays a foundation for understanding the research problem; 2) explain how your study specifically addresses gaps in the literature, insufficient consideration of the topic, or other deficiency in the literature; and, 3) note the broader theoretical, empirical, and/or policy contributions and implications of your research.

A well-written introduction is important because, quite simply, you never get a second chance to make a good first impression. The opening paragraphs of your paper will provide your readers with their initial impressions about the logic of your argument, your writing style, the overall quality of your research, and, ultimately, the validity of your findings and conclusions. A vague, disorganized, or error-filled introduction will create a negative impression, whereas, a concise, engaging, and well-written introduction will lead your readers to think highly of your analytical skills, your writing style, and your research approach. All introductions should conclude with a brief paragraph that describes the organization of the rest of the paper.

Hirano, Eliana. “Research Article Introductions in English for Specific Purposes: A Comparison between Brazilian, Portuguese, and English.” English for Specific Purposes 28 (October 2009): 240-250; Samraj, B. “Introductions in Research Articles: Variations Across Disciplines.” English for Specific Purposes 21 (2002): 1–17; Introductions. The Writing Center. University of North Carolina; “Writing Introductions.” In Good Essay Writing: A Social Sciences Guide. Peter Redman. 4th edition. (London: Sage, 2011), pp. 63-70; Reyes, Victoria. Demystifying the Journal Article. Inside Higher Education.

Structure and Writing Style

I.  Structure and Approach

The introduction is the broad beginning of the paper that answers three important questions for the reader:

  • What is this?
  • Why should I read it?
  • What do you want me to think about / consider doing / react to?

Think of the structure of the introduction as an inverted triangle of information that lays a foundation for understanding the research problem. Organize the information so as to present the more general aspects of the topic early in the introduction, then narrow your analysis to more specific topical information that provides context, finally arriving at your research problem and the rationale for studying it [often written as a series of key questions to be addressed or framed as a hypothesis or set of assumptions to be tested] and, whenever possible, a description of the potential outcomes your study can reveal.

These are general phases associated with writing an introduction: 1.  Establish an area to research by:

  • Highlighting the importance of the topic, and/or
  • Making general statements about the topic, and/or
  • Presenting an overview on current research on the subject.

2.  Identify a research niche by:

  • Opposing an existing assumption, and/or
  • Revealing a gap in existing research, and/or
  • Formulating a research question or problem, and/or
  • Continuing a disciplinary tradition.

3.  Place your research within the research niche by:

  • Stating the intent of your study,
  • Outlining the key characteristics of your study,
  • Describing important results, and
  • Giving a brief overview of the structure of the paper.

NOTE:   It is often useful to review the introduction late in the writing process. This is appropriate because outcomes are unknown until you've completed the study. After you complete writing the body of the paper, go back and review introductory descriptions of the structure of the paper, the method of data gathering, the reporting and analysis of results, and the conclusion. Reviewing and, if necessary, rewriting the introduction ensures that it correctly matches the overall structure of your final paper.

II.  Delimitations of the Study

Delimitations refer to those characteristics that limit the scope and define the conceptual boundaries of your research . This is determined by the conscious exclusionary and inclusionary decisions you make about how to investigate the research problem. In other words, not only should you tell the reader what it is you are studying and why, but you must also acknowledge why you rejected alternative approaches that could have been used to examine the topic.

Obviously, the first limiting step was the choice of research problem itself. However, implicit are other, related problems that could have been chosen but were rejected. These should be noted in the conclusion of your introduction. For example, a delimitating statement could read, "Although many factors can be understood to impact the likelihood young people will vote, this study will focus on socioeconomic factors related to the need to work full-time while in school." The point is not to document every possible delimiting factor, but to highlight why previously researched issues related to the topic were not addressed.

Examples of delimitating choices would be:

  • The key aims and objectives of your study,
  • The research questions that you address,
  • The variables of interest [i.e., the various factors and features of the phenomenon being studied],
  • The method(s) of investigation,
  • The time period your study covers, and
  • Any relevant alternative theoretical frameworks that could have been adopted.

Review each of these decisions. Not only do you clearly establish what you intend to accomplish in your research, but you should also include a declaration of what the study does not intend to cover. In the latter case, your exclusionary decisions should be based upon criteria understood as, "not interesting"; "not directly relevant"; “too problematic because..."; "not feasible," and the like. Make this reasoning explicit!

NOTE:   Delimitations refer to the initial choices made about the broader, overall design of your study and should not be confused with documenting the limitations of your study discovered after the research has been completed.

ANOTHER NOTE : Do not view delimitating statements as admitting to an inherent failing or shortcoming in your research. They are an accepted element of academic writing intended to keep the reader focused on the research problem by explicitly defining the conceptual boundaries and scope of your study. It addresses any critical questions in the reader's mind of, "Why the hell didn't the author examine this?"

III.  The Narrative Flow

Issues to keep in mind that will help the narrative flow in your introduction :

  • Your introduction should clearly identify the subject area of interest . A simple strategy to follow is to use key words from your title in the first few sentences of the introduction. This will help focus the introduction on the topic at the appropriate level and ensures that you get to the subject matter quickly without losing focus, or discussing information that is too general.
  • Establish context by providing a brief and balanced review of the pertinent published literature that is available on the subject. The key is to summarize for the reader what is known about the specific research problem before you did your analysis. This part of your introduction should not represent a comprehensive literature review--that comes next. It consists of a general review of the important, foundational research literature [with citations] that establishes a foundation for understanding key elements of the research problem. See the drop-down menu under this tab for " Background Information " regarding types of contexts.
  • Clearly state the hypothesis that you investigated . When you are first learning to write in this format it is okay, and actually preferable, to use a past statement like, "The purpose of this study was to...." or "We investigated three possible mechanisms to explain the...."
  • Why did you choose this kind of research study or design? Provide a clear statement of the rationale for your approach to the problem studied. This will usually follow your statement of purpose in the last paragraph of the introduction.

IV.  Engaging the Reader

A research problem in the social sciences can come across as dry and uninteresting to anyone unfamiliar with the topic . Therefore, one of the goals of your introduction is to make readers want to read your paper. Here are several strategies you can use to grab the reader's attention:

  • Open with a compelling story . Almost all research problems in the social sciences, no matter how obscure or esoteric , are really about the lives of people. Telling a story that humanizes an issue can help illuminate the significance of the problem and help the reader empathize with those affected by the condition being studied.
  • Include a strong quotation or a vivid, perhaps unexpected, anecdote . During your review of the literature, make note of any quotes or anecdotes that grab your attention because they can used in your introduction to highlight the research problem in a captivating way.
  • Pose a provocative or thought-provoking question . Your research problem should be framed by a set of questions to be addressed or hypotheses to be tested. However, a provocative question can be presented in the beginning of your introduction that challenges an existing assumption or compels the reader to consider an alternative viewpoint that helps establish the significance of your study. 
  • Describe a puzzling scenario or incongruity . This involves highlighting an interesting quandary concerning the research problem or describing contradictory findings from prior studies about a topic. Posing what is essentially an unresolved intellectual riddle about the problem can engage the reader's interest in the study.
  • Cite a stirring example or case study that illustrates why the research problem is important . Draw upon the findings of others to demonstrate the significance of the problem and to describe how your study builds upon or offers alternatives ways of investigating this prior research.

NOTE:   It is important that you choose only one of the suggested strategies for engaging your readers. This avoids giving an impression that your paper is more flash than substance and does not distract from the substance of your study.

Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions. University College Writing Centre. University of Toronto; Introduction. The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Introductions. The Writing Center. University of North Carolina; Introductions. The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Introductions, Body Paragraphs, and Conclusions for an Argument Paper. The Writing Lab and The OWL. Purdue University; “Writing Introductions.” In Good Essay Writing: A Social Sciences Guide . Peter Redman. 4th edition. (London: Sage, 2011), pp. 63-70; Resources for Writers: Introduction Strategies. Program in Writing and Humanistic Studies. Massachusetts Institute of Technology; Sharpling, Gerald. Writing an Introduction. Centre for Applied Linguistics, University of Warwick; Samraj, B. “Introductions in Research Articles: Variations Across Disciplines.” English for Specific Purposes 21 (2002): 1–17; Swales, John and Christine B. Feak. Academic Writing for Graduate Students: Essential Skills and Tasks . 2nd edition. Ann Arbor, MI: University of Michigan Press, 2004 ; Writing Your Introduction. Department of English Writing Guide. George Mason University.

Writing Tip

Avoid the "Dictionary" Introduction

Giving the dictionary definition of words related to the research problem may appear appropriate because it is important to define specific terminology that readers may be unfamiliar with. However, anyone can look a word up in the dictionary and a general dictionary is not a particularly authoritative source because it doesn't take into account the context of your topic and doesn't offer particularly detailed information. Also, placed in the context of a particular discipline, a term or concept may have a different meaning than what is found in a general dictionary. If you feel that you must seek out an authoritative definition, use a subject specific dictionary or encyclopedia [e.g., if you are a sociology student, search for dictionaries of sociology]. A good database for obtaining definitive definitions of concepts or terms is Credo Reference .

Saba, Robert. The College Research Paper. Florida International University; Introductions. The Writing Center. University of North Carolina.

Another Writing Tip

When Do I Begin?

A common question asked at the start of any paper is, "Where should I begin?" An equally important question to ask yourself is, "When do I begin?" Research problems in the social sciences rarely rest in isolation from history. Therefore, it is important to lay a foundation for understanding the historical context underpinning the research problem. However, this information should be brief and succinct and begin at a point in time that illustrates the study's overall importance. For example, a study that investigates coffee cultivation and export in West Africa as a key stimulus for local economic growth needs to describe the beginning of exporting coffee in the region and establishing why economic growth is important. You do not need to give a long historical explanation about coffee exports in Africa. If a research problem requires a substantial exploration of the historical context, do this in the literature review section. In your introduction, make note of this as part of the "roadmap" [see below] that you use to describe the organization of your paper.

Introductions. The Writing Center. University of North Carolina; “Writing Introductions.” In Good Essay Writing: A Social Sciences Guide . Peter Redman. 4th edition. (London: Sage, 2011), pp. 63-70.

Yet Another Writing Tip

Always End with a Roadmap

The final paragraph or sentences of your introduction should forecast your main arguments and conclusions and provide a brief description of the rest of the paper [the "roadmap"] that let's the reader know where you are going and what to expect. A roadmap is important because it helps the reader place the research problem within the context of their own perspectives about the topic. In addition, concluding your introduction with an explicit roadmap tells the reader that you have a clear understanding of the structural purpose of your paper. In this way, the roadmap acts as a type of promise to yourself and to your readers that you will follow a consistent and coherent approach to addressing the topic of inquiry. Refer to it often to help keep your writing focused and organized.

Cassuto, Leonard. “On the Dissertation: How to Write the Introduction.” The Chronicle of Higher Education , May 28, 2018; Radich, Michael. A Student's Guide to Writing in East Asian Studies . (Cambridge, MA: Harvard University Writing n. d.), pp. 35-37.

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How to write an effective introduction for your research paper

Last updated

20 January 2024

Reviewed by

However, the introduction is a vital element of your research paper . It helps the reader decide whether your paper is worth their time. As such, it's worth taking your time to get it right.

In this article, we'll tell you everything you need to know about writing an effective introduction for your research paper.

  • The importance of an introduction in research papers

The primary purpose of an introduction is to provide an overview of your paper. This lets readers gauge whether they want to continue reading or not. The introduction should provide a meaningful roadmap of your research to help them make this decision. It should let readers know whether the information they're interested in is likely to be found in the pages that follow.

Aside from providing readers with information about the content of your paper, the introduction also sets the tone. It shows readers the style of language they can expect, which can further help them to decide how far to read.

When you take into account both of these roles that an introduction plays, it becomes clear that crafting an engaging introduction is the best way to get your paper read more widely. First impressions count, and the introduction provides that impression to readers.

  • The optimum length for a research paper introduction

While there's no magic formula to determine exactly how long a research paper introduction should be, there are a few guidelines. Some variables that impact the ideal introduction length include:

Field of study

Complexity of the topic

Specific requirements of the course or publication

A commonly recommended length of a research paper introduction is around 10% of the total paper’s length. So, a ten-page paper has a one-page introduction. If the topic is complex, it may require more background to craft a compelling intro. Humanities papers tend to have longer introductions than those of the hard sciences.

The best way to craft an introduction of the right length is to focus on clarity and conciseness. Tell the reader only what is necessary to set up your research. An introduction edited down with this goal in mind should end up at an acceptable length.

  • Evaluating successful research paper introductions

A good way to gauge how to create a great introduction is by looking at examples from across your field. The most influential and well-regarded papers should provide some insights into what makes a good introduction.

Dissecting examples: what works and why

We can make some general assumptions by looking at common elements of a good introduction, regardless of the field of research.

A common structure is to start with a broad context, and then narrow that down to specific research questions or hypotheses. This creates a funnel that establishes the scope and relevance.

The most effective introductions are careful about the assumptions they make regarding reader knowledge. By clearly defining key terms and concepts instead of assuming the reader is familiar with them, these introductions set a more solid foundation for understanding.

To pull in the reader and make that all-important good first impression, excellent research paper introductions will often incorporate a compelling narrative or some striking fact that grabs the reader's attention.

Finally, good introductions provide clear citations from past research to back up the claims they're making. In the case of argumentative papers or essays (those that take a stance on a topic or issue), a strong thesis statement compels the reader to continue reading.

Common pitfalls to avoid in research paper introductions

You can also learn what not to do by looking at other research papers. Many authors have made mistakes you can learn from.

We've talked about the need to be clear and concise. Many introductions fail at this; they're verbose, vague, or otherwise fail to convey the research problem or hypothesis efficiently. This often comes in the form of an overemphasis on background information, which obscures the main research focus.

Ensure your introduction provides the proper emphasis and excitement around your research and its significance. Otherwise, fewer people will want to read more about it.

  • Crafting a compelling introduction for a research paper

Let’s take a look at the steps required to craft an introduction that pulls readers in and compels them to learn more about your research.

Step 1: Capturing interest and setting the scene

To capture the reader's interest immediately, begin your introduction with a compelling question, a surprising fact, a provocative quote, or some other mechanism that will hook readers and pull them further into the paper.

As they continue reading, the introduction should contextualize your research within the current field, showing readers its relevance and importance. Clarify any essential terms that will help them better understand what you're saying. This keeps the fundamentals of your research accessible to all readers from all backgrounds.

Step 2: Building a solid foundation with background information

Including background information in your introduction serves two major purposes:

It helps to clarify the topic for the reader

It establishes the depth of your research

The approach you take when conveying this information depends on the type of paper.

For argumentative papers, you'll want to develop engaging background narratives. These should provide context for the argument you'll be presenting.

For empirical papers, highlighting past research is the key. Often, there will be some questions that weren't answered in those past papers. If your paper is focused on those areas, those papers make ideal candidates for you to discuss and critique in your introduction.

Step 3: Pinpointing the research challenge

To capture the attention of the reader, you need to explain what research challenges you'll be discussing.

For argumentative papers, this involves articulating why the argument you'll be making is important. What is its relevance to current discussions or problems? What is the potential impact of people accepting or rejecting your argument?

For empirical papers, explain how your research is addressing a gap in existing knowledge. What new insights or contributions will your research bring to your field?

Step 4: Clarifying your research aims and objectives

We mentioned earlier that the introduction to a research paper can serve as a roadmap for what's within. We've also frequently discussed the need for clarity. This step addresses both of these.

When writing an argumentative paper, craft a thesis statement with impact. Clearly articulate what your position is and the main points you intend to present. This will map out for the reader exactly what they'll get from reading the rest.

For empirical papers, focus on formulating precise research questions and hypotheses. Directly link them to the gaps or issues you've identified in existing research to show the reader the precise direction your research paper will take.

Step 5: Sketching the blueprint of your study

Continue building a roadmap for your readers by designing a structured outline for the paper. Guide the reader through your research journey, explaining what the different sections will contain and their relationship to one another.

This outline should flow seamlessly as you move from section to section. Creating this outline early can also help guide the creation of the paper itself, resulting in a final product that's better organized. In doing so, you'll craft a paper where each section flows intuitively from the next.

Step 6: Integrating your research question

To avoid letting your research question get lost in background information or clarifications, craft your introduction in such a way that the research question resonates throughout. The research question should clearly address a gap in existing knowledge or offer a new perspective on an existing problem.

Tell users your research question explicitly but also remember to frequently come back to it. When providing context or clarification, point out how it relates to the research question. This keeps your focus where it needs to be and prevents the topic of the paper from becoming under-emphasized.

Step 7: Establishing the scope and limitations

So far, we've talked mostly about what's in the paper and how to convey that information to readers. The opposite is also important. Information that's outside the scope of your paper should be made clear to the reader in the introduction so their expectations for what is to follow are set appropriately.

Similarly, be honest and upfront about the limitations of the study. Any constraints in methodology, data, or how far your findings can be generalized should be fully communicated in the introduction.

Step 8: Concluding the introduction with a promise

The final few lines of the introduction are your last chance to convince people to continue reading the rest of the paper. Here is where you should make it very clear what benefit they'll get from doing so. What topics will be covered? What questions will be answered? Make it clear what they will get for continuing.

By providing a quick recap of the key points contained in the introduction in its final lines and properly setting the stage for what follows in the rest of the paper, you refocus the reader's attention on the topic of your research and guide them to read more.

  • Research paper introduction best practices

Following the steps above will give you a compelling introduction that hits on all the key points an introduction should have. Some more tips and tricks can make an introduction even more polished.

As you follow the steps above, keep the following tips in mind.

Set the right tone and style

Like every piece of writing, a research paper should be written for the audience. That is to say, it should match the tone and style that your academic discipline and target audience expect. This is typically a formal and academic tone, though the degree of formality varies by field.

Kno w the audience

The perfect introduction balances clarity with conciseness. The amount of clarification required for a given topic depends greatly on the target audience. Knowing who will be reading your paper will guide you in determining how much background information is required.

Adopt the CARS (create a research space) model

The CARS model is a helpful tool for structuring introductions. This structure has three parts. The beginning of the introduction establishes the general research area. Next, relevant literature is reviewed and critiqued. The final section outlines the purpose of your study as it relates to the previous parts.

Master the art of funneling

The CARS method is one example of a well-funneled introduction. These start broadly and then slowly narrow down to your specific research problem. It provides a nice narrative flow that provides the right information at the right time. If you stray from the CARS model, try to retain this same type of funneling.

Incorporate narrative element

People read research papers largely to be informed. But to inform the reader, you have to hold their attention. A narrative style, particularly in the introduction, is a great way to do that. This can be a compelling story, an intriguing question, or a description of a real-world problem.

Write the introduction last

By writing the introduction after the rest of the paper, you'll have a better idea of what your research entails and how the paper is structured. This prevents the common problem of writing something in the introduction and then forgetting to include it in the paper. It also means anything particularly exciting in the paper isn’t neglected in the intro.

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  • If you are writing in a new discipline, you should always make sure to ask about conventions and expectations for introductions, just as you would for any other aspect of the essay. For example, while it may be acceptable to write a two-paragraph (or longer) introduction for your papers in some courses, instructors in other disciplines, such as those in some Government courses, may expect a shorter introduction that includes a preview of the argument that will follow.  
  • In some disciplines (Government, Economics, and others), it’s common to offer an overview in the introduction of what points you will make in your essay. In other disciplines, you will not be expected to provide this overview in your introduction.  
  • Avoid writing a very general opening sentence. While it may be true that “Since the dawn of time, people have been telling love stories,” it won’t help you explain what’s interesting about your topic.  
  • Avoid writing a “funnel” introduction in which you begin with a very broad statement about a topic and move to a narrow statement about that topic. Broad generalizations about a topic will not add to your readers’ understanding of your specific essay topic.  
  • Avoid beginning with a dictionary definition of a term or concept you will be writing about. If the concept is complicated or unfamiliar to your readers, you will need to define it in detail later in your essay. If it’s not complicated, you can assume your readers already know the definition.  
  • Avoid offering too much detail in your introduction that a reader could better understand later in the paper.
  • picture_as_pdf Introductions

How to Write an Introduction For a Research Paper

Learn how to write a strong and efficient research paper introduction by following the suitable structure and avoiding typical errors.

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An introduction to any type of paper is sometimes misunderstood as the beginning; yet, an introduction is actually intended to present your chosen subject to the audience in a way that makes it more appealing and leaves your readers thirsty for more information. After the title and abstract, your audience will read the introduction, thus it’s critical to get off to a solid start.  

This article includes instructions on how to write an introduction for a research paper that engages the reader in your research. You can produce a strong opening for your research paper if you stick to the format and a few basic principles.

What is An Introduction To a Research Paper?

An introduction is the opening section of a research paper and the section that a reader is likely to read first, in which the objective and goals of the subsequent writing are stated. 

The introduction serves numerous purposes. It provides context for your research, explains your topic and objectives, and provides an outline of the work. A solid introduction will establish the tone for the remainder of your paper, enticing readers to continue reading through the methodology, findings, and discussion. 

Even though introductions are generally presented at the beginning of a document, we must distinguish an introduction from the beginning of your research. An introduction, as the name implies, is supposed to introduce your subject without extending it. All relevant information and facts should be placed in the body and conclusion, not the introduction.

Structure Of An Introduction

Before explaining how to write an introduction for a research paper , it’s necessary to comprehend a structure that will make your introduction stronger and more straightforward.

A Good Hook

A hook is one of the most effective research introduction openers. A hook’s objective is to stimulate the reader’s interest to read the research paper.  There are various approaches you may take to generate a strong hook:  startling facts, a question, a brief overview, or even a quotation. 

Broad Overview

Following an excellent hook, you should present a wide overview of your major issue and some background information on your research. If you’re unsure about how to begin an essay introduction, the best approach is to offer a basic explanation of your topic before delving into specific issues. Simply said, you should begin with general information and then narrow it down to your relevant topics.

After offering some background information regarding your research’s main topic, go on to give readers a better understanding of what you’ll be covering throughout your research. In this section of your introduction, you should swiftly clarify your important topics in the sequence in which they will be addressed later, gradually introducing your thesis statement. You can use some  The following are some critical questions to address in this section of your introduction: Who? What? Where? When? How? And why is that?

Thesis Statement

The thesis statement, which must be stated in the beginning clause of your research since your entire research revolves around it, is the most important component of your research.

A thesis statement presents your audience with a quick overview of the research’s main assertion. In the body section of your work, your key argument is what you will expose or debate about it. An excellent thesis statement is usually very succinct, accurate, explicit, clear, and focused. Typically, your thesis should be at the conclusion of your introductory paragraph/section.

Tips for Writing a Strong Introduction

Aside from the good structure, here are a few tips to make your introduction strong and accurate:

  • Keep in mind the aim of your research and make sure your introduction supports it.
  • Use an appealing and relevant hook that catches the reader’s attention right away.
  • Make it obvious to your readers what your stance is.
  • Demonstrate your knowledge of your subject.
  • Provide your readers with a road map to help them understand what you will address throughout the research.
  • Be succinct – it is advised that your opening introduction consists of around 8-9 percent of the overall amount of words in your article (for example, 160 words for a 2000 words essay). 
  • Make a strong and unambiguous thesis statement.
  • Explain why the article is significant in 1-2 sentences.
  • Remember to keep it interesting.

Mistakes to Avoid in Your Introduction

Check out what not to do and what to avoid now that you know the structure and how to write an introduction for a research paper .

  • Lacking a feeling of direction or purpose.
  • Giving out too much.
  • Creating lengthy paragraphs.
  • Excessive or insufficient background, literature, and theory.
  • Including material that should be placed in the body and conclusion.
  • Not writing enough or writing excessively.
  • Using too many quotes.

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How to Write the Introduction to a Scientific Paper?

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what is the content of the introduction part of a research paper

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  • Atul Kakar 5 &
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An Introduction to a scientific paper familiarizes the reader with the background of the issue at hand. It must reflect why the issue is topical and its current importance in the vast sea of research being done globally. It lays the foundation of biomedical writing and is the first portion of an article according to the IMRAD pattern ( I ntroduction, M ethodology, R esults, a nd D iscussion) [1].

I once had a professor tell a class that he sifted through our pile of essays, glancing at the titles and introductions, looking for something that grabbed his attention. Everything else went to the bottom of the pile to be read last, when he was tired and probably grumpy from all the marking. Don’t get put at the bottom of the pile, he said. Anonymous

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what is the content of the introduction part of a research paper

The Introduction Section

what is the content of the introduction part of a research paper

Abstract and Keywords

what is the content of the introduction part of a research paper

Writing and publishing a scientific paper

1 what is the importance of an introduction.

An Introduction to a scientific paper familiarizes the reader with the background of the issue at hand. It must reflect why the issue is topical and its current importance in the vast sea of research being done globally. It lays the foundation of biomedical writing and is the first portion of an article according to the IMRAD pattern ( I ntroduction, M ethodology, R esults, a nd D iscussion) [ 1 ].

It provides the flavour of the article and many authors have used phrases to describe it for example—'like a gate of the city’ [ 2 ], ‘the beginning is half of the whole’ [ 3 ], ‘an introduction is not just wrestling with words to fit the facts, but it also strongly modulated by perception of the anticipated reactions of peer colleagues’, [ 4 ] and ‘an introduction is like the trailer to a movie’. A good introduction helps captivate the reader early.

figure a

2 What Are the Principles of Writing a Good Introduction?

A good introduction will ‘sell’ an article to a journal editor, reviewer, and finally to a reader [ 3 ]. It should contain the following information [ 5 , 6 ]:

The known—The background scientific data

The unknown—Gaps in the current knowledge

Research hypothesis or question

Methodologies used for the study

The known consist of citations from a review of the literature whereas the unknown is the new work to be undertaken. This part should address how your work is the required missing piece of the puzzle.

3 What Are the Models of Writing an Introduction?

The Problem-solving model

First described by Swales et al. in 1979, in this model the writer should identify the ‘problem’ in the research, address the ‘solution’ and also write about ‘the criteria for evaluating the problem’ [ 7 , 8 ].

The CARS model that stands for C reating A R esearch S pace [ 9 , 10 ].

The two important components of this model are:

Establishing a territory (situation)

Establishing a niche (problem)

Occupying a niche (the solution)

In this popular model, one can add a fourth point, i.e., a conclusion [ 10 ].

4 What Is Establishing a Territory?

This includes: [ 9 ]

Stating the general topic and providing some background about it.

Providing a brief and relevant review of the literature related to the topic.

Adding a paragraph on the scope of the topic including the need for your study.

5 What Is Establishing a Niche?

Establishing a niche includes:

Stating the importance of the problem.

Outlining the current situation regarding the problem citing both global and national data.

Evaluating the current situation (advantages/ disadvantages).

Identifying the gaps.

Emphasizing the importance of the proposed research and how the gaps will be addressed.

Stating the research problem/ questions.

Stating the hypotheses briefly.

Figure 17.1 depicts how the introduction needs to be written. A scientific paper should have an introduction in the form of an inverted pyramid. The writer should start with the general information about the topic and subsequently narrow it down to the specific topic-related introduction.

figure 1

Flow of ideas from the general to the specific

6 What Does Occupying a Niche Mean?

This is the third portion of the introduction and defines the rationale of the research and states the research question. If this is missing the reviewers will not understand the logic for publication and is a common reason for rejection [ 11 , 12 ]. An example of this is given below:

Till date, no study has been done to see the effectiveness of a mesh alone or the effectiveness of double suturing along with a mesh in the closure of an umbilical hernia regarding the incidence of failure. So, the present study is aimed at comparing the effectiveness of a mesh alone versus the double suturing technique along with a mesh.

7 How Long Should the Introduction Be?

For a project protocol, the introduction should be about 1–2 pages long and for a thesis it should be 3–5 pages in a double-spaced typed setting. For a scientific paper it should be less than 10–15% of the total length of the manuscript [ 13 , 14 ].

8 How Many References Should an Introduction Have?

All sections in a scientific manuscript except the conclusion should contain references. It has been suggested that an introduction should have four or five or at the most one-third of the references in the whole paper [ 15 ].

9 What Are the Important Points Which Should be not Missed in an Introduction?

An introduction paves the way forward for the subsequent sections of the article. Frequently well-planned studies are rejected by journals during review because of the simple reason that the authors failed to clarify the data in this section to justify the study [ 16 , 17 ]. Thus, the existing gap in knowledge should be clearly brought out in this section (Fig. 17.2 ).

figure 2

How should the abstract, introduction, and discussion look

The following points are important to consider:

The introduction should be written in simple sentences and in the present tense.

Many of the terms will be introduced in this section for the first time and these will require abbreviations to be used later.

The references in this section should be to papers published in quality journals (e.g., having a high impact factor).

The aims, problems, and hypotheses should be clearly mentioned.

Start with a generalization on the topic and go on to specific information relevant to your research.

10 Example of an Introduction

figure b

11 Conclusions

An Introduction is a brief account of what the study is about. It should be short, crisp, and complete.

It has to move from a general to a specific research topic and must include the need for the present study.

The Introduction should include data from a literature search, i.e., what is already known about this subject and progress to what we hope to add to this knowledge.

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Nundy, S., Kakar, A., Bhutta, Z.A. (2022). How to Write the Introduction to a Scientific Paper?. In: How to Practice Academic Medicine and Publish from Developing Countries?. Springer, Singapore. https://doi.org/10.1007/978-981-16-5248-6_17

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Research Method

Home » Research Paper – Structure, Examples and Writing Guide

Research Paper – Structure, Examples and Writing Guide

Table of Contents

Research Paper

Research Paper

Definition:

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

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

Structure of Research Paper

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

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

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

Introduction

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

Literature Review

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

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

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

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

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

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

How to Write Research Paper

You can write Research Paper by the following guide:

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

Research Paper Example

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

Research Paper Example sample for Students:

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

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

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

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

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

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

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

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

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

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

References :

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

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

Social Media and Mental Health Survey

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

Thank you for your participation!

Applications of Research Paper

Research papers have several applications in various fields, including:

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

When to Write Research Paper

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

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

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

Purpose of Research Paper

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

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

Characteristics of Research Paper

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

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

Advantages of Research Paper

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

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

Limitations of Research Paper

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

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

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How to Write a Research Paper: Parts of the Paper

  • Choosing Your Topic
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Parts of the Research Paper Papers should have a beginning, a middle, and an end. Your introductory paragraph should grab the reader's attention, state your main idea, and indicate how you will support it. The body of the paper should expand on what you have stated in the introduction. Finally, the conclusion restates the paper's thesis and should explain what you have learned, giving a wrap up of your main ideas.

1. The Title The title should be specific and indicate the theme of the research and what ideas it addresses. Use keywords that help explain your paper's topic to the reader. Try to avoid abbreviations and jargon. Think about keywords that people would use to search for your paper and include them in your title.

2. The Abstract The abstract is used by readers to get a quick overview of your paper. Typically, they are about 200 words in length (120 words minimum to  250 words maximum). The abstract should introduce the topic and thesis, and should provide a general statement about what you have found in your research. The abstract allows you to mention each major aspect of your topic and helps readers decide whether they want to read the rest of the paper. Because it is a summary of the entire research paper, it is often written last. 

3. The Introduction The introduction should be designed to attract the reader's attention and explain the focus of the research. You will introduce your overview of the topic,  your main points of information, and why this subject is important. You can introduce the current understanding and background information about the topic. Toward the end of the introduction, you add your thesis statement, and explain how you will provide information to support your research questions. This provides the purpose and focus for the rest of the paper.

4. Thesis Statement Most papers will have a thesis statement or main idea and supporting facts/ideas/arguments. State your main idea (something of interest or something to be proven or argued for or against) as your thesis statement, and then provide your supporting facts and arguments. A thesis statement is a declarative sentence that asserts the position a paper will be taking. It also points toward the paper's development. This statement should be both specific and arguable. Generally, the thesis statement will be placed at the end of the first paragraph of your paper. The remainder of your paper will support this thesis.

Students often learn to write a thesis as a first step in the writing process, but often, after research, a writer's viewpoint may change. Therefore a thesis statement may be one of the final steps in writing. 

Examples of Thesis Statements from Purdue OWL

5. The Literature Review The purpose of the literature review is to describe past important research and how it specifically relates to the research thesis. It should be a synthesis of the previous literature and the new idea being researched. The review should examine the major theories related to the topic to date and their contributors. It should include all relevant findings from credible sources, such as academic books and peer-reviewed journal articles. You will want  to:

  • Explain how the literature helps the researcher understand the topic.
  • Try to show connections and any disparities between the literature.
  • Identify new ways to interpret prior research.
  • Reveal any gaps that exist in the literature.

More about writing a literature review. . .

6. The Discussion ​The purpose of the discussion is to interpret and describe what you have learned from your research. Make the reader understand why your topic is important. The discussion should always demonstrate what you have learned from your readings (and viewings) and how that learning has made the topic evolve, especially from the short description of main points in the introduction.Explain any new understanding or insights you have had after reading your articles and/or books. Paragraphs should use transitioning sentences to develop how one paragraph idea leads to the next. The discussion will always connect to the introduction, your thesis statement, and the literature you reviewed, but it does not simply repeat or rearrange the introduction. You want to: 

  • Demonstrate critical thinking, not just reporting back facts that you gathered.
  • If possible, tell how the topic has evolved over the past and give it's implications for the future.
  • Fully explain your main ideas with supporting information.
  • Explain why your thesis is correct giving arguments to counter points.

7. The Conclusion A concluding paragraph is a brief summary of your main ideas and restates the paper's main thesis, giving the reader the sense that the stated goal of the paper has been accomplished. What have you learned by doing this research that you didn't know before? What conclusions have you drawn? You may also want to suggest further areas of study, improvement of research possibilities, etc. to demonstrate your critical thinking regarding your research.

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How to Write a Research Introduction

Last Updated: December 6, 2023 Fact Checked

This article was co-authored by Megan Morgan, PhD . Megan Morgan is a Graduate Program Academic Advisor in the School of Public & International Affairs at the University of Georgia. She earned her PhD in English from the University of Georgia in 2015. There are 7 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 2,653,492 times.

The introduction to a research paper can be the most challenging part of the paper to write. The length of the introduction will vary depending on the type of research paper you are writing. An introduction should announce your topic, provide context and a rationale for your work, before stating your research questions and hypothesis. Well-written introductions set the tone for the paper, catch the reader's interest, and communicate the hypothesis or thesis statement.

Introducing the Topic of the Paper

Step 1 Announce your research topic.

  • In scientific papers this is sometimes known as an "inverted triangle", where you start with the broadest material at the start, before zooming in on the specifics. [2] X Research source
  • The sentence "Throughout the 20th century, our views of life on other planets have drastically changed" introduces a topic, but does so in broad terms.
  • It provides the reader with an indication of the content of the essay and encourages them to read on.

Step 2 Consider referring to key words.

  • For example, if you were writing a paper about the behaviour of mice when exposed to a particular substance, you would include the word "mice", and the scientific name of the relevant compound in the first sentences.
  • If you were writing a history paper about the impact of the First World War on gender relations in Britain, you should mention those key words in your first few lines.

Step 3 Define any key terms or concepts.

  • This is especially important if you are attempting to develop a new conceptualization that uses language and terminology your readers may be unfamiliar with.

Step 4 Introduce the topic through an anecdote or quotation.

  • If you use an anecdote ensure that is short and highly relevant for your research. It has to function in the same way as an alternative opening, namely to announce the topic of your research paper to your reader.
  • For example, if you were writing a sociology paper about re-offending rates among young offenders, you could include a brief story of one person whose story reflects and introduces your topic.
  • This kind of approach is generally not appropriate for the introduction to a natural or physical sciences research paper where the writing conventions are different.

Establishing the Context for Your Paper

Step 1 Include a brief literature review.

  • It is important to be concise in the introduction, so provide an overview on recent developments in the primary research rather than a lengthy discussion.
  • You can follow the "inverted triangle" principle to focus in from the broader themes to those to which you are making a direct contribution with your paper.
  • A strong literature review presents important background information to your own research and indicates the importance of the field.

Step 2 Use the literature to focus in on your contribution.

  • By making clear reference to existing work you can demonstrate explicitly the specific contribution you are making to move the field forward.
  • You can identify a gap in the existing scholarship and explain how you are addressing it and moving understanding forward.

Step 3 Elaborate on the rationale of your paper.

  • For example, if you are writing a scientific paper you could stress the merits of the experimental approach or models you have used.
  • Stress what is novel in your research and the significance of your new approach, but don't give too much detail in the introduction.
  • A stated rationale could be something like: "the study evaluates the previously unknown anti-inflammatory effects of a topical compound in order to evaluate its potential clinical uses".

Specifying Your Research Questions and Hypothesis

Step 1 State your research questions.

  • The research question or questions generally come towards the end of the introduction, and should be concise and closely focused.
  • The research question might recall some of the key words established in the first few sentences and the title of your paper.
  • An example of a research question could be "what were the consequences of the North American Free Trade Agreement on the Mexican export economy?"
  • This could be honed further to be specific by referring to a particular element of the Free Trade Agreement and the impact on a particular industry in Mexico, such as clothing manufacture.
  • A good research question should shape a problem into a testable hypothesis.

Step 2 Indicate your hypothesis.

  • If possible try to avoid using the word "hypothesis" and rather make this implicit in your writing. This can make your writing appear less formulaic.
  • In a scientific paper, giving a clear one-sentence overview of your results and their relation to your hypothesis makes the information clear and accessible. [10] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
  • An example of a hypothesis could be "mice deprived of food for the duration of the study were expected to become more lethargic than those fed normally".

Step 3 Outline the structure of your paper.

  • This is not always necessary and you should pay attention to the writing conventions in your discipline.
  • In a natural sciences paper, for example, there is a fairly rigid structure which you will be following.
  • A humanities or social science paper will most likely present more opportunities to deviate in how you structure your paper.

Research Introduction Help

what is the content of the introduction part of a research paper

Community Q&A

Community Answer

  • Use your research papers' outline to help you decide what information to include when writing an introduction. Thanks Helpful 0 Not Helpful 1
  • Consider drafting your introduction after you have already completed the rest of your research paper. Writing introductions last can help ensure that you don't leave out any major points. Thanks Helpful 0 Not Helpful 0

what is the content of the introduction part of a research paper

  • Avoid emotional or sensational introductions; these can create distrust in the reader. Thanks Helpful 50 Not Helpful 12
  • Generally avoid using personal pronouns in your introduction, such as "I," "me," "we," "us," "my," "mine," or "our." Thanks Helpful 31 Not Helpful 7
  • Don't overwhelm the reader with an over-abundance of information. Keep the introduction as concise as possible by saving specific details for the body of your paper. Thanks Helpful 24 Not Helpful 14

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Publish a Research Paper

  • ↑ https://library.sacredheart.edu/c.php?g=29803&p=185916
  • ↑ https://www.aresearchguide.com/inverted-pyramid-structure-in-writing.html
  • ↑ https://libguides.usc.edu/writingguide/introduction
  • ↑ https://writing.wisc.edu/Handbook/PlanResearchPaper.html
  • ↑ https://dept.writing.wisc.edu/wac/writing-an-introduction-for-a-scientific-paper/
  • ↑ https://writing.wisc.edu/handbook/assignments/planresearchpaper/
  • ↑ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178846/

About This Article

Megan Morgan, PhD

To introduce your research paper, use the first 1-2 sentences to describe your general topic, such as “women in World War I.” Include and define keywords, such as “gender relations,” to show your reader where you’re going. Mention previous research into the topic with a phrase like, “Others have studied…”, then transition into what your contribution will be and why it’s necessary. Finally, state the questions that your paper will address and propose your “answer” to them as your thesis statement. For more information from our English Ph.D. co-author about how to craft a strong hypothesis and thesis, keep reading! Did this summary help you? Yes No

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IMRAD (Introduction, Methods, Results and Discussion)

Academic research papers in STEM disciplines typically follow a well-defined I-M-R-A-D structure: Introduction, Methods, Results And Discussion (Wu, 2011). Although not included in the IMRAD name, these papers often include a Conclusion.

Introduction

The Introduction typically provides everything your reader needs to know in order to understand the scope and purpose of your research. This section should provide:

  • Context for your research (for example, the nature and scope of your topic)
  • A summary of how relevant scholars have approached your research topic to date, and a description of how your research makes a contribution to the scholarly conversation
  • An argument or hypothesis that relates to the scholarly conversation
  • A brief explanation of your methodological approach and a justification for this approach (in other words, a brief discussion of how you gather your data and why this is an appropriate choice for your contribution)
  • The main conclusions of your paper (or the “so what”)
  • A roadmap, or a brief description of how the rest of your paper proceeds

The Methods section describes exactly what you did to gather the data that you use in your paper. This should expand on the brief methodology discussion in the introduction and provide readers with enough detail to, if necessary, reproduce your experiment, design, or method for obtaining data; it should also help readers to anticipate your results. The more specific, the better!  These details might include:

  • An overview of the methodology at the beginning of the section
  • A chronological description of what you did in the order you did it
  • Descriptions of the materials used, the time taken, and the precise step-by-step process you followed
  • An explanation of software used for statistical calculations (if necessary)
  • Justifications for any choices or decisions made when designing your methods

Because the methods section describes what was done to gather data, there are two things to consider when writing. First, this section is usually written in the past tense (for example, we poured 250ml of distilled water into the 1000ml glass beaker). Second, this section should not be written as a set of instructions or commands but as descriptions of actions taken. This usually involves writing in the active voice (for example, we poured 250ml of distilled water into the 1000ml glass beaker), but some readers prefer the passive voice (for example, 250ml of distilled water was poured into the 1000ml beaker). It’s important to consider the audience when making this choice, so be sure to ask your instructor which they prefer.

The Results section outlines the data gathered through the methods described above and explains what the data show. This usually involves a combination of tables and/or figures and prose. In other words, the results section gives your reader context for interpreting the data. The results section usually includes:

  • A presentation of the data obtained through the means described in the methods section in the form of tables and/or figures
  • Statements that summarize or explain what the data show
  • Highlights of the most important results

Tables should be as succinct as possible, including only vital information (often summarized) and figures should be easy to interpret and be visually engaging. When adding your written explanation to accompany these visual aids, try to refer your readers to these in such a way that they provide an additional descriptive element, rather than simply telling people to look at them. This can be especially helpful for readers who find it hard to see patterns in data.

The Discussion section explains why the results described in the previous section are meaningful in relation to previous scholarly work and the specific research question your paper explores. This section usually includes:

  • Engagement with sources that are relevant to your work (you should compare and contrast your results to those of similar researchers)
  • An explanation of the results that you found, and why these results are important and/or interesting

Some papers have separate Results and Discussion sections, while others combine them into one section, Results and Discussion. There are benefits to both. By presenting these as separate sections, you’re able to discuss all of your results before moving onto the implications. By presenting these as one section, you’re able to discuss specific results and move onto their significance before introducing another set of results.

The Conclusion section of a paper should include a brief summary of the main ideas or key takeaways of the paper and their implications for future research. This section usually includes:

  • A brief overview of the main claims and/or key ideas put forth in the paper
  • A brief discussion of potential limitations of the study (if relevant)
  • Some suggestions for future research (these should be clearly related to the content of your paper)

Sample Research Article

Resource Download

Wu, Jianguo. “Improving the writing of research papers: IMRAD and beyond.” Landscape Ecology 26, no. 10 (November 2011): 1345–1349. http://dx.doi.org/10.1007/s10980-011-9674-3.

Further reading:

  • Organization of a Research Paper: The IMRAD Format by P. K. Ramachandran Nair and Vimala D. Nair
  • George Mason University Writing Centre’s guide on Writing a Scientific Research Report (IMRAD)
  • University of Wisconsin Writing Centre’s guide on Formatting Science Reports

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Scientific and Scholarly Writing

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Parts of a Scientific & Scholarly Paper

Introduction.

  • Writing Effectively
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Different sections are needed in different types of scientific papers (lab reports, literature reviews, systematic reviews, methods papers, research papers, etc.). Projects that overlap with the social sciences or humanities may have different requirements. Generally, however, you'll need to include:

INTRODUCTION (Background)

METHODS SECTION (Materials and Methods)

What is a title

Titles have two functions: to identify the main topic or the message of the paper and to attract readers.

The title will be read by many people. Only a few will read the entire paper, therefore all words in the title should be chosen with care. Too short a title is not helpful to the potential reader. Too long a title can sometimes be even less meaningful. Remember a title is not an abstract. Neither is a title a sentence.

What makes a good title?

A good title is accurate, complete, and specific. Imagine searching for your paper in PubMed. What words would you use?

  • Use the fewest possible words that describe the contents of the paper.
  • Avoid waste words like "Studies on", or "Investigations on".
  • Use specific terms rather than general.
  • Use the same key terms in the title as the paper.
  • Watch your word order and syntax.

The abstract is a miniature version of your paper. It should present the main story and a few essential details of the paper for readers who only look at the abstract and should serve as a clear preview for readers who read your whole paper. They are usually short (250 words or less).

The goal is to communicate:

  •  What was done?
  •  Why was it done?
  •  How was it done?
  •  What was found?

A good abstract is specific and selective. Try summarizing each of the sections of your paper in a sentence two. Do the abstract last, so you know exactly what you want to write.

  • Use 1 or more well developed paragraphs.
  • Use introduction/body/conclusion structure.
  • Present purpose, results, conclusions and recommendations in that order.
  • Make it understandable to a wide audience.
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  • Last Updated: Apr 17, 2024 3:27 PM
  • URL: https://libraryguides.umassmed.edu/scientific-writing

Sacred Heart University Library

Organizing Academic Research Papers: 4. The Introduction

  • Purpose of Guide
  • Design Flaws to Avoid
  • Glossary of Research Terms
  • 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
  • Executive Summary
  • Background Information
  • The Research Problem/Question
  • Theoretical Framework
  • Citation Tracking
  • Content Alert Services
  • Evaluating Sources
  • Primary Sources
  • Secondary Sources
  • Tertiary Sources
  • What Is Scholarly vs. Popular?
  • Qualitative Methods
  • Quantitative Methods
  • Using Non-Textual Elements
  • Limitations of the Study
  • Common Grammar Mistakes
  • Avoiding Plagiarism
  • Footnotes or Endnotes?
  • Further Readings
  • Annotated Bibliography
  • Dealing with Nervousness
  • Using Visual Aids
  • Grading Someone Else's Paper
  • How to Manage Group Projects
  • Multiple Book Review Essay
  • Reviewing Collected Essays
  • About Informed Consent
  • Writing Field Notes
  • Writing a Policy Memo
  • Writing a Research Proposal
  • Acknowledgements

The introduction serves the purpose of leading the reader from a general subject area to a particular field of research. It establishes the context of the research being conducted by summarizing current understanding and background information about the topic, stating the purpose of the work in the form of the hypothesis, question, or research problem, briefly explaining your rationale, methodological approach, highlighting the potential outcomes your study can reveal, and describing the remaining structure of the paper.

Key Elements of the Research Proposal. Prepared under the direction of the Superintendent and by the 2010 Curriculum Design and Writing Team. Baltimore County Public Schools.

Importance of a Good Introduction

Think of the introduction as a mental road map that must answer for the reader these four questions:

  • What was I studying?
  • Why was this topic important to investigate?
  • What did we know about this topic before I did this study?
  • How will this study advance our knowledge?

A well-written introduction is important because, quite simply, you never get a second chance to make a good first impression. The opening paragraph of your paper will provide your readers with their initial impressions about the logic of your argument, your writing style, the overall quality of your research, and, ultimately, the validity of your findings and conclusions. A vague, disorganized, or error-filled introduction will create a negative impression, whereas, a concise, engaging, and well-written introduction will start your readers off thinking highly of your analytical skills, your writing style, and your research approach.

Introductions . The Writing Center. University of North Carolina.

Structure and Writing Style

I. Structure and Approach

The introduction is the broad beginning of the paper that answers three important questions for the reader:

  • What is this?
  • Why am I reading it?
  • What do you want me to think about / consider doing / react to?

Think of the structure of the introduction as an inverted triangle of information. Organize the information so as to present the more general aspects of the topic early in the introduction, then narrow toward the more specific topical information that provides context, finally arriving at your statement of purpose and rationale and, whenever possible, the potential outcomes your study can reveal.

These are general phases associated with writing an introduction:

  • Highlighting the importance of the topic, and/or
  • Making general statements about the topic, and/or
  • Presenting an overview on current research on the subject.
  • Opposing an existing assumption, and/or
  • Revealing a gap in existing research, and/or
  • Formulating a research question or problem, and/or
  • Continuing a disciplinary tradition.
  • Stating the intent of your study,
  • Outlining the key characteristics of your study,
  • Describing important results, and
  • Giving a brief overview of the structure of the paper.

NOTE: Even though the introduction is the first main section of a research paper, it is often useful to finish the introduction very late in the writing process because the structure of the paper, the reporting and analysis of results, and the conclusion will have been completed and it ensures that your introduction matches the overall structure of your paper.

II.  Delimitations of the Study

Delimitations refer to those characteristics that limit the scope and define the conceptual boundaries of your study . This is determined by the conscious exclusionary and inclusionary decisions you make about how to investigate the research problem. In other words, not only should you tell the reader what it is you are studying and why, but you must also acknowledge why you rejected alternative approaches that could have been used to examine the research problem.

Obviously, the first limiting step was the choice of research problem itself. However, implicit are other, related problems that could have been chosen but were rejected. These should be noted in the conclusion of your introduction.

Examples of delimitating choices would be:

  • The key aims and objectives of your study,
  • The research questions that you address,
  • The variables of interest [i.e., the various factors and features of the phenomenon being studied],
  • The method(s) of investigation, and
  • Any relevant alternative theoretical frameworks that could have been adopted.

Review each of these decisions. You need to not only clearly establish what you intend to accomplish, but to also include a declaration of what the study does not intend to cover. In the latter case, your exclusionary decisions should be based upon criteria stated as, "not interesting"; "not directly relevant"; “too problematic because..."; "not feasible," and the like. Make this reasoning explicit!

NOTE: Delimitations refer to the initial choices made about the broader, overall design of your study and should not be confused with documenting the limitations of your study discovered after the research has been completed.

III. The Narrative Flow

Issues to keep in mind that will help the narrative flow in your introduction :

  • Your introduction should clearly identify the subject area of interest . A simple strategy to follow is to use key words from your title in the first few sentences of the introduction. This will help focus the introduction on the topic at the appropriate level and ensures that you get to the primary subject matter quickly without losing focus, or discussing information that is too general.
  • Establish context by providing a brief and balanced review of the pertinent published literature that is available on the subject. The key is to summarize for the reader what is known about the specific research problem before you did your analysis. This part of your introduction should not represent a comprehensive literature review but consists of a general review of the important, foundational research literature (with citations) that lays a foundation for understanding key elements of the research problem. See the drop-down tab for "Background Information" for types of contexts.
  • Clearly state the hypothesis that you investigated . When you are first learning to write in this format it is okay, and actually preferable, to use a past statement like, "The purpose of this study was to...." or "We investigated three possible mechanisms to explain the...."
  • Why did you choose this kind of research study or design? Provide a clear statement of the rationale for your approach to the problem studied. This will usually follow your statement of purpose in the last paragraph of the introduction.

IV. Engaging the Reader

The overarching goal of your introduction is to make your readers want to read your paper. The introduction should grab your reader's attention. Strategies for doing this can be to:

  • Open with a compelling story,
  • Include a strong quotation or a vivid, perhaps unexpected anecdote,
  • Pose a provocative or thought-provoking question,
  • Describe a puzzling scenario or incongruity, or
  • Cite a stirring example or case study that illustrates why the research problem is important.

NOTE:   Only choose one strategy for engaging your readers; avoid giving an impression that your paper is more flash than substance.

Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions . University College Writing Centre. University of Toronto; Introduction . The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Introductions . The Writing Center. University of North Carolina; Introductions . The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Introductions, Body Paragraphs, and Conclusions for an Argument Paper. The Writing Lab and The OWL. Purdue University; Resources for Writers: Introduction Strategies . Program in Writing and Humanistic Studies. Massachusetts Institute of Technology; Sharpling, Gerald. Writing an Introduction . Centre for Applied Linguistics, University of Warwick; Writing Your Introduction. Department of English Writing Guide. George Mason University.

Writing Tip

Avoid the "Dictionary" Introduction

Giving the dictionary definition of words related to the research problem may appear appropriate because it is important to define specific words or phrases with which readers may be unfamiliar. However, anyone can look a word up in the dictionary and a general dictionary is not a particularly authoritative source. It doesn't take into account the context of your topic and doesn't offer particularly detailed information. Also, placed in the context of a particular discipline, a term may have a different meaning than what is found in a general dictionary. If you feel that you must seek out an authoritative definition, try to find one that is from subject specific dictionaries or encyclopedias [e.g., if you are a sociology student, search for dictionaries of sociology].

Saba, Robert. The College Research Paper . Florida International University; Introductions . The Writing Center. University of North Carolina.

Another Writing Tip

When Do I Begin?

A common question asked at the start of any paper is, "where should I begin?" An equally important question to ask yourself is, "When do I begin?" Research problems in the social sciences rarely rest in isolation from the history of the issue being investigated. It is, therefore, important to lay a foundation for understanding the historical context underpinning the research problem. However, this information should be brief and succinct and begin at a point in time that best informs the reader of study's overall importance. For example, a study about coffee cultivation and export in West Africa as a key stimulus for local economic growth needs to describe the beginning of exporting coffee in the region and establishing why economic growth is important. You do not need to give a long historical explanation about coffee exportation in Africa. If a research problem demands a substantial exploration of historical context, do this in the literature review section; note in the introduction as part of your "roadmap" [see below] that you covering this in the literature review.

Yet Another Writing Tip

Always End with a Roadmap

The final paragraph or sentences of your introduction should forecast your main arguments and conclusions and provide a description of the rest of the paper [a "roadmap"] that let's the reader know where you are going and what to expect.

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  • Next: Background Information >>
  • Last Updated: Jul 18, 2023 11:58 AM
  • URL: https://library.sacredheart.edu/c.php?g=29803
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How to Write a Research Paper 

How to Write a Research Paper 

  • Smodin Editorial Team
  • Updated: May 17, 2024

Most students hate writing research papers. The process can often feel long, tedious, and sometimes outright boring. Nevertheless, these assignments are vital to a student’s academic journey. Want to learn how to write a research paper that captures the depth of the subject and maintains the reader’s interest? If so, this guide is for you.

Today, we’ll show you how to assemble a well-organized research paper to help you make the grade. You can transform any topic into a compelling research paper with a thoughtful approach to your research and a persuasive argument.

In this guide, we’ll provide seven simple but practical tips to help demystify the process and guide you on your way. We’ll also explain how AI tools can expedite the research and writing process so you can focus on critical thinking.

By the end of this article, you’ll have a clear roadmap for tackling these essays. You will also learn how to tackle them quickly and efficiently. With time and dedication, you’ll soon master the art of research paper writing.

Ready to get started?

What Is a Research Paper?

A research paper is a comprehensive essay that gives a detailed analysis, interpretation, or argument based on your own independent research. In higher-level academic settings, it goes beyond a simple summarization and includes a deep inquiry into the topic or topics.

The term “research paper” is a broad term that can be applied to many different forms of academic writing. The goal is to combine your thoughts with the findings from peer-reviewed scholarly literature.

By the time your essay is done, you should have provided your reader with a new perspective or challenged existing findings. This demonstrates your mastery of the subject and contributes to ongoing scholarly debates.

7 Tips for Writing a Research Paper

Often, getting started is the most challenging part of a research paper. While the process can seem daunting, breaking it down into manageable steps can make it easier to manage. The following are seven tips for getting your ideas out of your head and onto the page.

1. Understand Your Assignment

It may sound simple, but the first step in writing a successful research paper is to read the assignment. Sit down, take a few moments of your time, and go through the instructions so you fully understand your assignment.

Misinterpreting the assignment can not only lead to a significant waste of time but also affect your grade. No matter how patient your teacher or professor may be, ignoring basic instructions is often inexcusable.

If you read the instructions and are still confused, ask for clarification before you start writing. If that’s impossible, you can use tools like Smodin’s AI chat to help. Smodin can help highlight critical requirements that you may overlook.

This initial investment ensures that all your future efforts will be focused and efficient. Remember, thinking is just as important as actually writing the essay, and it can also pave the wave for a smoother writing process.

2. Gather Research Materials

Now comes the fun part: doing the research. As you gather research materials, always use credible sources, such as academic journals or peer-reviewed papers. Only use search engines that filter for accredited sources and academic databases so you can ensure your information is reliable.

To optimize your time, you must learn to master the art of skimming. If a source seems relevant and valuable, save it and review it later. The last thing you want to do is waste time on material that won’t make it into the final paper.

To speed up the process even more, consider using Smodin’s AI summarizer . This tool can help summarize large texts, highlighting key information relevant to your topic. By systematically gathering and filing research materials early in the writing process, you build a strong foundation for your thesis.

3. Write Your Thesis

Creating a solid thesis statement is the most important thing you can do to bring structure and focus to your research paper. Your thesis should express the main point of your argument in one or two simple sentences. Remember, when you create your thesis, you’re setting the tone and direction for the entire paper.

Of course, you can’t just pull a winning thesis out of thin air. Start by brainstorming potential thesis ideas based on your preliminary research. And don’t overthink things; sometimes, the most straightforward ideas are often the best.

You want a thesis that is specific enough to be manageable within the scope of your paper but broad enough to allow for a unique discussion. Your thesis should challenge existing expectations and provide the reader with fresh insight into the topic. Use your thesis to hook the reader in the opening paragraph and keep them engaged until the very last word.

4. Write Your Outline

An outline is an often overlooked but essential tool for organizing your thoughts and structuring your paper. Many students skip the outline because it feels like doing double work, but a strong outline will save you work in the long run.

Here’s how to effectively structure your outline.

  • Introduction: List your thesis statement and outline the main questions your essay will answer.
  • Literature Review: Outline the key literature you plan to discuss and explain how it will relate to your thesis.
  • Methodology: Explain the research methods you will use to gather and analyze the information.
  • Discussion: Plan how you will interpret the results and their implications for your thesis.
  • Conclusion: Summarize the content above to elucidate your thesis fully.

To further streamline this process, consider using Smodin’s Research Writer. This tool offers a feature that allows you to generate and tweak an outline to your liking based on the initial input you provide. You can adjust this outline to fit your research findings better and ensure that your paper remains well-organized and focused.

5. Write a Rough Draft

Once your outline is in place, you can begin the writing process. Remember, when you write a rough draft, it isn’t meant to be perfect. Instead, use it as a working document where you can experiment with and rearrange your arguments and evidence.

Don’t worry too much about grammar, style, or syntax as you write your rough draft. Focus on getting your ideas down on paper and flush out your thesis arguments. You can always refine and rearrange the content the next time around.

Follow the basic structure of your outline but with the freedom to explore different ways of expressing your thoughts. Smodin’s Essay Writer offers a powerful solution for those struggling with starting or structuring their drafts.

After you approve the outline, Smodin can generate an essay based on your initial inputs. This feature can help you quickly create a comprehensive draft, which you can then review and refine. You can even use the power of AI to create multiple rough drafts from which to choose.

6. Add or Subtract Supporting Evidence

Once you have a rough draft, but before you start the final revision, it’s time to do a little cleanup. In this phase, you need to review all your supporting evidence. You want to ensure that there is nothing redundant and that you haven’t overlooked any crucial details.

Many students struggle to make the required word count for an essay and resort to padding their writing with redundant statements. Instead of adding unnecessary content, focus on expanding your analysis to provide deeper insights.

A good essay, regardless of the topic or format, needs to be streamlined. It should convey clear, convincing, relevant information supporting your thesis. If you find some information doesn’t do that, consider tweaking your sources.

Include a variety of sources, including studies, data, and quotes from scholars or other experts. Remember, you’re not just strengthening your argument but demonstrating the depth of your research.

If you want comprehensive feedback on your essay without going to a writing center or pestering your professor, use Smodin. The AI Chat can look at your draft and offer suggestions for improvement.

7. Revise, Cite, and Submit

The final stages of crafting a research paper involve revision, citation, and final review. You must ensure your paper is polished, professionally presented, and plagiarism-free. Of course, integrating Smodin’s AI tools can significantly streamline this process and enhance the quality of your final submission.

Start by using Smodin’s Rewriter tool. This AI-powered feature can help rephrase and refine your draft to improve overall readability. If a specific section of your essay just “doesn’t sound right,” the AI can suggest alternative sentence structures and word choices.

Proper citation is a must for all academic papers. Thankfully, thanks to Smodin’s Research Paper app, this once tedious process is easier than ever. The AI ensures all sources are accurately cited according to the required style guide (APA, MLA, Chicago, etc.).

Plagiarism Checker:

All students need to realize that accidental plagiarism can happen. That’s why using a Plagiarism Checker to scan your essay before you submit it is always useful. Smodin’s Plagiarism Checker can highlight areas of concern so you can adjust accordingly.

Final Submission

After revising, rephrasing, and ensuring all citations are in order, use Smodin’s AI Content Detector to give your paper one last review. This tool can help you analyze your paper’s overall quality and readability so you can make any final tweaks or improvements.

Mastering Research Papers

Mastering the art of the research paper cannot be overstated, whether you’re in high school, college, or postgraduate studies. You can confidently prepare your research paper for submission by leveraging the AI tools listed above.

Research papers help refine your abilities to think critically and write persuasively. The skills you develop here will serve you well beyond the walls of the classroom. Communicating complex ideas clearly and effectively is one of the most powerful tools you can possess.

With the advancements of AI tools like Smodin , writing a research paper has become more accessible than ever before. These technologies streamline the process of organizing, writing, and revising your work. Write with confidence, knowing your best work is yet to come!

Antioxidants

a variety of berries and their stems including blueberries, gooseberries, red currants, white currants

Often used as a marketing buzzword, learn about the role of antioxidants beyond the hype, and some of the research on health and disease prevention.

Jump to: – What are antioxidants? – Health benefits of antioxidants: what’s the buzz? – Studies of antioxidant supplements and disease prevention – Antioxidants in food – Bottom line on antioxidants and disease prevention

What are antioxidants?

The body’s trillion or so cells face formidable threats, from lack of food to infection with a virus. Another constant threat comes from chemicals called free radicals. In very high levels, they are capable of damaging cells and genetic material. The body generates free radicals as the inevitable byproducts of turning food into energy. Free radicals are also formed after exercising or exposure to cigarette smoke, air pollution, and sunlight. [1]

Free radicals come in many shapes, sizes, and chemical configurations. What they all share is a voracious appetite for electrons, stealing them from any nearby substances that will yield them. This electron theft can radically alter the “loser’s” structure or function. Free radical damage can change the instructions coded in a strand of DNA. It can make a circulating low-density lipoprotein (LDL, sometimes called bad cholesterol) molecule more likely to get trapped in an artery wall. Or it can alter a cell’s membrane, changing the flow of what enters the cell and what leaves it. An excessive chronic amount of free radicals in the body causes a condition called oxidative stress, which may damage cells and lead to chronic diseases. [2]

We aren’t defenseless against free radicals. The body, long used to this relentless attack, makes many molecules that quench free radicals as surely as water douses fire. We also extract free-radical fighters from food. These defenders are labeled “antioxidants.” They work by generously giving electrons to free radicals without turning into electron-scavenging substances themselves. They are also involved in mechanisms that repair DNA and maintain the health of cells.

There are hundreds, probably thousands, of different substances that can act as antioxidants. The most familiar ones are vitamin C , vitamin E , beta-carotene , and other related carotenoids, along with the minerals selenium and manganese. They’re joined by glutathione, coenzyme Q10, lipoic acid, flavonoids, phenols, polyphenols, phytoestrogens, and many more.  Most are naturally occurring, and their presence in food is likely to prevent oxidation or to serve as a natural defense against the local environment.

But using the term “antioxidant” to refer to substances is misleading. It is really a chemical property, namely, the ability to act as an electron donor. Some substances that act as antioxidants in one situation may be pro-oxidants—electron grabbers—in a different situation. Another big misconception is that antioxidants are interchangeable. They aren’t. Each one has unique chemical behaviors and biological properties. They almost certainly evolved as parts of elaborate networks, with each different substance (or family of substances) playing slightly different roles. This means that no single substance can do the work of the whole crowd.

Health benefits of antioxidants: what’s the buzz?

Antioxidants came to public attention in the 1990s, when scientists began to understand that free radical damage was involved in the early stages of artery-clogging atherosclerosis. It was also linked to cancer , vision loss, and a host of other chronic conditions. Some studies showed that people with low intakes of antioxidant-rich fruits and vegetables were at greater risk for developing these chronic conditions than were people who ate plenty of those foods. Clinical trials began testing the impact of single substances in supplement form, especially beta-carotene and vitamin E, as weapons against chronic diseases.

Even before the results of these trials were in, the media and the supplement and food industries began to hype the benefits of “antioxidants.” Frozen berries, green tea, and other foods labeled as being rich in antioxidants began popping up in stores. Supplement makers touted the disease-fighting properties of all sorts of antioxidants.

The research results were mixed, but most did not find the hoped-for benefits. Most research teams reported that vitamin E and other antioxidant supplements didn’t protect against heart disease or cancer. [3] One study even showed that taking beta-carotene supplements actually increased the chances of developing lung cancer in smokers. On the other hand, some trials reported benefits; for example, after 18 years of follow-up, the Physicians’ Health Study found that taking beta-carotene supplements was associated with a modest reduction in the rate of cognitive decline. [4]

These mostly disappointing results haven’t stopped food companies and supplement sellers from banking on antioxidants. Antioxidants are still added to breakfast cereals, sports bars, energy drinks, and other processed foods , and they are promoted as additives that can prevent heart disease, cancer, cataracts, memory loss, and other conditions.

Often the claims have stretched and distorted the data: While it’s true that the package of antioxidants, minerals , fiber , and other substances found naturally in fruits , vegetables , and whole grains helps prevent a variety of chronic diseases , it is unlikely that high doses of antioxidant supplements can accomplish the same feat.

pomegranate, oats, blueberries, almonds, cilantro, basil flax seeds, matcha, brussels sprouts, turmeric, rolled oats, jasmine peal tea, soybeans,

Antioxidant foods hyped to super-status

Antioxidant supplements and disease prevention: little supportive evidence.

Randomized placebo-controlled trials, which can provide the strongest evidence, offer little support that taking vitamin C, vitamin E, beta-carotene, or other single antioxidants provides substantial protection against heart disease, cancer, or other chronic conditions. The results of the largest trials have been mostly negative.

Vitamin E, beta-carotene, and other antioxidants in supplement form aren’t the silver bullet against heart disease and stroke that researchers were hoping for.  A modest effect of vitamin E has been found in some studies but more research is needed.

  • In the Women’s Health Study, 39,876 initially healthy women took 600 IU of natural source vitamin E or a placebo every other day for 10 years. At the study’s end, the rates of major cardiovascular events and cancer were no lower among those taking vitamin E than those taking the placebo. However, the trial did observe a significant 24% reduction in total cardiovascular mortality. Although this was not a primary endpoint for the trial, it nevertheless represents an important outcome. [6]
  • Earlier large vitamin E trials, conducted among individuals with previously diagnosed coronary disease or at high risk for it, generally showed no benefit. In the Heart Outcomes Prevention Evaluation (HOPE) trial, the rates of major cardiovascular events were essentially the same in the vitamin E (21.5%) and placebo (20.6%) groups, although participants taking vitamin E had higher risks of heart failure and hospitalization for heart failure. [7] In the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI) trial, the results were mixed but mostly showed no preventive effects after more than three years of treatment with vitamin E among 11,000 heart attack survivors. [8] However, some studies suggest potential benefits among certain subgroups. A recent trial of vitamin E in Israel, for example, showed a marked reduction in coronary heart disease among people with type 2 diabetes who have a common genetic predisposition for greater oxidative stress. [9]
  • Beta-carotene, meanwhile, did not provide any protection against heart disease or stroke, as demonstrated by the Physicians’ Health Study. [10]
  • What about combinations? In the Supplementation en Vitamines et Mineraux Antioxydants (SU.VI.MAX) study, 13,017 French men and women took a single daily capsule that contained 120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 mcg selenium, and 20 mg zinc, or a placebo, for seven and a half years. The vitamins had no effect on overall rates of cardiovascular disease. [11]
  • In the Women’s Antioxidant Cardiovascular Study, vitamin E, vitamin C, and beta-carotene had similar effects as a placebo on myocardial infarction, stroke, coronary revascularization, and cardiovascular death, although there was a modest and significant benefit for vitamin E among women with existing cardiovascular disease. [12]

A 2014 study from the Journal of Respiratory Research found that different isoforms of vitamin E (called tocopherols) had opposing effects on lung function. [13] The study analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort and measured serum levels of alpha- and gamma-tocopherol in 4,526 adults. Lung function was tested using spirometric parameters: higher parameters are indicative of increased lung function, while lower parameters are indicative of decreased lung function. The study found that higher serum levels of alpha-tocopherol were associated with higher spirometric parameters and that high serum levels of gamma-tocopherol were associated with lower spirometric parameters. Though the study was observational in nature, it confirmed the mechanistic pathway of alpha- and gamma-tocopherol in mice studies. [14]

When it comes to cancer prevention, the picture remains inconclusive for antioxidant supplements. Few trials have gone on long enough to provide an adequate test for cancer.

  • In the long-term Physicians’ Health Study, cancer rates were similar among men taking beta-carotene and among those taking a placebo. [10] Other trials have also largely shown no effect, including HOPE. [7]
  • The SU.VI.MAX randomized placebo-controlled trial showed a reduction in cancer risk and all-cause mortality among men taking an antioxidant cocktail (low doses of vitamins C and E, beta-carotene, selenium, and zinc) but no apparent effect in women, possibly because men tended to have low blood levels of beta-carotene and other vitamins at the beginning of the study. [11]
  • A randomized trial of selenium in people with skin cancer demonstrated significant reductions in cancer and cancer mortality at various sites, including colon, lung, and prostate. [15]  The effects were strongest among those with low selenium levels at baseline.
  • A six-year trial, the Age-Related Eye Disease Study (AREDS), found that a combination of vitamin C, vitamin E, beta-carotene, and zinc offered some protection against the development of advanced age-related macular degeneration, but not cataracts, in people who were at high risk of the disease. [16,17]
  • Lutein, a naturally occurring carotenoid found in green, leafy vegetables such as spinach and kale, may protect vision. However, relatively short trials of lutein supplementation for age-related macular degeneration have yielded conflicting findings. [18,19] A follow-up trial to the AREDS, the AREDS2, examined lutein/zeaxanthin supplementation on late age-related macular degeneration (AMD) in men and women for up to five years. [20] It found a favorable but not significant effect of the supplements on AMD.
  • A Cochrane review of 19 randomized controlled trials compared antioxidant vitamin/mineral supplements (multivitamin, vitamin E, lutein, zeaxanthin, zinc) with placebo or no intervention in people with AMD. [21] The participants were generally well-nourished. The study found that people taking the vitamins were less likely to progress to late-stage AMD and vision loss. However, the study authors noted that taking lutein and zeaxanthin alone or vitamin E alone did not have a beneficial effect on these eye conditions.
  • The Selenium and Vitamin E Cancer Prevention Trial (SELECT) Eye Endpoints Study, which followed 11,267 men for a mean of five years, did not find that vitamin E and selenium supplements, in combination or alone, protected from age-related cataracts. [22]
  • The Physicians’ Health Study II, a randomized trial giving 50 mg beta-carotene supplements or a placebo to 5,956 men older than 65 years, found that longer-term supplementation for at least 15 years provided cognitive benefits. [4]
  • The Prevention of Alzheimer’s Disease by Vitamin E and Selenium (PREADViSE) trial followed more than 3,700 men ages 60 and older for six years. It did not find that antioxidant supplements of vitamin E or selenium, alone or in combination, protected against dementia compared with a placebo. [23]
  • A meta-analysis of 68 antioxidant supplement trials found that taking beta-carotene and vitamin A and E supplements increased the risk of dying. [24] Although healthy participants were included in 21 of the trials, most of the studies included people who already had some type of serious illness. It was also difficult to compare interventions because the types of supplements, the dosages taken, and the length of time they were taken varied widely.
  • The same authors conducted another systematic review of 78 randomized clinical trials on antioxidant supplements including beta-carotene, vitamin A, vitamin C, vitamin E, and selenium (alone or in combination). [25]   Again, the majority of trials included people with various established diseases. The study found that both people who were healthy and those with diseases taking beta-carotene and vitamin E supplements had a higher rate of death. The duration of the studies varied widely from one month to 12 years, with varying dosages.

If antioxidants were harmless, it wouldn’t much matter if you took them “just in case.” A few studies, though, have raised the possibility that taking antioxidant supplements, either single agents or combinations, could interfere with health.

  • The first inkling came in a large trial of beta-carotene conducted among men in Finland who were heavy smokers, and therefore at high risk for developing lung cancer. The trial was stopped early when researchers saw a significant increase in lung cancer among those taking the supplement compared to those taking the placebo. [26]
  • In another trial among heavy smokers and people exposed to asbestos, beta-carotene was combined with vitamin A. Again, an increase in lung cancer was seen in the supplement group. [27] Not all trials of beta-carotene show this harmful effect, however. In the Physicians’ Health Study, which included few active smokers, no increase in lung cancer or any other adverse affect was seen even after 18 years of follow-up. [10]
  • In the SU.VI.MAX trial, rates of skin cancer were higher in women who were assigned to take vitamin C, vitamin E, beta-carotene, selenium, and zinc. [28]
  • Vitamin E supplements were found to significantly increase the risk of prostate cancer by 17% in healthy men compared with those who took a placebo. These results came from the Selenium and Vitamin E Cancer Prevention Trial (SELECT) that followed 35,533 men for up to 12 years. [29]

High-dose antioxidant supplements can also interfere with medicines. Vitamin E supplements can have a blood-thinning effect and increase the risk of bleeding in people who are already taking blood-thinning medicines. Some studies have suggested that taking antioxidant supplements during cancer treatment might interfere with the effectiveness of the treatment. Inform your doctor if starting supplements of any kind. [1]

Antioxidants in food

One possible reason why many studies on antioxidant supplements do not show a health benefit is because antioxidants tend to work best in combination with other nutrients, plant chemicals, and even other antioxidants.

For example, a cup of fresh strawberries contains about 80 mg of vitamin C, a nutrient classified as having high antioxidant activity. But a supplement containing 500 mg of vitamin C (667% of the RDA) does not contain the plant chemicals (polyphenols) naturally found in strawberries like proanthocyanins and flavonoids, which also possess antioxidant activity and may team up with vitamin C to fight disease.  Polyphenols also have many other chemical properties besides their ability to serve as antioxidants.  There is a question if a nutrient with antioxidant activity can cause the opposite effect with pro-oxidant activity if too much is taken. This is why using an antioxidant supplement with a single isolated substance may not be an effective strategy for everyone.

Differences in the amount and type of antioxidants in foods versus those in supplements might also influence their effects. For example, there are eight chemical forms of vitamin E present in foods. However, vitamin E supplements typically only include one form, alpha-tocopherol. [1]

Epidemiological prospective studies show that higher intakes of antioxidant-rich fruits, vegetables, and legumes are associated with a lower risk of chronic oxidative stress-related diseases like cardiovascular diseases , cancer, and deaths from all causes. [30-33] A plant-based diet is believed to protect against chronic oxidative stress-related diseases.  [2] It is not clear if this protective effect is due to the antioxidants, other substances in the foods, or a combination of both. The following are nutrients with antioxidant activity and the foods in which they are found:

  • Vitamin C : Broccoli, Brussels sprouts , cantaloupe, cauliflower, grapefruit, leafy greens (turnip, mustard, beet, collards), honeydew, kale , kiwi, lemon, orange, papaya, snow peas, strawberries, sweet potato , tomatoes, and bell peppers (all colors)
  • Vitamin E : Almonds , avocado, Swiss chard, leafy greens (beet, mustard, turnip), peanuts, red peppers, spinach (boiled), and sunflower seeds
  • Carotenoids including beta-carotene and lycopene: Apricots, asparagus, beets, broccoli, cantaloupe, carrots, bell peppers, kale , mangos, turnip and collard greens, oranges, peaches, pink grapefruit, pumpkin, winter squash , spinach, sweet potato , tangerines, tomatoes, and watermelon
  • Selenium: Brazil nuts, fish, shellfish, beef, poultry, barley, brown rice
  • Zinc : Beef, poultry, oysters, shrimp, sesame seeds, pumpkin seeds, chickpeas , lentils , cashews, fortified cereals
  • Phenolic compounds: Quercetin ( apples , red wine, onions), catechins ( tea , cocoa , berries), resveratrol ( red and white wine , grapes, peanuts, berries), coumaric acid (spices, berries), anthocyanins (blueberries, strawberries)

Bottom line on antioxidants and disease prevention

Excessive free radicals contribute to chronic diseases including cancer, heart disease, cognitive decline, and vision loss. This doesn’t automatically mean that substances with antioxidant properties will fix the problem, especially if they are taken out of their natural context. The studies so far are inconclusive but generally don’t provide strong evidence that antioxidant supplements have a substantial impact on disease. Keep in mind that most of the trials conducted have had fundamental limitations due to their relatively short duration and inclusion of people with existing disease. At the same time, abundant evidence suggests that eating whole in fruits , vegetables , and whole grains —all rich in networks of naturally occurring antioxidants and their helper molecules—provides protection against many scourges of aging.

  • National Center for Complementary and Integrative Health (NCCIH). Antioxidants: In Depth. https://nccih.nih.gov/health/antioxidants/introduction.htm Accessed 7/1/19.
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  • GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. The Lancet . 1999 Aug 7;354(9177):447-55.
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  • Hennekens CH, Buring JE, Manson JE, Stampfer M, Rosner B, Cook NR, Belanger C, LaMotte F, Gaziano JM, Ridker PM, Willett W. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. New England Journal of Medicine . 1996 May 2;334(18):1145-9.
  • Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel AM, Favier A, Briançon S. The SU. VI. MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Archives of internal medicine . 2004 Nov 22;164(21):2335-42.
  • Cook NR, Albert CM, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women’s Antioxidant Cardiovascular Study. Archives of internal medicine . 2007 Aug 13;167(15):1610-8.
  • Marchese ME, Kumar R, Colangelo LA, Avila PC, Jacobs DR, Gross M, Sood A, Liu K, Cook-Mills JM. The vitamin E isoforms α-tocopherol and γ-tocopherol have opposite associations with spirometric parameters: the CARDIA study. Respiratory research . 2014 Dec;15(1):31.
  • Berdnikovs S, Abdala-Valencia H, McCary C, Somand M, Cole R, Garcia A, Bryce P, Cook-Mills JM. Isoforms of vitamin E have opposing immunoregulatory functions during inflammation by regulating leukocyte recruitment. The Journal of Immunology . 2009 Apr 1;182(7):4395-405.
  • Duffield-Lillico AJ, Reid ME, Turnbull BW, Combs GF, Slate EH, Fischbach LA, Marshall JR, Clark LC. Baseline characteristics and the effect of selenium supplementation on cancer incidence in a randomized clinical trial: a summary report of the Nutritional Prevention of Cancer Trial. Cancer Epidemiology and Prevention Biomarkers . 2002 Jul 1;11(7):630-9.
  • Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Archives of ophthalmology . 2001 Oct;119(10):1417.
  • Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E and beta carotene for age-related cataract and vision loss: AREDS report no. 9. Archives of Ophthalmology . 2001 Oct;119(10):1439.
  • Richer S, Stiles W, Statkute L, Pulido J, Frankowski J, Rudy D, Pei K, Tsipursky M, Nyland J. Double-masked, placebo-controlled, randomized trial of lutein and antioxidant supplementation in the intervention of atrophic age-related macular degeneration: the Veterans LAST study (Lutein Antioxidant Supplementation Trial). Optometry-Journal of the American Optometric Association . 2004 Apr 1;75(4):216-29.
  • Bartlett HE, Eperjesi F. Effect of lutein and antioxidant dietary supplementation on contrast sensitivity in age-related macular disease: a randomized controlled trial. European journal of clinical nutrition . 2007 Sep;61(9):1121.
  • Chew EY, Clemons TE, SanGiovanni JP, Danis RP, Ferris FL, Elman MJ, Antoszyk AN, Ruby AJ, Orth D, Bressler SB, Fish GE. Secondary analyses of the effects of lutein/zeaxanthin on age-related macular degeneration progression: AREDS2 report No. 3. JAMA ophthalmology . 2014 Feb 1;132(2):142-9.
  • Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age‐related macular degeneration. Cochrane Database of Systematic Reviews . 2017(7).
  • Christen WG, Glynn RJ, Gaziano JM, Darke AK, Crowley JJ, Goodman PJ, Lippman SM, Lad TE, Bearden JD, Goodman GE, Minasian LM. Age-related cataract in men in the selenium and vitamin e cancer prevention trial eye endpoints study: a randomized clinical trial. JAMA ophthalmology . 2015 Jan 1;133(1):17-24.
  • Kryscio RJ, Abner EL, Caban-Holt A, Lovell M, Goodman P, Darke AK, Yee M, Crowley J, Schmitt FA. Association of antioxidant supplement use and dementia in the prevention of Alzheimer’s disease by vitamin E and selenium trial (PREADViSE). JAMA neurology . 2017 May 1;74(5):567-73.
  • Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA . 2007 Feb 28;297(8):842-57.
  • Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane database of systematic reviews . 2012(3).
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  • Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, Keogh JP, Meyskens Jr FL, Valanis B, Williams Jr JH, Barnhart S. Effects of a combination of beta carotene and vitamin A on lung cancer and cardiovascular disease. New England journal of medicine . 1996 May 2;334(18):1150-5.
  • Hercberg S, Ezzedine K, Guinot C, Preziosi P, Galan P, Bertrais S, Estaquio C, Briançon S, Favier A, Latreille J, Malvy D. Antioxidant supplementation increases the risk of skin cancers in women but not in men. The Journal of nutrition . 2007 Sep 1;137(9):2098-105.
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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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Main Article Content

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

INTRODUCTION

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

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

I.     Global Cultural Perspective of Embryonic Stem Cells

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

a.     US and Rights-Based Cultures

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

b.     Ubuntu and Collective Cultures

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

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

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

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

c.     Asia

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

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

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

d.     Middle East

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

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

e.     Europe

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

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

II.     Religious Perspectives on ESC

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

The Qur'an states:

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

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

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

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

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

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

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

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

III.     A Flexible Ethical Approach

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

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

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

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

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

IV.     Concerns

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

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

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

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

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

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

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

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

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

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Research involvement of medical students in a medical school of India: exploring knowledge, attitude, practices, and perceived barriers

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Introduction: Research in the medical discipline significantly impacts society by improving the general well-being of the population, through improvements in diagnostic and treatment modalities. However, of 579 Indian medical colleges, 332 (57.3%) did not publish a single paper from the year 2005 to 2014," indicating a limited contribution from medical fraternity In order to probe in to the cause of this a study was conducted to assess the knowledge, attitude, practices (KAP) and perceived barriers to research among students of a medical school in Delhi, India. Methods: A cross-sectional study was conducted among medical students and the data on academic-cum-demographic information, assessment of knowledge, attitude, practices and barriers to research was collected using a pre-tested, semi-structured questionnaire. Chi-square test was used to check the association of various factors with the KAP of research. A p-value less than 0.05 was considered significant. Results: A total of 402 (N) subjects were enrolled in the study. Majority were male (79.6%) and from clinical professional years (57%). Majority (266, 66.2%) of the subjects had adequate knowledge. Of the study subjects (61,15%) having inadequate knowledge of research, sixty percent were from pre- and para- clinical years, while around 70 % of those having good knowledge were from clinical professional years. However, only 16.9% of the participants had participated in a research project, and only 4.72% had authored a publication. Sixty one percent of study subjects having a positive attitude towards research, were from pre- and para- clinical years. Among the study subjects having a positive attitude towards research, over 60% were from pre- and para- clinical years. The barriers for conducting research were mostly; lack of funds/laboratory equipment/infrastructure (85.1%), lack of exposure to opportunities for research in the medical (MBBS) curriculum (83.8%), and lack of time (83.3%). There was a statistically significant association between knowledge and attitude towards research with a professional year of study. Conclusions: The study revealed that while most of the students had a positive attitude towards research as well as an adequate knowledge of research, there was a poor level of participation in research. These challenges can be overcome by incorporating research as a part of the medical school curriculum from early years on, setting aside separate time for research, and establishing student research societies that can actively promote research.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The ethics committee of Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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All data produced in the present study are available upon reasonable request to the authors.

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  • Volume 83, Issue 6
  • EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update
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  • http://orcid.org/0000-0003-0920-888X Tuva Moseng 1 ,
  • http://orcid.org/0000-0001-6322-3859 Theodora P M Vliet Vlieland 2 ,
  • Simone Battista 3 ,
  • David Beckwée 4 ,
  • Vladimira Boyadzhieva 5 ,
  • http://orcid.org/0000-0002-3478-5665 Philip G Conaghan 6 ,
  • Daniela Costa 7 ,
  • Michael Doherty 8 ,
  • Andrew G Finney 9 , 10 ,
  • Tsvetoslav Georgiev 11 ,
  • Milena Gobbo 12 ,
  • Norelee Kennedy 13 ,
  • Ingvild Kjeken 1 ,
  • http://orcid.org/0000-0002-8940-0582 Féline P B Kroon 14 , 15 ,
  • http://orcid.org/0000-0002-5424-9448 L Stefan Lohmander 16 ,
  • Hans Lund 17 ,
  • Christian D Mallen 18 ,
  • Karel Pavelka 19 ,
  • Irene A Pitsillidou 20 ,
  • Margaret P Rayman 21 ,
  • Anne Therese Tveter 1 ,
  • http://orcid.org/0000-0003-4783-8663 Johanna E Vriezekolk 22 ,
  • Dieter Wiek 23 ,
  • Gustavo Zanoli 24 ,
  • http://orcid.org/0000-0001-8602-342X Nina Østerås 1
  • 1 Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) , Diakonhjemmet Hospital , Oslo , Norway
  • 2 Department of Orthopaedics, Rehabilitation and Physical Therapy , Leiden University Medical Center (LUMC) , Leiden , Netherlands
  • 3 University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health , Genova , Italy
  • 4 Rehabilitation Research Department , Vrije Universiteit Brussel , Brussel , Belgium
  • 5 UMHAT “St. Iv. Rilski” Clinic of Rheumatology, Medical University Sofia , Sofia , Bulgaria
  • 6 Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds and NIHR Leeds Biomechanical Reserch Centre , Leeds , UK
  • 7 Comprehensive Health Research Center (CHRC) , Universidade Nova de Lisboa , Lisboa , Portugal
  • 8 Department of Academic Rheumatology , University of Nottingham , Nottingham , UK
  • 9 Research Institute for Primary Care and Health Sciences , Keele University School of Medicine , Keele , UK
  • 10 School of Nursing and Midwifery , Keele University , Keele , UK
  • 11 Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine , Medical University Varna , Varna , Bulgaria
  • 12 Positivamente Centro de Psicología , Madrid , Spain
  • 13 School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute , University of Limerick , Limerick , Ireland
  • 14 Department of Rheumatology , Leiden University Medical Center (LUMC) , Leiden , The Netherlands
  • 15 Department of Rheumatology , Zuyderland Medical Centre Heerlen , Heerlen , The Netherlands
  • 16 Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden
  • 17 Centre for Evidence-Based Practice , Western Norway University of Applied Sciences , Bergen , Norway
  • 18 Keele University School of Medicine , Keele , UK
  • 19 Institute of Rheumatology, Department of Rheumatology , Charles University First Faculty of Medicine , Praha , Czech Republic
  • 20 EULAR Patient Research Partner , Cyprus League Against Rheumatism , Nicosia , Cyprus
  • 21 Department of Nutritional Sciences , University of Surrey Faculty of Health and Medical Sciences , Guildford , UK
  • 22 Research & Innovation , Sint Maartenskliniek , Nijmegen , The Netherlands
  • 23 EULAR Patient Research Partner , Deutsche Rheuma-Liga , Bonn , Germany
  • 24 Orthopaedic Ward , Casa di Cura Santa Maria Maddalena , Novara , Italy
  • Correspondence to Dr Tuva Moseng, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; tuva.moseng{at}diakonsyk.no

Introduction Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

Methods The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

Results The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0–10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

Conclusions The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

  • Osteoarthritis, Knee
  • Osteoarthritis
  • Rehabilitation
  • Physical Therapy Modalities
  • Therapeutics

This is an open access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/ard-2023-225041

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Introduction

Osteoarthritis (OA) is the most common joint disease worldwide, 1 with an increasing global burden of disability and healthcare utilisation. 2 The number of people with OA globally rose by 28% from 2010 to 2019, affecting over 500 million people, and about 6%, worldwide. 3 Due to an ageing population, increasing obesity and sport-related joint injuries, the disease will become even more prevalent in the forthcoming years. 2 In 2019, OA was the 15th highest-ranked cause of years lived with disability (YLDs) worldwide and was responsible for 2% of the total global YLDs. 3 OA is regarded as a severe disease, and serious condition and people with OA commonly experience pain, stiffness and associated functional loss. 4 Optimal management of hip and knee OA has important implications for the individual and society through the potential for improving individual health, work participation and utilisation of healthcare services. However, most people with OA do not receive optimal management. 5 6 In order to reduce the evidence-to-practice gap and the future burden 7 of this disease, the healthcare services’, policy-makers’ and the population awareness of the importance and benefits of evidence-based management of OA must be improved.

EULAR recommendations, including priorities for implementation and future research, can play a role in increasing awareness and uptake of best evidence care. In 2013, an EULAR Task Force (TF) developed recommendations for the non-pharmacological core management of hip and knee OA. 8 Since then there remains no cure in sight for OA, and effective disease-modifying drugs are lacking. 2 Therefore, non-pharmacological approaches are still considered a core treatment for people with hip and knee OA, aiming to alleviate symptoms and improve or maintain physical function. Since the publication of the 2013 recommendations, a large number of studies on the effectiveness of core non-pharmacological treatment modalities and new methods for delivery and follow-up of such treatments have been published. An update of these recommendations would potentially have implications for the level of evidence (LoE) categories and could lead to revisions of the recommendations and formulation of new recommendations with important implications for OA management.

The main aim of this TF process was to update the 2013 evidence-based recommendations for non-pharmacological core management, provide additional details on effectiveness, safety and cost-effectiveness, and formulate research and educational agendas and priorities for implementation activities. The target groups for the updated recommendations are people with hip or knee OA, all healthcare providers involved in the delivery of non-pharmacological interventions in OA care, researchers in the field of OA, officials in healthcare governance and reimbursement agencies and policy-makers.

The Standardised Operating Procedures for EULAR-endorsed Recommendations 9 were used as a framework for this project. The structure of the manuscript is guided by the Appraisal of Guidelines, Research and Evaluation instrument. 10

To pursue the task of updating the 2013 recommendations, a multidisciplinary TF with in-depth knowledge of non-pharmacological OA care was established. The TF consisted of 25 members from 14 European countries and included 9 physiotherapists, 6 rheumatologists, 2 orthopaedic surgeons, 2 psychologists, 2 patient research partners, 1 occupational therapist, 1 nurse, 1 general practitioner and 1 nutrition expert. A steering group, including a convenor (NØ), a methodologist (TPMVV) and a research fellow (TM), managed the process.

During the first digital TF meeting, the rationale for the update of the recommendations was presented, and the definition of core non-pharmacological management was clarified. The TF agreed on 11 research questions based on the research propositions from the 2013 recommendation. For the subsequent systematic literature review (SLR), the research questions were organised according to the population, intervention, control and outcome (PICO) format with associated search terms ( online supplemental file 1 ). The new search terms added to the previous search strategy were related to the following topics: remote care, shared decision-making, psychological interventions/cognitive behaviour therapy (CBT)-based interventions and specific exercise modalities (eg, strength training and aerobic exercise). Due to the expected large body of published literature since the previous literature review from 2012, combined with the available resources and strict timeline for this update, it was decided that this SLR should primarily focus on evidence from systematic reviews (SRs) and meta-analyses of randomised controlled trials (RCTs) and secondarily on evidence from single RCTs. As this SLR was an update of a previously unpublished SLR, along with its pragmatic approach, it was decided that the details were best presented as online supplemental file 1 rather than a publication of its own.

Supplemental material

The SLR was conducted by the fellow and convenor in close collaboration with an experienced librarian (HIF) and with support from the methodologist. Three main literature searches were conducted in the databases Medline (Ovid), Embase (Ovid), AMED (Ovid), Cochrane Library (Cochrane TRIALS), CINAHL (Ebsco) and Epistemonikos (SR search only).

The primary literature search aimed at identifying relevant SRs of RCTs investigating the effectiveness of core non-pharmacological management strategies as specified in the PICOs. The search was conducted from 2012 (the end year of the previous search) until 17 February 2022 and later updated until 27 May 2022 ( online supplemental file 1 ). Based on the PICOs, two authors (TM and NØ) independently screened titles and abstracts. Potentially relevant studies were read and evaluated in full text. Studies were included if they were SRs, including a meta-analysis of two or more RCTs on people diagnosed with hip or knee OA or with persisting knee pain in people 45 years or older and investigating non-pharmacological core management strategies. Relevant comparisons were no intervention, usual care or any other intervention. Relevant outcomes were pain, physical function, quality of life (QoL), patient global assessment of target joint, adverse effects or cost-effectiveness. The included studies were categorised under the 11 research questions. If relevant, one study could inform multiple research questions. The quality of the included SRs was evaluated with A MeaSurement Tool to Assess systematic Reviews (AMSTAR II). 11 The assessments were conducted independently by three assessors (GS, EAB and IS), working in pairs independent of the TF, with experience in quality assessment of SRs and RCTs. Disagreements between the assessors were resolved through discussion.

A second literature search with a comparable search strategy was conducted to identify newer RCTs not included in the latest published SR on the same topic, or relevant RCTs not included in any SRs, or RCTs on research questions for which no relevant SRs were identified. To identify such RCTs published in the past four to 5 years, the search was conducted from 1 January 2018 to 27 May 2022.

A third literature search was conducted with a similar search strategy from 1 January 2012 to 31 December 2017, aiming to identify relevant RCTs specifically on the research questions for which no relevant SRs had been identified. The two last searches were screened independently by the same two authors, and relevant studies were read and evaluated in full text. Studies were included if they were RCTs relevant to the PICOs. The quality of the included RCTs was assessed with the Cochrane Risk of Bias tool 2 (RoB2) 12 independently by two researchers (EAB and IS) independent of the TF. Disagreements between the assessors were resolved through discussion.

In the period before the second TF meeting, five digital subgroup meetings were arranged. Groups of 4–5 TF members and the steering group participated in each meeting. The purpose of the subgroup meetings was to go through the relevant results from the SLR and to discuss and prepare preliminary suggestions for revisions and updates of the recommendations to guide the discussion at the second TF meeting. The group discussed between 1 and 3 of the previous 11 recommendations in each subgroup meeting. This method was implemented to allow all TF members to express their opinions in smaller forums and potentially to reduce the workload of the second TF meeting.

During the second digital TF meeting, the results from the SLR, along with the proposed updates from the subgroups, were presented to the whole TF. The previous recommendations and the proposed updates were then discussed in light of the SLR and the expertise of the group. After the discussions and revisions, the TF members voted for consensus on each revised overarching principle and recommendation (defined as 75% or more in favour of the suggested updates). After the meeting, the updated list of recommendations was collated and emailed to the TF members in a digital survey to rate the level of agreement (LoA) on a 0–10 point scale (0=totally disagree, 10=totally agree). Further, the TF voted on the prioritised order of the recommendations for implementation activities. The TF also formulated a research agenda based on identified gaps in the evidence. The steering group defined the LoE and strength of each recommendation in accordance with the Oxford Levels of Evidence. 13 The steering group also formulated the educational agenda on behalf of the TF.

The three systematic literature searches yielded a total of 6816 references after the removal of duplicates ( figure 1 ). From these, 67 SRs and 31 RCTs were initially considered relevant for the SLR. However, we chose to extract data from 36 of the SRs due to reasons elaborated in online supplemental file 1, p.49 ,. The most frequent reason was that the interventions under study were not considered relevant for this review. The quality of the included SRs was generally poor, with 35 of 36 studies being rated with an overall low or critically low quality by the AMSTAR II tool ( online supplemental file 1 ). The critical items that most often contributed to the overall low quality of the studies were: the lack of an explicit statement that the review methods were established prior to the conduct of the review; the lack of the use of a comprehensive literature search strategy; and lack of a list of excluded studies with reasons for exclusion. There was large variation in the overall quality of the included RCTs as assessed by the RoB2 tool ( online supplemental file 1 ). Most studies with a low risk of bias were on exercise interventions and delivery, whereas there were higher concerns related to the studies on, for example, lifestyle-related interventions. Most commonly, these concerns were related to the elements of measurement of the outcome (eg, the lack of a blinded outcome assessor).

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PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

The main updates to the recommendations are summarised in box 1 . The TF agreed to rephrase and change two previous recommendations into overarching principles. These were the recommendations on: (1) the use of a biopsychosocial approach in the initial assessment and (2) the recommendation on individualisation of treatment. It was decided that these were generic statements used to inform the basis for management rather than specific treatment recommendations. Inherent to the nature of these statements, relevant studies were absent from the SLR. 14

What is new?

The updated recommendations have been reorganised into two overarching principles and eight treatment recommendations.

The wording of each recommendation is condensed.

The level of agreement is above 9 for all recommendations.

The level of evidence is 1a/1b for seven of the eight recommendations.

It was further decided to revise the nine previous recommendations into eight updated recommendations by merging the recommendations on footwear and walking aids, other assistive devices and adaptations. Moreover, to improve readability the previous recommendations were shortened, and subsections were rewritten and moved to the explanatory text. In addition, the TF also discussed the order for the presentation of the recommendations and decided to change this into a more logical sequence.

High LoAs were achieved for all eight recommendations, and seven recommendations were graded with LoE 1a/1b and strength level A. Recommendation 2—on delivery of information, patient education and self-management—was ranked by the TF as having the highest priority for implementation. Table 1 summarises the updated overarching principles, recommendations, LoA, LoE, strength of recommendation and priority for implementation.

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Overarching principles and specific recommendations for the non-pharmacological core management of hip and knee osteoarthritis

Recommendation 1

People with hip or knee OA should be offered an individualised, multicomponent management plan that includes the recommended core non-pharmacological approaches.

This recommendation deals with the provision of an integrated package of care rather than single treatments alone or in succession. The majority of new, relevant SRs and RCTs informing this recommendation investigated the effectiveness of the combination of patient education and exercise or the combination of patient education, exercise and diet or the combination of behaviour change techniques/pain-coping skills training and exercise, compared with information or one of the treatments alone. 15–18 The updated evidence shows that combining treatments leads to larger effects on pain and function compared with providing the treatments separately, thereby providing a rationale for combining different treatment modalities. The combination of education, exercise and dietary weight management was also considered cost-effective compared with physician-delivered usual care investigated in five healthcare systems. 19 The TF discussed that, although not all potential combinations of treatments are investigated in meta-analyses or newer RCTs, the results of available studies are likely to be generalisable to different combinations. Thus, the TF agreed on the general consideration of multicomponent treatments from a broader spectrum of potential combinations based on an assessment of a patient’s individual needs and preferences.

Through the SLR, no specific evidence was retrieved with regard to the effects of pacing and maintenance of activity. This specific element was therefore removed from the recommendation.

Recommendation 2

People with hip or knee OA should be offered information, education and advice on self-management strategies (considering available modes of delivery) and these should be included and reinforced at subsequent clinical encounters.

Recommendation 2 concerns the delivery of information, education and advice on self-management strategies. New evidence from the SLR showed zero to small significant effects on pain and function from patient education as a single intervention in the short term, which is in line with the previous recommendation. 15 20 In 2013, this recommendation focused on how education and information should be delivered in terms of being individualised, being included in every aspect of management, and specifically addressing the nature, causes, consequences and prognosis of OA. Moreover, it was stated that this should be reinforced and developed, supported by written or other types of material, including partners or carers of the individual, if relevant. The current TF acknowledged the importance of these aspects to ensure the effective delivery of information and education for people with hip and knee OA. However, none of the studies from the SLR could provide specific evidence for any of these aspects, except with regard to delivery method. One SR reported the effects of patient education delivered through telephone when compared with usual care, but the results were not significant for pain or disability. 20 The TF further chose to add self-management to the updated recommendation. Evidence from two SRs, including seven RCTs, compared structured self-management programmes against a large range of control interventions. Zero to small favourable effects were found for self-management, delivered face to face or digitally, compared with routine/usual care. 21 22 Despite the limited effects reported in the literature, the TF agreed that self-management is a concept closely related both to the delivery of information and education in a clinical setting and to the uptake of other relevant treatment modalities.

Recommendation 3

All people with hip or knee OA should be offered an exercise programme (eg, strength, aerobic, flexibility or neuromotor) of adequate dosage with progression tailored to their physical function, preferences and available services.

The body of literature investigating the effects of different types of exercise regimes was already large when the 2013 recommendations were published. Aiming to progress the knowledge on the effects of exercise for hip and knee OA, the current SLR did not focus on studies investigating the effects of general exercise on hip and knee OA as these effects were well established previously. 23 24 The aim was rather to identify studies investigating the effects of well-defined exercise modalities, as well as studies looking more specifically into exercise dosage.

For hip OA, one SR summarised the effects of supervised, progressive resistance training, which reported beneficial effects on pain, function and QoL. The effect sizes, however, were small with large CIs. 25

For knee OA, four SRs and five additional RCTs were identified on the exercise 26–28 modalities Tai Chi, yoga, stationary cycling, proprioceptive training, weight-bearing and non-weight bearing exercise, and neuromuscular exercise combined with strength training. 29–33 Overall, the results showed small to moderate positive effects on pain and function for all these exercise modalities compared with no-exercise control (no intervention, waiting list or non-exercise interventions). Still, the results were less clear in head-to-head comparisons of different exercise types, modalities or doses.

In summary, results showed that a variety of exercise modalities might lead to improved pain and function for people with hip or knee OA, making it difficult to recommend one type of exercise over another. The optimal exercise dosage is also difficult to establish, with evidence from 1 SR on hip OA (including 12 RCTs) and 1 SR on knee OA (including 45 RCTs) providing some evidence that exercise in line with dose recommendations from the American College of Sports Medicine provided larger improvements in pain compared with non-compliant exercise programmes. 34–36 The differences, however, were small, and the clinical relevance is debatable. Two newer RCTs on knee OA, comparing high-intensity to low-intensity resistance training or no-exercise control, found no or only small between-group differences with regard to pain and function, 37 38 thus making it difficult to make explicit recommendations on exercise dosage.

With respect to safety, adverse events in exercise studies for hip and knee OA were investigated in two SRs. 39 40 The two studies concluded that, although the report of adverse events in exercise studies was inconsistent and some patient drop-outs were potentially misclassified, adverse events were generally uncommon and non-serious, and that exercise seemed to be associated with minimal risk of harm. Concerning the economic aspects of exercise, one SR on cost-effectiveness found that in the majority of the 12 included studies, exercise for hip and knee OA showed cost-effectiveness at conventional willingness-to-pay thresholds. 19

The TF chose to update this recommendation, highlighting that the choice of exercise should be based on individual function, patient preferences and available services. 41 Overall, exercise is by far the most studied and strongly recognised non-pharmacological core management treatment option and this recommendation has the strongest evidence base. The TF also expressed the importance of maintaining exercise over time for the positive effects to persist.

Recommendation 4

The mode of delivery of exercises (eg, individual or group sessions, supervised or unsupervised, face to face or by using digital technology, land-based or aquatic exercise) should be selected according to local availability and patient preferences. The exercises preferably should be embedded in an individual plan for physical activity.

As established in the description of recommendation 3, there is convincing evidence for the effectiveness of various exercise modalities on pain and function in hip and knee OA. However, the delivery method of exercise programmes varies largely across studies and may influence study outcomes.

One SR found superior effects from technology-supported exercise compared with control with non-technological or no care services on pain, function and QoL, 42 whereas another SR found superior effects from telehealth-based exercise compared with no-telehealth exercise control for pain but not for function or QoL. 43 The reported effect sizes were small. One additional RCT found a small, significant effect on function at 6 months follow-up for an education combined with strengthening exercise follow-up through telephone calls compared with education alone, but no other between-group differences in pain and function were detected after 6 and 12 months. 44 Another RCT comparing access to an educational website combined with exercise supported by automated behaviour change text messages to access to the educational website alone found significant superior effects of the combined first intervention on pain and function after 24 weeks. 45 For aquatic exercise, one SR reported small short-term beneficial effects for pain and function compared with no intervention or usual care. However, another SR comparing aquatic exercise to land-based exercise did not find any of these modes superior to the other. 46 47 One RCT of a three-stage stepped care exercise programme compared with educational materials found beneficial, although not clinically relevant, effects of the stepped care programme on pain and function at 3 and 9 months, but not at 6 months. 48 Analyses of the cost-effectiveness of the same stepped-care intervention concluded that there is a high probability of short-term cost-effectiveness. 49

The new evidence adds information on technology-supported delivery of exercise, aquatic exercise and a stepped care strategy for exercise delivery. The results from these studies show a wide variety of potentially effective delivery methods for exercise, which in clinical practice should be aligned with patient preferences and the availability of local services. The TF also underlined the importance of the exercise programme being embedded in an individual plan for physical activity. Such plans should be set up in accordance with well-recognised recommendations for physical activity, such as from the WHO or EULAR. 41 50 General physical activity has multiple health benefits and is also important for the management of common comorbidities associated with OA, such as cardiovascular disease and diabetes. 51 52

Recommendation 5

People with hip or knee OA should be offered education on the importance of maintaining a healthy weight. Those overweight or obese should be offered support to achieve and maintain weight loss.

In the updated SLR, three SRs were identified, including one network meta-analysis investigating the effects of weight loss interventions. Two were on studies of knee OA, 19 53 whereas the third included studies of both hip and knee OA, although only 2 of the 19 trials included in that study were conducted on a mixed hip and knee OA population. 54 The results from this SR showed beneficial effects, compared with minimal care, of both diet and multifocused weight-loss interventions (combining diets, telephone coaching, psychological pain-coping interventions/CBT, specialist referral education and exercise) on pain and disability, with the largest effect size on pain for multifocused interventions. Further, it was reported that when comparing weight-loss-focused interventions (diets) to exercise, no between-group differences were detected for pain or disability. When comparing combined interventions of dietary weight loss and exercise to dietary weight loss or exercise alone, small effects were found in favour of the combined intervention.

In the network meta-analysis, bariatric surgery was the most effective pain-reducing intervention, followed by a low-calorie diet combined with exercise intervention. 53 The last SR on knee OA used cost-effectiveness as an outcome and reported that an intensive 18-month diet and exercise intervention with the goal of 5% weigth loss was likely to be an efficient use of healthcare resources compared with a healthy lifestyle control. 19

The above-mentioned studies made it clear that there is increasing evidence supporting multifocused weight loss interventions as beneficial for OA pain and disability. Therefore, the TF recommended that people with overweight or obesity and OA should be offered support to achieve and maintain weight loss. The TF notes that the amount of evidence mainly stems from studies on knee OA. As overweight and obesity are strong risk factors for the development and progression of OA, and in particular knee OA, 2 the TF also wanted to add to the recommendation the importance of education on the benefits of maintaining a healthy weight.

Recommendation 6

For people with hip or knee OA, consider walking aids, appropriate footwear, assistive devices and adaptations at home and at work to reduce pain and increase participation.

Through the SLR, four SRs investigating the effects on knee OA of lateral wedge insoles compared with other types of insoles, including flat/neutral insoles or knee braces, were retrieved. These studies did not report any between-group differences for any comparisons on pain or function. 55–58 On the other hand, one RCT reported a small between-group difference in favour of lateral wedge insoles compared with neutral insoles on a single pain scale in people prescreened to knee adduction moment improvements (but not on other pain scales, function or QoL). 59 For footwear, one RCT found positive effects of biomechanical footwear with individually adjustable external convex pods attached to the outsole compared with control footwear. 60 Another RCT found small effects after 6 months on pain, but not on function, from wearing stable, supportive shoes over flat flexible shoes for at least 6 hours per day. 61

Summarised, most evidence did not support the use of any lateral wedged or other insoles to affect pain or function in knee OA. The results from one RCT provided some support for the use of stable, supportive shoes. The TF wanted to add that from a clinical perspective, the use of comfortable shoes, big enough to give ample space for the toes when weight-bearing, is still a general recommendation for people with hip and knee OA.

For other types of assistive aids and devices, two RCTs comparing the use of canes to the non-use of auxiliary gait devices were identified. The results were contradictory, and conclusions on the effect of cane were difficult to draw from the available evidence. 62 63 No studies were retrieved for other types of assistive devices or home adaptations. Based on the expert knowledge of the group, it was argued that such devices could still be useful to some people with hip or knee OA in terms of reducing pain, undertaking daily activities and improving participation. The TF wanted to emphasise that improving participation is an important aspect underpinning this specific recommendation. Assistive devices may serve as means to reduce pain and improve participation both at home and at work and should, therefore, be considered in that context. Examples of such devices might be devices to aid dressing, height-adjustable chairs, raised toilet seats, handrails in staircases or the use of appropriate walking aids.

Recommendation 7

People with hip or knee OA with or at risk of work disability should be offered timely advice on modifiable work-related factors and, where appropriate, referral for expert advice.

OA is one of the leading causes of reduced work participation, and the disease may critically affect the number of sick days and, ultimately, the extension of a person’s work career. 64 Although there are well-known occupational risk factors, such as heavy lifting and knee straining activities associated with the development of knee OA, 65 it was noted that there is a lack of studies on vocational rehabilitation for people with hip or knee OA. In the current update, only one relevant RCT was retrieved. This study used workability as an outcome, whereas the study intervention in both groups focused on self-management with the addition of an activity tracker in the intervention group. In this study, no between-group differences were reported for workability. 66

Although little research has been conducted, the TF considered that appropriate interventions to increase work participation for people with hip and knee OA are highly relevant. A proper assessment of the individual work situation may have a large impact and should receive attention during consultations. 67 Health professionals, in cooperation with the employer, should be able to offer timely advice on modifiable work-related factors such as working from home, the use of height-adjustable desks and office chairs, the possibility of changing work tasks, commuting to/from work, use of assistive technology, and receiving support from management, colleagues and family towards employment. The TF also noted that adaptations to improve workability might be considered and applied not only at the workplace but also in the home.

Recommendation 8

Consider employing elements of behaviour change techniques when lifestyle modifications are needed (eg, physical activity, weight loss) for people with hip or knee OA.

This recommendation concerns the potential need for lifestyle change in people with hip and knee OA. It focuses specifically on physical activity and weight loss as part of a healthy lifestyle since these aspects are specifically relevant for people with hip or knee OA. One SR and eight additional RCTs were identified on various interventions to enhance a healthy lifestyle, mainly through maintaining physical activity over time. The SR reported small to moderate effects of adding booster sessions to exercise programmes to improve mid-term to long-term adherence to exercise. 68 Furthermore, one RCT reported statistically significant improvements in pain and function from a combined programme of pain coping skills training and lifestyle behavioural weight management lasting 24 weeks compared with these interventions alone or standard care. 69 Interventions from the other RCTs aiming to support people with OA to improve their lifestyle and sustain such changes over time, included interventions of behaviour-graded activity, improving exercise adherence with telephone counselling, an app to enhance a healthy lifestyle, physical activity with telephone follow-up and a self-management lifestyle intervention. 70–72 However, when the effects on pain and function of these interventions were compared with standard care or other minimal interventions, none to very small between-group differences were observed for the comparisons. The TF wanted to enhance the importance of long-term follow-up on health behaviour change and not just recommend lifestyle change as a single intervention. The TF also discussed that the EULAR recommendation on core competencies for health professionals in rheumatology underlines that health professionals should be able to provide the principles of behaviour change techniques in the management of people with rheumatic and musculoskeletal disorders. 73

Research and educational agendas

The proposed research agenda ( table 2 ) was based on gaps identified in the literature and on topics which emerged during discussions among the TF members.

Research agenda for the non-pharmacological core management of people with hip and knee osteoarthritis

The education agenda ( table 3 ) highlights activities relevant to promote appropriate management of people with hip and knee OA.

Educational agenda for the non-pharmacological core management of people with hip and knee OA

Through this update, the recommendations for the non-pharmacological core management of hip and knee OA have been revised into two overarching principles and eight treatment recommendations. The revisions are based on research evidence, expert discussions and consensus. Since the publication of the 2013 recommendations, a number of new studies have been published on non-pharmacological treatment modalities and their methods of delivery. The updates to the recommendations are thus well anchored in evidence from research and the perspectives of the TF members, representing different professional, cultural and personal backgrounds, including the perspective of people with OA. The process led to a broad consensus within the TF on the updated principles and recommendations, reflected by the high LoA for all the revised recommendations. Such strong consensus gives reason to believe that the recommendations are suitable for use and implementation across European healthcare systems. These recommendations are also in line with recently published treatment recommendations for hip and knee OA by other societies. 74–76

The number of relevant SRs and RCTs retrieved through the SLR was high, especially for the research questions concerning exercise and delivery of exercise, with data drawn from a total of 15 SRs and 11 additional RCTs. The number of new studies led to an upgrade of the LoE for most of the recommendations, and seven of eight recommendations are now supported by level 1a or 1b evidence. However, it should be noted that the stated LoE does not necessarily involve all aspects of every recommendation and does not distinguish between hip and knee OA. The number of studies on hip OA was markedly lower than those on knee OA for all the treatment modalities. Therefore, the recommendations are generally weaker for hip OA than knee OA. There is an increasing recognition of differences between hip and knee OA, which heightens the need for more hip OA-specific studies to improve outcomes for this group specifically. 77 This is also highlighted in the proposed research agenda ( table 2 ). Further, as the aim was to address relevant non-pharmacological core management strategies, the recommendations do not specifically advise the management of subgroups of the OA population, for instance, younger adults or adults with a high burden of comorbidities. The authors are also aware of a number of ongoing studies addressing a range of innovative digital programmes in OA care. Such approaches will likely receive further attention in future updates of these recommendations. 78–81

With regard to outcomes, most of the included studies reported effects primarily on pain and physical function. To follow the recommendations on prioritised outcomes in OA research, 82 more studies investigating the effects of interventions on QoL and patients’ global assessment of the target joint may have provided additional relevant information. Workability and cost-effectiveness are two other outcomes of increasing interest when investigating the effect of interventions from a broader perspective. This SLR identified some studies including these outcomes, thus adding new and important knowledge to the recommendations. Nevertheless, additional studies with a focus on interventions to prevent the decline in workability and studies examining cost-effectiveness are still needed as such knowledge is important for healthcare governance and policy-makers when planning and prioritising effective OA care. Another relevant aspect of this update is the inclusion of studies investigating potential harm or adverse events from the interventions under study. Only two SRs specifically looking into this subject were identified. Still, the results add new knowledge to this important, although understudied, aspect of non-pharmacological interventions. 83

The challenges of implementing recommended care for people with hip and knee OA are well documented. 84 It is also apparent that developing recommendations is not sufficient on its own to influence practice. 85 Therefore, efforts have been made to address the impact and to develop strategies for the implementation of treatment recommendations. For future implementation, collaboration with other organisations focusing on OA care, such as The Osteoarthritis Research Society International, must be considered. EULAR highlights that implementing all recommendations at once is probably not feasible in practice. 86 The TF voted that the recommendation on information, education and self-management was ranked as the recommendation with the highest priority for implementation. This recommendation may play an important role as a basis for all other management and may improve people’s ability to live a good life with OA, as well as being an enabler of, aspects such as physical activity. 87 The prioritisation of the recommendations for implementation activities is also important with respect to the effective utilisation of healthcare services. As the OA population is growing, the need for effective healthcare utilisation and sustainable management strategies to improve outcomes will be vital to minimising the burden of OA at an individual and a societal level. 88

To conclude, the TF reached a broad consensus on the updated recommendation for non-pharmacological core OA management as well as on a research agenda highlighting the current evidence gaps, on an educational agenda and on the priority of the recommendations to support implementation activities.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

We thank the librarian Hilde Iren Flaatten, University of Oslo, Norway, for supporting the literature searches and Emilie Andrea Bakke, Ingrid Skaalvik and Geir Smedslund, Diakonhjemmet Hospital, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway, for their thorough work in the AMSTAR II and Cochrane risk of bias assessments of the included studies.

PGC is funded in part by the National Institute for Health and Care Research (NIHR) through the Leeds Biomedical Research Centre.

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Supplementary materials

Supplementary data.

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

  • Data supplement 1

Handling editor Josef S Smolen

X @DrS_Battista

Contributors TM was the research fellow for the project, undertaking the SLR in cooperation with NØ. The fellow was supervised by the steering group consisting of NØ (convenor) and TPMVV (methodologist). NØ and TPMVV supervised the process of the SLR. NØ organised and chaired the TF meetings. TM drafted the manuscript with advice from NØ and TPMVV. All authors have contributed to the recommendations by participating in the TF meetings; during discussion and agreement on the recommendations; revising and approving the manuscript for publication.

Funding This study was funded by European League Against Rheumatism (HPR055).

Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Competing interests TPMVV was the Vice president EULAR health professionals 2020–2022 and is part of the EULAR Advocacy Committee 2020–present. MG holds a leadership position in OpenReuma/Spanish Association of Health Professionals in Rheumatology (unpaid). CDM received Grants from Versus Arthritis, MRC, NIHR (paid to Keele University) and is the director of the NIHR School for Primary Care Research. SL received payment as scientific consultant from Arthro Therapeutics AB and received payment from AstraZeneca as a member of DSMB. DC received grants from Fundação para a Ciência e Tecnologia SFRH/BD/148420/2019 and Pfizer (ID 64165707). GZ received payment for expert testimony from Casa di Cura San Francesco, Verona and Support for attending meetings and/or travel from Orthotech and Jtech, payment for participation on a Data Safety Monitoring Board or Advisory Board from VIVENKO for Gruenenthal and Ethos for Angelini and holds other financial interests related to clinical practice as an orthopedic surgeon (performing total joint replacement, arthroscopies and other types of surgeries), either directly from private patients or indirectly from the health system or insurances acting as a private consultant. JEV has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly Netherlands BV. TG has received paid honoraria for lectures by Abbvie, Novartis, Boehringer Ingelheim, UCB, Berlin-Chemie/A. Menarini Bulgaria, Sandoz and received support for attending meetings by Abbvie, Pfizer and UCB. DW is an International Advisory Board Member of DRFZ (Germany) 2019–current and was the EULAR PARE Chair 2015–2017and an EULAR Vice President representing PARE 2017–2021.

Provenance and peer review Not commissioned; externally peer reviewed.

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

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  • http://orcid.org/0000-0003-4431-8822 Phil J Edwards ,
  • Siobhan Moore ,
  • Craig Higgins
  • London School of Hygiene & Tropical Medicine , London , UK
  • Correspondence to Dr Phil J Edwards, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; phil.edwards{at}LSHTM.ac.uk

Background Plans to phase out fossil fuel-powered internal combustion engine (ICE) vehicles and to replace these with electric and hybrid-electric (E-HE) vehicles represent a historic step to reduce air pollution and address the climate emergency. However, there are concerns that E-HE cars are more hazardous to pedestrians, due to being quieter. We investigated and compared injury risks to pedestrians from E-HE and ICE cars in urban and rural environments.

Methods We conducted a cross-sectional study of pedestrians injured by cars or taxis in Great Britain. We estimated casualty rates per 100 million miles of travel by E-HE and ICE vehicles. Numerators (pedestrians) were extracted from STATS19 datasets. Denominators (car travel) were estimated by multiplying average annual mileage (using National Travel Survey datasets) by numbers of vehicles. We used Poisson regression to investigate modifying effects of environments where collisions occurred.

Results During 2013–2017, casualty rates per 100 million miles were 5.16 (95% CI 4.92 to 5.42) for E-HE vehicles and 2.40 (95%CI 2.38 to 2.41) for ICE vehicles, indicating that collisions were twice as likely (RR 2.15; 95% CI 2.05 to 2.26) with E-HE vehicles. Poisson regression found no evidence that E-HE vehicles were more dangerous in rural environments (RR 0.91; 95% CI 0.74 to 1.11); but strong evidence that E-HE vehicles were three times more dangerous than ICE vehicles in urban environments (RR 2.97; 95% CI 2.41 to 3.7). Sensitivity analyses of missing data support main findings.

Conclusion E-HE cars pose greater risk to pedestrians than ICE cars in urban environments. This risk must be mitigated as governments phase out petrol and diesel cars.

  • WOUNDS AND INJURIES
  • CLIMATE CHANGE

Data availability statement

Data are available in a public, open-access repository. Numerator data (numbers of pedestrians injured in collisions) are publicly available from the Road Safety Data (STATS19) datasets ( https://www.data.gov.uk/dataset/cb7ae6f0-4be6-4935-9277-47e5ce24a11f/road-safety-data ). Denominator data (100 million miles of car travel per year) may be estimated by multiplying average annual mileage by numbers of vehicle registrations (publicly available from Department for Transport, https://www.gov.uk/government/statistical-data-sets/veh02-licensed-cars ). Average annual mileage for E-HE and ICE vehicles may be estimated separately for urban and rural environments using data that may obtained under special licence from the National Travel Survey datasets ( http://doi.org/10.5255/UKDA-Series-2000037 ).

https://doi.org/10.1136/jech-2024-221902

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Electric cars are quieter than cars with petrol or diesel engines and may pose a greater risk to pedestrians.

The US National Highway Transportation Safety Agency found that during 2000–2007 the odds of an electric or hybrid-electric car causing a pedestrian injury were 35% greater than a car with a petrol or diesel engine.

The UK Transport Research Laboratory found the pedestrian casualty rate per 10 000 registered electric or hybrid-electric vehicles during 2005–2007 in Great Britain was lower than the rate for petrol or diesel vehicles.

WHAT THIS STUDY ADDS

In Great Britain during 2013–2017, pedestrians were twice as likely to be hit by an electric or hybrid-electric car than by a petrol or diesel car; the risks were higher in urban areas.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

The greater risk to pedestrian safety posed by electric or hybrid-electric cars needs to be mitigated as governments proceed to phase out petrol and diesel cars.

Drivers of electric or hybrid-electric cars must be cautious of pedestrians who may not hear them approaching and may step into the road thinking it is safe to do so, particularly in towns and cities.

Introduction

Many governments have set targets to reach net-zero emissions to help mitigate the harms of climate change. Short-term health benefits of reduced emissions are expected from better air quality with longer-term benefits from reduced global temperatures. 1

Transition to electric and hybrid-electric (E-HE) cars

One such target is to phase out sales of new fossil fuel-powered internal combustion engine (ICE) vehicles and replace these with E-HE vehicles. 2 3

Pedestrian safety

Road traffic injuries are the leading cause of death for children and young adults. 4 A quarter of all road traffic deaths are of pedestrians. 5 Concerns have been raised that E-HE cars may be more hazardous to pedestrians than ICE cars, due to being quieter. 6 7 It has been hypothesised that E-HE cars pose a greater risk of injury to pedestrians in urban areas where background ambient noise levels are higher. 8 However, there has been relatively little empirical research on possible impacts of E-HE cars on pedestrian road safety. A study commissioned for the US National Highway Transportation Safety Agency based on data from 16 States found that the odds of an E-HE vehicle causing a pedestrian injury were 35% greater than an ICE vehicle. 9 In contrast, a study commissioned by the UK Department for Transport found pedestrian casualty rates from collisions with E-HE vehicles during 2005–2007 were lower than for ICE vehicles. 10 Possible reasons for these conflicting results are that the two studies used different designs and estimated different measures of relative risk—the first used a case–control design and estimated an OR, whereas the second used a cross-sectional study and estimated a rate ratio. ORs will often differ from rate ratios. 11 Other reasons include differences between the USA and the UK in the amount and quality of walking infrastructure. 12

Aim and objectives

We aimed to add to the evidence base on whether E-HE cars pose a greater injury risk to pedestrians than ICE cars by analysing road traffic injury data and travel survey data in Great Britain.

We sought to improve on the previous UK study by using distance travelled instead of number of registered vehicles as the measure of exposure in estimation of collision rates.

The objectives of this study were:

To estimate pedestrian casualty rates for E-HE and ICE vehicles and to compare these by calculating a rate ratio;

To assess whether or not the evidence supports the hypothesis that casualty rate ratios vary according to urban or rural environments. 8

Study design

This study was an analysis of differences in casualty rates of pedestrians per 100 million miles of E-HE car travel and rates per 100 million miles of ICE car travel.

This study was set in Great Britain between 2013 and 2017.

Participants

The study participants were all pedestrians reported to have been injured in a collision with a car or a taxi.

The exposure was the type of propulsion of the colliding vehicle, E-HE or ICE. E-HE vehicles were treated as a single powertrain type, regardless of the mode of operation that a hybrid vehicle was in at the time of collision (hybrid vehicles typically start in electric mode and change from battery to combustion engine at higher speeds). 13

The outcome of interest was a pedestrian casualty.

Effect modification by road environment

We used the urban–rural classification 14 of the roads on which the collisions occurred to investigate whether casualty rate ratios comparing E-HE with ICE vehicles differed between rural and urban environments.

Data sources/measurement

Numerator data (numbers of pedestrians injured in collisions) were extracted from the Road Safety Data (STATS19) datasets. 15

Denominator data (100 million miles of car travel per year) were estimated by multiplying average annual mileage by numbers of vehicle registrations. 16 Average annual mileage for E-HE and ICE vehicles was estimated separately for urban and rural environments using data obtained under special licence from the National Travel Survey (NTS) datasets. 17 We estimated average annual mileage for the years 2013–2017 because the NTS variable for the vehicle fuel type did not include ‘hybrid’ prior to 2013 and data from 2018 had not been uploaded to the UK data service due to problems with the archiving process (Andrew Kelly, Database Manager, NTS, Department for Transport, 23 March 2020, personal communication). Denominators were thus available for the years 2013–2017.

Data preparation

The datasets for collisions, casualties and vehicles from the STATS19 database were merged using a unique identification number for each collision.

Statistical methods

We calculated annual casualty rates for E-HE and ICE vehicles separately and we compared these by calculating a rate ratio. We used Poisson regression models to estimate rate ratios with 95% CIs and to investigate any modifying effects of the road environment in which the collisions occurred. For this analysis, our regression model included explanatory terms for the main effects of the road environment, plus terms for the interaction between type of propulsion and the road environment. The assumptions for Poisson regression were met in our study: we modelled count data (counts of pedestrians injured), traffic collisions were independent of each other, occurring in different places over time, and never occurring simultaneously. Data preparation, management and analyses were carried out using Microsoft Access 2019 and Stata V.16. 18

Sensitivity analysis

We conducted an extreme case analysis where all missing propulsion codes were assumed to be ICE vehicles (there were over a 100 times more ICE vehicles than E-HE vehicles on the roads in Great Britain during our study period, 16 so missing propulsion is more likely to have been ICE).

The sample size for this study included all available recorded road traffic collisions in Great Britain during the study period. We estimated that for our study to have 80% power at the 5% significance level to show a difference in casualty rates of 2 per 100 miles versus 5.5 per 100 miles, we would require 481 million miles of vehicle travel in each group (E-HE and ICE); whereas to have 90% power at the 1% significance level to show this difference, 911 million miles of vehicle travel would be required in each group. Our study includes 32 000 million miles of E-HE vehicle travel and 3 000 000 million miles of ICE vehicle travel and therefore our study was sufficiently powered to detect differences in casualty rates of these magnitudes.

Between 2013 and 2017, there were 916 713 casualties from reported road traffic collisions in Great Britain. 120 197 casualties were pedestrians. Of these pedestrians, 96 285 had been hit by a car or taxi. Most pedestrians—71 666 (74%) were hit by an ICE car or taxi. 1652 (2%) casualties were hit by an E-HE car or taxi. For 22 829 (24%) casualties, the vehicle propulsion code was missing. Most collisions occurred in urban environments and a greater proportion of the collisions with E-HE vehicles occurred in an urban environment (94%) than did collisions with ICE vehicles (88%) ( figure 1 ).

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Flow chart of pedestrian casualties in collisions with E-HE or ICE cars or taxis from reported road traffic collisions in Great Britain 2013–2017. E-HE, electric and hybrid-electric; ICE, internal combustion engine.

Main results

During the period 2013 to 2017, the average annual casualty rates of pedestrians per 100 million miles were 5.16 (95% CI 4.92 to 5.42) for E-HE vehicles and 2.40 (95% CI 2.38 to 2.41) for ICE vehicles, which indicates that collisions with pedestrians were on average twice as likely (RR 2.15 (95% CI 2.05 to 2.26), p<0.001) with E-HE vehicles as with ICE vehicles ( table 1 ).

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Pedestrian casualties due to collisions with cars or taxis from reported road traffic collisions in Great Britain 2013–2017—by vehicle propulsion type

In our extreme case analysis, the 22 829 pedestrian casualties where vehicle propulsion was missing were all assumed to have been struck by ICE vehicles. In this case, average casualty rates of pedestrians per 100 million miles were 3.16 (95% CI 3.14 to 3.18) for ICE vehicles, which would indicate that collisions with pedestrians were on average 63% more likely (RR 1.63 (95% CI 1.56 to 1.71), p<0.001) with E-HE vehicles than with ICE vehicles ( table 2 ).

Extreme case sensitivity analysis—pedestrian casualties due to collisions with cars or taxis from reported road traffic collisions in Great Britain 2013–2017 by vehicle propulsion type where 22 829 missing vehicle propulsion codes are assumed to be ICE vehicles

Relative risks according to road environment

Casualty rates were higher in urban than rural environments ( tables 3 and 4 ).

Pedestrian casualties due to collisions with cars or taxis from reported road traffic collisions in Great Britain 2013–2017—by vehicle propulsion type in urban road environments

Pedestrian casualties due to collisions with cars or taxis from reported road traffic collisions in Great Britain 2013–2017—by vehicle propulsion type in rural road environments

Urban environments

Collisions with pedestrians in urban environments were on average over two and a half times as likely (RR 2.69 (95% CI 2.56 to 2.83, p<0.001) with E-HE vehicles as with ICE vehicles ( table 3 ).

The extreme case sensitivity analysis showed collisions with pedestrians in urban environments were more likely with E-HE vehicles (RR 2.05; 95% CI 1.95 to 2.15).

Rural environments

Collisions with pedestrians in rural environments were equally likely (RR 0.91; 95% CI 0.74 to 1.11) with E-HE vehicles as with ICE vehicles ( table 4 ).

The extreme case sensitivity analysis found evidence that collisions with pedestrians in rural environments were less likely with E-HE vehicles (RR 0.68; 95% CI 0.55 to 0.83).

Results of Poisson regression analysis

Our Poisson regression model results ( table 5 ) showed that pedestrian injury rates were on average 9.28 (95% CI 9.07 to 9.49) times greater in urban than in rural environments. There was no evidence that E-HE vehicles were more dangerous than ICE vehicles in rural environments (RR 0.91; 95% CI 0.74 to 1.11), consistent with our finding in table 4 . There was strong evidence that E-HE vehicles were on average three times more dangerous than ICE vehicles in urban environments (RR 2.97; 95% CI 2.41 to 3.67).

Results of Poisson regression analysis of annual casualty rates of pedestrians per 100 million miles by road environment and the interaction between vehicle propulsion type and environment

Statement of principal findings

This study found that in Great Britain between 2013 and 2017, casualty rates of pedestrians due to collisions with E-HE cars and taxis were higher than those due to collisions with ICE cars and taxis. Our best estimate is that such collisions are on average twice as likely, and in urban areas E-HE vehicles are on average three times more dangerous than ICE vehicles, consistent with the theory that E-HE vehicles are less audible to pedestrians in urban areas where background ambient noise levels are higher.

Strengths and weaknesses of the study

There are several limitations to this study which are discussed below.

The data used were not very recent. However, ours is the most current analysis of E-HE vehicle collisions using the STATS19 dataset.

Before we can infer that E-HE vehicles pose a greater risk to pedestrians than ICE vehicles, we must consider whether our study is free from confounding and selection bias. Confounding occurs when the exposure and outcome share a common cause. 19 Confounders in this study would be factors that may both cause a traffic collision and also cause the exposure (use of an E-HE car). Younger, less experienced drivers (ie, ages 16–24) are more likely to be involved in a road traffic collision 20 and are also more likely to own an electric car. 21 Some of the observed increased risk of electric cars may therefore be due to younger drivers preferring electric cars. This would cause positive confounding, meaning that the true relative risk of electric cars is less than we have estimated in our study. Regarding selection bias, it is known that the STATS19 dataset does not include every road traffic casualty in Great Britain, as some non-fatal casualties are not reported to the police. 22 If casualties from collisions are reported to the police differentially according to the type of vehicle propulsion, this may have biased our results; however, there is no reason to suspect that a pedestrian struck by a petrol or diesel car is any more or less likely to report the collision to the police than one struck by an electric car.

We must also address two additional concerns as ours is a cross-sectional study: The accuracy of exposure assignment (including the potential for recall bias) and the adequacy of prevalence as a proxy for incidence. 23 First, the accuracy of exposure assignment and the potential for recall bias are not issues for this study, as the exposure (type of propulsion of the colliding vehicle, E-HE or ICE), is assigned independently of the casualties by the UK Department for Transport who link the vehicle registration number (VRN) of each colliding vehicle to vehicle data held by the UK Driver Vehicle and Licensing Agency (DVLA). 10 Second, we have not used prevalence as a proxy for incidence but have estimated incidence using total distance travelled by cars as the measure of exposure.

We may therefore reasonably infer from our study results that E-HE vehicles pose a greater risk to pedestrians than ICE vehicles in urban environments, and that part of the risk may be due to younger people’s preference for E-HE cars.

A major limitation of the STATS19 road safety dataset used in this study was that it did not contain a vehicle propulsion code for all vehicles in collisions with pedestrians. We excluded these vehicles from our primary analysis (a complete case analysis) and we also conducted an extreme case sensitivity analysis. We will now argue why imputation of missing vehicle propulsion codes would not have added value to this study. Vehicle propulsion data are obtained for the STATS19 dataset by the UK Department for Transport who link the VRN of each colliding vehicle recorded in STATS19 to vehicles data held by the UK DVLA. The STATS19 data on reported collisions and casualties are collected by a Police Officer when an injury road accident is reported to them; Most police officers write details of the casualties and the vehicles involved in their notebooks for transcription onto the STATS19 form later at the Police station. 24 The VRN is one of 18 items recorded on each vehicle involved in a collision. Items may occasionally be missed due to human error during this process. Where a VRN is missing, vehicle propulsion will be missing in the STATS19 dataset. The chance that any vehicle-related item is missing will be independent of any characteristics of the casualties involved and so the vehicle propulsion codes are missing completely at random (MCAR). As the missing propulsion data are very likely MCAR, the set of pedestrians with no missing data is a random sample from the source population and hence our complete case analysis for handling the missing data gives unbiased results. The extreme case sensitivity analysis we performed shows a possible result that could occur, and it demonstrates our conclusions in urban environments are robust to the missing data. Lastly, to impute the missing data would require additional variables which are related to the likelihood of a VRN being missing. Such variables were not available and therefore we do not believe a useful multiple imputation analysis could have been performed.

Strengths and weaknesses in relation to other studies

Our study uses hundreds of millions of miles of car travel as the denominators in our estimates of annual pedestrian casualty rates which is a more accurate measure of exposure to road hazards than the number of registered vehicles, which was used as the denominator in a previous study in the UK. 10 Our results differ to this previous study which found that pedestrian casualty rates from collisions with E-HE vehicles during 2005–2007 were lower than those from ICE vehicles. Our study has updated this previous analysis and shows that casualty rates due to E-HE vehicle collisions exceed those due to ICE vehicle collisions. Similarly, our study uses a more robust measure of risk (casualty rates per miles of car travel) than that used in a US study. 9 Our study results are consistent with this US study that found that the odds of an E-HE vehicle causing a pedestrian injury were 35% greater than an ICE vehicle. Brand et al 8 hypothesised, without any supporting data, that “hybrid and electric low-noise cars cause an increase in traffic collisions involving vulnerable road users in urban areas” and recommended that “further investigations have to be done with the increase of low-noise cars to prove our hypothesis right.” 8 We believe that our study is the first to provide empirical evidence in support of this hypothesis.

Meaning of the study: possible explanations and implications for clinicians and policymakers

More pedestrians are injured in Great Britain by petrol and diesel cars than by electric cars, but compared with petrol and diesel cars, electric cars pose a greater risk to pedestrians and the risk is greater in urban environments. One plausible explanation for our results is that background ambient noise levels differ between urban and rural areas, causing electric vehicles to be less audible to pedestrians in urban areas. Such differences may impact on safety because pedestrians usually hear traffic approaching and take care to avoid any collision, which is more difficult if they do not hear electric vehicles. This is consistent with audio-testing evidence in a small study of vision-impaired participants. 10 From a Public Health perspective, our results should not discourage active forms of transport beneficial to health, such as walking and cycling, rather they can be used to ensure that any potential increased traffic injury risks are understood and safeguarded against. A better transport policy response to the climate emergency might be the provision of safe, affordable, accessible and integrated public transport systems for all. 25

Unanswered questions and future research

It will be of interest to investigate the extent to which younger drivers are involved in collisions of E-HE cars with pedestrians.

If the braking distance of electric cars is longer, 26 and electric cars are heavier than their petrol and diesel counterparts, 27 these factors may increase the risks and the severity of injuries sustained by pedestrians and require investigation.

As car manufacturers continue to develop and equip new electric cars with Collision Avoidance Systems and Autonomous Emergency Braking to ensure automatic braking in cases where pedestrians or cyclists move into the path of an oncoming car, future research can repeat the analyses presented in this study to evaluate whether the risks of E-HE cars to pedestrians in urban areas have been sufficiently mitigated.

Conclusions

E-HE vehicles pose a greater risk to pedestrians than petrol and diesel powered vehicles in urban environments. This risk needs to be mitigated as governments proceed to phase out petrol and diesel cars.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by the LSHTM MSc Research Ethics Committee (reference #16400). The study uses the anonymised records of people injured in road traffic collisions, data which are routinely collected by UK police forces. The participants are unknown to the investigators and could not be contacted.

Acknowledgments

We thank Rebecca Steinbach for her advice on analysis of National Travel Survey data, Jonathan Bartlett for his advice on missing data, and Ben Armstrong for his advice on Poisson regression. We are grateful to the reviewers and to Dr C Mary Schooling, Associate Editor, whose comments helped us improve the manuscript. We are grateful to Jim Edwards and Graham Try for their comments on earlier versions of this manuscript.

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  • ↵ WHO factsheet on road traffic injuries . Available : https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries#:~:text=Approximately%201.19%20million%20people%20die,adults%20aged%205%E2%80%9329%20years [Accessed 14 Apr 2024 ].
  • ↵ Reported road casualties great Britain, annual report . 2022 . Available : https://www.gov.uk/government/statistics/reported-road-casualties-great-britain-annual-report-2022 [Accessed 14 Apr 2024 ].
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Contributors CH and PJE developed the idea for this study and supervised SM in performing the literature search, downloading, managing and analysing the data. SM wrote the first draft of the manuscript, which was the dissertation for her MSc in Public Health. PJE prepared the first draft of the manuscript for the journal. All authors assisted in editing and refining the manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. PJE (guarantor) accepts full responsibility for the work and the conduct of the study, had access to the data and controlled the decision to publish.

Funding This study was conducted in part fulfilment of the Masters degree in Public Health at the London School of Hygiene & Tropical Medicine. The second author was self-funded for her studies for this degree.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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    Step 2: Building a solid foundation with background information. Including background information in your introduction serves two major purposes: It helps to clarify the topic for the reader. It establishes the depth of your research. The approach you take when conveying this information depends on the type of paper.

  6. Introductions

    In general, your introductions should contain the following elements: When you're writing an essay, it's helpful to think about what your reader needs to know in order to follow your argument. Your introduction should include enough information so that readers can understand the context for your thesis. For example, if you are analyzing ...

  7. How to Write an Essay Introduction

    Table of contents. Step 1: Hook your reader. Step 2: Give background information. Step 3: Present your thesis statement. Step 4: Map your essay's structure. Step 5: Check and revise. More examples of essay introductions. Other interesting articles. Frequently asked questions about the essay introduction.

  8. How to Write a Thesis or Dissertation Introduction

    Overview of the structure. To help guide your reader, end your introduction with an outline of the structure of the thesis or dissertation to follow. Share a brief summary of each chapter, clearly showing how each contributes to your central aims. However, be careful to keep this overview concise: 1-2 sentences should be enough.

  9. How to Write an Introduction For a Research Paper

    Be succinct - it is advised that your opening introduction consists of around 8-9 percent of the overall amount of words in your article (for example, 160 words for a 2000 words essay). Make a strong and unambiguous thesis statement. Explain why the article is significant in 1-2 sentences. Remember to keep it interesting.

  10. How to Write an Introduction for a Research Paper

    Introducing Your Topic. Provide a brief overview, which should give the reader a general understanding of the subject matter and its significance. Explain the importance of the topic and its relevance to the field. This will help the reader understand why your research is significant and why they should continue reading.

  11. 4 Step approach to writing the Introduction section of a research paper

    The 4-step approach to writing the Introduction section. As a rule of thumb, this section accounts for about 10% of the total word count of the body of a typical research paper, or about 400 words spread over three paragraphs in a 4000-word paper.1 With that, let us now understand how to write the Introduction section step-by-step: 1.

  12. How to Write the Introduction to a Scientific Paper?

    A scientific paper should have an introduction in the form of an inverted pyramid. The writer should start with the general information about the topic and subsequently narrow it down to the specific topic-related introduction. Fig. 17.1. Flow of ideas from the general to the specific. Full size image.

  13. Research Paper

    Definition: Research Paper is a written document that presents the author's original research, analysis, and interpretation of a specific topic or issue. It is typically based on Empirical Evidence, and may involve qualitative or quantitative research methods, or a combination of both. The purpose of a research paper is to contribute new ...

  14. How to Write a Research Paper: Parts of the Paper

    Writing Your Paper. Parts of the Research Paper. Papers should have a beginning, a middle, and an end. Your introductory paragraph should grab the reader's attention, state your main idea, and indicate how you will support it. The body of the paper should expand on what you have stated in the introduction. Finally, the conclusion restates the ...

  15. How to Write a Research Introduction: 10 Steps (with Pictures)

    Download Article. 1. Announce your research topic. You can start your introduction with a few sentences which announce the topic of your paper and give an indication of the kind of research questions you will be asking. This is a good way to introduce your readers to your topic and pique their interest.

  16. IMRAD (Introduction, Methods, Results and Discussion)

    Introduction. The Introduction typically provides everything your reader needs to know in order to understand the scope and purpose of your research. This section should provide: Context for your research (for example, the nature and scope of your topic) A summary of how relevant scholars have approached your research topic to date, and a description of how your research makes a contribution ...

  17. Parts of the paper

    A good introduction is not the same as an abstract. Where the abstract summarizes your paper, the introduction justifies your project and lets readers know what to expect. • Keep it brief. You conducted an extensive literature review, so that you can give readers just the relevant information. • Cite your sources using in-text citations.

  18. Organizing Academic Research Papers: 4. The Introduction

    The introduction serves the purpose of leading the reader from a general subject area to a particular field of research. It establishes the context of the research being conducted by summarizing current understanding and background information about the topic, stating the purpose of the work in the form of the hypothesis, question, or research problem, briefly explaining your rationale ...

  19. PDF The Structure of an Academic Paper

    • Suggest what the reader should take away from your paper. • Pose questions for future study, actions to take, policy interventions, or other implications of your ideas. Take care not to repeat your words exactly in the conclusion. At the same time, you should not introduce any major new concepts or parts of your argument in this section.

  20. How to Write a Research Paper

    7 Tips for Writing a Research Paper. Often, getting started is the most challenging part of a research paper. While the process can seem daunting, breaking it down into manageable steps can make it easier to manage. The following are seven tips for getting your ideas out of your head and onto the page. 1. Understand Your Assignment

  21. Report Writing Format with Templates and Sample Report

    2. Follow the Right Report Writing Format: Adhere to a structured format, including a clear title, table of contents, summary, introduction, body, conclusion, recommendations, and appendices. This ensures clarity and coherence. Follow the format suggestions in this article to start off on the right foot. 3.

  22. Antioxidants

    The research results were mixed, but most did not find the hoped-for benefits. Most research teams reported that vitamin E and other antioxidant supplements didn't protect against heart disease or cancer. [3] One study even showed that taking beta-carotene supplements actually increased the chances of developing lung cancer in smokers.

  23. Cultural Relativity and Acceptance of Embryonic Stem Cell Research

    Cultural Relativity and Acceptance of Embryonic Stem Cell Research. ABSTRACT. There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives.

  24. What should I include in a research paper introduction?

    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.

  25. Contact Cisco

    Complete the form below, and one of our sales specialists will call you within 15 minutes or on a date and time you request. Specialists are available Monday through Friday, 8 a.m. to 5 p.m. Eastern Time.We are currently experiencing delays in response times. If you require an immediate sales response - please call us 1 800-553-6387.

  26. Research involvement of medical students in a medical school of India

    Introduction: Research in the medical discipline significantly impacts society by improving the general well-being of the population, through improvements in diagnostic and treatment modalities. However, of 579 Indian medical colleges, 332 (57.3%) did not publish a single paper from the year 2005 to 2014," indicating a limited contribution from medical fraternity In order to probe in to the ...

  27. EULAR recommendations for the management of psoriatic arthritis with

    Introduction. Psoriatic arthritis (PsA) is a disease which has benefited from notable progress over recent years. Concepts have evolved, such as very early diagnosis and pre-PsA, as well as defining treatment targets and applying a holistic approach to comorbidity management.1-4 Pharmacological options have extended, with the approval of new agents targeting various modes of action for PsA ...

  28. EULAR recommendations for the non-pharmacological core management of

    Introduction Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an ...

  29. About Physical Activity

    Key points. Physical activity is one of the best things people can do to improve their health. Physical activity is vital for healthy aging. It can help reduce the chances of getting some chronic diseases and prevent early deaths. CDC works with state and local organizations to increase physical activity.

  30. Pedestrian safety on the road to net zero: cross-sectional study of

    Background Plans to phase out fossil fuel-powered internal combustion engine (ICE) vehicles and to replace these with electric and hybrid-electric (E-HE) vehicles represent a historic step to reduce air pollution and address the climate emergency. However, there are concerns that E-HE cars are more hazardous to pedestrians, due to being quieter. We investigated and compared injury risks to ...