findings sample in research

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How to Write the Results/Findings Section in Research

What is the research paper Results section and what does it do?

The Results section of a scientific research paper represents the core findings of a study derived from the methods applied to gather and analyze information. It presents these findings in a logical sequence without bias or interpretation from the author, setting up the reader for later interpretation and evaluation in the Discussion section. A major purpose of the Results section is to break down the data into sentences that show its significance to the research question(s).

The Results section appears third in the section sequence in most scientific papers. It follows the presentation of the Methods and Materials and is presented before the Discussion section —although the Results and Discussion are presented together in many journals. This section answers the basic question “What did you find in your research?”

What is included in the Results section?

The Results section should include the findings of your study and ONLY the findings of your study. The findings include:

• Data presented in tables, charts, graphs, and other figures (may be placed into the text or on separate pages at the end of the manuscript)
• A contextual analysis of this data explaining its meaning in sentence form
• All data that corresponds to the central research question(s)
• All secondary findings (secondary outcomes, subgroup analyses, etc.)

If the scope of the study is broad, or if you studied a variety of variables, or if the methodology used yields a wide range of different results, the author should present only those results that are most relevant to the research question stated in the Introduction section .

As a general rule, any information that does not present the direct findings or outcome of the study should be left out of this section. Unless the journal requests that authors combine the Results and Discussion sections, explanations and interpretations should be omitted from the Results.

How are the results organized?

The best way to organize your Results section is “logically.” One logical and clear method of organizing research results is to provide them alongside the research questions—within each research question, present the type of data that addresses that research question.

Let’s look at an example. Your research question is based on a survey among patients who were treated at a hospital and received postoperative care. Let’s say your first research question is:

“What do hospital patients over age 55 think about postoperative care?”

This can actually be represented as a heading within your Results section, though it might be presented as a statement rather than a question:

Attitudes towards postoperative care in patients over the age of 55

Now present the results that address this specific research question first. In this case, perhaps a table illustrating data from a survey. Likert items can be included in this example. Tables can also present standard deviations, probabilities, correlation matrices, etc.

Following this, present a content analysis, in words, of one end of the spectrum of the survey or data table. In our example case, start with the POSITIVE survey responses regarding postoperative care, using descriptive phrases. For example:

“Sixty-five percent of patients over 55 responded positively to the question “ Are you satisfied with your hospital’s postoperative care ?” (Fig. 2)

Include other results such as subcategory analyses. The amount of textual description used will depend on how much interpretation of tables and figures is necessary and how many examples the reader needs in order to understand the significance of your research findings.

Next, present a content analysis of another part of the spectrum of the same research question, perhaps the NEGATIVE or NEUTRAL responses to the survey. For instance:

  “As Figure 1 shows, 15 out of 60 patients in Group A responded negatively to Question 2.”

After you have assessed the data in one figure and explained it sufficiently, move on to your next research question. For example:

  “How does patient satisfaction correspond to in-hospital improvements made to postoperative care?”

This kind of data may be presented through a figure or set of figures (for instance, a paired T-test table).

Explain the data you present, here in a table, with a concise content analysis:

“The p-value for the comparison between the before and after groups of patients was .03% (Fig. 2), indicating that the greater the dissatisfaction among patients, the more frequent the improvements that were made to postoperative care.”

Let’s examine another example of a Results section from a study on plant tolerance to heavy metal stress . In the Introduction section, the aims of the study are presented as “determining the physiological and morphological responses of Allium cepa L. towards increased cadmium toxicity” and “evaluating its potential to accumulate the metal and its associated environmental consequences.” The Results section presents data showing how these aims are achieved in tables alongside a content analysis, beginning with an overview of the findings:

“Cadmium caused inhibition of root and leave elongation, with increasing effects at higher exposure doses (Fig. 1a-c).”

The figure containing this data is cited in parentheses. Note that this author has combined three graphs into one single figure. Separating the data into separate graphs focusing on specific aspects makes it easier for the reader to assess the findings, and consolidating this information into one figure saves space and makes it easy to locate the most relevant results.

Following this overall summary, the relevant data in the tables is broken down into greater detail in text form in the Results section.

• “Results on the bio-accumulation of cadmium were found to be the highest (17.5 mg kgG1) in the bulb, when the concentration of cadmium in the solution was 1×10G2 M and lowest (0.11 mg kgG1) in the leaves when the concentration was 1×10G3 M.”

Captioning and Referencing Tables and Figures

Tables and figures are central components of your Results section and you need to carefully think about the most effective way to use graphs and tables to present your findings . Therefore, it is crucial to know how to write strong figure captions and to refer to them within the text of the Results section.

The most important advice one can give here as well as throughout the paper is to check the requirements and standards of the journal to which you are submitting your work. Every journal has its own design and layout standards, which you can find in the author instructions on the target journal’s website. Perusing a journal’s published articles will also give you an idea of the proper number, size, and complexity of your figures.

Regardless of which format you use, the figures should be placed in the order they are referenced in the Results section and be as clear and easy to understand as possible. If there are multiple variables being considered (within one or more research questions), it can be a good idea to split these up into separate figures. Subsequently, these can be referenced and analyzed under separate headings and paragraphs in the text.

To create a caption, consider the research question being asked and change it into a phrase. For instance, if one question is “Which color did participants choose?”, the caption might be “Color choice by participant group.” Or in our last research paper example, where the question was “What is the concentration of cadmium in different parts of the onion after 14 days?” the caption reads:

 “Fig. 1(a-c): Mean concentration of Cd determined in (a) bulbs, (b) leaves, and (c) roots of onions after a 14-day period.”

Steps for Composing the Results Section

Because each study is unique, there is no one-size-fits-all approach when it comes to designing a strategy for structuring and writing the section of a research paper where findings are presented. The content and layout of this section will be determined by the specific area of research, the design of the study and its particular methodologies, and the guidelines of the target journal and its editors. However, the following steps can be used to compose the results of most scientific research studies and are essential for researchers who are new to preparing a manuscript for publication or who need a reminder of how to construct the Results section.

Step 1 : Consult the guidelines or instructions that the target journal or publisher provides authors and read research papers it has published, especially those with similar topics, methods, or results to your study.

• The guidelines will generally outline specific requirements for the results or findings section, and the published articles will provide sound examples of successful approaches.
• Note length limitations on restrictions on content. For instance, while many journals require the Results and Discussion sections to be separate, others do not—qualitative research papers often include results and interpretations in the same section (“Results and Discussion”).
• Reading the aims and scope in the journal’s “ guide for authors ” section and understanding the interests of its readers will be invaluable in preparing to write the Results section.

Step 2 : Consider your research results in relation to the journal’s requirements and catalogue your results.

• Focus on experimental results and other findings that are especially relevant to your research questions and objectives and include them even if they are unexpected or do not support your ideas and hypotheses.
• Catalogue your findings—use subheadings to streamline and clarify your report. This will help you avoid excessive and peripheral details as you write and also help your reader understand and remember your findings. Create appendices that might interest specialists but prove too long or distracting for other readers.
• Decide how you will structure of your results. You might match the order of the research questions and hypotheses to your results, or you could arrange them according to the order presented in the Methods section. A chronological order or even a hierarchy of importance or meaningful grouping of main themes or categories might prove effective. Consider your audience, evidence, and most importantly, the objectives of your research when choosing a structure for presenting your findings.

Step 3 : Design figures and tables to present and illustrate your data.

• Tables and figures should be numbered according to the order in which they are mentioned in the main text of the paper.
• Information in figures should be relatively self-explanatory (with the aid of captions), and their design should include all definitions and other information necessary for readers to understand the findings without reading all of the text.
• Use tables and figures as a focal point to tell a clear and informative story about your research and avoid repeating information. But remember that while figures clarify and enhance the text, they cannot replace it.

Step 4 : Draft your Results section using the findings and figures you have organized.

• The goal is to communicate this complex information as clearly and precisely as possible; precise and compact phrases and sentences are most effective.
• In the opening paragraph of this section, restate your research questions or aims to focus the reader’s attention to what the results are trying to show. It is also a good idea to summarize key findings at the end of this section to create a logical transition to the interpretation and discussion that follows.
• Try to write in the past tense and the active voice to relay the findings since the research has already been done and the agent is usually clear. This will ensure that your explanations are also clear and logical.
• Make sure that any specialized terminology or abbreviation you have used here has been defined and clarified in the  Introduction section .

Step 5 : Review your draft; edit and revise until it reports results exactly as you would like to have them reported to your readers.

• Double-check the accuracy and consistency of all the data, as well as all of the visual elements included.
• Read your draft aloud to catch language errors (grammar, spelling, and mechanics), awkward phrases, and missing transitions.
• Ensure that your results are presented in the best order to focus on objectives and prepare readers for interpretations, valuations, and recommendations in the Discussion section . Look back over the paper’s Introduction and background while anticipating the Discussion and Conclusion sections to ensure that the presentation of your results is consistent and effective.
• Consider seeking additional guidance on your paper. Find additional readers to look over your Results section and see if it can be improved in any way. Peers, professors, or qualified experts can provide valuable insights.

One excellent option is to use a professional English proofreading and editing service  such as Wordvice, including our paper editing service . With hundreds of qualified editors from dozens of scientific fields, Wordvice has helped thousands of authors revise their manuscripts and get accepted into their target journals. Read more about the  proofreading and editing process  before proceeding with getting academic editing services and manuscript editing services for your manuscript.

As the representation of your study’s data output, the Results section presents the core information in your research paper. By writing with clarity and conciseness and by highlighting and explaining the crucial findings of their study, authors increase the impact and effectiveness of their research manuscripts.

For more articles and videos on writing your research manuscript, visit Wordvice’s Resources page.

Wordvice Resources

• How to Write a Research Paper Introduction 
• Which Verb Tenses to Use in a Research Paper
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• How to Write a Research Paper Title
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• Active and Passive Voice in Research Papers
• 100+ Verbs That Will Make Your Research Writing Amazing
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How to Write the Dissertation Findings or Results – Tips

Published by Grace Graffin at August 11th, 2021 , Revised On August 13, 2024

Each  part of the dissertation is unique, and some general and specific rules must be followed. The dissertation’s findings section presents the key results of your research without interpreting their meaning .

Theoretically, this is an exciting section of a dissertation because it involves writing what you have observed and found. However, it can be a little tricky if there is too much information to confuse the readers.

The goal is to include only the essential and relevant findings in this section. The results must be presented in an orderly sequence to provide clarity to the readers.

This section of the dissertation should be easy for the readers to follow, so you should avoid going into a lengthy debate over the interpretation of the results.

It is vitally important to focus only on clear and precise observations. The findings chapter of the  dissertation  is theoretically the easiest to write.

It includes  statistical analysis and a brief write-up about whether or not the results emerging from the analysis are significant. This segment should be written in the past sentence as you describe what you have done in the past.

This article will provide detailed information about  how to   write the findings of a dissertation .

When to Write Dissertation Findings Chapter

As soon as you have gathered and analysed your data, you can start to write up the findings chapter of your dissertation paper. Remember that it is your chance to report the most notable findings of your research work and relate them to the research hypothesis  or  research questions set out in  the introduction chapter of the dissertation .

You will be required to separately report your study’s findings before moving on to the discussion chapter  if your dissertation is based on the  collection of primary data  or experimental work.

However, you may not be required to have an independent findings chapter if your dissertation is purely descriptive and focuses on the analysis of case studies or interpretation of texts.

• Always report the findings of your research in the past tense.
• The dissertation findings chapter varies from one project to another, depending on the data collected and analyzed.
• Avoid reporting results that are not relevant to your research questions or research hypothesis.

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1. Reporting Quantitative Findings

The best way to present your quantitative findings is to structure them around the research  hypothesis or  questions you intend to address as part of your dissertation project.

Report the relevant findings for each research question or hypothesis, focusing on how you analyzed them.

Analysis of your findings will help you determine how they relate to the different research questions and whether they support the hypothesis you formulated.

While you must highlight meaningful relationships, variances, and tendencies, it is important not to guess their interpretations and implications because this is something to save for the discussion  and  conclusion  chapters.

Any findings not directly relevant to your research questions or explanations concerning the data collection process  should be added to the dissertation paper’s appendix section.

Use of Figures and Tables in Dissertation Findings

Suppose your dissertation is based on quantitative research. In that case, it is important to include charts, graphs, tables, and other visual elements to help your readers understand the emerging trends and relationships in your findings.

Repeating information will give the impression that you are short on ideas. Refer to all charts, illustrations, and tables in your writing but avoid recurrence.

The text should be used only to elaborate and summarize certain parts of your results. On the other hand, illustrations and tables are used to present multifaceted data.

It is recommended to give descriptive labels and captions to all illustrations used so the readers can figure out what each refers to.

How to Report Quantitative Findings

Here is an example of how to report quantitative results in your dissertation findings chapter;

Two hundred seventeen participants completed both the pretest and post-test and a Pairwise T-test was used for the analysis. The quantitative data analysis reveals a statistically significant difference between the mean scores of the pretest and posttest scales from the Teachers Discovering Computers course. The pretest mean was 29.00 with a standard deviation of 7.65, while the posttest mean was 26.50 with a standard deviation of 9.74 (Table 1). These results yield a significance level of .000, indicating a strong treatment effect (see Table 3). With the correlation between the scores being .448, the little relationship is seen between the pretest and posttest scores (Table 2). This leads the researcher to conclude that the impact of the course on the educators’ perception and integration of technology into the curriculum is dramatic.

Paired Samples

Paired Samples Correlation

Paired Samples Test

Also Read: How to Write the Abstract for the Dissertation.

2. Reporting Qualitative Findings

A notable issue with reporting qualitative findings is that not all results directly relate to your research questions or hypothesis.

The best way to present the results of qualitative research is to frame your findings around the most critical areas or themes you obtained after you examined the data.

In-depth data analysis will help you observe what the data shows for each theme. Any developments, relationships, patterns, and independent responses directly relevant to your research question or hypothesis should be mentioned to the readers.

Additional information not directly relevant to your research can be included in the appendix .

How to Report Qualitative Findings

Here is an example of how to report qualitative results in your dissertation findings chapter;

The last question of the interview focused on the need for improvement in Thai ready-to-eat products and the industry at large, emphasizing the need for enhancement in the current products being offered in the market. When asked if there was any particular need for Thai ready-to-eat meals to be improved and how to improve them in case of ‘yes,’ the males replied mainly by saying that the current products need improvement in terms of the use of healthier raw materials and preservatives or additives. There was an agreement amongst all males concerning the need to improve the industry for ready-to-eat meals and the use of more healthy items to prepare such meals. The females were also of the opinion that the fast-food items needed to be improved in the sense that more healthy raw materials such as vegetable oil and unsaturated fats, including whole-wheat products, to overcome risks associated with trans fat leading to obesity and hypertension should be used for the production of RTE products. The frozen RTE meals and packaged snacks included many preservatives and chemical-based flavouring enhancers that harmed human health and needed to be reduced. The industry is said to be aware of this fact and should try to produce RTE products that benefit the community in terms of healthy consumption.

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What to Avoid in Dissertation Findings Chapter

• Avoid using interpretive and subjective phrases and terms such as “confirms,” “reveals,” “suggests,” or “validates.” These terms are more suitable for the discussion chapter , where you will be expected to interpret the results in detail.
• Only briefly explain findings in relation to the key themes, hypothesis, and research questions. You don’t want to write a detailed subjective explanation for any research questions at this stage.

The Do’s of Writing the Findings or Results Section

• Ensure you are not presenting results from other research studies in your findings.
• Observe whether or not your hypothesis is tested or research questions answered.
• Illustrations and tables present data and are labelled to help your readers understand what they relate to.
• Use software such as Excel, STATA, and SPSS to analyse results and important trends.

Essential Guidelines on How to Write Dissertation Findings

The dissertation findings chapter should provide the context for understanding the results. The research problem should be repeated, and the research goals should be stated briefly.

This approach helps to gain the reader’s attention toward the research problem. The first step towards writing the findings is identifying which results will be presented in this section.

The results relevant to the questions must be presented, considering whether the results support the hypothesis. You do not need to include every result in the findings section. The next step is ensuring the data can be appropriately organized and accurate.

You will need to have a basic idea about writing the findings of a dissertation because this will provide you with the knowledge to arrange the data chronologically.

Start each paragraph by writing about the most important results and concluding the section with the most negligible actual results.

A short paragraph can conclude the findings section, summarising the findings so readers will remember as they transition to the next chapter. This is essential if findings are unexpected or unfamiliar or impact the study.

Our writers can help you with all parts of your dissertation, including statistical analysis of your results . To obtain free non-binding quotes, please complete our online quote form here .

Be Impartial in your Writing

When crafting your findings, knowing how you will organize the work is important. The findings are the story that needs to be told in response to the research questions that have been answered.

Therefore, the story needs to be organized to make sense to you and the reader. The findings must be compelling and responsive to be linked to the research questions being answered.

Always ensure that the size and direction of any changes, including percentage change, can be mentioned in the section. The details of p values or confidence intervals and limits should be included.

The findings sections only have the relevant parts of the primary evidence mentioned. Still, it is a good practice to include all the primary evidence in an appendix that can be referred to later.

The results should always be written neutrally without speculation or implication. The statement of the results mustn’t have any form of evaluation or interpretation.

Negative results should be added in the findings section because they validate the results and provide high neutrality levels.

The length of the dissertation findings chapter is an important question that must be addressed. It should be noted that the length of the section is directly related to the total word count of your dissertation paper.

The writer should use their discretion in deciding the length of the findings section or refer to the dissertation handbook or structure guidelines.

It should neither belong nor be short nor concise and comprehensive to highlight the reader’s main findings.

Ethically, you should be confident in the findings and provide counter-evidence. Anything that does not have sufficient evidence should be discarded. The findings should respond to the problem presented and provide a solution to those questions.

Structure of the Findings Chapter

The chapter should use appropriate words and phrases to present the results to the readers. Logical sentences should be used, while paragraphs should be linked to produce cohesive work.

You must ensure all the significant results have been added in the section. Recheck after completing the section to ensure no mistakes have been made.

The structure of the findings section is something you may have to be sure of primarily because it will provide the basis for your research work and ensure that the discussions section can be written clearly and proficiently.

One way to arrange the results is to provide a brief synopsis and then explain the essential findings. However, there should be no speculation or explanation of the results, as this will be done in the discussion section.

Another way to arrange the section is to present and explain a result. This can be done for all the results while the section is concluded with an overall synopsis.

This is the preferred method when you are writing more extended dissertations. It can be helpful when multiple results are equally significant. A brief conclusion should be written to link all the results and transition to the discussion section.

Numerous data analysis dissertation examples are available on the Internet, which will help you improve your understanding of writing the dissertation’s findings.

Problems to Avoid When Writing Dissertation Findings

One of the problems to avoid while writing the dissertation findings is reporting background information or explaining the findings. This should be done in the introduction section .

You can always revise the introduction chapter based on the data you have collected if that seems an appropriate thing to do.

Raw data or intermediate calculations should not be added in the findings section. Always ask your professor if raw data needs to be included.

If the data is to be included, then use an appendix or a set of appendices referred to in the text of the findings chapter.

Do not use vague or non-specific phrases in the findings section. It is important to be factual and concise for the reader’s benefit.

The findings section presents the crucial data collected during the research process. It should be presented concisely and clearly to the reader. There should be no interpretation, speculation, or analysis of the data.

The significant results should be categorized systematically with the text used with charts, figures, and tables. Furthermore, avoiding using vague and non-specific words in this section is essential.

It is essential to label the tables and visual material properly. You should also check and proofread the section to avoid mistakes.

The dissertation findings chapter is a critical part of your overall dissertation paper. If you struggle with presenting your results and statistical analysis, our expert dissertation writers can help you get things right. Whether you need help with the entire dissertation paper or individual chapters, our dissertation experts can provide customized dissertation support .

FAQs About Findings of a Dissertation

How do i report quantitative findings.

The best way to present your quantitative findings is to structure them around the research hypothesis or research questions you intended to address as part of your dissertation project. Report the relevant findings for each of the research questions or hypotheses, focusing on how you analyzed them.

How do I report qualitative findings?

The best way to present the qualitative research results is to frame your findings around the most important areas or themes that you obtained after examining the data.

An in-depth analysis of the data will help you observe what the data is showing for each theme. Any developments, relationships, patterns, and independent responses that are directly relevant to your research question or hypothesis should be clearly mentioned for the readers.

Can I use interpretive phrases like ‘it confirms’ in the finding chapter?

No, It is highly advisable to avoid using interpretive and subjective phrases in the finding chapter. These terms are more suitable for the discussion chapter , where you will be expected to provide your interpretation of the results in detail.

Can I report the results from other research papers in my findings chapter?

NO, you must not be presenting results from other research studies in your findings.

You May Also Like

A literature review is a survey of theses, articles, books and other academic sources. Here are guidelines on how to write dissertation literature review.

Dissertation discussion is where you explore the relevance and significance of results. Here are guidelines to help you write the perfect discussion chapter.

Not sure how to start your dissertation and get it right the first time? Here are some tips and guidelines for you to kick start your dissertation project.

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How To Write The Results/Findings Chapter

For qualitative studies (dissertations & theses).

By: Jenna Crossley (PhD). Expert Reviewed By: Dr. Eunice Rautenbach | August 2021

So, you’ve collected and analysed your qualitative data, and it’s time to write up your results chapter. But where do you start? In this post, we’ll guide you through the qualitative results chapter (also called the findings chapter), step by step. 

Overview: Qualitative Results Chapter

• What (exactly) the qualitative results chapter is
• What to include in your results chapter
• How to write up your results chapter
• A few tips and tricks to help you along the way
• Free results chapter template

What exactly is the results chapter?

The results chapter in a dissertation or thesis (or any formal academic research piece) is where you objectively and neutrally present the findings of your qualitative analysis (or analyses if you used multiple qualitative analysis methods ). This chapter can sometimes be combined with the discussion chapter (where you interpret the data and discuss its meaning), depending on your university’s preference.  We’ll treat the two chapters as separate, as that’s the most common approach.

In contrast to a quantitative results chapter that presents numbers and statistics, a qualitative results chapter presents data primarily in the form of words . But this doesn’t mean that a qualitative study can’t have quantitative elements – you could, for example, present the number of times a theme or topic pops up in your data, depending on the analysis method(s) you adopt.

Adding a quantitative element to your study can add some rigour, which strengthens your results by providing more evidence for your claims. This is particularly common when using qualitative content analysis. Keep in mind though that qualitative research aims to achieve depth, richness and identify nuances , so don’t get tunnel vision by focusing on the numbers. They’re just cream on top in a qualitative analysis.

So, to recap, the results chapter is where you objectively present the findings of your analysis, without interpreting them (you’ll save that for the discussion chapter). With that out the way, let’s take a look at what you should include in your results chapter.

What should you include in the results chapter?

As we’ve mentioned, your qualitative results chapter should purely present and describe your results , not interpret them in relation to the existing literature or your research questions . Any speculations or discussion about the implications of your findings should be reserved for your discussion chapter.

In your results chapter, you’ll want to talk about your analysis findings and whether or not they support your hypotheses (if you have any). Naturally, the exact contents of your results chapter will depend on which qualitative analysis method (or methods) you use. For example, if you were to use thematic analysis, you’d detail the themes identified in your analysis, using extracts from the transcripts or text to support your claims.

While you do need to present your analysis findings in some detail, you should avoid dumping large amounts of raw data in this chapter. Instead, focus on presenting the key findings and using a handful of select quotes or text extracts to support each finding . The reams of data and analysis can be relegated to your appendices.

While it’s tempting to include every last detail you found in your qualitative analysis, it is important to make sure that you report only that which is relevant to your research aims, objectives and research questions .  Always keep these three components, as well as your hypotheses (if you have any) front of mind when writing the chapter and use them as a filter to decide what’s relevant and what’s not.

Need a helping hand?

How do I write the results chapter?

Now that we’ve covered the basics, it’s time to look at how to structure your chapter. Broadly speaking, the results chapter needs to contain three core components – the introduction, the body and the concluding summary. Let’s take a look at each of these.

Section 1: Introduction

The first step is to craft a brief introduction to the chapter. This intro is vital as it provides some context for your findings. In your introduction, you should begin by reiterating your problem statement and research questions and highlight the purpose of your research . Make sure that you spell this out for the reader so that the rest of your chapter is well contextualised.

The next step is to briefly outline the structure of your results chapter. In other words, explain what’s included in the chapter and what the reader can expect. In the results chapter, you want to tell a story that is coherent, flows logically, and is easy to follow , so make sure that you plan your structure out well and convey that structure (at a high level), so that your reader is well oriented.

The introduction section shouldn’t be lengthy. Two or three short paragraphs should be more than adequate. It is merely an introduction and overview, not a summary of the chapter.

Pro Tip – To help you structure your chapter, it can be useful to set up an initial draft with (sub)section headings so that you’re able to easily (re)arrange parts of your chapter. This will also help your reader to follow your results and give your chapter some coherence.  Be sure to use level-based heading styles (e.g. Heading 1, 2, 3 styles) to help the reader differentiate between levels visually. You can find these options in Word (example below).

Section 2: Body

Before we get started on what to include in the body of your chapter, it’s vital to remember that a results section should be completely objective and descriptive, not interpretive . So, be careful not to use words such as, “suggests” or “implies”, as these usually accompany some form of interpretation – that’s reserved for your discussion chapter.

The structure of your body section is very important , so make sure that you plan it out well. When planning out your qualitative results chapter, create sections and subsections so that you can maintain the flow of the story you’re trying to tell. Be sure to systematically and consistently describe each portion of results. Try to adopt a standardised structure for each portion so that you achieve a high level of consistency throughout the chapter.

For qualitative studies, results chapters tend to be structured according to themes , which makes it easier for readers to follow. However, keep in mind that not all results chapters have to be structured in this manner. For example, if you’re conducting a longitudinal study, you may want to structure your chapter chronologically. Similarly, you might structure this chapter based on your theoretical framework . The exact structure of your chapter will depend on the nature of your study , especially your research questions.

As you work through the body of your chapter, make sure that you use quotes to substantiate every one of your claims . You can present these quotes in italics to differentiate them from your own words. A general rule of thumb is to use at least two pieces of evidence per claim, and these should be linked directly to your data. Also, remember that you need to include all relevant results , not just the ones that support your assumptions or initial leanings.

In addition to including quotes, you can also link your claims to the data by using appendices , which you should reference throughout your text. When you reference, make sure that you include both the name/number of the appendix , as well as the line(s) from which you drew your data.

As referencing styles can vary greatly, be sure to look up the appendix referencing conventions of your university’s prescribed style (e.g. APA , Harvard, etc) and keep this consistent throughout your chapter.

Section 3: Concluding summary

The concluding summary is very important because it summarises your key findings and lays the foundation for the discussion chapter . Keep in mind that some readers may skip directly to this section (from the introduction section), so make sure that it can be read and understood well in isolation.

In this section, you need to remind the reader of the key findings. That is, the results that directly relate to your research questions and that you will build upon in your discussion chapter. Remember, your reader has digested a lot of information in this chapter, so you need to use this section to remind them of the most important takeaways.

Importantly, the concluding summary should not present any new information and should only describe what you’ve already presented in your chapter. Keep it concise – you’re not summarising the whole chapter, just the essentials.

Tips for writing an A-grade results chapter

Now that you’ve got a clear picture of what the qualitative results chapter is all about, here are some quick tips and reminders to help you craft a high-quality chapter:

• Your results chapter should be written in the past tense . You’ve done the work already, so you want to tell the reader what you found , not what you are currently finding .
• Make sure that you review your work multiple times and check that every claim is adequately backed up by evidence . Aim for at least two examples per claim, and make use of an appendix to reference these.
• When writing up your results, make sure that you stick to only what is relevant . Don’t waste time on data that are not relevant to your research objectives and research questions.
• Use headings and subheadings to create an intuitive, easy to follow piece of writing. Make use of Microsoft Word’s “heading styles” and be sure to use them consistently.
• When referring to numerical data, tables and figures can provide a useful visual aid. When using these, make sure that they can be read and understood independent of your body text (i.e. that they can stand-alone). To this end, use clear, concise labels for each of your tables or figures and make use of colours to code indicate differences or hierarchy.
• Similarly, when you’re writing up your chapter, it can be useful to highlight topics and themes in different colours . This can help you to differentiate between your data if you get a bit overwhelmed and will also help you to ensure that your results flow logically and coherently.

If you have any questions, leave a comment below and we’ll do our best to help. If you’d like 1-on-1 help with your results chapter (or any chapter of your dissertation or thesis), check out our private dissertation coaching service here or book a free initial consultation to discuss how we can help you.

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21 Comments

This was extremely helpful. Thanks a lot guys

Hi, thanks for the great research support platform created by the gradcoach team!

I wanted to ask- While “suggests” or “implies” are interpretive terms, what terms could we use for the results chapter? Could you share some examples of descriptive terms?

I think that instead of saying, ‘The data suggested, or The data implied,’ you can say, ‘The Data showed or revealed, or illustrated or outlined’…If interview data, you may say Jane Doe illuminated or elaborated, or Jane Doe described… or Jane Doe expressed or stated.

I found this article very useful. Thank you very much for the outstanding work you are doing.

What if i have 3 different interviewees answering the same interview questions? Should i then present the results in form of the table with the division on the 3 perspectives or rather give a results in form of the text and highlight who said what?

I think this tabular representation of results is a great idea. I am doing it too along with the text. Thanks

That was helpful was struggling to separate the discussion from the findings

this was very useful, Thank you.

Very helpful, I am confident to write my results chapter now.

It is so helpful! It is a good job. Thank you very much!

Very useful, well explained. Many thanks.

Hello, I appreciate the way you provided a supportive comments about qualitative results presenting tips

I loved this! It explains everything needed, and it has helped me better organize my thoughts. What words should I not use while writing my results section, other than subjective ones.

Thanks a lot, it is really helpful

Thank you so much dear, i really appropriate your nice explanations about this.

Thank you so much for this! I was wondering if anyone could help with how to prproperly integrate quotations (Excerpts) from interviews in the finding chapter in a qualitative research. Please GradCoach, address this issue and provide examples.

what if I’m not doing any interviews myself and all the information is coming from case studies that have already done the research.

Very helpful thank you.

This was very helpful as I was wondering how to structure this part of my dissertation, to include the quotes… Thanks for this explanation

This is very helpful, thanks! I am required to write up my results chapters with the discussion in each of them – any tips and tricks for this strategy?

For qualitative studies, can the findings be structured according to the Research questions? Thank you.

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Sampling Methods In Reseach: Types, Techniques, & Examples

Saul McLeod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Sampling methods in psychology refer to strategies used to select a subset of individuals (a sample) from a larger population, to study and draw inferences about the entire population. Common methods include random sampling, stratified sampling, cluster sampling, and convenience sampling. Proper sampling ensures representative, generalizable, and valid research results.

• Sampling : the process of selecting a representative group from the population under study.
• Target population : the total group of individuals from which the sample might be drawn.
• Sample: a subset of individuals selected from a larger population for study or investigation. Those included in the sample are termed “participants.”
• Generalizability : the ability to apply research findings from a sample to the broader target population, contingent on the sample being representative of that population.

For instance, if the advert for volunteers is published in the New York Times, this limits how much the study’s findings can be generalized to the whole population, because NYT readers may not represent the entire population in certain respects (e.g., politically, socio-economically).

The Purpose of Sampling

We are interested in learning about large groups of people with something in common in psychological research. We call the group interested in studying our “target population.”

In some types of research, the target population might be as broad as all humans. Still, in other types of research, the target population might be a smaller group, such as teenagers, preschool children, or people who misuse drugs.

Studying every person in a target population is more or less impossible. Hence, psychologists select a sample or sub-group of the population that is likely to be representative of the target population we are interested in.

This is important because we want to generalize from the sample to the target population. The more representative the sample, the more confident the researcher can be that the results can be generalized to the target population.

One of the problems that can occur when selecting a sample from a target population is sampling bias. Sampling bias refers to situations where the sample does not reflect the characteristics of the target population.

Many psychology studies have a biased sample because they have used an opportunity sample that comprises university students as their participants (e.g., Asch ).

OK, so you’ve thought up this brilliant psychological study and designed it perfectly. But who will you try it out on, and how will you select your participants?

There are various sampling methods. The one chosen will depend on a number of factors (such as time, money, etc.).

Random Sampling

Random sampling is a type of probability sampling where everyone in the entire target population has an equal chance of being selected.

This is similar to the national lottery. If the “population” is everyone who bought a lottery ticket, then everyone has an equal chance of winning the lottery (assuming they all have one ticket each).

Random samples require naming or numbering the target population and then using some raffle method to choose those to make up the sample. Random samples are the best method of selecting your sample from the population of interest.

• The advantages are that your sample should represent the target population and eliminate sampling bias.
• The disadvantage is that it is very difficult to achieve (i.e., time, effort, and money).

Stratified Sampling

During stratified sampling , the researcher identifies the different types of people that make up the target population and works out the proportions needed for the sample to be representative.

A list is made of each variable (e.g., IQ, gender, etc.) that might have an effect on the research. For example, if we are interested in the money spent on books by undergraduates, then the main subject studied may be an important variable.

For example, students studying English Literature may spend more money on books than engineering students, so if we use a large percentage of English students or engineering students, our results will not be accurate.

We have to determine the relative percentage of each group at a university, e.g., Engineering 10%, Social Sciences 15%, English 20%, Sciences 25%, Languages 10%, Law 5%, and Medicine 15%. The sample must then contain all these groups in the same proportion as the target population (university students).

• The disadvantage of stratified sampling is that gathering such a sample would be extremely time-consuming and difficult to do. This method is rarely used in Psychology.
• However, the advantage is that the sample should be highly representative of the target population, and therefore we can generalize from the results obtained.

Opportunity Sampling

Opportunity sampling is a method in which participants are chosen based on their ease of availability and proximity to the researcher, rather than using random or systematic criteria. It’s a type of convenience sampling .

An opportunity sample is obtained by asking members of the population of interest if they would participate in your research. An example would be selecting a sample of students from those coming out of the library.

• This is a quick and easy way of choosing participants (advantage)
• It may not provide a representative sample and could be biased (disadvantage).

Systematic Sampling

Systematic sampling is a method where every nth individual is selected from a list or sequence to form a sample, ensuring even and regular intervals between chosen subjects.

Participants are systematically selected (i.e., orderly/logical) from the target population, like every nth participant on a list of names.

To take a systematic sample, you list all the population members and then decide upon a sample you would like. By dividing the number of people in the population by the number of people you want in your sample, you get a number we will call n.

If you take every nth name, you will get a systematic sample of the correct size. If, for example, you wanted to sample 150 children from a school of 1,500, you would take every 10th name.

• The advantage of this method is that it should provide a representative sample.

Sample size

The sample size is a critical factor in determining the reliability and validity of a study’s findings. While increasing the sample size can enhance the generalizability of results, it’s also essential to balance practical considerations, such as resource constraints and diminishing returns from ever-larger samples.

Reliability and Validity

Reliability refers to the consistency and reproducibility of research findings across different occasions, researchers, or instruments. A small sample size may lead to inconsistent results due to increased susceptibility to random error or the influence of outliers. In contrast, a larger sample minimizes these errors, promoting more reliable results.

Validity pertains to the accuracy and truthfulness of research findings. For a study to be valid, it should accurately measure what it intends to do. A small, unrepresentative sample can compromise external validity, meaning the results don’t generalize well to the larger population. A larger sample captures more variability, ensuring that specific subgroups or anomalies don’t overly influence results.

Practical Considerations

Resource Constraints : Larger samples demand more time, money, and resources. Data collection becomes more extensive, data analysis more complex, and logistics more challenging.

Diminishing Returns : While increasing the sample size generally leads to improved accuracy and precision, there’s a point where adding more participants yields only marginal benefits. For instance, going from 50 to 500 participants might significantly boost a study’s robustness, but jumping from 10,000 to 10,500 might not offer a comparable advantage, especially considering the added costs.

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Cochrane Training

Chapter 14: completing ‘summary of findings’ tables and grading the certainty of the evidence.

Holger J Schünemann, Julian PT Higgins, Gunn E Vist, Paul Glasziou, Elie A Akl, Nicole Skoetz, Gordon H Guyatt; on behalf of the Cochrane GRADEing Methods Group (formerly Applicability and Recommendations Methods Group) and the Cochrane Statistical Methods Group

Key Points:

• A ‘Summary of findings’ table for a given comparison of interventions provides key information concerning the magnitudes of relative and absolute effects of the interventions examined, the amount of available evidence and the certainty (or quality) of available evidence.
• ‘Summary of findings’ tables include a row for each important outcome (up to a maximum of seven). Accepted formats of ‘Summary of findings’ tables and interactive ‘Summary of findings’ tables can be produced using GRADE’s software GRADEpro GDT.
• Cochrane has adopted the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) for assessing certainty (or quality) of a body of evidence.
• The GRADE approach specifies four levels of the certainty for a body of evidence for a given outcome: high, moderate, low and very low.
• GRADE assessments of certainty are determined through consideration of five domains: risk of bias, inconsistency, indirectness, imprecision and publication bias. For evidence from non-randomized studies and rarely randomized studies, assessments can then be upgraded through consideration of three further domains.

Cite this chapter as: Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, Guyatt GH. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from www.training.cochrane.org/handbook .

14.1 ‘Summary of findings’ tables

14.1.1 introduction to ‘summary of findings’ tables.

‘Summary of findings’ tables present the main findings of a review in a transparent, structured and simple tabular format. In particular, they provide key information concerning the certainty or quality of evidence (i.e. the confidence or certainty in the range of an effect estimate or an association), the magnitude of effect of the interventions examined, and the sum of available data on the main outcomes. Cochrane Reviews should incorporate ‘Summary of findings’ tables during planning and publication, and should have at least one key ‘Summary of findings’ table representing the most important comparisons. Some reviews may include more than one ‘Summary of findings’ table, for example if the review addresses more than one major comparison, or includes substantially different populations that require separate tables (e.g. because the effects differ or it is important to show results separately). In the Cochrane Database of Systematic Reviews (CDSR),  all ‘Summary of findings’ tables for a review appear at the beginning, before the Background section.

14.1.2 Selecting outcomes for ‘Summary of findings’ tables

Planning for the ‘Summary of findings’ table starts early in the systematic review, with the selection of the outcomes to be included in: (i) the review; and (ii) the ‘Summary of findings’ table. This is a crucial step, and one that review authors need to address carefully.

To ensure production of optimally useful information, Cochrane Reviews begin by developing a review question and by listing all main outcomes that are important to patients and other decision makers (see Chapter 2 and Chapter 3 ). The GRADE approach to assessing the certainty of the evidence (see Section 14.2 ) defines and operationalizes a rating process that helps separate outcomes into those that are critical, important or not important for decision making. Consultation and feedback on the review protocol, including from consumers and other decision makers, can enhance this process.

Critical outcomes are likely to include clearly important endpoints; typical examples include mortality and major morbidity (such as strokes and myocardial infarction). However, they may also represent frequent minor and rare major side effects, symptoms, quality of life, burdens associated with treatment, and resource issues (costs). Burdens represent the impact of healthcare workload on patient function and well-being, and include the demands of adhering to an intervention that patients or caregivers (e.g. family) may dislike, such as having to undergo more frequent tests, or the restrictions on lifestyle that certain interventions require (Spencer-Bonilla et al 2017).

Frequently, when formulating questions that include all patient-important outcomes for decision making, review authors will confront reports of studies that have not included all these outcomes. This is particularly true for adverse outcomes. For instance, randomized trials might contribute evidence on intended effects, and on frequent, relatively minor side effects, but not report on rare adverse outcomes such as suicide attempts. Chapter 19 discusses strategies for addressing adverse effects. To obtain data for all important outcomes it may be necessary to examine the results of non-randomized studies (see Chapter 24 ). Cochrane, in collaboration with others, has developed guidance for review authors to support their decision about when to look for and include non-randomized studies (Schünemann et al 2013).

If a review includes only randomized trials, these trials may not address all important outcomes and it may therefore not be possible to address these outcomes within the constraints of the review. Review authors should acknowledge these limitations and make them transparent to readers. Review authors are encouraged to include non-randomized studies to examine rare or long-term adverse effects that may not adequately be studied in randomized trials. This raises the possibility that harm outcomes may come from studies in which participants differ from those in studies used in the analysis of benefit. Review authors will then need to consider how much such differences are likely to impact on the findings, and this will influence the certainty of evidence because of concerns about indirectness related to the population (see Section 14.2.2 ).

Non-randomized studies can provide important information not only when randomized trials do not report on an outcome or randomized trials suffer from indirectness, but also when the evidence from randomized trials is rated as very low and non-randomized studies provide evidence of higher certainty. Further discussion of these issues appears also in Chapter 24 .

14.1.3 General template for ‘Summary of findings’ tables

Several alternative standard versions of ‘Summary of findings’ tables have been developed to ensure consistency and ease of use across reviews, inclusion of the most important information needed by decision makers, and optimal presentation (see examples at Figures 14.1.a and 14.1.b ). These formats are supported by research that focused on improved understanding of the information they intend to convey (Carrasco-Labra et al 2016, Langendam et al 2016, Santesso et al 2016). They are available through GRADE’s official software package developed to support the GRADE approach: GRADEpro GDT (www.gradepro.org).

Standard Cochrane ‘Summary of findings’ tables include the following elements using one of the accepted formats. Further guidance on each of these is provided in Section 14.1.6 .

• A brief description of the population and setting addressed by the available evidence (which may be slightly different to or narrower than those defined by the review question).
• A brief description of the comparison addressed in the ‘Summary of findings’ table, including both the experimental and comparison interventions.
• A list of the most critical and/or important health outcomes, both desirable and undesirable, limited to seven or fewer outcomes.
• A measure of the typical burden of each outcomes (e.g. illustrative risk, or illustrative mean, on comparator intervention).
• The absolute and relative magnitude of effect measured for each (if both are appropriate).
• The numbers of participants and studies contributing to the analysis of each outcomes.
• A GRADE assessment of the overall certainty of the body of evidence for each outcome (which may vary by outcome).
• Space for comments.
• Explanations (formerly known as footnotes).

Ideally, ‘Summary of findings’ tables are supported by more detailed tables (known as ‘evidence profiles’) to which the review may be linked, which provide more detailed explanations. Evidence profiles include the same important health outcomes, and provide greater detail than ‘Summary of findings’ tables of both of the individual considerations feeding into the grading of certainty and of the results of the studies (Guyatt et al 2011a). They ensure that a structured approach is used to rating the certainty of evidence. Although they are rarely published in Cochrane Reviews, evidence profiles are often used, for example, by guideline developers in considering the certainty of the evidence to support guideline recommendations. Review authors will find it easier to develop the ‘Summary of findings’ table by completing the rating of the certainty of evidence in the evidence profile first in GRADEpro GDT. They can then automatically convert this to one of the ‘Summary of findings’ formats in GRADEpro GDT, including an interactive ‘Summary of findings’ for publication.

As a measure of the magnitude of effect for dichotomous outcomes, the ‘Summary of findings’ table should provide a relative measure of effect (e.g. risk ratio, odds ratio, hazard) and measures of absolute risk. For other types of data, an absolute measure alone (such as a difference in means for continuous data) might be sufficient. It is important that the magnitude of effect is presented in a meaningful way, which may require some transformation of the result of a meta-analysis (see also Chapter 15, Section 15.4 and Section 15.5 ). Reviews with more than one main comparison should include a separate ‘Summary of findings’ table for each comparison.

Figure 14.1.a provides an example of a ‘Summary of findings’ table. Figure 15.1.b  provides an alternative format that may further facilitate users’ understanding and interpretation of the review’s findings. Evidence evaluating different formats suggests that the ‘Summary of findings’ table should include a risk difference as a measure of the absolute effect and authors should preferably use a format that includes a risk difference .

A detailed description of the contents of a ‘Summary of findings’ table appears in Section 14.1.6 .

Figure 14.1.a Example of a ‘Summary of findings’ table

Summary of findings (for interactive version click here )

a All the stockings in the nine studies included in this review were below-knee compression stockings. In four studies the compression strength was 20 mmHg to 30 mmHg at the ankle. It was 10 mmHg to 20 mmHg in the other four studies. Stockings come in different sizes. If a stocking is too tight around the knee it can prevent essential venous return causing the blood to pool around the knee. Compression stockings should be fitted properly. A stocking that is too tight could cut into the skin on a long flight and potentially cause ulceration and increased risk of DVT. Some stockings can be slightly thicker than normal leg covering and can be potentially restrictive with tight foot wear. It is a good idea to wear stockings around the house prior to travel to ensure a good, comfortable fit. Participants put their stockings on two to three hours before the flight in most of the studies. The availability and cost of stockings can vary.

b Two studies recruited high risk participants defined as those with previous episodes of DVT, coagulation disorders, severe obesity, limited mobility due to bone or joint problems, neoplastic disease within the previous two years, large varicose veins or, in one of the studies, participants taller than 190 cm and heavier than 90 kg. The incidence for the seven studies that excluded high risk participants was 1.45% and the incidence for the two studies that recruited high-risk participants (with at least one risk factor) was 2.43%. We have used 10 and 30 per 1000 to express different risk strata, respectively.

c The confidence interval crosses no difference and does not rule out a small increase.

d The measurement of oedema was not validated (indirectness of the outcome) or blinded to the intervention (risk of bias).

e If there are very few or no events and the number of participants is large, judgement about the certainty of evidence (particularly judgements about imprecision) may be based on the absolute effect. Here the certainty rating may be considered ‘high’ if the outcome was appropriately assessed and the event, in fact, did not occur in 2821 studied participants.

f None of the other studies reported adverse effects, apart from four cases of superficial vein thrombosis in varicose veins in the knee region that were compressed by the upper edge of the stocking in one study.

Figure 14.1.b Example of alternative ‘Summary of findings’ table

14.1.4 Producing ‘Summary of findings’ tables

The GRADE Working Group’s software, GRADEpro GDT ( www.gradepro.org ), including GRADE’s interactive handbook, is available to assist review authors in the preparation of ‘Summary of findings’ tables. GRADEpro can use data on the comparator group risk and the effect estimate (entered by the review authors or imported from files generated in RevMan) to produce the relative effects and absolute risks associated with experimental interventions. In addition, it leads the user through the process of a GRADE assessment, and produces a table that can be used as a standalone table in a review (including by direct import into software such as RevMan or integration with RevMan Web), or an interactive ‘Summary of findings’ table (see help resources in GRADEpro).

14.1.5 Statistical considerations in ‘Summary of findings’ tables

14.1.5.1 dichotomous outcomes.

‘Summary of findings’ tables should include both absolute and relative measures of effect for dichotomous outcomes. Risk ratios, odds ratios and risk differences are different ways of comparing two groups with dichotomous outcome data (see Chapter 6, Section 6.4.1 ). Furthermore, there are two distinct risk ratios, depending on which event (e.g. ‘yes’ or ‘no’) is the focus of the analysis (see Chapter 6, Section 6.4.1.5 ). In the presence of a non-zero intervention effect, any variation across studies in the comparator group risks (i.e. variation in the risk of the event occurring without the intervention of interest, for example in different populations) makes it impossible for more than one of these measures to be truly the same in every study.

It has long been assumed in epidemiology that relative measures of effect are more consistent than absolute measures of effect from one scenario to another. There is empirical evidence to support this assumption (Engels et al 2000, Deeks and Altman 2001, Furukawa et al 2002). For this reason, meta-analyses should generally use either a risk ratio or an odds ratio as a measure of effect (see Chapter 10, Section 10.4.3 ). Correspondingly, a single estimate of relative effect is likely to be a more appropriate summary than a single estimate of absolute effect. If a relative effect is indeed consistent across studies, then different comparator group risks will have different implications for absolute benefit. For instance, if the risk ratio is consistently 0.75, then the experimental intervention would reduce a comparator group risk of 80% to 60% in the intervention group (an absolute risk reduction of 20 percentage points), but would also reduce a comparator group risk of 20% to 15% in the intervention group (an absolute risk reduction of 5 percentage points).

‘Summary of findings’ tables are built around the assumption of a consistent relative effect. It is therefore important to consider the implications of this effect for different comparator group risks (these can be derived or estimated from a number of sources, see Section 14.1.6.3 ), which may require an assessment of the certainty of evidence for prognostic evidence (Spencer et al 2012, Iorio et al 2015). For any comparator group risk, it is possible to estimate a corresponding intervention group risk (i.e. the absolute risk with the intervention) from the meta-analytic risk ratio or odds ratio. Note that the numbers provided in the ‘Corresponding risk’ column are specific to the ‘risks’ in the adjacent column.

For the meta-analytic risk ratio (RR) and assumed comparator risk (ACR) the corresponding intervention risk is obtained as:

As an example, in Figure 14.1.a , the meta-analytic risk ratio for symptomless deep vein thrombosis (DVT) is RR = 0.10 (95% CI 0.04 to 0.26). Assuming a comparator risk of ACR = 10 per 1000 = 0.01, we obtain:

For the meta-analytic odds ratio (OR) and assumed comparator risk, ACR, the corresponding intervention risk is obtained as:

Upper and lower confidence limits for the corresponding intervention risk are obtained by replacing RR or OR by their upper and lower confidence limits, respectively (e.g. replacing 0.10 with 0.04, then with 0.26, in the example). Such confidence intervals do not incorporate uncertainty in the assumed comparator risks.

When dealing with risk ratios, it is critical that the same definition of ‘event’ is used as was used for the meta-analysis. For example, if the meta-analysis focused on ‘death’ (as opposed to survival) as the event, then corresponding risks in the ‘Summary of findings’ table must also refer to ‘death’.

In (rare) circumstances in which there is clear rationale to assume a consistent risk difference in the meta-analysis, in principle it is possible to present this for relevant ‘assumed risks’ and their corresponding risks, and to present the corresponding (different) relative effects for each assumed risk.

The risk difference expresses the difference between the ACR and the corresponding intervention risk (or the difference between the experimental and the comparator intervention).

For the meta-analytic risk ratio (RR) and assumed comparator risk (ACR) the corresponding risk difference is obtained as (note that risks can also be expressed using percentage or percentage points):

As an example, in Figure 14.1.b the meta-analytic risk ratio is 0.41 (95% CI 0.29 to 0.55) for diarrhoea in children less than 5 years of age. Assuming a comparator group risk of 22.3% we obtain:

For the meta-analytic odds ratio (OR) and assumed comparator risk (ACR) the absolute risk difference is obtained as (percentage points):

Upper and lower confidence limits for the absolute risk difference are obtained by re-running the calculation above while replacing RR or OR by their upper and lower confidence limits, respectively (e.g. replacing 0.41 with 0.28, then with 0.55, in the example). Such confidence intervals do not incorporate uncertainty in the assumed comparator risks.

14.1.5.2 Time-to-event outcomes

Time-to-event outcomes measure whether and when a particular event (e.g. death) occurs (van Dalen et al 2007). The impact of the experimental intervention relative to the comparison group on time-to-event outcomes is usually measured using a hazard ratio (HR) (see Chapter 6, Section 6.8.1 ).

A hazard ratio expresses a relative effect estimate. It may be used in various ways to obtain absolute risks and other interpretable quantities for a specific population. Here we describe how to re-express hazard ratios in terms of: (i) absolute risk of event-free survival within a particular period of time; (ii) absolute risk of an event within a particular period of time; and (iii) median time to the event. All methods are built on an assumption of consistent relative effects (i.e. that the hazard ratio does not vary over time).

(i) Absolute risk of event-free survival within a particular period of time Event-free survival (e.g. overall survival) is commonly reported by individual studies. To obtain absolute effects for time-to-event outcomes measured as event-free survival, the summary HR can be used in conjunction with an assumed proportion of patients who are event-free in the comparator group (Tierney et al 2007). This proportion of patients will be specific to a period of time of observation. However, it is not strictly necessary to specify this period of time. For instance, a proportion of 50% of event-free patients might apply to patients with a high event rate observed over 1 year, or to patients with a low event rate observed over 2 years.

As an example, suppose the meta-analytic hazard ratio is 0.42 (95% CI 0.25 to 0.72). Assuming a comparator group risk of event-free survival (e.g. for overall survival people being alive) at 2 years of ACR = 900 per 1000 = 0.9 we obtain:

so that that 956 per 1000 people will be alive with the experimental intervention at 2 years. The derivation of the risk should be explained in a comment or footnote.

(ii) Absolute risk of an event within a particular period of time To obtain this absolute effect, again the summary HR can be used (Tierney et al 2007):

In the example, suppose we assume a comparator group risk of events (e.g. for mortality, people being dead) at 2 years of ACR = 100 per 1000 = 0.1. We obtain:

so that that 44 per 1000 people will be dead with the experimental intervention at 2 years.

(iii) Median time to the event Instead of absolute numbers, the time to the event in the intervention and comparison groups can be expressed as median survival time in months or years. To obtain median survival time the pooled HR can be applied to an assumed median survival time in the comparator group (Tierney et al 2007):

In the example, assuming a comparator group median survival time of 80 months, we obtain:

For all three of these options for re-expressing results of time-to-event analyses, upper and lower confidence limits for the corresponding intervention risk are obtained by replacing HR by its upper and lower confidence limits, respectively (e.g. replacing 0.42 with 0.25, then with 0.72, in the example). Again, as for dichotomous outcomes, such confidence intervals do not incorporate uncertainty in the assumed comparator group risks. This is of special concern for long-term survival with a low or moderate mortality rate and a corresponding high number of censored patients (i.e. a low number of patients under risk and a high censoring rate).

14.1.6 Detailed contents of a ‘Summary of findings’ table

14.1.6.1 table title and header.

The title of each ‘Summary of findings’ table should specify the healthcare question, framed in terms of the population and making it clear exactly what comparison of interventions are made. In Figure 14.1.a , the population is people taking long aeroplane flights, the intervention is compression stockings, and the control is no compression stockings.

The first rows of each ‘Summary of findings’ table should provide the following ‘header’ information:

Patients or population This further clarifies the population (and possibly the subpopulations) of interest and ideally the magnitude of risk of the most crucial adverse outcome at which an intervention is directed. For instance, people on a long-haul flight may be at different risks for DVT; those using selective serotonin reuptake inhibitors (SSRIs) might be at different risk for side effects; while those with atrial fibrillation may be at low (< 1%), moderate (1% to 4%) or high (> 4%) yearly risk of stroke.

Setting This should state any specific characteristics of the settings of the healthcare question that might limit the applicability of the summary of findings to other settings (e.g. primary care in Europe and North America).

Intervention The experimental intervention.

Comparison The comparator intervention (including no specific intervention).

14.1.6.2 Outcomes

The rows of a ‘Summary of findings’ table should include all desirable and undesirable health outcomes (listed in order of importance) that are essential for decision making, up to a maximum of seven outcomes. If there are more outcomes in the review, review authors will need to omit the less important outcomes from the table, and the decision selecting which outcomes are critical or important to the review should be made during protocol development (see Chapter 3 ). Review authors should provide time frames for the measurement of the outcomes (e.g. 90 days or 12 months) and the type of instrument scores (e.g. ranging from 0 to 100).

Note that review authors should include the pre-specified critical and important outcomes in the table whether data are available or not. However, they should be alert to the possibility that the importance of an outcome (e.g. a serious adverse effect) may only become known after the protocol was written or the analysis was carried out, and should take appropriate actions to include these in the ‘Summary of findings’ table.

The ‘Summary of findings’ table can include effects in subgroups of the population for different comparator risks and effect sizes separately. For instance, in Figure 14.1.b effects are presented for children younger and older than 5 years separately. Review authors may also opt to produce separate ‘Summary of findings’ tables for different populations.

Review authors should include serious adverse events, but it might be possible to combine minor adverse events as a single outcome, and describe this in an explanatory footnote (note that it is not appropriate to add events together unless they are independent, that is, a participant who has experienced one adverse event has an unaffected chance of experiencing the other adverse event).

Outcomes measured at multiple time points represent a particular problem. In general, to keep the table simple, review authors should present multiple time points only for outcomes critical to decision making, where either the result or the decision made are likely to vary over time. The remainder should be presented at a common time point where possible.

Review authors can present continuous outcome measures in the ‘Summary of findings’ table and should endeavour to make these interpretable to the target audience. This requires that the units are clear and readily interpretable, for example, days of pain, or frequency of headache, and the name and scale of any measurement tools used should be stated (e.g. a Visual Analogue Scale, ranging from 0 to 100). However, many measurement instruments are not readily interpretable by non-specialist clinicians or patients, for example, points on a Beck Depression Inventory or quality of life score. For these, a more interpretable presentation might involve converting a continuous to a dichotomous outcome, such as >50% improvement (see Chapter 15, Section 15.5 ).

14.1.6.3 Best estimate of risk with comparator intervention

Review authors should provide up to three typical risks for participants receiving the comparator intervention. For dichotomous outcomes, we recommend that these be presented in the form of the number of people experiencing the event per 100 or 1000 people (natural frequency) depending on the frequency of the outcome. For continuous outcomes, this would be stated as a mean or median value of the outcome measured.

Estimated or assumed comparator intervention risks could be based on assessments of typical risks in different patient groups derived from the review itself, individual representative studies in the review, or risks derived from a systematic review of prognosis studies or other sources of evidence which may in turn require an assessment of the certainty for the prognostic evidence (Spencer et al 2012, Iorio et al 2015). Ideally, risks would reflect groups that clinicians can easily identify on the basis of their presenting features.

An explanatory footnote should specify the source or rationale for each comparator group risk, including the time period to which it corresponds where appropriate. In Figure 14.1.a , clinicians can easily differentiate individuals with risk factors for deep venous thrombosis from those without. If there is known to be little variation in baseline risk then review authors may use the median comparator group risk across studies. If typical risks are not known, an option is to choose the risk from the included studies, providing the second highest for a high and the second lowest for a low risk population.

14.1.6.4 Risk with intervention

For dichotomous outcomes, review authors should provide a corresponding absolute risk for each comparator group risk, along with a confidence interval. This absolute risk with the (experimental) intervention will usually be derived from the meta-analysis result presented in the relative effect column (see Section 14.1.6.6 ). Formulae are provided in Section 14.1.5 . Review authors should present the absolute effect in the same format as the risks with comparator intervention (see Section 14.1.6.3 ), for example as the number of people experiencing the event per 1000 people.

For continuous outcomes, a difference in means or standardized difference in means should be presented with its confidence interval. These will typically be obtained directly from a meta-analysis. Explanatory text should be used to clarify the meaning, as in Figures 14.1.a and 14.1.b .

14.1.6.5 Risk difference

For dichotomous outcomes, the risk difference can be provided using one of the ‘Summary of findings’ table formats as an additional option (see Figure 14.1.b ). This risk difference expresses the difference between the experimental and comparator intervention and will usually be derived from the meta-analysis result presented in the relative effect column (see Section 14.1.6.6 ). Formulae are provided in Section 14.1.5 . Review authors should present the risk difference in the same format as assumed and corresponding risks with comparator intervention (see Section 14.1.6.3 ); for example, as the number of people experiencing the event per 1000 people or as percentage points if the assumed and corresponding risks are expressed in percentage.

For continuous outcomes, if the ‘Summary of findings’ table includes this option, the mean difference can be presented here and the ‘corresponding risk’ column left blank (see Figure 14.1.b ).

14.1.6.6 Relative effect (95% CI)

The relative effect will typically be a risk ratio or odds ratio (or occasionally a hazard ratio) with its accompanying 95% confidence interval, obtained from a meta-analysis performed on the basis of the same effect measure. Risk ratios and odds ratios are similar when the comparator intervention risks are low and effects are small, but may differ considerably when comparator group risks increase. The meta-analysis may involve an assumption of either fixed or random effects, depending on what the review authors consider appropriate, and implying that the relative effect is either an estimate of the effect of the intervention, or an estimate of the average effect of the intervention across studies, respectively.

14.1.6.7 Number of participants (studies)

This column should include the number of participants assessed in the included studies for each outcome and the corresponding number of studies that contributed these participants.

14.1.6.8 Certainty of the evidence (GRADE)

Review authors should comment on the certainty of the evidence (also known as quality of the body of evidence or confidence in the effect estimates). Review authors should use the specific evidence grading system developed by the GRADE Working Group (Atkins et al 2004, Guyatt et al 2008, Guyatt et al 2011a), which is described in detail in Section 14.2 . The GRADE approach categorizes the certainty in a body of evidence as ‘high’, ‘moderate’, ‘low’ or ‘very low’ by outcome. This is a result of judgement, but the judgement process operates within a transparent structure. As an example, the certainty would be ‘high’ if the summary were of several randomized trials with low risk of bias, but the rating of certainty becomes lower if there are concerns about risk of bias, inconsistency, indirectness, imprecision or publication bias. Judgements other than of ‘high’ certainty should be made transparent using explanatory footnotes or the ‘Comments’ column in the ‘Summary of findings’ table (see Section 14.1.6.10 ).

14.1.6.9 Comments

The aim of the ‘Comments’ field is to help interpret the information or data identified in the row. For example, this may be on the validity of the outcome measure or the presence of variables that are associated with the magnitude of effect. Important caveats about the results should be flagged here. Not all rows will need comments, and it is best to leave a blank if there is nothing warranting a comment.

14.1.6.10 Explanations

Detailed explanations should be included as footnotes to support the judgements in the ‘Summary of findings’ table, such as the overall GRADE assessment. The explanations should describe the rationale for important aspects of the content. Table 14.1.a lists guidance for useful explanations. Explanations should be concise, informative, relevant, easy to understand and accurate. If explanations cannot be sufficiently described in footnotes, review authors should provide further details of the issues in the Results and Discussion sections of the review.

Table 14.1.a Guidance for providing useful explanations in ‘Summary of findings’ (SoF) tables. Adapted from Santesso et al (2016)

14.2 Assessing the certainty or quality of a body of evidence

14.2.1 the grade approach.

The Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE Working Group) has developed a system for grading the certainty of evidence (Schünemann et al 2003, Atkins et al 2004, Schünemann et al 2006, Guyatt et al 2008, Guyatt et al 2011a). Over 100 organizations including the World Health Organization (WHO), the American College of Physicians, the American Society of Hematology (ASH), the Canadian Agency for Drugs and Technology in Health (CADTH) and the National Institutes of Health and Clinical Excellence (NICE) in the UK have adopted the GRADE system ( www.gradeworkinggroup.org ).

Cochrane has also formally adopted this approach, and all Cochrane Reviews should use GRADE to evaluate the certainty of evidence for important outcomes (see MECIR Box 14.2.a ).

MECIR Box 14.2.a Relevant expectations for conduct of intervention reviews

For systematic reviews, the GRADE approach defines the certainty of a body of evidence as the extent to which one can be confident that an estimate of effect or association is close to the quantity of specific interest. Assessing the certainty of a body of evidence involves consideration of within- and across-study risk of bias (limitations in study design and execution or methodological quality), inconsistency (or heterogeneity), indirectness of evidence, imprecision of the effect estimates and risk of publication bias (see Section 14.2.2 ), as well as domains that may increase our confidence in the effect estimate (as described in Section 14.2.3 ). The GRADE system entails an assessment of the certainty of a body of evidence for each individual outcome. Judgements about the domains that determine the certainty of evidence should be described in the results or discussion section and as part of the ‘Summary of findings’ table.

The GRADE approach specifies four levels of certainty ( Figure 14.2.a ). For interventions, including diagnostic and other tests that are evaluated as interventions (Schünemann et al 2008b, Schünemann et al 2008a, Balshem et al 2011, Schünemann et al 2012), the starting point for rating the certainty of evidence is categorized into two types:

• randomized trials; and
• non-randomized studies of interventions (NRSI), including observational studies (including but not limited to cohort studies, and case-control studies, cross-sectional studies, case series and case reports, although not all of these designs are usually included in Cochrane Reviews).

There are many instances in which review authors rely on information from NRSI, in particular to evaluate potential harms (see Chapter 24 ). In addition, review authors can obtain relevant data from both randomized trials and NRSI, with each type of evidence complementing the other (Schünemann et al 2013).

In GRADE, a body of evidence from randomized trials begins with a high-certainty rating while a body of evidence from NRSI begins with a low-certainty rating. The lower rating with NRSI is the result of the potential bias induced by the lack of randomization (i.e. confounding and selection bias).

However, when using the new Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool (Sterne et al 2016), an assessment tool that covers the risk of bias due to lack of randomization, all studies may start as high certainty of the evidence (Schünemann et al 2018). The approach of starting all study designs (including NRSI) as high certainty does not conflict with the initial GRADE approach of starting the rating of NRSI as low certainty evidence. This is because a body of evidence from NRSI should generally be downgraded by two levels due to the inherent risk of bias associated with the lack of randomization, namely confounding and selection bias. Not downgrading NRSI from high to low certainty needs transparent and detailed justification for what mitigates concerns about confounding and selection bias (Schünemann et al 2018). Very few examples of where not rating down by two levels is appropriate currently exist.

The highest certainty rating is a body of evidence when there are no concerns in any of the GRADE factors listed in Figure 14.2.a . Review authors often downgrade evidence to moderate, low or even very low certainty evidence, depending on the presence of the five factors in Figure 14.2.a . Usually, certainty rating will fall by one level for each factor, up to a maximum of three levels for all factors. If there are very severe problems for any one domain (e.g. when assessing risk of bias, all studies were unconcealed, unblinded and lost over 50% of their patients to follow-up), evidence may fall by two levels due to that factor alone. It is not possible to rate lower than ‘very low certainty’ evidence.

Review authors will generally grade evidence from sound non-randomized studies as low certainty, even if ROBINS-I is used. If, however, such studies yield large effects and there is no obvious bias explaining those effects, review authors may rate the evidence as moderate or – if the effect is large enough – even as high certainty ( Figure 14.2.a ). The very low certainty level is appropriate for, but is not limited to, studies with critical problems and unsystematic clinical observations (e.g. case series or case reports).

Figure 14.2.a Levels of the certainty of a body of evidence in the GRADE approach. *Upgrading criteria are usually applicable to non-randomized studies only (but exceptions exist).

14.2.2 Domains that can lead to decreasing the certainty level of a body of evidence   

We now describe in more detail the five reasons (or domains) for downgrading the certainty of a body of evidence for a specific outcome. In each case, if no reason is found for downgrading the evidence, it should be classified as 'no limitation or not serious' (not important enough to warrant downgrading). If a reason is found for downgrading the evidence, it should be classified as 'serious' (downgrading the certainty rating by one level) or 'very serious' (downgrading the certainty grade by two levels). For non-randomized studies assessed with ROBINS-I, rating down by three levels should be classified as 'extremely' serious.

(1) Risk of bias or limitations in the detailed design and implementation

Our confidence in an estimate of effect decreases if studies suffer from major limitations that are likely to result in a biased assessment of the intervention effect. For randomized trials, these methodological limitations include failure to generate a random sequence, lack of allocation sequence concealment, lack of blinding (particularly with subjective outcomes that are highly susceptible to biased assessment), a large loss to follow-up or selective reporting of outcomes. Chapter 8 provides a discussion of study-level assessments of risk of bias in the context of a Cochrane Review, and proposes an approach to assessing the risk of bias for an outcome across studies as ‘Low’ risk of bias, ‘Some concerns’ and ‘High’ risk of bias for randomized trials. Levels of ‘Low’. ‘Moderate’, ‘Serious’ and ‘Critical’ risk of bias arise for non-randomized studies assessed with ROBINS-I ( Chapter 25 ). These assessments should feed directly into this GRADE domain. In particular, ‘Low’ risk of bias would indicate ‘no limitation’; ‘Some concerns’ would indicate either ‘no limitation’ or ‘serious limitation’; and ‘High’ risk of bias would indicate either ‘serious limitation’ or ‘very serious limitation’. ‘Critical’ risk of bias on ROBINS-I would indicate extremely serious limitations in GRADE. Review authors should use their judgement to decide between alternative categories, depending on the likely magnitude of the potential biases.

Every study addressing a particular outcome will differ, to some degree, in the risk of bias. Review authors should make an overall judgement on whether the certainty of evidence for an outcome warrants downgrading on the basis of study limitations. The assessment of study limitations should apply to the studies contributing to the results in the ‘Summary of findings’ table, rather than to all studies that could potentially be included in the analysis. We have argued in Chapter 7, Section 7.6.2 , that the primary analysis should be restricted to studies at low (or low and unclear) risk of bias where possible.

Table 14.2.a presents the judgements that must be made in going from assessments of the risk of bias to judgements about study limitations for each outcome included in a ‘Summary of findings’ table. A rating of high certainty evidence can be achieved only when most evidence comes from studies that met the criteria for low risk of bias. For example, of the 22 studies addressing the impact of beta-blockers on mortality in patients with heart failure, most probably or certainly used concealed allocation of the sequence, all blinded at least some key groups and follow-up of randomized patients was almost complete (Brophy et al 2001). The certainty of evidence might be downgraded by one level when most of the evidence comes from individual studies either with a crucial limitation for one item, or with some limitations for multiple items. An example of very serious limitations, warranting downgrading by two levels, is provided by evidence on surgery versus conservative treatment in the management of patients with lumbar disc prolapse (Gibson and Waddell 2007). We are uncertain of the benefit of surgery in reducing symptoms after one year or longer, because the one study included in the analysis had inadequate concealment of the allocation sequence and the outcome was assessed using a crude rating by the surgeon without blinding.

(2) Unexplained heterogeneity or inconsistency of results

When studies yield widely differing estimates of effect (heterogeneity or variability in results), investigators should look for robust explanations for that heterogeneity. For instance, drugs may have larger relative effects in sicker populations or when given in larger doses. A detailed discussion of heterogeneity and its investigation is provided in Chapter 10, Section 10.10 and Section 10.11 . If an important modifier exists, with good evidence that important outcomes are different in different subgroups (which would ideally be pre-specified), then a separate ‘Summary of findings’ table may be considered for a separate population. For instance, a separate ‘Summary of findings’ table would be used for carotid endarterectomy in symptomatic patients with high grade stenosis (70% to 99%) in which the intervention is, in the hands of the right surgeons, beneficial, and another (if review authors considered it relevant) for asymptomatic patients with low grade stenosis (less than 30%) in which surgery appears harmful (Orrapin and Rerkasem 2017). When heterogeneity exists and affects the interpretation of results, but review authors are unable to identify a plausible explanation with the data available, the certainty of the evidence decreases.

(3) Indirectness of evidence

Two types of indirectness are relevant. First, a review comparing the effectiveness of alternative interventions (say A and B) may find that randomized trials are available, but they have compared A with placebo and B with placebo. Thus, the evidence is restricted to indirect comparisons between A and B. Where indirect comparisons are undertaken within a network meta-analysis context, GRADE for network meta-analysis should be used (see Chapter 11, Section 11.5 ).

Second, a review may find randomized trials that meet eligibility criteria but address a restricted version of the main review question in terms of population, intervention, comparator or outcomes. For example, suppose that in a review addressing an intervention for secondary prevention of coronary heart disease, most identified studies happened to be in people who also had diabetes. Then the evidence may be regarded as indirect in relation to the broader question of interest because the population is primarily related to people with diabetes. The opposite scenario can equally apply: a review addressing the effect of a preventive strategy for coronary heart disease in people with diabetes may consider studies in people without diabetes to provide relevant, albeit indirect, evidence. This would be particularly likely if investigators had conducted few if any randomized trials in the target population (e.g. people with diabetes). Other sources of indirectness may arise from interventions studied (e.g. if in all included studies a technical intervention was implemented by expert, highly trained specialists in specialist centres, then evidence on the effects of the intervention outside these centres may be indirect), comparators used (e.g. if the comparator groups received an intervention that is less effective than standard treatment in most settings) and outcomes assessed (e.g. indirectness due to surrogate outcomes when data on patient-important outcomes are not available, or when investigators seek data on quality of life but only symptoms are reported). Review authors should make judgements transparent when they believe downgrading is justified, based on differences in anticipated effects in the group of primary interest. Review authors may be aided and increase transparency of their judgements about indirectness if they use Table 14.2.b available in the GRADEpro GDT software (Schünemann et al 2013).

(4) Imprecision of results

When studies include few participants or few events, and thus have wide confidence intervals, review authors can lower their rating of the certainty of the evidence. The confidence intervals included in the ‘Summary of findings’ table will provide readers with information that allows them to make, to some extent, their own rating of precision. Review authors can use a calculation of the optimal information size (OIS) or review information size (RIS), similar to sample size calculations, to make judgements about imprecision (Guyatt et al 2011b, Schünemann 2016). The OIS or RIS is calculated on the basis of the number of participants required for an adequately powered individual study. If the 95% confidence interval excludes a risk ratio (RR) of 1.0, and the total number of events or patients exceeds the OIS criterion, precision is adequate. If the 95% CI includes appreciable benefit or harm (an RR of under 0.75 or over 1.25 is often suggested as a very rough guide) downgrading for imprecision may be appropriate even if OIS criteria are met (Guyatt et al 2011b, Schünemann 2016).

(5) High probability of publication bias

The certainty of evidence level may be downgraded if investigators fail to report studies on the basis of results (typically those that show no effect: publication bias) or outcomes (typically those that may be harmful or for which no effect was observed: selective outcome non-reporting bias). Selective reporting of outcomes from among multiple outcomes measured is assessed at the study level as part of the assessment of risk of bias (see Chapter 8, Section 8.7 ), so for the studies contributing to the outcome in the ‘Summary of findings’ table this is addressed by domain 1 above (limitations in the design and implementation). If a large number of studies included in the review do not contribute to an outcome, or if there is evidence of publication bias, the certainty of the evidence may be downgraded. Chapter 13 provides a detailed discussion of reporting biases, including publication bias, and how it may be tackled in a Cochrane Review. A prototypical situation that may elicit suspicion of publication bias is when published evidence includes a number of small studies, all of which are industry-funded (Bhandari et al 2004). For example, 14 studies of flavanoids in patients with haemorrhoids have shown apparent large benefits, but enrolled a total of only 1432 patients (i.e. each study enrolled relatively few patients) (Alonso-Coello et al 2006). The heavy involvement of sponsors in most of these studies raises questions of whether unpublished studies that suggest no benefit exist (publication bias).

A particular body of evidence can suffer from problems associated with more than one of the five factors listed here, and the greater the problems, the lower the certainty of evidence rating that should result. One could imagine a situation in which randomized trials were available, but all or virtually all of these limitations would be present, and in serious form. A very low certainty of evidence rating would result.

Table 14.2.a Further guidelines for domain 1 (of 5) in a GRADE assessment: going from assessments of risk of bias in studies to judgements about study limitations for main outcomes across studies

Table 14.2.b Judgements about indirectness by outcome (available in GRADEpro GDT)

Intervention:

Comparator:

Direct comparison:

Final judgement about indirectness across domains:

14.2.3 Domains that may lead to increasing the certainty level of a body of evidence

Although NRSI and downgraded randomized trials will generally yield a low rating for certainty of evidence, there will be unusual circumstances in which review authors could ‘upgrade’ such evidence to moderate or even high certainty ( Table 14.3.a ).

• Large effects On rare occasions when methodologically well-done observational studies yield large, consistent and precise estimates of the magnitude of an intervention effect, one may be particularly confident in the results. A large estimated effect (e.g. RR >2 or RR <0.5) in the absence of plausible confounders, or a very large effect (e.g. RR >5 or RR <0.2) in studies with no major threats to validity, might qualify for this. In these situations, while the NRSI may possibly have provided an over-estimate of the true effect, the weak study design may not explain all of the apparent observed benefit. Thus, despite reservations based on the observational study design, review authors are confident that the effect exists. The magnitude of the effect in these studies may move the assigned certainty of evidence from low to moderate (if the effect is large in the absence of other methodological limitations). For example, a meta-analysis of observational studies showed that bicycle helmets reduce the risk of head injuries in cyclists by a large margin (odds ratio (OR) 0.31, 95% CI 0.26 to 0.37) (Thompson et al 2000). This large effect, in the absence of obvious bias that could create the association, suggests a rating of moderate-certainty evidence.  Note : GRADE guidance suggests the possibility of rating up one level for a large effect if the relative effect is greater than 2.0. However, if the point estimate of the relative effect is greater than 2.0, but the confidence interval is appreciably below 2.0, then some hesitation would be appropriate in the decision to rate up for a large effect. Another situation allows inference of a strong association without a formal comparative study. Consider the question of the impact of routine colonoscopy versus no screening for colon cancer on the rate of perforation associated with colonoscopy. Here, a large series of representative patients undergoing colonoscopy may provide high certainty evidence about the risk of perforation associated with colonoscopy. When the risk of the event among patients receiving the relevant comparator is known to be near 0 (i.e. we are certain that the incidence of spontaneous colon perforation in patients not undergoing colonoscopy is extremely low), case series or cohort studies of representative patients can provide high certainty evidence of adverse effects associated with an intervention, thereby allowing us to infer a strong association from even a limited number of events.
• Dose-response The presence of a dose-response gradient may increase our confidence in the findings of observational studies and thereby enhance the assigned certainty of evidence. For example, our confidence in the result of observational studies that show an increased risk of bleeding in patients who have supratherapeutic anticoagulation levels is increased by the observation that there is a dose-response gradient between the length of time needed for blood to clot (as measured by the international normalized ratio (INR)) and an increased risk of bleeding (Levine et al 2004). A systematic review of NRSI investigating the effect of cyclooxygenase-2 inhibitors on cardiovascular events found that the summary estimate (RR) with rofecoxib was 1.33 (95% CI 1.00 to 1.79) with doses less than 25mg/d, and 2.19 (95% CI 1.64 to 2.91) with doses more than 25mg/d. Although residual confounding is likely to exist in the NRSI that address this issue, the existence of a dose-response gradient and the large apparent effect of higher doses of rofecoxib markedly increase our strength of inference that the association cannot be explained by residual confounding, and is therefore likely to be both causal and, at high levels of exposure, substantial.  Note : GRADE guidance suggests the possibility of rating up one level for a large effect if the relative effect is greater than 2.0. Here, the fact that the point estimate of the relative effect is greater than 2.0, but the confidence interval is appreciably below 2.0 might make some hesitate in the decision to rate up for a large effect
• Plausible confounding On occasion, all plausible biases from randomized or non-randomized studies may be working to under-estimate an apparent intervention effect. For example, if only sicker patients receive an experimental intervention or exposure, yet they still fare better, it is likely that the actual intervention or exposure effect is larger than the data suggest. For instance, a rigorous systematic review of observational studies including a total of 38 million patients demonstrated higher death rates in private for-profit versus private not-for-profit hospitals (Devereaux et al 2002). One possible bias relates to different disease severity in patients in the two hospital types. It is likely, however, that patients in the not-for-profit hospitals were sicker than those in the for-profit hospitals. Thus, to the extent that residual confounding existed, it would bias results against the not-for-profit hospitals. The second likely bias was the possibility that higher numbers of patients with excellent private insurance coverage could lead to a hospital having more resources and a spill-over effect that would benefit those without such coverage. Since for-profit hospitals are likely to admit a larger proportion of such well-insured patients than not-for-profit hospitals, the bias is once again against the not-for-profit hospitals. Since the plausible biases would all diminish the demonstrated intervention effect, one might consider the evidence from these observational studies as moderate rather than low certainty. A parallel situation exists when observational studies have failed to demonstrate an association, but all plausible biases would have increased an intervention effect. This situation will usually arise in the exploration of apparent harmful effects. For example, because the hypoglycaemic drug phenformin causes lactic acidosis, the related agent metformin was under suspicion for the same toxicity. Nevertheless, very large observational studies have failed to demonstrate an association (Salpeter et al 2007). Given the likelihood that clinicians would be more alert to lactic acidosis in the presence of the agent and over-report its occurrence, one might consider this moderate, or even high certainty, evidence refuting a causal relationship between typical therapeutic doses of metformin and lactic acidosis.

14.3 Describing the assessment of the certainty of a body of evidence using the GRADE framework

Review authors should report the grading of the certainty of evidence in the Results section for each outcome for which this has been performed, providing the rationale for downgrading or upgrading the evidence, and referring to the ‘Summary of findings’ table where applicable.

Table 14.3.a provides a framework and examples for how review authors can justify their judgements about the certainty of evidence in each domain. These justifications should also be included in explanatory notes to the ‘Summary of Findings’ table (see Section 14.1.6.10 ).

Chapter 15, Section 15.6 , describes in more detail how the overall GRADE assessment across all domains can be used to draw conclusions about the effects of the intervention, as well as providing implications for future research.

Table 14.3.a Framework for describing the certainty of evidence and justifying downgrading or upgrading

14.4 Chapter information

Authors: Holger J Schünemann, Julian PT Higgins, Gunn E Vist, Paul Glasziou, Elie A Akl, Nicole Skoetz, Gordon H Guyatt; on behalf of the Cochrane GRADEing Methods Group (formerly Applicability and Recommendations Methods Group) and the Cochrane Statistical Methods Group

Acknowledgements: Andrew D Oxman contributed to earlier versions. Professor Penny Hawe contributed to the text on adverse effects in earlier versions. Jon Deeks provided helpful contributions on an earlier version of this chapter. For details of previous authors and editors of the Handbook , please refer to the Preface.

Funding: This work was in part supported by funding from the Michael G DeGroote Cochrane Canada Centre and the Ontario Ministry of Health.

14.5 References

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A Practical Guide to Writing Quantitative and Qualitative Research Questions and Hypotheses in Scholarly Articles

Edward barroga.

1 Department of General Education, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan.

Glafera Janet Matanguihan

2 Department of Biological Sciences, Messiah University, Mechanicsburg, PA, USA.

The development of research questions and the subsequent hypotheses are prerequisites to defining the main research purpose and specific objectives of a study. Consequently, these objectives determine the study design and research outcome. The development of research questions is a process based on knowledge of current trends, cutting-edge studies, and technological advances in the research field. Excellent research questions are focused and require a comprehensive literature search and in-depth understanding of the problem being investigated. Initially, research questions may be written as descriptive questions which could be developed into inferential questions. These questions must be specific and concise to provide a clear foundation for developing hypotheses. Hypotheses are more formal predictions about the research outcomes. These specify the possible results that may or may not be expected regarding the relationship between groups. Thus, research questions and hypotheses clarify the main purpose and specific objectives of the study, which in turn dictate the design of the study, its direction, and outcome. Studies developed from good research questions and hypotheses will have trustworthy outcomes with wide-ranging social and health implications.

INTRODUCTION

Scientific research is usually initiated by posing evidenced-based research questions which are then explicitly restated as hypotheses. 1 , 2 The hypotheses provide directions to guide the study, solutions, explanations, and expected results. 3 , 4 Both research questions and hypotheses are essentially formulated based on conventional theories and real-world processes, which allow the inception of novel studies and the ethical testing of ideas. 5 , 6

It is crucial to have knowledge of both quantitative and qualitative research 2 as both types of research involve writing research questions and hypotheses. 7 However, these crucial elements of research are sometimes overlooked; if not overlooked, then framed without the forethought and meticulous attention it needs. Planning and careful consideration are needed when developing quantitative or qualitative research, particularly when conceptualizing research questions and hypotheses. 4

There is a continuing need to support researchers in the creation of innovative research questions and hypotheses, as well as for journal articles that carefully review these elements. 1 When research questions and hypotheses are not carefully thought of, unethical studies and poor outcomes usually ensue. Carefully formulated research questions and hypotheses define well-founded objectives, which in turn determine the appropriate design, course, and outcome of the study. This article then aims to discuss in detail the various aspects of crafting research questions and hypotheses, with the goal of guiding researchers as they develop their own. Examples from the authors and peer-reviewed scientific articles in the healthcare field are provided to illustrate key points.

DEFINITIONS AND RELATIONSHIP OF RESEARCH QUESTIONS AND HYPOTHESES

A research question is what a study aims to answer after data analysis and interpretation. The answer is written in length in the discussion section of the paper. Thus, the research question gives a preview of the different parts and variables of the study meant to address the problem posed in the research question. 1 An excellent research question clarifies the research writing while facilitating understanding of the research topic, objective, scope, and limitations of the study. 5

On the other hand, a research hypothesis is an educated statement of an expected outcome. This statement is based on background research and current knowledge. 8 , 9 The research hypothesis makes a specific prediction about a new phenomenon 10 or a formal statement on the expected relationship between an independent variable and a dependent variable. 3 , 11 It provides a tentative answer to the research question to be tested or explored. 4

Hypotheses employ reasoning to predict a theory-based outcome. 10 These can also be developed from theories by focusing on components of theories that have not yet been observed. 10 The validity of hypotheses is often based on the testability of the prediction made in a reproducible experiment. 8

Conversely, hypotheses can also be rephrased as research questions. Several hypotheses based on existing theories and knowledge may be needed to answer a research question. Developing ethical research questions and hypotheses creates a research design that has logical relationships among variables. These relationships serve as a solid foundation for the conduct of the study. 4 , 11 Haphazardly constructed research questions can result in poorly formulated hypotheses and improper study designs, leading to unreliable results. Thus, the formulations of relevant research questions and verifiable hypotheses are crucial when beginning research. 12

CHARACTERISTICS OF GOOD RESEARCH QUESTIONS AND HYPOTHESES

Excellent research questions are specific and focused. These integrate collective data and observations to confirm or refute the subsequent hypotheses. Well-constructed hypotheses are based on previous reports and verify the research context. These are realistic, in-depth, sufficiently complex, and reproducible. More importantly, these hypotheses can be addressed and tested. 13

There are several characteristics of well-developed hypotheses. Good hypotheses are 1) empirically testable 7 , 10 , 11 , 13 ; 2) backed by preliminary evidence 9 ; 3) testable by ethical research 7 , 9 ; 4) based on original ideas 9 ; 5) have evidenced-based logical reasoning 10 ; and 6) can be predicted. 11 Good hypotheses can infer ethical and positive implications, indicating the presence of a relationship or effect relevant to the research theme. 7 , 11 These are initially developed from a general theory and branch into specific hypotheses by deductive reasoning. In the absence of a theory to base the hypotheses, inductive reasoning based on specific observations or findings form more general hypotheses. 10

TYPES OF RESEARCH QUESTIONS AND HYPOTHESES

Research questions and hypotheses are developed according to the type of research, which can be broadly classified into quantitative and qualitative research. We provide a summary of the types of research questions and hypotheses under quantitative and qualitative research categories in Table 1 .

Research questions in quantitative research

In quantitative research, research questions inquire about the relationships among variables being investigated and are usually framed at the start of the study. These are precise and typically linked to the subject population, dependent and independent variables, and research design. 1 Research questions may also attempt to describe the behavior of a population in relation to one or more variables, or describe the characteristics of variables to be measured ( descriptive research questions ). 1 , 5 , 14 These questions may also aim to discover differences between groups within the context of an outcome variable ( comparative research questions ), 1 , 5 , 14 or elucidate trends and interactions among variables ( relationship research questions ). 1 , 5 We provide examples of descriptive, comparative, and relationship research questions in quantitative research in Table 2 .

Hypotheses in quantitative research

In quantitative research, hypotheses predict the expected relationships among variables. 15 Relationships among variables that can be predicted include 1) between a single dependent variable and a single independent variable ( simple hypothesis ) or 2) between two or more independent and dependent variables ( complex hypothesis ). 4 , 11 Hypotheses may also specify the expected direction to be followed and imply an intellectual commitment to a particular outcome ( directional hypothesis ) 4 . On the other hand, hypotheses may not predict the exact direction and are used in the absence of a theory, or when findings contradict previous studies ( non-directional hypothesis ). 4 In addition, hypotheses can 1) define interdependency between variables ( associative hypothesis ), 4 2) propose an effect on the dependent variable from manipulation of the independent variable ( causal hypothesis ), 4 3) state a negative relationship between two variables ( null hypothesis ), 4 , 11 , 15 4) replace the working hypothesis if rejected ( alternative hypothesis ), 15 explain the relationship of phenomena to possibly generate a theory ( working hypothesis ), 11 5) involve quantifiable variables that can be tested statistically ( statistical hypothesis ), 11 6) or express a relationship whose interlinks can be verified logically ( logical hypothesis ). 11 We provide examples of simple, complex, directional, non-directional, associative, causal, null, alternative, working, statistical, and logical hypotheses in quantitative research, as well as the definition of quantitative hypothesis-testing research in Table 3 .

Research questions in qualitative research

Unlike research questions in quantitative research, research questions in qualitative research are usually continuously reviewed and reformulated. The central question and associated subquestions are stated more than the hypotheses. 15 The central question broadly explores a complex set of factors surrounding the central phenomenon, aiming to present the varied perspectives of participants. 15

There are varied goals for which qualitative research questions are developed. These questions can function in several ways, such as to 1) identify and describe existing conditions ( contextual research question s); 2) describe a phenomenon ( descriptive research questions ); 3) assess the effectiveness of existing methods, protocols, theories, or procedures ( evaluation research questions ); 4) examine a phenomenon or analyze the reasons or relationships between subjects or phenomena ( explanatory research questions ); or 5) focus on unknown aspects of a particular topic ( exploratory research questions ). 5 In addition, some qualitative research questions provide new ideas for the development of theories and actions ( generative research questions ) or advance specific ideologies of a position ( ideological research questions ). 1 Other qualitative research questions may build on a body of existing literature and become working guidelines ( ethnographic research questions ). Research questions may also be broadly stated without specific reference to the existing literature or a typology of questions ( phenomenological research questions ), may be directed towards generating a theory of some process ( grounded theory questions ), or may address a description of the case and the emerging themes ( qualitative case study questions ). 15 We provide examples of contextual, descriptive, evaluation, explanatory, exploratory, generative, ideological, ethnographic, phenomenological, grounded theory, and qualitative case study research questions in qualitative research in Table 4 , and the definition of qualitative hypothesis-generating research in Table 5 .

Qualitative studies usually pose at least one central research question and several subquestions starting with How or What . These research questions use exploratory verbs such as explore or describe . These also focus on one central phenomenon of interest, and may mention the participants and research site. 15

Hypotheses in qualitative research

Hypotheses in qualitative research are stated in the form of a clear statement concerning the problem to be investigated. Unlike in quantitative research where hypotheses are usually developed to be tested, qualitative research can lead to both hypothesis-testing and hypothesis-generating outcomes. 2 When studies require both quantitative and qualitative research questions, this suggests an integrative process between both research methods wherein a single mixed-methods research question can be developed. 1

FRAMEWORKS FOR DEVELOPING RESEARCH QUESTIONS AND HYPOTHESES

Research questions followed by hypotheses should be developed before the start of the study. 1 , 12 , 14 It is crucial to develop feasible research questions on a topic that is interesting to both the researcher and the scientific community. This can be achieved by a meticulous review of previous and current studies to establish a novel topic. Specific areas are subsequently focused on to generate ethical research questions. The relevance of the research questions is evaluated in terms of clarity of the resulting data, specificity of the methodology, objectivity of the outcome, depth of the research, and impact of the study. 1 , 5 These aspects constitute the FINER criteria (i.e., Feasible, Interesting, Novel, Ethical, and Relevant). 1 Clarity and effectiveness are achieved if research questions meet the FINER criteria. In addition to the FINER criteria, Ratan et al. described focus, complexity, novelty, feasibility, and measurability for evaluating the effectiveness of research questions. 14

The PICOT and PEO frameworks are also used when developing research questions. 1 The following elements are addressed in these frameworks, PICOT: P-population/patients/problem, I-intervention or indicator being studied, C-comparison group, O-outcome of interest, and T-timeframe of the study; PEO: P-population being studied, E-exposure to preexisting conditions, and O-outcome of interest. 1 Research questions are also considered good if these meet the “FINERMAPS” framework: Feasible, Interesting, Novel, Ethical, Relevant, Manageable, Appropriate, Potential value/publishable, and Systematic. 14

As we indicated earlier, research questions and hypotheses that are not carefully formulated result in unethical studies or poor outcomes. To illustrate this, we provide some examples of ambiguous research question and hypotheses that result in unclear and weak research objectives in quantitative research ( Table 6 ) 16 and qualitative research ( Table 7 ) 17 , and how to transform these ambiguous research question(s) and hypothesis(es) into clear and good statements.

a These statements were composed for comparison and illustrative purposes only.

b These statements are direct quotes from Higashihara and Horiuchi. 16

a This statement is a direct quote from Shimoda et al. 17

The other statements were composed for comparison and illustrative purposes only.

CONSTRUCTING RESEARCH QUESTIONS AND HYPOTHESES

To construct effective research questions and hypotheses, it is very important to 1) clarify the background and 2) identify the research problem at the outset of the research, within a specific timeframe. 9 Then, 3) review or conduct preliminary research to collect all available knowledge about the possible research questions by studying theories and previous studies. 18 Afterwards, 4) construct research questions to investigate the research problem. Identify variables to be accessed from the research questions 4 and make operational definitions of constructs from the research problem and questions. Thereafter, 5) construct specific deductive or inductive predictions in the form of hypotheses. 4 Finally, 6) state the study aims . This general flow for constructing effective research questions and hypotheses prior to conducting research is shown in Fig. 1 .

Research questions are used more frequently in qualitative research than objectives or hypotheses. 3 These questions seek to discover, understand, explore or describe experiences by asking “What” or “How.” The questions are open-ended to elicit a description rather than to relate variables or compare groups. The questions are continually reviewed, reformulated, and changed during the qualitative study. 3 Research questions are also used more frequently in survey projects than hypotheses in experiments in quantitative research to compare variables and their relationships.

Hypotheses are constructed based on the variables identified and as an if-then statement, following the template, ‘If a specific action is taken, then a certain outcome is expected.’ At this stage, some ideas regarding expectations from the research to be conducted must be drawn. 18 Then, the variables to be manipulated (independent) and influenced (dependent) are defined. 4 Thereafter, the hypothesis is stated and refined, and reproducible data tailored to the hypothesis are identified, collected, and analyzed. 4 The hypotheses must be testable and specific, 18 and should describe the variables and their relationships, the specific group being studied, and the predicted research outcome. 18 Hypotheses construction involves a testable proposition to be deduced from theory, and independent and dependent variables to be separated and measured separately. 3 Therefore, good hypotheses must be based on good research questions constructed at the start of a study or trial. 12

In summary, research questions are constructed after establishing the background of the study. Hypotheses are then developed based on the research questions. Thus, it is crucial to have excellent research questions to generate superior hypotheses. In turn, these would determine the research objectives and the design of the study, and ultimately, the outcome of the research. 12 Algorithms for building research questions and hypotheses are shown in Fig. 2 for quantitative research and in Fig. 3 for qualitative research.

EXAMPLES OF RESEARCH QUESTIONS FROM PUBLISHED ARTICLES

• EXAMPLE 1. Descriptive research question (quantitative research)
• - Presents research variables to be assessed (distinct phenotypes and subphenotypes)
• “BACKGROUND: Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts.
• RESEARCH QUESTION: Does the clinical spectrum of patients with COVID-19 contain distinct phenotypes and subphenotypes? ” 19
• EXAMPLE 2. Relationship research question (quantitative research)
• - Shows interactions between dependent variable (static postural control) and independent variable (peripheral visual field loss)
• “Background: Integration of visual, vestibular, and proprioceptive sensations contributes to postural control. People with peripheral visual field loss have serious postural instability. However, the directional specificity of postural stability and sensory reweighting caused by gradual peripheral visual field loss remain unclear.
• Research question: What are the effects of peripheral visual field loss on static postural control ?” 20
• EXAMPLE 3. Comparative research question (quantitative research)
• - Clarifies the difference among groups with an outcome variable (patients enrolled in COMPERA with moderate PH or severe PH in COPD) and another group without the outcome variable (patients with idiopathic pulmonary arterial hypertension (IPAH))
• “BACKGROUND: Pulmonary hypertension (PH) in COPD is a poorly investigated clinical condition.
• RESEARCH QUESTION: Which factors determine the outcome of PH in COPD?
• STUDY DESIGN AND METHODS: We analyzed the characteristics and outcome of patients enrolled in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) with moderate or severe PH in COPD as defined during the 6th PH World Symposium who received medical therapy for PH and compared them with patients with idiopathic pulmonary arterial hypertension (IPAH) .” 21
• EXAMPLE 4. Exploratory research question (qualitative research)
• - Explores areas that have not been fully investigated (perspectives of families and children who receive care in clinic-based child obesity treatment) to have a deeper understanding of the research problem
• “Problem: Interventions for children with obesity lead to only modest improvements in BMI and long-term outcomes, and data are limited on the perspectives of families of children with obesity in clinic-based treatment. This scoping review seeks to answer the question: What is known about the perspectives of families and children who receive care in clinic-based child obesity treatment? This review aims to explore the scope of perspectives reported by families of children with obesity who have received individualized outpatient clinic-based obesity treatment.” 22
• EXAMPLE 5. Relationship research question (quantitative research)
• - Defines interactions between dependent variable (use of ankle strategies) and independent variable (changes in muscle tone)
• “Background: To maintain an upright standing posture against external disturbances, the human body mainly employs two types of postural control strategies: “ankle strategy” and “hip strategy.” While it has been reported that the magnitude of the disturbance alters the use of postural control strategies, it has not been elucidated how the level of muscle tone, one of the crucial parameters of bodily function, determines the use of each strategy. We have previously confirmed using forward dynamics simulations of human musculoskeletal models that an increased muscle tone promotes the use of ankle strategies. The objective of the present study was to experimentally evaluate a hypothesis: an increased muscle tone promotes the use of ankle strategies. Research question: Do changes in the muscle tone affect the use of ankle strategies ?” 23

EXAMPLES OF HYPOTHESES IN PUBLISHED ARTICLES

• EXAMPLE 1. Working hypothesis (quantitative research)
• - A hypothesis that is initially accepted for further research to produce a feasible theory
• “As fever may have benefit in shortening the duration of viral illness, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response when taken during the early stages of COVID-19 illness .” 24
• “In conclusion, it is plausible to hypothesize that the antipyretic efficacy of ibuprofen may be hindering the benefits of a fever response . The difference in perceived safety of these agents in COVID-19 illness could be related to the more potent efficacy to reduce fever with ibuprofen compared to acetaminophen. Compelling data on the benefit of fever warrant further research and review to determine when to treat or withhold ibuprofen for early stage fever for COVID-19 and other related viral illnesses .” 24
• EXAMPLE 2. Exploratory hypothesis (qualitative research)
• - Explores particular areas deeper to clarify subjective experience and develop a formal hypothesis potentially testable in a future quantitative approach
• “We hypothesized that when thinking about a past experience of help-seeking, a self distancing prompt would cause increased help-seeking intentions and more favorable help-seeking outcome expectations .” 25
• “Conclusion
• Although a priori hypotheses were not supported, further research is warranted as results indicate the potential for using self-distancing approaches to increasing help-seeking among some people with depressive symptomatology.” 25
• EXAMPLE 3. Hypothesis-generating research to establish a framework for hypothesis testing (qualitative research)
• “We hypothesize that compassionate care is beneficial for patients (better outcomes), healthcare systems and payers (lower costs), and healthcare providers (lower burnout). ” 26
• Compassionomics is the branch of knowledge and scientific study of the effects of compassionate healthcare. Our main hypotheses are that compassionate healthcare is beneficial for (1) patients, by improving clinical outcomes, (2) healthcare systems and payers, by supporting financial sustainability, and (3) HCPs, by lowering burnout and promoting resilience and well-being. The purpose of this paper is to establish a scientific framework for testing the hypotheses above . If these hypotheses are confirmed through rigorous research, compassionomics will belong in the science of evidence-based medicine, with major implications for all healthcare domains.” 26
• EXAMPLE 4. Statistical hypothesis (quantitative research)
• - An assumption is made about the relationship among several population characteristics ( gender differences in sociodemographic and clinical characteristics of adults with ADHD ). Validity is tested by statistical experiment or analysis ( chi-square test, Students t-test, and logistic regression analysis)
• “Our research investigated gender differences in sociodemographic and clinical characteristics of adults with ADHD in a Japanese clinical sample. Due to unique Japanese cultural ideals and expectations of women's behavior that are in opposition to ADHD symptoms, we hypothesized that women with ADHD experience more difficulties and present more dysfunctions than men . We tested the following hypotheses: first, women with ADHD have more comorbidities than men with ADHD; second, women with ADHD experience more social hardships than men, such as having less full-time employment and being more likely to be divorced.” 27
• “Statistical Analysis
• ( text omitted ) Between-gender comparisons were made using the chi-squared test for categorical variables and Students t-test for continuous variables…( text omitted ). A logistic regression analysis was performed for employment status, marital status, and comorbidity to evaluate the independent effects of gender on these dependent variables.” 27

EXAMPLES OF HYPOTHESIS AS WRITTEN IN PUBLISHED ARTICLES IN RELATION TO OTHER PARTS

• EXAMPLE 1. Background, hypotheses, and aims are provided
• “Pregnant women need skilled care during pregnancy and childbirth, but that skilled care is often delayed in some countries …( text omitted ). The focused antenatal care (FANC) model of WHO recommends that nurses provide information or counseling to all pregnant women …( text omitted ). Job aids are visual support materials that provide the right kind of information using graphics and words in a simple and yet effective manner. When nurses are not highly trained or have many work details to attend to, these job aids can serve as a content reminder for the nurses and can be used for educating their patients (Jennings, Yebadokpo, Affo, & Agbogbe, 2010) ( text omitted ). Importantly, additional evidence is needed to confirm how job aids can further improve the quality of ANC counseling by health workers in maternal care …( text omitted )” 28
• “ This has led us to hypothesize that the quality of ANC counseling would be better if supported by job aids. Consequently, a better quality of ANC counseling is expected to produce higher levels of awareness concerning the danger signs of pregnancy and a more favorable impression of the caring behavior of nurses .” 28
• “This study aimed to examine the differences in the responses of pregnant women to a job aid-supported intervention during ANC visit in terms of 1) their understanding of the danger signs of pregnancy and 2) their impression of the caring behaviors of nurses to pregnant women in rural Tanzania.” 28
• EXAMPLE 2. Background, hypotheses, and aims are provided
• “We conducted a two-arm randomized controlled trial (RCT) to evaluate and compare changes in salivary cortisol and oxytocin levels of first-time pregnant women between experimental and control groups. The women in the experimental group touched and held an infant for 30 min (experimental intervention protocol), whereas those in the control group watched a DVD movie of an infant (control intervention protocol). The primary outcome was salivary cortisol level and the secondary outcome was salivary oxytocin level.” 29
• “ We hypothesize that at 30 min after touching and holding an infant, the salivary cortisol level will significantly decrease and the salivary oxytocin level will increase in the experimental group compared with the control group .” 29
• EXAMPLE 3. Background, aim, and hypothesis are provided
• “In countries where the maternal mortality ratio remains high, antenatal education to increase Birth Preparedness and Complication Readiness (BPCR) is considered one of the top priorities [1]. BPCR includes birth plans during the antenatal period, such as the birthplace, birth attendant, transportation, health facility for complications, expenses, and birth materials, as well as family coordination to achieve such birth plans. In Tanzania, although increasing, only about half of all pregnant women attend an antenatal clinic more than four times [4]. Moreover, the information provided during antenatal care (ANC) is insufficient. In the resource-poor settings, antenatal group education is a potential approach because of the limited time for individual counseling at antenatal clinics.” 30
• “This study aimed to evaluate an antenatal group education program among pregnant women and their families with respect to birth-preparedness and maternal and infant outcomes in rural villages of Tanzania.” 30
• “ The study hypothesis was if Tanzanian pregnant women and their families received a family-oriented antenatal group education, they would (1) have a higher level of BPCR, (2) attend antenatal clinic four or more times, (3) give birth in a health facility, (4) have less complications of women at birth, and (5) have less complications and deaths of infants than those who did not receive the education .” 30

Research questions and hypotheses are crucial components to any type of research, whether quantitative or qualitative. These questions should be developed at the very beginning of the study. Excellent research questions lead to superior hypotheses, which, like a compass, set the direction of research, and can often determine the successful conduct of the study. Many research studies have floundered because the development of research questions and subsequent hypotheses was not given the thought and meticulous attention needed. The development of research questions and hypotheses is an iterative process based on extensive knowledge of the literature and insightful grasp of the knowledge gap. Focused, concise, and specific research questions provide a strong foundation for constructing hypotheses which serve as formal predictions about the research outcomes. Research questions and hypotheses are crucial elements of research that should not be overlooked. They should be carefully thought of and constructed when planning research. This avoids unethical studies and poor outcomes by defining well-founded objectives that determine the design, course, and outcome of the study.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

• Conceptualization: Barroga E, Matanguihan GJ.
• Methodology: Barroga E, Matanguihan GJ.
• Writing - original draft: Barroga E, Matanguihan GJ.
• Writing - review & editing: Barroga E, Matanguihan GJ.

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Research Summary – Structure, Examples and Writing Guide

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Research Summary

Definition:

A research summary is a brief and concise overview of a research project or study that highlights its key findings, main points, and conclusions. It typically includes a description of the research problem, the research methods used, the results obtained, and the implications or significance of the findings. It is often used as a tool to quickly communicate the main findings of a study to other researchers, stakeholders, or decision-makers.

Structure of Research Summary

The Structure of a Research Summary typically include:

• Introduction : This section provides a brief background of the research problem or question, explains the purpose of the study, and outlines the research objectives.
• Methodology : This section explains the research design, methods, and procedures used to conduct the study. It describes the sample size, data collection methods, and data analysis techniques.
• Results : This section presents the main findings of the study, including statistical analysis if applicable. It may include tables, charts, or graphs to visually represent the data.
• Discussion : This section interprets the results and explains their implications. It discusses the significance of the findings, compares them to previous research, and identifies any limitations or future directions for research.
• Conclusion : This section summarizes the main points of the research and provides a conclusion based on the findings. It may also suggest implications for future research or practical applications of the results.
• References : This section lists the sources cited in the research summary, following the appropriate citation style.

How to Write Research Summary

Here are the steps you can follow to write a research summary:

• Read the research article or study thoroughly: To write a summary, you must understand the research article or study you are summarizing. Therefore, read the article or study carefully to understand its purpose, research design, methodology, results, and conclusions.
• Identify the main points : Once you have read the research article or study, identify the main points, key findings, and research question. You can highlight or take notes of the essential points and findings to use as a reference when writing your summary.
• Write the introduction: Start your summary by introducing the research problem, research question, and purpose of the study. Briefly explain why the research is important and its significance.
• Summarize the methodology : In this section, summarize the research design, methods, and procedures used to conduct the study. Explain the sample size, data collection methods, and data analysis techniques.
• Present the results: Summarize the main findings of the study. Use tables, charts, or graphs to visually represent the data if necessary.
• Interpret the results: In this section, interpret the results and explain their implications. Discuss the significance of the findings, compare them to previous research, and identify any limitations or future directions for research.
• Conclude the summary : Summarize the main points of the research and provide a conclusion based on the findings. Suggest implications for future research or practical applications of the results.
• Revise and edit : Once you have written the summary, revise and edit it to ensure that it is clear, concise, and free of errors. Make sure that your summary accurately represents the research article or study.
• Add references: Include a list of references cited in the research summary, following the appropriate citation style.

Example of Research Summary

Here is an example of a research summary:

Title: The Effects of Yoga on Mental Health: A Meta-Analysis

Introduction: This meta-analysis examines the effects of yoga on mental health. The study aimed to investigate whether yoga practice can improve mental health outcomes such as anxiety, depression, stress, and quality of life.

Methodology : The study analyzed data from 14 randomized controlled trials that investigated the effects of yoga on mental health outcomes. The sample included a total of 862 participants. The yoga interventions varied in length and frequency, ranging from four to twelve weeks, with sessions lasting from 45 to 90 minutes.

Results : The meta-analysis found that yoga practice significantly improved mental health outcomes. Participants who practiced yoga showed a significant reduction in anxiety and depression symptoms, as well as stress levels. Quality of life also improved in those who practiced yoga.

Discussion : The findings of this study suggest that yoga can be an effective intervention for improving mental health outcomes. The study supports the growing body of evidence that suggests that yoga can have a positive impact on mental health. Limitations of the study include the variability of the yoga interventions, which may affect the generalizability of the findings.

Conclusion : Overall, the findings of this meta-analysis support the use of yoga as an effective intervention for improving mental health outcomes. Further research is needed to determine the optimal length and frequency of yoga interventions for different populations.

References :

• Cramer, H., Lauche, R., Langhorst, J., Dobos, G., & Berger, B. (2013). Yoga for depression: a systematic review and meta-analysis. Depression and anxiety, 30(11), 1068-1083.
• Khalsa, S. B. (2004). Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian journal of physiology and pharmacology, 48(3), 269-285.
• Ross, A., & Thomas, S. (2010). The health benefits of yoga and exercise: a review of comparison studies. The Journal of Alternative and Complementary Medicine, 16(1), 3-12.

Purpose of Research Summary

The purpose of a research summary is to provide a brief overview of a research project or study, including its main points, findings, and conclusions. The summary allows readers to quickly understand the essential aspects of the research without having to read the entire article or study.

Research summaries serve several purposes, including:

• Facilitating comprehension: A research summary allows readers to quickly understand the main points and findings of a research project or study without having to read the entire article or study. This makes it easier for readers to comprehend the research and its significance.
• Communicating research findings: Research summaries are often used to communicate research findings to a wider audience, such as policymakers, practitioners, or the general public. The summary presents the essential aspects of the research in a clear and concise manner, making it easier for non-experts to understand.
• Supporting decision-making: Research summaries can be used to support decision-making processes by providing a summary of the research evidence on a particular topic. This information can be used by policymakers or practitioners to make informed decisions about interventions, programs, or policies.
• Saving time: Research summaries save time for researchers, practitioners, policymakers, and other stakeholders who need to review multiple research studies. Rather than having to read the entire article or study, they can quickly review the summary to determine whether the research is relevant to their needs.

Characteristics of Research Summary

The following are some of the key characteristics of a research summary:

• Concise : A research summary should be brief and to the point, providing a clear and concise overview of the main points of the research.
• Objective : A research summary should be written in an objective tone, presenting the research findings without bias or personal opinion.
• Comprehensive : A research summary should cover all the essential aspects of the research, including the research question, methodology, results, and conclusions.
• Accurate : A research summary should accurately reflect the key findings and conclusions of the research.
• Clear and well-organized: A research summary should be easy to read and understand, with a clear structure and logical flow.
• Relevant : A research summary should focus on the most important and relevant aspects of the research, highlighting the key findings and their implications.
• Audience-specific: A research summary should be tailored to the intended audience, using language and terminology that is appropriate and accessible to the reader.
• Citations : A research summary should include citations to the original research articles or studies, allowing readers to access the full text of the research if desired.

When to write Research Summary

Here are some situations when it may be appropriate to write a research summary:

• Proposal stage: A research summary can be included in a research proposal to provide a brief overview of the research aims, objectives, methodology, and expected outcomes.
• Conference presentation: A research summary can be prepared for a conference presentation to summarize the main findings of a study or research project.
• Journal submission: Many academic journals require authors to submit a research summary along with their research article or study. The summary provides a brief overview of the study’s main points, findings, and conclusions and helps readers quickly understand the research.
• Funding application: A research summary can be included in a funding application to provide a brief summary of the research aims, objectives, and expected outcomes.
• Policy brief: A research summary can be prepared as a policy brief to communicate research findings to policymakers or stakeholders in a concise and accessible manner.

Advantages of Research Summary

Research summaries offer several advantages, including:

• Time-saving: A research summary saves time for readers who need to understand the key findings and conclusions of a research project quickly. Rather than reading the entire research article or study, readers can quickly review the summary to determine whether the research is relevant to their needs.
• Clarity and accessibility: A research summary provides a clear and accessible overview of the research project’s main points, making it easier for readers to understand the research without having to be experts in the field.
• Improved comprehension: A research summary helps readers comprehend the research by providing a brief and focused overview of the key findings and conclusions, making it easier to understand the research and its significance.
• Enhanced communication: Research summaries can be used to communicate research findings to a wider audience, such as policymakers, practitioners, or the general public, in a concise and accessible manner.
• Facilitated decision-making: Research summaries can support decision-making processes by providing a summary of the research evidence on a particular topic. Policymakers or practitioners can use this information to make informed decisions about interventions, programs, or policies.
• Increased dissemination: Research summaries can be easily shared and disseminated, allowing research findings to reach a wider audience.

Limitations of Research Summary

Limitations of the Research Summary are as follows:

• Limited scope: Research summaries provide a brief overview of the research project’s main points, findings, and conclusions, which can be limiting. They may not include all the details, nuances, and complexities of the research that readers may need to fully understand the study’s implications.
• Risk of oversimplification: Research summaries can be oversimplified, reducing the complexity of the research and potentially distorting the findings or conclusions.
• Lack of context: Research summaries may not provide sufficient context to fully understand the research findings, such as the research background, methodology, or limitations. This may lead to misunderstandings or misinterpretations of the research.
• Possible bias: Research summaries may be biased if they selectively emphasize certain findings or conclusions over others, potentially distorting the overall picture of the research.
• Format limitations: Research summaries may be constrained by the format or length requirements, making it challenging to fully convey the research’s main points, findings, and conclusions.
• Accessibility: Research summaries may not be accessible to all readers, particularly those with limited literacy skills, visual impairments, or language barriers.

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How to Write the Discussion Section of a Research Paper

The discussion section of a research paper analyzes and interprets the findings, provides context, compares them with previous studies, identifies limitations, and suggests future research directions.

Updated on September 15, 2023

Structure your discussion section right, and you’ll be cited more often while doing a greater service to the scientific community. So, what actually goes into the discussion section? And how do you write it?

The discussion section of your research paper is where you let the reader know how your study is positioned in the literature, what to take away from your paper, and how your work helps them. It can also include your conclusions and suggestions for future studies.

First, we’ll define all the parts of your discussion paper, and then look into how to write a strong, effective discussion section for your paper or manuscript.

Discussion section: what is it, what it does

The discussion section comes later in your paper, following the introduction, methods, and results. The discussion sets up your study’s conclusions. Its main goals are to present, interpret, and provide a context for your results.

What is it?

The discussion section provides an analysis and interpretation of the findings, compares them with previous studies, identifies limitations, and suggests future directions for research.

This section combines information from the preceding parts of your paper into a coherent story. By this point, the reader already knows why you did your study (introduction), how you did it (methods), and what happened (results). In the discussion, you’ll help the reader connect the ideas from these sections.

Why is it necessary?

The discussion provides context and interpretations for the results. It also answers the questions posed in the introduction. While the results section describes your findings, the discussion explains what they say. This is also where you can describe the impact or implications of your research.

Adds context for your results

Most research studies aim to answer a question, replicate a finding, or address limitations in the literature. These goals are first described in the introduction. However, in the discussion section, the author can refer back to them to explain how the study's objective was achieved. 

Shows what your results actually mean and real-world implications

The discussion can also describe the effect of your findings on research or practice. How are your results significant for readers, other researchers, or policymakers?

What to include in your discussion (in the correct order)

A complete and effective discussion section should at least touch on the points described below.

Summary of key findings

The discussion should begin with a brief factual summary of the results. Concisely overview the main results you obtained.

Begin with key findings with supporting evidence

Your results section described a list of findings, but what message do they send when you look at them all together?

Your findings were detailed in the results section, so there’s no need to repeat them here, but do provide at least a few highlights. This will help refresh the reader’s memory and help them focus on the big picture.

Read the first paragraph of the discussion section in this article (PDF) for an example of how to start this part of your paper. Notice how the authors break down their results and follow each description sentence with an explanation of why each finding is relevant. 

State clearly and concisely

Following a clear and direct writing style is especially important in the discussion section. After all, this is where you will make some of the most impactful points in your paper. While the results section often contains technical vocabulary, such as statistical terms, the discussion section lets you describe your findings more clearly. 

Interpretation of results

Once you’ve given your reader an overview of your results, you need to interpret those results. In other words, what do your results mean? Discuss the findings’ implications and significance in relation to your research question or hypothesis.

Analyze and interpret your findings

Look into your findings and explore what’s behind them or what may have caused them. If your introduction cited theories or studies that could explain your findings, use these sources as a basis to discuss your results.

For example, look at the second paragraph in the discussion section of this article on waggling honey bees. Here, the authors explore their results based on information from the literature.

Unexpected or contradictory results

Sometimes, your findings are not what you expect. Here’s where you describe this and try to find a reason for it. Could it be because of the method you used? Does it have something to do with the variables analyzed? Comparing your methods with those of other similar studies can help with this task.

Context and comparison with previous work

Refer to related studies to place your research in a larger context and the literature. Compare and contrast your findings with existing literature, highlighting similarities, differences, and/or contradictions.

How your work compares or contrasts with previous work

Studies with similar findings to yours can be cited to show the strength of your findings. Information from these studies can also be used to help explain your results. Differences between your findings and others in the literature can also be discussed here. 

How to divide this section into subsections

If you have more than one objective in your study or many key findings, you can dedicate a separate section to each of these. Here’s an example of this approach. You can see that the discussion section is divided into topics and even has a separate heading for each of them. 

Limitations

Many journals require you to include the limitations of your study in the discussion. Even if they don’t, there are good reasons to mention these in your paper.

Why limitations don’t have a negative connotation

A study’s limitations are points to be improved upon in future research. While some of these may be flaws in your method, many may be due to factors you couldn’t predict.

Examples include time constraints or small sample sizes. Pointing this out will help future researchers avoid or address these issues. This part of the discussion can also include any attempts you have made to reduce the impact of these limitations, as in this study .

How limitations add to a researcher's credibility

Pointing out the limitations of your study demonstrates transparency. It also shows that you know your methods well and can conduct a critical assessment of them.  

Implications and significance

The final paragraph of the discussion section should contain the take-home messages for your study. It can also cite the “strong points” of your study, to contrast with the limitations section.

Restate your hypothesis

Remind the reader what your hypothesis was before you conducted the study. 

How was it proven or disproven?

Identify your main findings and describe how they relate to your hypothesis.

How your results contribute to the literature

Were you able to answer your research question? Or address a gap in the literature?

Future implications of your research

Describe the impact that your results may have on the topic of study. Your results may show, for instance, that there are still limitations in the literature for future studies to address. There may be a need for studies that extend your findings in a specific way. You also may need additional research to corroborate your findings. 

Sample discussion section

This fictitious example covers all the aspects discussed above. Your actual discussion section will probably be much longer, but you can read this to get an idea of everything your discussion should cover.

Our results showed that the presence of cats in a household is associated with higher levels of perceived happiness by its human occupants. These findings support our hypothesis and demonstrate the association between pet ownership and well-being. 

The present findings align with those of Bao and Schreer (2016) and Hardie et al. (2023), who observed greater life satisfaction in pet owners relative to non-owners. Although the present study did not directly evaluate life satisfaction, this factor may explain the association between happiness and cat ownership observed in our sample.

Our findings must be interpreted in light of some limitations, such as the focus on cat ownership only rather than pets as a whole. This may limit the generalizability of our results.

Nevertheless, this study had several strengths. These include its strict exclusion criteria and use of a standardized assessment instrument to investigate the relationships between pets and owners. These attributes bolster the accuracy of our results and reduce the influence of confounding factors, increasing the strength of our conclusions. Future studies may examine the factors that mediate the association between pet ownership and happiness to better comprehend this phenomenon.

This brief discussion begins with a quick summary of the results and hypothesis. The next paragraph cites previous research and compares its findings to those of this study. Information from previous studies is also used to help interpret the findings. After discussing the results of the study, some limitations are pointed out. The paper also explains why these limitations may influence the interpretation of results. Then, final conclusions are drawn based on the study, and directions for future research are suggested.

How to make your discussion flow naturally

If you find writing in scientific English challenging, the discussion and conclusions are often the hardest parts of the paper to write. That’s because you’re not just listing up studies, methods, and outcomes. You’re actually expressing your thoughts and interpretations in words.

• How formal should it be?
• What words should you use, or not use?
• How do you meet strict word limits, or make it longer and more informative?

Always give it your best, but sometimes a helping hand can, well, help. Getting a professional edit can help clarify your work’s importance while improving the English used to explain it. When readers know the value of your work, they’ll cite it. We’ll assign your study to an expert editor knowledgeable in your area of research. Their work will clarify your discussion, helping it to tell your story. Find out more about AJE Editing.

Adam Goulston, PsyD, MS, MBA, MISD, ELS

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How To Write the Findings Section of a Research Paper

Posted by Rene Tetzner | Sep 2, 2021 | Paper Writing Advice | 0 |

How To Write the Findings Section of a Research Paper Each research project is unique, so it is natural for one researcher to make use of somewhat different strategies than another when it comes to designing and writing the section of a research paper dedicated to findings. The academic or scientific discipline of the research, the field of specialisation, the particular author or authors, the targeted journal or other publisher and the editor making the decisions about publication can all have a significant impact. The practical steps outlined below can be effectively applied to writing about the findings of most advanced research, however, and will prove especially helpful for early-career scholars who are preparing a research paper for a first publication.

Step 1 : Consult the guidelines or instructions that the targeted journal (or other publisher) provides for authors and read research papers it has already published, particularly ones similar in topic, methods or results to your own. The guidelines will generally outline specific requirements for the results or findings section, and the published articles will provide sound examples of successful approaches. Watch particularly for length limitations and restrictions on content. Interpretation, for instance, is usually reserved for a later discussion section, though not always – qualitative research papers often combine findings and interpretation. Background information and descriptions of methods, on the other hand, almost always appear in earlier sections of a research paper. In most cases it is appropriate in a findings section to offer basic comparisons between the results of your study and those of other studies, but knowing exactly what the journal wants in the report of research findings is essential. Learning as much as you can about the journal’s aims and scope as well as the interests of its readers is invaluable as well.

Step 2 : Reflect at some length on your research results in relation to the journal’s requirements while planning the findings section of your paper. Choose for particular focus experimental results and other research discoveries that are particularly relevant to your research questions and objectives, and include them even if they are unexpected or do not support your ideas and hypotheses. Streamline and clarify your report, especially if it is long and complex, by using subheadings that will help you avoid excessive and peripheral details as you write and also help your reader understand and remember your findings. Consider appendices for raw data that might interest specialists but prove too long or distracting for other readers. The opening paragraph of a findings section often restates research questions or aims to refocus the reader’s attention, and it is always wise to summarise key findings at the end of the section, providing a smooth intellectual transition to the interpretation and discussion that follows in most research papers. There are many effective ways in which to organise research findings. The structure of your findings section might be determined by your research questions and hypotheses or match the arrangement of your methods section. A chronological order or hierarchy of importance or meaningful grouping of main themes or categories might prove effective. It may be best to present all the relevant findings and then explain them and your analysis of them, or explaining the results of each trial or test immediately after reporting it may render the material clearer and more comprehensible for your readers. Keep your audience, your most important evidence and your research goals in mind.

Step 3 : Design effective visual presentations of your research results to enhance the textual report of your findings. Tables of various styles and figures of all kinds such as graphs, maps and photos are used in reporting research findings, but do check the journal guidelines for instructions on the number of visual aids allowed, any required design elements and the preferred formats for numbering, labelling and placement in the manuscript. As a general rule, tables and figures should be numbered according to first mention in the main text of the paper, and each one should be clearly introduced and explained at least briefly in that text so that readers know what is presented and what they are expected to see in a particular visual element. Tables and figures should also be self-explanatory, however, so their design should include all definitions and other information necessary for a reader to understand the findings you intend to show without returning to your text. If you construct your tables and figures before drafting your findings section, they can serve as focal points to help you tell a clear and informative story about your findings and avoid unnecessary repetition. Some authors will even work on tables and figures before organising the findings section (Step 2), which can be an extremely effective approach, but it is important to remember that the textual report of findings remains primary. Visual aids can clarify and enrich the text, but they cannot take its place.

Step 4 : Write your findings section in a factual and objective manner. The goal is to communicate information – in some cases a great deal of complex information – as clearly, accurately and precisely as possible, so well-constructed sentences that maintain a simple structure will be far more effective than convoluted phrasing and expressions. The active voice is often recommended by publishers and the authors of writing manuals, and the past tense is appropriate because the research has already been done. Make sure your grammar, spelling and punctuation are correct and effective so that you are conveying the meaning you intend. Statements that are vague, imprecise or ambiguous will often confuse and mislead readers, and a verbose style will add little more than padding while wasting valuable words that might be put to far better use in clear and logical explanations. Some specialised terminology may be required when reporting findings, but anything potentially unclear or confusing that has not already been defined earlier in the paper should be clarified for readers, and the same principle applies to unusual or nonstandard abbreviations. Your readers will want to understand what you are reporting about your results, not waste time looking up terms simply to understand what you are saying. A logical approach to organising your findings section (Step 2) will help you tell a logical story about your research results as you explain, highlight, offer analysis and summarise the information necessary for readers to understand the discussion section that follows.

Step 5 : Review the draft of your findings section and edit and revise until it reports your key findings exactly as you would have them presented to your readers. Check for accuracy and consistency in data across the section as a whole and all its visual elements. Read your prose aloud to catch language errors, awkward phrases and abrupt transitions. Ensure that the order in which you have presented results is the best order for focussing readers on your research objectives and preparing them for the interpretations, speculations, recommendations and other elements of the discussion that you are planning. This will involve looking back over the paper’s introductory and background material as well as anticipating the discussion and conclusion sections, and this is precisely the right point in the process for reviewing and reflecting. Your research results have taken considerable time to obtain and analyse, so a little more time to stand back and take in the wider view from the research door you have opened is a wise investment. The opinions of any additional readers you can recruit, whether they are professional mentors and colleagues or family and friends, will often prove invaluable as well.

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How To Write the Findings Section of a Research Paper These five steps will help you write a clear & interesting findings section for a research paper

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• 10 Research Question Examples to Guide Your Research Project

10 Research Question Examples to Guide your Research Project

Published on October 30, 2022 by Shona McCombes . Revised on October 19, 2023.

The research question is one of the most important parts of your research paper , thesis or dissertation . It’s important to spend some time assessing and refining your question before you get started.

The exact form of your question will depend on a few things, such as the length of your project, the type of research you’re conducting, the topic , and the research problem . However, all research questions should be focused, specific, and relevant to a timely social or scholarly issue.

Once you’ve read our guide on how to write a research question , you can use these examples to craft your own.

Note that the design of your research question can depend on what method you are pursuing. Here are a few options for qualitative, quantitative, and statistical research questions.

Other interesting articles

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

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How to Write a Research Proposal: (with Examples & Templates)

Table of Contents

Before conducting a study, a research proposal should be created that outlines researchers’ plans and methodology and is submitted to the concerned evaluating organization or person. Creating a research proposal is an important step to ensure that researchers are on track and are moving forward as intended. A research proposal can be defined as a detailed plan or blueprint for the proposed research that you intend to undertake. It provides readers with a snapshot of your project by describing what you will investigate, why it is needed, and how you will conduct the research.  

Your research proposal should aim to explain to the readers why your research is relevant and original, that you understand the context and current scenario in the field, have the appropriate resources to conduct the research, and that the research is feasible given the usual constraints.  

This article will describe in detail the purpose and typical structure of a research proposal , along with examples and templates to help you ace this step in your research journey.  

What is a Research Proposal ?  

A research proposal¹ ,²  can be defined as a formal report that describes your proposed research, its objectives, methodology, implications, and other important details. Research proposals are the framework of your research and are used to obtain approvals or grants to conduct the study from various committees or organizations. Consequently, research proposals should convince readers of your study’s credibility, accuracy, achievability, practicality, and reproducibility.   

With research proposals , researchers usually aim to persuade the readers, funding agencies, educational institutions, and supervisors to approve the proposal. To achieve this, the report should be well structured with the objectives written in clear, understandable language devoid of jargon. A well-organized research proposal conveys to the readers or evaluators that the writer has thought out the research plan meticulously and has the resources to ensure timely completion.  

Purpose of Research Proposals  

A research proposal is a sales pitch and therefore should be detailed enough to convince your readers, who could be supervisors, ethics committees, universities, etc., that what you’re proposing has merit and is feasible . Research proposals can help students discuss their dissertation with their faculty or fulfill course requirements and also help researchers obtain funding. A well-structured proposal instills confidence among readers about your ability to conduct and complete the study as proposed.  

Research proposals can be written for several reasons:³  

• To describe the importance of research in the specific topic  
• Address any potential challenges you may encounter  
• Showcase knowledge in the field and your ability to conduct a study  
• Apply for a role at a research institute  
• Convince a research supervisor or university that your research can satisfy the requirements of a degree program  
• Highlight the importance of your research to organizations that may sponsor your project  
• Identify implications of your project and how it can benefit the audience  

What Goes in a Research Proposal?    

Research proposals should aim to answer the three basic questions—what, why, and how.  

The What question should be answered by describing the specific subject being researched. It should typically include the objectives, the cohort details, and the location or setting.  

The Why question should be answered by describing the existing scenario of the subject, listing unanswered questions, identifying gaps in the existing research, and describing how your study can address these gaps, along with the implications and significance.  

The How question should be answered by describing the proposed research methodology, data analysis tools expected to be used, and other details to describe your proposed methodology.   

Research Proposal Example  

Here is a research proposal sample template (with examples) from the University of Rochester Medical Center. 4 The sections in all research proposals are essentially the same although different terminology and other specific sections may be used depending on the subject.  

Structure of a Research Proposal  

If you want to know how to make a research proposal impactful, include the following components:¹  

1. Introduction  

This section provides a background of the study, including the research topic, what is already known about it and the gaps, and the significance of the proposed research.  

2. Literature review  

This section contains descriptions of all the previous relevant studies pertaining to the research topic. Every study cited should be described in a few sentences, starting with the general studies to the more specific ones. This section builds on the understanding gained by readers in the Introduction section and supports it by citing relevant prior literature, indicating to readers that you have thoroughly researched your subject.  

3. Objectives  

Once the background and gaps in the research topic have been established, authors must now state the aims of the research clearly. Hypotheses should be mentioned here. This section further helps readers understand what your study’s specific goals are.  

4. Research design and methodology  

Here, authors should clearly describe the methods they intend to use to achieve their proposed objectives. Important components of this section include the population and sample size, data collection and analysis methods and duration, statistical analysis software, measures to avoid bias (randomization, blinding), etc.  

5. Ethical considerations  

This refers to the protection of participants’ rights, such as the right to privacy, right to confidentiality, etc. Researchers need to obtain informed consent and institutional review approval by the required authorities and mention this clearly for transparency.  

6. Budget/funding  

Researchers should prepare their budget and include all expected expenditures. An additional allowance for contingencies such as delays should also be factored in.  

7. Appendices  

This section typically includes information that supports the research proposal and may include informed consent forms, questionnaires, participant information, measurement tools, etc.  

8. Citations  

Important Tips for Writing a Research Proposal  

Writing a research proposal begins much before the actual task of writing. Planning the research proposal structure and content is an important stage, which if done efficiently, can help you seamlessly transition into the writing stage. 3,5  

The Planning Stage  

• Manage your time efficiently. Plan to have the draft version ready at least two weeks before your deadline and the final version at least two to three days before the deadline.
• What is the primary objective of your research?  
• Will your research address any existing gap?  
• What is the impact of your proposed research?  
• Do people outside your field find your research applicable in other areas?  
• If your research is unsuccessful, would there still be other useful research outcomes?  

  The Writing Stage  

• Create an outline with main section headings that are typically used.  
• Focus only on writing and getting your points across without worrying about the format of the research proposal , grammar, punctuation, etc. These can be fixed during the subsequent passes. Add details to each section heading you created in the beginning.   
• Ensure your sentences are concise and use plain language. A research proposal usually contains about 2,000 to 4,000 words or four to seven pages.  
• Don’t use too many technical terms and abbreviations assuming that the readers would know them. Define the abbreviations and technical terms.  
• Ensure that the entire content is readable. Avoid using long paragraphs because they affect the continuity in reading. Break them into shorter paragraphs and introduce some white space for readability.  
• Focus on only the major research issues and cite sources accordingly. Don’t include generic information or their sources in the literature review.  
• Proofread your final document to ensure there are no grammatical errors so readers can enjoy a seamless, uninterrupted read.  
• Use academic, scholarly language because it brings formality into a document.  
• Ensure that your title is created using the keywords in the document and is neither too long and specific nor too short and general.  
• Cite all sources appropriately to avoid plagiarism.  
• Make sure that you follow guidelines, if provided. This includes rules as simple as using a specific font or a hyphen or en dash between numerical ranges.  
• Ensure that you’ve answered all questions requested by the evaluating authority.  

Key Takeaways   

Here’s a summary of the main points about research proposals discussed in the previous sections:  

• A research proposal is a document that outlines the details of a proposed study and is created by researchers to submit to evaluators who could be research institutions, universities, faculty, etc.  
• Research proposals are usually about 2,000-4,000 words long, but this depends on the evaluating authority’s guidelines.  
• A good research proposal ensures that you’ve done your background research and assessed the feasibility of the research.  
• Research proposals have the following main sections—introduction, literature review, objectives, methodology, ethical considerations, and budget.  

Frequently Asked Questions  

Q1. How is a research proposal evaluated?  

A1. In general, most evaluators, including universities, broadly use the following criteria to evaluate research proposals . 6  

• Significance —Does the research address any important subject or issue, which may or may not be specific to the evaluator or university?  
• Content and design —Is the proposed methodology appropriate to answer the research question? Are the objectives clear and well aligned with the proposed methodology?  
• Sample size and selection —Is the target population or cohort size clearly mentioned? Is the sampling process used to select participants randomized, appropriate, and free of bias?  
• Timing —Are the proposed data collection dates mentioned clearly? Is the project feasible given the specified resources and timeline?  
• Data management and dissemination —Who will have access to the data? What is the plan for data analysis?  

Q2. What is the difference between the Introduction and Literature Review sections in a research proposal ?  

A2. The Introduction or Background section in a research proposal sets the context of the study by describing the current scenario of the subject and identifying the gaps and need for the research. A Literature Review, on the other hand, provides references to all prior relevant literature to help corroborate the gaps identified and the research need.  

Q3. How long should a research proposal be?  

A3. Research proposal lengths vary with the evaluating authority like universities or committees and also the subject. Here’s a table that lists the typical research proposal lengths for a few universities.  

Q4. What are the common mistakes to avoid in a research proposal ?  

A4. Here are a few common mistakes that you must avoid while writing a research proposal . 7  

• No clear objectives: Objectives should be clear, specific, and measurable for the easy understanding among readers.  
• Incomplete or unconvincing background research: Background research usually includes a review of the current scenario of the particular industry and also a review of the previous literature on the subject. This helps readers understand your reasons for undertaking this research because you identified gaps in the existing research.  
• Overlooking project feasibility: The project scope and estimates should be realistic considering the resources and time available.   
• Neglecting the impact and significance of the study: In a research proposal , readers and evaluators look for the implications or significance of your research and how it contributes to the existing research. This information should always be included.  
• Unstructured format of a research proposal : A well-structured document gives confidence to evaluators that you have read the guidelines carefully and are well organized in your approach, consequently affirming that you will be able to undertake the research as mentioned in your proposal.  
• Ineffective writing style: The language used should be formal and grammatically correct. If required, editors could be consulted, including AI-based tools such as Paperpal , to refine the research proposal structure and language.  

Thus, a research proposal is an essential document that can help you promote your research and secure funds and grants for conducting your research. Consequently, it should be well written in clear language and include all essential details to convince the evaluators of your ability to conduct the research as proposed.  

This article has described all the important components of a research proposal and has also provided tips to improve your writing style. We hope all these tips will help you write a well-structured research proposal to ensure receipt of grants or any other purpose.  

References  

• Sudheesh K, Duggappa DR, Nethra SS. How to write a research proposal? Indian J Anaesth. 2016;60(9):631-634. Accessed July 15, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037942/  
• Writing research proposals. Harvard College Office of Undergraduate Research and Fellowships. Harvard University. Accessed July 14, 2024. https://uraf.harvard.edu/apply-opportunities/app-components/essays/research-proposals  
• What is a research proposal? Plus how to write one. Indeed website. Accessed July 17, 2024. https://www.indeed.com/career-advice/career-development/research-proposal  
• Research proposal template. University of Rochester Medical Center. Accessed July 16, 2024. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/pediatrics/research/documents/Research-proposal-Template.pdf  
• Tips for successful proposal writing. Johns Hopkins University. Accessed July 17, 2024. https://research.jhu.edu/wp-content/uploads/2018/09/Tips-for-Successful-Proposal-Writing.pdf  
• Formal review of research proposals. Cornell University. Accessed July 18, 2024. https://irp.dpb.cornell.edu/surveys/survey-assessment-review-group/research-proposals  
• 7 Mistakes you must avoid in your research proposal. Aveksana (via LinkedIn). Accessed July 17, 2024. https://www.linkedin.com/pulse/7-mistakes-you-must-avoid-your-research-proposal-aveksana-cmtwf/  

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Where Data-Driven Decision-Making Can Go Wrong

• Michael Luca
• Amy C. Edmondson

When considering internal data or the results of a study, often business leaders either take the evidence presented as gospel or dismiss it altogether. Both approaches are misguided. What leaders need to do instead is conduct rigorous discussions that assess any findings and whether they apply to the situation in question.

Such conversations should explore the internal validity of any analysis (whether it accurately answers the question) as well as its external validity (the extent to which results can be generalized from one context to another). To avoid missteps, you need to separate causation from correlation and control for confounding factors. You should examine the sample size and setting of the research and the period over which it was conducted. You must ensure that you’re measuring an outcome that really matters instead of one that is simply easy to measure. And you need to look for—or undertake—other research that might confirm or contradict the evidence.

By employing a systematic approach to the collection and interpretation of information, you can more effectively reap the benefits of the ever-increasing mountain of external and internal data and make better decisions.

Five pitfalls to avoid

Idea in Brief

The problem.

When managers are presented with internal data or an external study, all too often they either automatically accept its accuracy and relevance to their business or dismiss it out of hand.

Why It Happens

Leaders mistakenly conflate causation with correlation, underestimate the importance of sample size, focus on the wrong outcomes, misjudge generalizability, or overweight a specific result.

The Right Approach

Leaders should ask probing questions about the evidence in a rigorous discussion about its usefulness. They should create a psychologically safe environment so that participants will feel comfortable offering diverse points of view.

Let’s say you’re leading a meeting about the hourly pay of your company’s warehouse employees. For several years it has automatically been increased by small amounts to keep up with inflation. Citing a study of a large company that found that higher pay improved productivity so much that it boosted profits, someone on your team advocates for a different approach: a substantial raise of $2 an hour for all workers in the warehouse. What would you do?

• Michael Luca is a professor of business administration and the director of the Technology and Society Initiative at Johns Hopkins University, Carey Business School.
• Amy C. Edmondson is the Novartis Professor of Leadership and Management at Harvard Business School. Her latest book is Right Kind of Wrong: The Science of Failing Well (Atria Books, 2023).

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• Open access
• Published: 07 August 2024

Management training programs in healthcare: effectiveness factors, challenges and outcomes

• Lucia Giovanelli 1 ,
• Federico Rotondo 2 &
• Nicoletta Fadda 1  

BMC Health Services Research volume  24 , Article number:  904 ( 2024 ) Cite this article

163 Accesses

Metrics details

Different professionals working in healthcare organizations (e.g., physicians, veterinarians, pharmacists, biologists, engineers, etc.) must be able to properly manage scarce resources to meet increasingly complex needs and demands. Due to the lack of specific courses in curricular university education, particularly in the field of medicine, management training programs have become an essential element in preparing health professionals to cope with global challenges. This study aims to examine factors influencing the effectiveness of management training programs and their outcomes in healthcare settings, at middle-management level, in general and by different groups of participants: physicians and non-physicians, participants with or without management positions.

A survey was used for gathering information from a purposive sample of professionals in the healthcare field attending management training programs in Italy. Factor analysis, a set of ordinal logistic regressions and an unpaired two-sample t-test were used for data elaboration.

The findings show the importance of diversity of pedagogical approaches and tools and debate, and class homogeneity, as effectiveness factors. Lower competencies held before the training programs and problems of dialogue and discussion during the course are conducive to innovative practice introduction. Interpersonal and career outcomes are greater for those holding management positions.

Conclusions

The study reveals four profiles of participants with different gaps and needs. Training programs should be tailored based on participants’ profiles, in terms of pedagogical approaches and tools, and preserve class homogeneity in terms of professional backgrounds and management levels to facilitate constructive dialogue and solution finding approach.

Peer Review reports

Several healthcare systems worldwide have identified management training as a precondition for developing appropriate strategies to address global challenges such as, on one hand, poor health service outcomes in front of increased health expenditure, particularly for pharmaceuticals, personnel shortages and low productivity, and on the other hand in terms of unbalanced quality and equal access to healthcare across the population [ 1 ]. The sustainability of health systems itself seems to be associated with the presence of leaders, at all levels of health organizations, who are able to correctly manage scarce resources to meet increasingly complex health needs and demands, at the same time motivating health personnel under an increasing amount of stress and steering their behaviors towards the system’s goals, in order to drive the transition towards more decentralized, interorganizational and patient-centered care models [ 2 ].

Recently, professional training as an activity aimed at increasing learning of new capabilities (reskilling) and improving existing ones (upskilling) during the lifetime of individuals (lifelong learning) has been identified by the European Commission as one of the seven flagship programs to be developed in the National Recovery and Resilience Plans (NRRP) to support the achievement of European Union’s goals, such as green and digital transitions, innovation, economic and social inclusion and occupation [ 3 ]. As a consequence, many member states have implemented training programs to face current and future challenges in health, which often represents a core mission in their NRRPs.

The increased importance of developing management training programs is also related to the rigidity and focalization of university degree courses in medicine, which do not provide physicians with the basic tools for fulfilling managerial roles [ 4 ]. Furthermore, taking on these roles does not automatically mean filling existing gaps in management capabilities and skills [ 5 ]. Several studies have demonstrated that, in the health setting, management competencies are influenced by positions and management levels as well as by organization and system’s features [ 6 , 7 ]. Hence, training programs aimed at increasing management competencies cannot be developed without considering these differences.

To date, few studies have focused on investigating management training programs in healthcare [ 8 ]. In particular, much more investigation is required on methods, contents, processes and challenges determining the effectiveness of training programs addressed to health managers by taking into account different environments, positions and management levels [ 1 ]. A gap also exists in the assessment of management training programs’ outcomes [ 9 ]. This study aims to examine factors influencing the effectiveness and outcomes of management training, at the middle-management level, in healthcare. It intends to answer the following research questions: which factors influence the management training process? Which relationships exist between management competencies held before the program, factors of effectiveness, critical issues encountered, and results achieved or prefigured at the end of the program? Are there differences, in terms of factors of effectiveness, challenges and outcomes, between the following groups of management training programs’ participants: physicians and non-physicians, participants with or without management positions?

Management training in healthcare

Currently, there is a wide debate about the added value of management to health organizations [ 10 ] and thus about the importance of spreading management competencies within health organizations to improve their performance. Through a systematic review, Lega et al. [ 11 ] highlighted four approaches to examine the impact of management on healthcare performance, focusing on management practices, managers’ characteristics, engagement of professionals in performance management and organizational features and management styles.

Although findings have not always been univocal, several studies suggest a positive relationship between management competencies and practices and outcomes in healthcare organizations, both from a clinical and financial point of view [ 12 ]. Among others, Vainieri et al. [ 13 ] found, in the Italian setting, a positive association between top management’s competencies and organizational performance, assessed through a multidimensional perspective. This study also reveals the mediating effect of information sharing, in terms of strategy, results and organization structure, in the relationship between managerial competencies and performance.

The key role of management competencies clearly emerges for health executives, who have to turn system policies into a vision, and then articulate it into effective strategies and actions within their organizations to steer and engage professionals [ 14 , 15 , 16 , 17 , 18 , 19 ]. However, health systems are increasingly complex and continually changing across contexts and health service levels. This means the role of health executives is evolving as well and identifying the capacities they need to address current and emerging issues becomes more difficult. For instance, a literature review conducted by Figueroa et al. [ 20 ] sheds light on priorities and challenges for health leadership at three structural levels: macro context (international and national), meso context (organizations) and micro context (individual healthcare managers).

Doctor-managers are requested to carry both clinical tasks and tasks related to budgeting, goal setting and performance evaluation. As a consequence, a growing stream of research has speculated whether managers with a clinical background actually affect healthcare performance outcomes, but studies have produced inconclusive findings. In relation to this topic, Sarto and Veronesi [ 21 ] carried out a literature review showing a generally positive impact of clinical leadership on different types of outcome measures, with only a few studies reporting negative impacts on financial and social performance. Morandi et al. [ 22 ] focused on doctor-managers who have become middle managers and investigated the potential bias in performance appraisal due to the mismatch between self-reported and official performance data. At the individual level, the role played by managerial behavior, training, engagement, and perceived organizational support was analyzed. Among others indications they suggested that training programs should be revised to reduce bias in performance appraisal. Tasi et al. [ 23 ] conducted a cross-sectional analysis of the 115 largest U.S. hospitals, divided into physician-led and non-physician-led, which revealed that physician-led hospital systems have higher quality ratings across all specialities and more inpatient days per hospital bed than non-physician-led hospitals. No differences between the groups were found in total revenue and profit margins. The main implication of their study is that hospital systems may benefit from the presence of physician leadership to improve the quality and efficiency of care delivered to patients as long as education and training are able to adequately prepare them. The main issue, as also observed by others [ 4 , 24 ], is that university education in medicine still includes little focus on aspects such as collaborative management, communication and coordination, and leadership skills. Such a circumstance motivates the call for further training. Regarding the implementation of training programs, Liang et al. [ 1 ] have recently shown how it is hindered, among others, by a lack of sufficient knowledge about needed competencies and existing gaps. Their analysis, which focuses on senior managers from three categories in Chinese hospitals, shows that before commencing the programs senior managers had not acquired adequate management competencies either through formal or informal training. It is worth noticing that significant differences exist between hospital categories and management levels. For this reason, they recommend using a systemic approach to design training programs, which considers different hospital types, management levels and positions. Yarbrough et al. [ 6 ] examined how competence training worked in healthcare organizations and the competencies needed for leaders at different points of their careers at various organizational levels. They carried out a cross-sectional survey of 492 US hospital executives, whose most significant result was that competence training is effective in healthcare organizations.

Walston and Khaliq [ 25 ], from a survey of 2,001 hospital CEOs across the US concluded that the greatest contribution of continuing education is to keep CEOs updated on technological and market changes that impact their current job responsibilities. Conversely, it does not seem to be valued for career or succession planning. About the methods of continuing education, an increasing use of some internet-based tools was found. Walston et al. [ 26 ] identified the factors affecting continuing education, finding, among others, that CEOs from for-profit and larger hospitals tend to take less continuing education, whereas senior managers' commitment to continuing education is influenced by region, gender, the CEO's personal continuing education hours and the focus on change.

Furthermore, the principles that inspire modern healthcare models, such as dehospitalization, horizontal coordination and patient-centeredness, imply the increased importance of middle managers, within single structures but also along clinical pathways and projects, to create and sustain high performances [ 27 , 28 , 29 ].

Whaley and Gillis [ 8 ] investigated the development of training programs aimed at increasing managerial competencies and leadership of middle managers, both from clinical and nonclinical backgrounds, in the US context. By adopting the top managers’ perspective, they found a widespread difficulty in aligning training needs and program contents. A 360° assessment of the competencies of Australian middle-level health service managers from two public hospitals was then conducted by Liang et al. [ 7 ] to identify managerial competence levels and training and development needs. The assessment found competence gaps and confirmed that managerial strengths and weaknesses varied across management groups from different organizations. In general, several studies have shown that leading at various organizational levels, in healthcare, does not necessarily require the same levels and types of competencies.

Liang et al. [ 30 ] explored the core competencies required for middle to senior-level managers in Victorian public hospitals. By adopting mixed methods, they confirmed six core competencies and provided guidance to the development of the competence-based educational approach for training the current and future management workforce. Liang et al. [ 31 ] then focused on the poorly investigated area of community health services, which are one of the main solutions to reducing the increasing demand for hospital care in general, and, in particular, in the reforms of the Australian health system. Their study advanced the understanding of the key competencies required by senior and mid-level managers for effective and efficient community health service delivery. A following cross-sectional study by AbuDagga et al. [ 32 ] highlighted that some community health services, such as home healthcare and hospice agencies, also need specific cultural competence training to be effective, in terms of reducing health disparities.

Using both qualitative and quantitative methods, Liang et al. [ 33 ] developed a management competence framework. Such a framework was then validated on a sample of 117 senior and middle managers working in two public hospitals and five community services in Victoria, Australia [ 34 ]. Fanelli et al. [ 35 ] used mixed methods to identify the following specific managerial competencies, which healthcare professionals perceive as crucial to improve their performance: quality evaluation based on outcomes, enhancement of professional competencies, programming based on process management, project cost assessment, informal communication style and participatory leadership.

Loh [ 5 ], through a qualitative analysis conducted in Australian hospitals, examined the motivation behind the choice of medically trained managers to undertake postgraduate management training. Interesting results stemming from the analysis include the fact that doctors often move into management positions without first undertaking training, but also that clinical experience alone does not lead to required management competencies. It is also interesting to remark that effective postgraduate management training for doctors requires a combination of theory and practice, and that doctors choose to undertake training mostly to gain credibility.

Ravaghi et al. [ 36 ] conducted a literature review to assess the evidence on the effectiveness of different types of training and educational programs delivered to hospital managers. The analysis identifies a set of aspects that are impacted by training programs. Training programs focus on technical, interpersonal and conceptual skills, and positive effects are mainly reported for technical skills. Numerous challenges are involved in designing and delivering training programs, including lack of time, difficulty in employing competencies in the workplace, also due to position instability, continuous changes in the health system environment, and lack of support by policymakers. One of the more common flaws concerns the fact that managers are mainly trained as individuals, but they work in teams. The implications of the study are that increased investments and large-scale planning are required to develop the knowledge and competencies of hospital managers. Another shortage concerns the outcome measurement of training programs, which is a usually neglected issue in the literature [ 9 ]. It also emerges that the training programs performing best are specific, structured and comprehensive.

Kakemam and Liang [ 2 ] conducted a literature review to shed light on the methods used to assess management competencies, and, thus, professional development needs in healthcare. Their analysis confirms that most studies focus on middle and senior managers and demonstrate great variability in methods and processes of assessment. As a consequence, they elaborate a framework to guide the design and implementation of management competence studies in different contexts and countries.

In the end, the literature has long pointed out that developing and strengthening the competencies and skills of health managers represent a core goal for increasing the efficiency and effectiveness of health systems, and management training is crucial for achieving such a goal [ 37 ]. The reasons can be summarized as follows: university education has scarcely been able to provide physicians and, in general, health operators, with adequate, or at least basic, managerial competencies and skills; over time, professionals have been involved in increasingly complex and rapidly changing working environments, requiring increased management responsibilities as well as new competencies and skills; in many settings, for instance in Italy, delays in the enforcement of law requiring the attendance of specific management training courses to take up a leadership position, hindered the acquisition of new competencies and the improvement of existing ones by those already managing health organizations, structures and services.

For the purposes of this study, management competencies refer to the possession and ability to use skills and tools for service organization and service planning, control and evaluation, evidence-informed decision-making and human resource management in the healthcare field.

Management training in the Italian National Health System

The reform of the Italian National Health System (INHS), implemented by Legislative Decree No. 502/1992 and inspired by neo-managerial theories, introduced the role of the general manager and assigned new responsibilities to managers.

However, the inadequate performance achieved in the first years of the application of the reform highlighted the cultural gap that made the normative adoption of managerial approach and tools unproductive on the operational level. Legislation evolved accordingly, and in order to hold management positions, management training became mandatory. Decree-Law No. 583/1996 (converted into Law No. 4/1997) provided that the requirements and criteria for access to the top management level were to be determined. Therefore, Presidential Decree No. 484/1997 determined these requirements and also the requirements and criteria to access the middle-management level of INHS’ healthcare authorities. This regulation also imposed the acquisition of a specific management training certificate, dictated rules concerning the duration, contents, and teaching methods of management training courses issuing this certificate, and indicated the requirements for attendance. Immediately afterwards, Legislative Decree No. 229/1999 amended the discipline of medical management and health professions and promoted continuous training in healthcare. It also regulated management training, which became an essential requirement for the appointments of health directors and directors of complex structures in the healthcare authorities, for the categories of physicians, dentists, veterinarians, pharmacists, biologists, chemists, physicists and psychologists.

The second pillar of the INHS reform was the regionalization of the INHS. Therefore, the Regions had to organize the courses to achieve management training certificates on the basis of specific agreements with the State, which regulated the contents, the methodology, the duration and the procedures for obtaining certification. The State-Regions Conference approved the first interregional agreement on management training in July 2003, whereas the State-Regions Agreement of 16 May 2019 regulated the training courses. The mandatory contents of the management training outlined the skills and behaviors expected from general managers and other top management key players (Health Director, Administrative Director and Social and Health Director), but also for all middle managers.

A survey was used to gather information from a purposive sample of professionals in the healthcare field taking part in management training programs. In particular, a structured questionnaire was submitted to 140 participants enrolled in two management programs organized by an Italian university: a second-level specializing master course and a training program carried out in collaboration with the Region. The programs awarded participants the title needed to be appointed as a director of a ward or administrative unit in a public healthcare organization, and share the same scientific committee, teaching staff, administrative staff and venue. The respondents’ profile is shown in Table  1 .

It is worth pointing out that the teaching staff is characterized by diversity: teachers have different educational and professional backgrounds, are practitioners or academics, and come from different Italian regions.

The questionnaire was submitted and completed in presence and online between November 2022 and February 2023. All participants decided to take part in the analysis spontaneously and gave their consent, being granted total anonymity.

The questionnaire, which was developed for this study and based on the literature, consisted of 64 questions shared in the following five sections: participant profile (10 items), management competencies held by participants before the training program (4 items), effectiveness factors of the training program (23 items), challenges to effectiveness (10 items), and outcomes of the training program (17 items) (an English language version of the questionnaire is attached to this paper as a supplementary file). In particular, the second section aimed to shed light on the participants’ situation regarding management competencies held before the start of the training program and how they were acquired; the third section aimed to collect participants’ opinions regarding how the program was conducted and the factors influencing its effectiveness; the fourth section aimed to collect participants’ opinions regarding the main obstacles encountered during the program; and the fifth section aimed to reveal the main outcomes of the program in terms of knowledge, skills, practices and career.

Except for those of the first section, which collected personal information, all the items of the next four categories – management competencies, effectiveness factors, challenges and outcome — were measured through a 5-point Likert scale. To ensure that the content of the questionnaire was appropriate, clear and relevant, a pre-testing was conducted in October 2022 by asking four academics and four practitioners, both physicians and not, with and without management positions, to fill it out. The aim was to understand whether the questionnaire really addressed the information needs behind the study and was easily and correctly understood by respondents. Therefore, the four individuals involved in the pre-testing were asked to fill it out simultaneously but independently, and at the end of the compilation, a focus group that included them and the three authors was used to collect their opinions and suggestions. After this phase, the following changes were made: in the ‘Participant profile’ section, ‘Veterinary medicine’ was added to the fields accounting for the ‘Educational background’ (item 3); in Sect. 2, it was decided to modify the explanation given to ‘basic management competencies’ and align it to what required by Presidential Decree No. 484/1997; in Sect. 3, item 25 was added to catch a missing aspect that respondents considered important, and brackets were added to the description of items 15, 16 and 29 to clarify the concepts of mixed and homogenous class and pedagogical approaches and tools; in Sect. 4, in the description of item 40, the words ‘find the energy required’ were added to avoid confusion with items 38 and 39, whereas brackets were added to items 41 and 45 to provide more explanation; in Sect. 5, brackets were added to the description of item 51 to increase clarity, and the last item was divided into two (now items 63 and 64) to distinguish the training program’s impact on career at different times.

With reference to the methods, first, a factor analysis based on the principal component method was conducted within each section of the questionnaire (except for the first again), in order to reduce the number of variables and shed light on the factors influencing the management training process. Bartlett's sphericity test and the Kaiser–Meyer–Olkin (KMO) value were performed to assess sampling adequacy, whereas factors were extracted following the Kaiser criterion, i.e., eigenvalues greater than unity, and total variance explained. The rotation method used was the Varimax method with Kaiser normalization, except for the second section (i.e., management competencies held by participants before the training program) that), which did not require rotation since a single factor emerged from the analysis. Bartlett's sphericity test was statistically significant ( p  < 0.001) in all sections, KMO values were all greater than 0.65 (average value 0.765), and the total variances explained were all greater than 65% (average value of approximately 70.89%), which are acceptable values for such analysis.

Second, a set of ordinal logistic regressions were performed to assess the relationships existing between management competencies held before the start of the course, effectiveness factors, challenges, and outcomes of the training program.

The factors that emerged from the factor analysis were used as independent variables, whereas some significant outcome items accounting for different performance aspects were selected as dependent variables: improved management competencies, innovation practices, professional relationships, and career prospects. Ordered logit regressions were used because the dependent variables (outcomes) were measured on ordinal scales. Some control variables for the respondent profiles were included in the regression models: age, gender, educational background, management position, and working in the healthcare field.

With the aim of understanding which explanatory variables could exert an influence, a backward elimination method was used, adopting a threshold level of significance values below 0.20 ( p  < 0.20). Table 4 shows the results of regressions with independent variables obtained following the criterion mentioned above. All four models respected the null hypothesis, which means that the proportional odds assumption behind the ordered logit regressions had not been rejected ( p  > 0.05). Third and last, an unpaired two-sample t-test was used to examine the differences between groups of participants in the management training programs selected based on two criteria: physicians and non-physicians, and participants with or without management positions.

First, descriptive statistics is useful for understanding the aspects participants considered the most and least important by category. This can be done by focusing on the items of the four sections of the questionnaire (except for the first one depicting participant profiles) that were given the highest and lowest scores at the sample level and by different groups of participants (physicians and non-physicians, participants with or without management positions). Table 2 summarizes the mean values and standard deviations by group of these higher and lower scores. Focusing on management competencies, all groups reported having mainly acquired them through professional experience, except for non-physicians who attributed major significance to postgraduate training programs, with a mean value of 3.05 out of 5. All groups agreed on the poor role of university education in providing management competencies, with mean values for the sample and all four groups below 2.5. It is worth noting that this item exhibits the lowest value for physicians (1.67) and the highest for non-physicians (2.37). In addition, physicians are the group attributing the lowest values to postgraduate education and professional experience for acquiring management competencies. In reference to factors of effectiveness, all groups also agree on the necessity of mixing theoretical and practical lessons during the training program with mean values of well above 4.5, whereas exclusive use of self-assessment is generally viewed as the most ineffective practice, except for non-physician, who attribute the lowest value to remote lessons (mean 1.82). Among the challenges, the whole sample and physicians and participants without management positions see the lack of financial support from their organization as the main problem (mean 4.10), while non-physicians and participants with management positions believe this is represented by a lack of time, with mean values, respectively, of 3.75 and 4. All agree that dialogue and discussion during the course have been the least relevant of the problems, with mean values below 1.5. Outcomes show generally high values, as revealed by the fact that the lowest values exhibit mean values around 3.5. It is worth noting that an increased understanding of the healthcare systems has been the main benefit gained from the program, with mean values equal to or higher than 4.50. The lowest positive impact is attributed by all attendees to improved relationships with superiors and top management, with mean values between 3.44 and 3.74, with the exception of participants without management positions who mention improved career prospects.

To shed light on the factors influencing the management training process, the findings of the factor analyses conducted by category are reported. Starting from the management competencies held before the training program, the following single factor was extracted from the four items, named and interpreted as follows:

Basic management competencies, which measures the level of management competencies acquired by participants through higher education, post-graduate training and professional experience.

The effectiveness factors are then grouped into six factors, named and explained as follows:

Diversity and debate, which aggregates five items assessing the importance of diversity in participants’ and teachers’ educational and professional backgrounds and pedagogical approaches and tools, as well as level of participant engagement and discussion during lessons and in carrying out the project work required to complete the program.

Specialization, which includes three items accounting for a robust knowledge of healthcare systems by focusing on teachers’ profiles and lessons’ theoretical approaches.

Lessons in presence, which groups three items explaining that in-presence lessons increase learning outcomes and discussion among participants.

Final self-assessment, made up of three items asserting that learning outcomes should be assessed by participants themselves at the end of the course.

Written intermediate assessment, composed of two items explaining that mid-terms assessment should only be written.

Homogeneous class, which is made up of a single component accounting for participants’ similarity in terms of professional backgrounds and management levels, tasks and responsibilities.

The challenges are aggregated into the following four factors:

Lack of time, which includes three items reporting scarce time and energy for lessons and study.

Problems of dialogue and discussion, which groups three items focusing on difficulties in relating to and debating with other participants and teachers.

Low support from organization, which is made up of two items reporting poor financial support and low value given to the initiative from participants’ own organizations.

Organizational issues, which aggregates two items demonstrating scarce flexibility and collaboration by superiors and colleagues of participants’ own organizations and unfamiliarity to study.

Table 3 shows the component matrix with saturation coefficients and factors obtained for the management competencies held before the training program (unrotated), effectiveness factors (rotated), and challenges (rotated).

A set of ordinal logistic regressions was performed to examine the relationships between management competencies held before the start of the course, effectiveness factors, challenges and outcomes of the training program. The results, shown in Table  4 , are articulated into four models, one for each selected outcome. In relation to model 1, the factors ‘diversity and debate’ ( p  < 0.001), ‘written intermediate assessment’ ( p  < 0.05) and ‘homogeneous class’ ( p  < 0.001) have a significant positive impact on the improvement of management competencies, which is also increased by low values attributed to ‘problems of dialogue and discussion’ ( p  < 0.01). In model 2, the change of professional practices in light of lessons learned during the program, selected as an innovation outcome, is then positively affected by ‘diversity and debate’ ( p  < 0.001), ‘homogeneous class’ ( p  < 0.05) and ‘organizational issues’ ( p  < 0.01), while it was negatively influenced by a high value of ‘basic management competencies’ held before the course ( p  < 0.05). Regarding model 3, ‘Diversity and debate’ ( p  < 0.001) and ‘homogeneous class’ ( p  < 0.01) have a significant positive effect on the improvement of professional relationships as well, whereas the same is negatively affected by ‘lessons in presence’ ( p  < 0.05). Finally, concerning model 4, the outcome career prospects benefit from ‘diversity and debate’ ( p  < 0.05) and ‘homogeneous class’ ( p  < 0.01), since both factors exert a positive effect. ‘Low support from organization’ negatively influences career prospects ( p  < 0.001). Table 4 also shows that the LR test of proportionality of odds across the response categories cannot be rejected (all four p  > 0.05).

Finally, it is worth noting that none of the control variables reflecting the respondent profiles (age, gender, management position, working in the healthcare field, and educational background) was found to be statistically significant. These variables are not reported in Table  4 because regression models were obtained following a backward elimination method, as explained in the method section.

In the end, the t-test reveals significant differences between physicians and non-physicians, as well as between participants with or without management positions. Table 5 shows only figures of t-test statistically significant with regards to competencies held before the attendance of the course, the factors of effectiveness, challenges of the training program, and outcomes achieved. In the first comparison, non-physicians show higher management competencies at the start of the program, with a mean value of 0.31, while physicians suffer from less support from their own organization with a mean value of 0.13 compared to -0.18, the mean value of the non-physicians. Concerning the second comparison, participants with management positions have higher management competencies at the start of the program (0.19 versus -0.13) and suffer more from lack of time, with higher mean values compared to participants without managerial positions, respectively 0.23 and -0.16. For what concerns the factors related to the effectiveness of the training program, participants with management positions exhibit a lower mean value in relation to written mid-term assessments, -0.24 versus 0.17, reported by participants with management positions. Differently, the final self-assessment at the end of the program is higher for participants with management positions, 0.24 compared to -0.17, the mean value of the participants without management positions. This latter category feels more the problem of low support from their organizations, with a mean value of 0.16 compared to -0.23, and is slightly less motivated by possible career improvement, with a mean value of 3.31 compared to 3.73 reported by participants with management positions.

The results stemming from the different analyses are now considered and interpreted in the light of the extant literature. Personal characteristics such as gender and age, differently from what was found by Walston et al. [ 26 ] for executives’ continuing education, and professional characteristics such as seniority and working in public or private sectors, do not seem to affect participation in management training programs.

The findings clearly show the outstanding importance of ‘diversity and debate’ and ‘class homogeneity’ as factors of effectiveness, since they positively impact all outcomes: competencies, innovation, professional relationships and career. These factors capture two key aspects complementing each other: on the one hand, participants and teachers’ different backgrounds provide the class with a wider pool of resources and expertise, whereas the use of pedagogical tools fostering discussion enriches the educational experience and stimulates creativity. On the other hand, due to the high level of professionalism in the setting, sharing common management levels means similar tasks and responsibilities, as well as facing similar problems. Consequently, speaking the same language leads to deeper knowledge and effective technical solutions.

In relation to the improvement of management competencies, it also emerges the critical role of a good class atmosphere, that is, the absence of problems of dialogue and discussion. ‘Diversity and debate’ and ‘class homogeneity’, as explained before, seem to contribute to this, since they enhance freedom of expression and fair confrontation, leading to improved learning outcomes. It is interesting to notice that the problems of dialogue and discussion turned out to be the least relevant challenge across the sample.

Two interesting points come from the factors affecting innovation. First, it seems that lower competencies before the training programs lead to the development of more innovative practices. The reason is that holding fewer basic competencies means a greater scope for action once new capabilities are learned: the spirit of openness is conducive to breaking down routines, and innovative practices hindered by a lack of knowledge and tools can thus be introduced. The reason is that holding fewer basic competencies means greater scope for action once new capabilities are learned: the spirit of openness is conducive to breaking down routines, and innovative practices hindered by a lack of knowledge and tools can thus be introduced. This extends the findings of previous studies since the employment of competencies in the workplace is influenced by the starting competence equipment of professionals [ 36 ], and those showing gaps have more room to recover, also in terms of motivation to change, that is, understanding the importance of meeting current and future challenges [ 26 ]. Second, more innovative practices are introduced by participants perceiving more organizational issues. This may reveal, on the one side, a stronger individual motivation towards professional growth of participants who suffer from lack of flexibility and collaboration from their own superiors and colleagues. In this regard, poor tolerance, flexibility and permissions in their workplace act as a stimulus to innovation, which can be viewed as a way of challenging the status quo. On the other side, in line with the above-mentioned concept, this confirms that unfamiliarity with the study increases the innovative potential of participants. Since this study reveals that physicians are neither adequately educated from a management point of view nor incentivized to attend post-graduation training programs, it points out how important is extending continuing education to all health professional categories [ 25 , 26 ].

The topic of competencies held by different categories needs more attention. The study reveals that physicians and participants without management positions start the program with less basic competencies. At the sample level, higher education is viewed as the most ineffective tool to provide such competencies, whereas professional experience is seen as the best way to gather them. Actually, non-physicians give the highest value to postgraduate education, which suggests they are those more interested or incentivized to take part in continuing education. Although holding managerial positions does not automatically mean having higher competencies [ 5 ], it is evident that such a professional experience contributes to filling existing gaps. Physicians stand out as the category for which university education, postgraduate education and professional experience exert the lowest impact on management competence improvement. Considering the relationship between competence held before the course and innovation, as described above, engaging physicians in training programs, even more if they do not have management responsibilities, has a major impact on health organizations’ development prospects. The findings also point out that effective management training requires a combination of theory and practice for all categories of professionals, not just for physicians, as observed by Loh [ 5 ].

The main outcome, in general and for all participant categories, is an increased understanding of how healthcare systems work, which anticipates increased competencies. This confirms the importance of knowledge on the healthcare environment [ 31 ], and clarifies the order of aspects impacted by training programs as reported by Ravaghi et al. [ 36 ]: first conceptual, then technical, and finally interpersonal. However, interpersonal outcomes are by far greater for those holding management positions, which extends the findings by Liang et al. [ 31 ]. In particular, participants already managing units report the greatest impacts in terms of ability to understand colleagues’ problems, improvement of professional relationships and collaboration with colleagues from other units. Obviously, participants with management positions, more than others, feel the lack of collaborative and communication skills, which represents one of the main flaws of university education in the field of medicine [ 4 ] and is also often neglected in management training [ 36 ]. This also confirms that different management levels show specific competence requirements and education needs [ 6 , 7 ]. 

It is then important to discuss the negative effect of lessons in presence on the improvement of professional relationships. At first glance, it may sound strange, but its real meaning emerges from a comprehensive interpretation of all the findings. First, it does not mean that remote lessons are more effective, as revealed by the fact that they, as a factor of effectiveness, are attributed very low values and, for all categories of participants, lower values than those attributed to lessons in presence and hybrid lessons. Non-physicians, in particular, attribute them the lowest value at all. At most, remote lessons are viewed as convenient rather than effective. The negative influence of lessons in presence can be explained by the fact that a specific category, i.e., those with management positions, rate this aspect much more important than other participants and, as reported above, find much more benefits in terms of improved relationships from management training. Participants with management positions, due to their tasks and responsibilities, suffer more than others from lack of time to be devoted to course participation. For them, as for the category of non-physicians, lack of time represents the main challenge to effectively attending the course. In the literature, such a problem is well considered, and lack of time is also viewed as a challenge to apply the skills learned during the course [ 36 ]. Considering that class discussion and homogeneity contribute to fostering relationships, a comprehensive reading of the findings reveals that due to workload, participants with management positions see particularly convenient and still effective remote lessons. Furthermore, if the class is formed by participants sharing similar professional backgrounds and management levels, debate is not precluded and interpersonal relationships improved as a consequence. From the observation of single items, it can be concluded that participants with management positions and in general those with higher basic management competencies at the start of the program, prefer more flexible and leaner training programs: intermediate assessment through conversation, self-assessment at the end of the course, more concentrated scheduled lessons and greater use of remote lessons.

Differently from what was found by Walston and Khaliq [ 25 ], the findings highlight that participants with management positions value the impact of management training on career prospects positively. These participants are also those more supported by their own organizations. Conversely, the lack of support, especially in terms of inadequate funds devoted to these initiatives, strongly affects physicians and participants without management positions, which clarifies what this challenge is about and who is mainly affected by it [ 36 ]. Low incentives mean having attended fewer training programs in the past, which, together with less management experience, explains why they have developed less competencies. Among the outcomes of the training program, the little attention paid by organizations is also testified by the lowest values attributed by all categories, except for participants without management positions, to the improvement of relationships with superiors and top management.

In general, the study contributes to a better understanding of the outcomes of management training programs in healthcare and their determinants [ 9 ]. In particular, it sheds light on gaps and education needs [ 1 ] by category of health professionals [ 2 ]. The research findings have major implications for practice, which can be drawn after identifying the four profiles of participants revealed by the study. All profiles share common characteristics, such as value given to debate, diversity of pedagogical approaches and tools and class homogeneity, rather than the need for a deeper comprehension of healthcare systems. However, they present characteristics that determine specific issues and education gaps, which are summarized as follows:

Physicians without management positions: low competencies at the start of the program and scarce incentives for attending the course from their own organization;

Physicians with management positions: they partially compensate for competence gaps through professional experience, suffer from lack of time, and are motivated by the chance to improve their career prospects;

Non-physicians without management positions: they partially fill competence gaps through postgraduate education, suffer from lack of time, and have scarce incentives for attending the course from their own organization;

Non-physicians with management positions: they partially bridge competence gaps through postgraduate education and professional experience, are the most affected by a lack of time, and are motivated by the chance to improve their career prospects.

Recommendations are outlined for different levels of action:

For policymakers, it is suggested to strengthen the ability of higher education courses in medicine and related fields to advance the understanding of healthcare systems’ structure and operation, as well as their current and future challenges. Such a new approach in the design curricula should then have as a main goal the provision of adequate management competencies.

For healthcare organizations, it is suggested to incentivize the acquisition of management competencies by all categories of professionals through postgraduate education and training programs. This means supporting them from both financial and organizational point of view, for instance, in terms of more flexible working conditions. Special attention should be paid to physicians who, even without executive roles, manage resources and directly impact the organization's effectiveness and efficiency levels through their day-by-day activity, and are the players holding the greatest innovative potential within the organization. Concerning the executives, especially in the current changing context of healthcare systems, much higher attention should be paid to fostering interpersonal skills, in terms of communication and cooperation.

For those designing training programs, it is suggested to tailor courses on the basis of participants’ profiles, using different pedagogical approaches and tools, for instance, in terms of teacher composition, lesson delivery methods and learning assessment methods, while preserving class homogeneity in terms of professional backgrounds and management levels to facilitate constructive dialogue and solution finding approaches. Designing ad hoc training programs would give the possibility to meet the needs of participants from an organizational point of view as well as, for instance, in terms of program length and lesson concentration.

Limitations

This study has some limitations, which pave the way for future research. First, it is context-specific by country, since it is carried out within the INHS, which mandatorily requires health professionals to attend management training programs to hold certain positions. It is then context-specific by training program, since it focuses on management training programs providing participants with the title to be appointed as a director of a ward or administrative unit in a public healthcare organization. This determines the kind of management competencies included in the study, which are those mandatorily required for such a middle-management category. Therefore, there is a need to extend research and test these findings on different types of management training programs, participants and countries. Second, this study is based on a survey of participants’ perceptions, which causes two kinds of unavoidable issues: although based on the literature and pre-tested, the questionnaire could not be able to measure what it intends to or capture detailed and nuanced insights from respondents, and responses may be affected by biases due to reactive effects. Third, a backward elimination method was adopted to select variables in model building. Providing a balance between simplicity and fit of models, this variable selection technique is not consequences-free. Despite advantages such as starting the process with all variables included, removing the least important early, and leaving the most important in, it also has some disadvantages. The major is that once a variable is deleted from the model, it is not included anymore, although it may become significant later [ 38 ]. For these reasons, it is intended to reinforce research with new data sources, such as teachers’ perspectives and official assessments, and different variable selection strategies. A combination of qualitative and quantitative methods for data elaboration could then be used to deepen the analysis of the relationships between motivations, effectiveness factors and outcomes. Furthermore, since the investigation of competence development, acquisition of new competencies and the transfer of acquired competencies was beyond the purpose of this study, a longitudinal approach will be used to collect data from participants attending future training programs to track changes and identify patterns.

Availability of data and materials

An English-language version of the questionnaire used in this study is attached to this paper as a supplementary file. The raw data collected via the questionnaire are not publicly available due to privacy and other restrictions. However, datasets generated and analyzed during the current study may be available from the corresponding author upon reasonable request.

Abbreviations

Italian National Health System

Kaiser–Meyer–Olkin

National Recovery and Resilience Plan

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Giovanelli, L., Rotondo, F. & Fadda, N. Management training programs in healthcare: effectiveness factors, challenges and outcomes. BMC Health Serv Res 24 , 904 (2024). https://doi.org/10.1186/s12913-024-11229-z

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Research has shown that the unilateral accumulation of international reserves by a country can improve its own macro-financial stability. However, we show that when many countries accumulate reserves, the induced general equilibrium effects weaken financial and macroeconomic stability, especially for countries that do not accumulate reserves. The issuance of public debt by advanced economies has the opposite effect. We derive these results from a two-region model where private defaultable debt has a productive use. Quantitative counterfactuals show that the surge in reserves (public debt) contributed to reduce (increase) world interest rates but also to increase (reduce) private leverage. This in turn increased (decreased) volatility in both emerging and advanced economies.

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9 Best Marketing Research Methods to Know Your Buyer Better [+ Examples]

Published: August 08, 2024

One of the most underrated skills you can have as a marketer is marketing research — which is great news for this unapologetic cyber sleuth.

From brand design and product development to buyer personas and competitive analysis, I’ve researched a number of initiatives in my decade-long marketing career.

And let me tell you: having the right marketing research methods in your toolbox is a must.

Market research is the secret to crafting a strategy that will truly help you accomplish your goals. The good news is there is no shortage of options.

How to Choose a Marketing Research Method

Thanks to the Internet, we have more marketing research (or market research) methods at our fingertips than ever, but they’re not all created equal. Let’s quickly go over how to choose the right one.

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1. Identify your objective.

What are you researching? Do you need to understand your audience better? How about your competition? Or maybe you want to know more about your customer’s feelings about a specific product.

Before starting your research, take some time to identify precisely what you’re looking for. This could be a goal you want to reach, a problem you need to solve, or a question you need to answer.

For example, an objective may be as foundational as understanding your ideal customer better to create new buyer personas for your marketing agency (pause for flashbacks to my former life).

Or if you’re an organic sode company, it could be trying to learn what flavors people are craving.

2. Determine what type of data and research you need.

Next, determine what data type will best answer the problems or questions you identified. There are primarily two types: qualitative and quantitative. (Sound familiar, right?)

• Qualitative Data is non-numerical information, like subjective characteristics, opinions, and feelings. It’s pretty open to interpretation and descriptive, but it’s also harder to measure. This type of data can be collected through interviews, observations, and open-ended questions.
• Quantitative Data , on the other hand, is numerical information, such as quantities, sizes, amounts, or percentages. It’s measurable and usually pretty hard to argue with, coming from a reputable source. It can be derived through surveys, experiments, or statistical analysis.

Understanding the differences between qualitative and quantitative data will help you pinpoint which research methods will yield the desired results.

For instance, thinking of our earlier examples, qualitative data would usually be best suited for buyer personas, while quantitative data is more useful for the soda flavors.

However, truth be told, the two really work together.

Qualitative conclusions are usually drawn from quantitative, numerical data. So, you’ll likely need both to get the complete picture of your subject.

For example, if your quantitative data says 70% of people are Team Black and only 30% are Team Green — Shout out to my fellow House of the Dragon fans — your qualitative data will say people support Black more than Green.

(As they should.)

Primary Research vs Secondary Research

You’ll also want to understand the difference between primary and secondary research.

Primary research involves collecting new, original data directly from the source (say, your target market). In other words, it’s information gathered first-hand that wasn’t found elsewhere.

Some examples include conducting experiments, surveys, interviews, observations, or focus groups.

Meanwhile, secondary research is the analysis and interpretation of existing data collected from others. Think of this like what we used to do for school projects: We would read a book, scour the internet, or pull insights from others to work from.

So, which is better?

Personally, I say any research is good research, but if you have the time and resources, primary research is hard to top. With it, you don’t have to worry about your source's credibility or how relevant it is to your specific objective.

You are in full control and best equipped to get the reliable information you need.

3. Put it all together.

Once you know your objective and what kind of data you want, you’re ready to select your marketing research method.

For instance, let’s say you’re a restaurant trying to see how attendees felt about the Speed Dating event you hosted last week.

You shouldn’t run a field experiment or download a third-party report on speed dating events; those would be useless to you. You need to conduct a survey that allows you to ask pointed questions about the event.

This would yield both qualitative and quantitative data you can use to improve and bring together more love birds next time around.

Best Market Research Methods for 2024

Now that you know what you’re looking for in a marketing research method, let’s dive into the best options.

Note: According to HubSpot’s 2024 State of Marketing report, understanding customers and their needs is one of the biggest challenges facing marketers today. The options we discuss are great consumer research methodologies , but they can also be used for other areas.

Primary Research

1. interviews.

Interviews are a form of primary research where you ask people specific questions about a topic or theme. They typically deliver qualitative information.

I’ve conducted many interviews for marketing purposes, but I’ve also done many for journalistic purposes, like this profile on comedian Zarna Garg . There’s no better way to gather candid, open-ended insights in my book, but that doesn’t mean they’re a cure-all.

What I like: Real-time conversations allow you to ask different questions if you’re not getting the information you need. They also push interviewees to respond quickly, which can result in more authentic answers.

What I dislike: They can be time-consuming and harder to measure (read: get quantitative data) unless you ask pointed yes or no questions.

Best for: Creating buyer personas or getting feedback on customer experience, a product, or content.

2. Focus Groups

Focus groups are similar to conducting interviews but on a larger scale.

In marketing and business, this typically means getting a small group together in a room (or Zoom), asking them questions about various topics you are researching. You record and/or observe their responses to then take action.

They are ideal for collecting long-form, open-ended feedback, and subjective opinions.

One well-known focus group you may remember was run by Domino’s Pizza in 2009 .

After poor ratings and dropping over $100 million in revenue, the brand conducted focus groups with real customers to learn where they could have done better.

It was met with comments like “worst excuse for pizza I’ve ever had” and “the crust tastes like cardboard.” But rather than running from the tough love, it took the hit and completely overhauled its recipes.

The team admitted their missteps and returned to the market with better food and a campaign detailing their “Pizza Turn Around.”

The result? The brand won a ton of praise for its willingness to take feedback, efforts to do right by its consumers, and clever campaign. But, most importantly, revenue for Domino’s rose by 14.3% over the previous year.

The brand continues to conduct focus groups and share real footage from them in its promotion:

What I like: Similar to interviewing, you can dig deeper and pivot as needed due to the real-time nature. They’re personal and detailed.

What I dislike: Once again, they can be time-consuming and make it difficult to get quantitative data. There is also a chance some participants may overshadow others.

Best for: Product research or development

Pro tip: Need help planning your focus group? Our free Market Research Kit includes a handy template to start organizing your thoughts in addition to a SWOT Analysis Template, Survey Template, Focus Group Template, Presentation Template, Five Forces Industry Analysis Template, and an instructional guide for all of them. Download yours here now.

3. Surveys or Polls

Surveys are a form of primary research where individuals are asked a collection of questions. It can take many different forms.

They could be in person, over the phone or video call, by email, via an online form, or even on social media. Questions can be also open-ended or closed to deliver qualitative or quantitative information.

A great example of a close-ended survey is HubSpot’s annual State of Marketing .

In the State of Marketing, HubSpot asks marketing professionals from around the world a series of multiple-choice questions to gather data on the state of the marketing industry and to identify trends.

The survey covers various topics related to marketing strategies, tactics, tools, and challenges that marketers face. It aims to provide benchmarks to help you make informed decisions about your marketing.

It also helps us understand where our customers’ heads are so we can better evolve our products to meet their needs.

Apple is no stranger to surveys, either.

In 2011, the tech giant launched Apple Customer Pulse , which it described as “an online community of Apple product users who provide input on a variety of subjects and issues concerning Apple.”

"For example, we did a large voluntary survey of email subscribers and top readers a few years back."

While these readers gave us a long list of topics, formats, or content types they wanted to see, they sometimes engaged more with content types they didn’t select or favor as much on the surveys when we ran follow-up ‘in the wild’ tests, like A/B testing.”  

Pepsi saw similar results when it ran its iconic field experiment, “The Pepsi Challenge” for the first time in 1975.

The beverage brand set up tables at malls, beaches, and other public locations and ran a blindfolded taste test. Shoppers were given two cups of soda, one containing Pepsi, the other Coca-Cola (Pepsi’s biggest competitor). They were then asked to taste both and report which they preferred.

People overwhelmingly preferred Pepsi, and the brand has repeated the experiment multiple times over the years to the same results.

What I like: It yields qualitative and quantitative data and can make for engaging marketing content, especially in the digital age.

What I dislike: It can be very time-consuming. And, if you’re not careful, there is a high risk for scientific error.

Best for: Product testing and competitive analysis

Pro tip:  " Don’t make critical business decisions off of just one data set," advises Pamela Bump. "Use the survey, competitive intelligence, external data, or even a focus group to give you one layer of ideas or a short-list for improvements or solutions to test. Then gather your own fresh data to test in an experiment or trial and better refine your data-backed strategy."

Secondary Research

8. public domain or third-party research.

While original data is always a plus, there are plenty of external resources you can access online and even at a library when you’re limited on time or resources.

Some reputable resources you can use include:

• Pew Research Center
• McKinley Global Institute
• Relevant Global or Government Organizations (i.e United Nations or NASA)

It’s also smart to turn to reputable organizations that are specific to your industry or field. For instance, if you’re a gardening or landscaping company, you may want to pull statistics from the Environmental Protection Agency (EPA).

If you’re a digital marketing agency, you could look to Google Research or HubSpot Research . (Hey, I know them!)

What I like: You can save time on gathering data and spend more time on analyzing. You can also rest assured the data is from a source you trust.

What I dislike: You may not find data specific to your needs.

Best for: Companies under a time or resource crunch, adding factual support to content

Pro tip: Fellow HubSpotter Iskiev suggests using third-party data to inspire your original research. “Sometimes, I use public third-party data for ideas and inspiration. Once I have written my survey and gotten all my ideas out, I read similar reports from other sources and usually end up with useful additions for my own research.”

9. Buy Research

If the data you need isn’t available publicly and you can’t do your own market research, you can also buy some. There are many reputable analytics companies that offer subscriptions to access their data. Statista is one of my favorites, but there’s also Euromonitor , Mintel , and BCC Research .

What I like: Same as public domain research

What I dislike: You may not find data specific to your needs. It also adds to your expenses.

Best for: Companies under a time or resource crunch or adding factual support to content

Which marketing research method should you use?

You’re not going to like my answer, but “it depends.” The best marketing research method for you will depend on your objective and data needs, but also your budget and timeline.

My advice? Aim for a mix of quantitative and qualitative data. If you can do your own original research, awesome. But if not, don’t beat yourself up. Lean into free or low-cost tools . You could do primary research for qualitative data, then tap public sources for quantitative data. Or perhaps the reverse is best for you.

Whatever your marketing research method mix, take the time to think it through and ensure you’re left with information that will truly help you achieve your goals.

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