purpose of the study in research example

Thesis and Purpose Statements

Use the guidelines below to learn the differences between thesis and purpose statements.

In the first stages of writing, thesis or purpose statements are usually rough or ill-formed and are useful primarily as planning tools.

A thesis statement or purpose statement will emerge as you think and write about a topic. The statement can be restricted or clarified and eventually worked into an introduction.

As you revise your paper, try to phrase your thesis or purpose statement in a precise way so that it matches the content and organization of your paper.

Thesis statements

A thesis statement is a sentence that makes an assertion about a topic and predicts how the topic will be developed. It does not simply announce a topic: it says something about the topic.

Good: X has made a significant impact on the teenage population due to its . . . Bad: In this paper, I will discuss X.

A thesis statement makes a promise to the reader about the scope, purpose, and direction of the paper. It summarizes the conclusions that the writer has reached about the topic.

A thesis statement is generally located near the end of the introduction. Sometimes in a long paper, the thesis will be expressed in several sentences or an entire paragraph.

A thesis statement is focused and specific enough to be proven within the boundaries of the paper. Key words (nouns and verbs) should be specific, accurate, and indicative of the range of research, thrust of the argument or analysis, and the organization of supporting information.

Purpose statements

A purpose statement announces the purpose, scope, and direction of the paper. It tells the reader what to expect in a paper and what the specific focus will be.

Common beginnings include:

“This paper examines . . .,” “The aim of this paper is to . . .,” and “The purpose of this essay is to . . .”

A purpose statement makes a promise to the reader about the development of the argument but does not preview the particular conclusions that the writer has drawn.

A purpose statement usually appears toward the end of the introduction. The purpose statement may be expressed in several sentences or even an entire paragraph.

A purpose statement is specific enough to satisfy the requirements of the assignment. Purpose statements are common in research papers in some academic disciplines, while in other disciplines they are considered too blunt or direct. If you are unsure about using a purpose statement, ask your instructor.

This paper will examine the ecological destruction of the Sahel preceding the drought and the causes of this disintegration of the land. The focus will be on the economic, political, and social relationships which brought about the environmental problems in the Sahel.

Sample purpose and thesis statements

The following example combines a purpose statement and a thesis statement (bold).

The goal of this paper is to examine the effects of Chile’s agrarian reform on the lives of rural peasants. The nature of the topic dictates the use of both a chronological and a comparative analysis of peasant lives at various points during the reform period. . . The Chilean reform example provides evidence that land distribution is an essential component of both the improvement of peasant conditions and the development of a democratic society. More extensive and enduring reforms would likely have allowed Chile the opportunity to further expand these horizons.

For more tips about writing thesis statements, take a look at our new handout on Developing a Thesis Statement.

Writing Process and Structure

This is an accordion element with a series of buttons that open and close related content panels.

Getting Started with Your Paper

Interpreting Writing Assignments from Your Courses

Generating Ideas for Your Paper

Creating an Argument

Thesis vs. Purpose Statements

Developing a Thesis Statement

Architecture of Arguments

Working with Sources

Quoting and Paraphrasing Sources

Using Literary Quotations

Citing Sources in Your Paper

Drafting Your Paper

Introductions

Paragraphing

Developing Strategic Transitions

Conclusions

Revising Your Paper

Peer Reviews

Reverse Outlines

Revising an Argumentative Paper

Revision Strategies for Longer Projects

Finishing Your Paper

Twelve Common Errors: An Editing Checklist

How to Proofread your Paper

Writing Collaboratively

Collaborative and Group Writing

educational research techniques

Research techniques and education.

Research Purpose, Hypotheses, and Questions

Four key components to a research project are the purpose statement, research questions, hypotheses, and research objectives. In this post, we will define each of these.

Definitions

The purpose of this study is to examine the relationship between college completion and organizational commitment of undergraduate students in Thailand. 

Here is an example of a qualitative purpose statement.

The purpose of this study is to explore student experiences at a university in Thailand about completing their tertiary degree.

Both of these examples are short one-sentence responses to what the study will attempt to do. This is a critical first step in shaping the study.

Research Question

The research question(s) in a quantitative or qualitative study narrows the purpose down to a specific question(s) for the researcher to find answers. Below are examples from both the quantitative and qualitative perspective. We are continuing the research themes from the previous section on the purpose statement.

Quantitative

Does organizational commitment affect college completion of students?

Qualitative

What kinds of experiences have students had while completing their degree?

On closer examination, you may have noticed that the research questions sound a lot like the purpose statement. Research questions often split a part a long complex purpose statement into several questions. This is why questions sound so redundant when compared to the purpose statement. Despite this apparent problem, this thought process helps researchers to organize their thinking and proceed in a manner that is much more efficient.

The next two components only relate to quantitative research and they are the hypotheses and research objective(s). For this reason our illustration of qualitative concepts will stop at this point.

Hypotheses are statements a researcher makes about the potential outcome(s) of a study based on the examination of literature. Below is an example from the same theme as before.

Students who have a higher perception of organizational commitment will also have a higher likelihood of completing college.

Again, the wording of the research questions, hypotheses and purpose statement are similarly. The difference is only slightly and is due to context. Seeing these similarities quickly will help you to move faster in finishing a study. The difference between these elements is a matter of perspective rather than a strong difference, as they do sound awfully similar.

Research Objectives

Research objectives are the goals a researcher has for a study. This component is not always included in a study. Below is an example.

To examine the correlation between organizational commitment and the rate of college completion

Share this:

10 thoughts on “ research purpose, hypotheses, and questions ”.

This is the wrong use of the word, it should be “their” not “there”.

The purpose of this study is to explore student experiences at a university in Thailand about completing there tertiary degree.

Whoops, thanks for catching that

Thank you for this, very helpful 🙂

This has been helpful.

This was helpful. Thank you

Pingback: Developing a Data Analysis Plan | educational research techniques

This was helpful.

Glad to be of service

As an emerging researcher, my worry is that I have six objectives but five research questions and hypotheses. Am I correct or they must all be the same in times of numbers? Thank you

Thank you, this information helped me so much.

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Research Aims, Objectives & Questions

The “Golden Thread” Explained Simply (+ Examples)

By: David Phair (PhD) and Alexandra Shaeffer (PhD) | June 2022

The research aims , objectives and research questions (collectively called the “golden thread”) are arguably the most important thing you need to get right when you’re crafting a research proposal , dissertation or thesis . We receive questions almost every day about this “holy trinity” of research and there’s certainly a lot of confusion out there, so we’ve crafted this post to help you navigate your way through the fog.

Overview: The Golden Thread

• What is the golden thread
• What are research aims ( examples )
• What are research objectives ( examples )
• What are research questions ( examples )
• The importance of alignment in the golden thread

What is the “golden thread”?  

The golden thread simply refers to the collective research aims , research objectives , and research questions for any given project (i.e., a dissertation, thesis, or research paper ). These three elements are bundled together because it’s extremely important that they align with each other, and that the entire research project aligns with them.

Importantly, the golden thread needs to weave its way through the entirety of any research project , from start to end. In other words, it needs to be very clearly defined right at the beginning of the project (the topic ideation and proposal stage) and it needs to inform almost every decision throughout the rest of the project. For example, your research design and methodology will be heavily influenced by the golden thread (we’ll explain this in more detail later), as well as your literature review.

The research aims, objectives and research questions (the golden thread) define the focus and scope ( the delimitations ) of your research project. In other words, they help ringfence your dissertation or thesis to a relatively narrow domain, so that you can “go deep” and really dig into a specific problem or opportunity. They also help keep you on track , as they act as a litmus test for relevance. In other words, if you’re ever unsure whether to include something in your document, simply ask yourself the question, “does this contribute toward my research aims, objectives or questions?”. If it doesn’t, chances are you can drop it.

Alright, enough of the fluffy, conceptual stuff. Let’s get down to business and look at what exactly the research aims, objectives and questions are and outline a few examples to bring these concepts to life.

Research Aims: What are they?

Simply put, the research aim(s) is a statement that reflects the broad overarching goal (s) of the research project. Research aims are fairly high-level (low resolution) as they outline the general direction of the research and what it’s trying to achieve .

Research Aims: Examples  

True to the name, research aims usually start with the wording “this research aims to…”, “this research seeks to…”, and so on. For example:

“This research aims to explore employee experiences of digital transformation in retail HR.”   “This study sets out to assess the interaction between student support and self-care on well-being in engineering graduate students”  

As you can see, these research aims provide a high-level description of what the study is about and what it seeks to achieve. They’re not hyper-specific or action-oriented, but they’re clear about what the study’s focus is and what is being investigated.

Need a helping hand?

Research Objectives: What are they?

The research objectives take the research aims and make them more practical and actionable . In other words, the research objectives showcase the steps that the researcher will take to achieve the research aims.

The research objectives need to be far more specific (higher resolution) and actionable than the research aims. In fact, it’s always a good idea to craft your research objectives using the “SMART” criteria. In other words, they should be specific, measurable, achievable, relevant and time-bound”.

Research Objectives: Examples  

Let’s look at two examples of research objectives. We’ll stick with the topic and research aims we mentioned previously.  

For the digital transformation topic:

To observe the retail HR employees throughout the digital transformation. To assess employee perceptions of digital transformation in retail HR. To identify the barriers and facilitators of digital transformation in retail HR.

And for the student wellness topic:

To determine whether student self-care predicts the well-being score of engineering graduate students. To determine whether student support predicts the well-being score of engineering students. To assess the interaction between student self-care and student support when predicting well-being in engineering graduate students.

  As you can see, these research objectives clearly align with the previously mentioned research aims and effectively translate the low-resolution aims into (comparatively) higher-resolution objectives and action points . They give the research project a clear focus and present something that resembles a research-based “to-do” list.

Research Questions: What are they?

Finally, we arrive at the all-important research questions. The research questions are, as the name suggests, the key questions that your study will seek to answer . Simply put, they are the core purpose of your dissertation, thesis, or research project. You’ll present them at the beginning of your document (either in the introduction chapter or literature review chapter) and you’ll answer them at the end of your document (typically in the discussion and conclusion chapters).  

The research questions will be the driving force throughout the research process. For example, in the literature review chapter, you’ll assess the relevance of any given resource based on whether it helps you move towards answering your research questions. Similarly, your methodology and research design will be heavily influenced by the nature of your research questions. For instance, research questions that are exploratory in nature will usually make use of a qualitative approach, whereas questions that relate to measurement or relationship testing will make use of a quantitative approach.  

Let’s look at some examples of research questions to make this more tangible.

Research Questions: Examples  

Again, we’ll stick with the research aims and research objectives we mentioned previously.  

For the digital transformation topic (which would be qualitative in nature):

How do employees perceive digital transformation in retail HR? What are the barriers and facilitators of digital transformation in retail HR?  

And for the student wellness topic (which would be quantitative in nature):

Does student self-care predict the well-being scores of engineering graduate students? Does student support predict the well-being scores of engineering students? Do student self-care and student support interact when predicting well-being in engineering graduate students?  

You’ll probably notice that there’s quite a formulaic approach to this. In other words, the research questions are basically the research objectives “converted” into question format. While that is true most of the time, it’s not always the case. For example, the first research objective for the digital transformation topic was more or less a step on the path toward the other objectives, and as such, it didn’t warrant its own research question.  

So, don’t rush your research questions and sloppily reword your objectives as questions. Carefully think about what exactly you’re trying to achieve (i.e. your research aim) and the objectives you’ve set out, then craft a set of well-aligned research questions . Also, keep in mind that this can be a somewhat iterative process , where you go back and tweak research objectives and aims to ensure tight alignment throughout the golden thread.

The importance of strong alignment 

Alignment is the keyword here and we have to stress its importance . Simply put, you need to make sure that there is a very tight alignment between all three pieces of the golden thread. If your research aims and research questions don’t align, for example, your project will be pulling in different directions and will lack focus . This is a common problem students face and can cause many headaches (and tears), so be warned.

Take the time to carefully craft your research aims, objectives and research questions before you run off down the research path. Ideally, get your research supervisor/advisor to review and comment on your golden thread before you invest significant time into your project, and certainly before you start collecting data .  

Recap: The golden thread

In this post, we unpacked the golden thread of research, consisting of the research aims , research objectives and research questions . You can jump back to any section using the links below.

As always, feel free to leave a comment below – we always love to hear from you. Also, if you’re interested in 1-on-1 support, take a look at our private coaching service here.

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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39 Comments

Thank you very much for your great effort put. As an Undergraduate taking Demographic Research & Methodology, I’ve been trying so hard to understand clearly what is a Research Question, Research Aim and the Objectives in a research and the relationship between them etc. But as for now I’m thankful that you’ve solved my problem.

Well appreciated. This has helped me greatly in doing my dissertation.

An so delighted with this wonderful information thank you a lot.

so impressive i have benefited a lot looking forward to learn more on research.

I am very happy to have carefully gone through this well researched article.

Infact,I used to be phobia about anything research, because of my poor understanding of the concepts.

Now,I get to know that my research question is the same as my research objective(s) rephrased in question format.

I please I would need a follow up on the subject,as I intends to join the team of researchers. Thanks once again.

Thanks so much. This was really helpful.

I know you pepole have tried to break things into more understandable and easy format. And God bless you. Keep it up

i found this document so useful towards my study in research methods. thanks so much.

This is my 2nd read topic in your course and I should commend the simplified explanations of each part. I’m beginning to understand and absorb the use of each part of a dissertation/thesis. I’ll keep on reading your free course and might be able to avail the training course! Kudos!

Thank you! Better put that my lecture and helped to easily understand the basics which I feel often get brushed over when beginning dissertation work.

This is quite helpful. I like how the Golden thread has been explained and the needed alignment.

This is quite helpful. I really appreciate!

The article made it simple for researcher students to differentiate between three concepts.

Very innovative and educational in approach to conducting research.

I am very impressed with all these terminology, as I am a fresh student for post graduate, I am highly guided and I promised to continue making consultation when the need arise. Thanks a lot.

A very helpful piece. thanks, I really appreciate it .

Very well explained, and it might be helpful to many people like me.

Wish i had found this (and other) resource(s) at the beginning of my PhD journey… not in my writing up year… 😩 Anyways… just a quick question as i’m having some issues ordering my “golden thread”…. does it matter in what order you mention them? i.e., is it always first aims, then objectives, and finally the questions? or can you first mention the research questions and then the aims and objectives?

Thank you for a very simple explanation that builds upon the concepts in a very logical manner. Just prior to this, I read the research hypothesis article, which was equally very good. This met my primary objective.

My secondary objective was to understand the difference between research questions and research hypothesis, and in which context to use which one. However, I am still not clear on this. Can you kindly please guide?

In research, a research question is a clear and specific inquiry that the researcher wants to answer, while a research hypothesis is a tentative statement or prediction about the relationship between variables or the expected outcome of the study. Research questions are broader and guide the overall study, while hypotheses are specific and testable statements used in quantitative research. Research questions identify the problem, while hypotheses provide a focus for testing in the study.

Exactly what I need in this research journey, I look forward to more of your coaching videos.

This helped a lot. Thanks so much for the effort put into explaining it.

What data source in writing dissertation/Thesis requires?

What is data source covers when writing dessertation/thesis

This is quite useful thanks

I’m excited and thankful. I got so much value which will help me progress in my thesis.

where are the locations of the reserch statement, research objective and research question in a reserach paper? Can you write an ouline that defines their places in the researh paper?

Very helpful and important tips on Aims, Objectives and Questions.

Thank you so much for making research aim, research objectives and research question so clear. This will be helpful to me as i continue with my thesis.

Thanks much for this content. I learned a lot. And I am inspired to learn more. I am still struggling with my preparation for dissertation outline/proposal. But I consistently follow contents and tutorials and the new FB of GRAD Coach. Hope to really become confident in writing my dissertation and successfully defend it.

As a researcher and lecturer, I find splitting research goals into research aims, objectives, and questions is unnecessarily bureaucratic and confusing for students. For most biomedical research projects, including ‘real research’, 1-3 research questions will suffice (numbers may differ by discipline).

Awesome! Very important resources and presented in an informative way to easily understand the golden thread. Indeed, thank you so much.

Well explained

The blog article on research aims, objectives, and questions by Grad Coach is a clear and insightful guide that aligns with my experiences in academic research. The article effectively breaks down the often complex concepts of research aims and objectives, providing a straightforward and accessible explanation. Drawing from my own research endeavors, I appreciate the practical tips offered, such as the need for specificity and clarity when formulating research questions. The article serves as a valuable resource for students and researchers, offering a concise roadmap for crafting well-defined research goals and objectives. Whether you’re a novice or an experienced researcher, this article provides practical insights that contribute to the foundational aspects of a successful research endeavor.

A great thanks for you. it is really amazing explanation. I grasp a lot and one step up to research knowledge.

I really found these tips helpful. Thank you very much Grad Coach.

I found this article helpful. Thanks for sharing this.

thank you so much, the explanation and examples are really helpful

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Airport Passenger-Related Processing Rates Guidebook (2009)

Chapter: chapter 3 - defining the research: purpose, focus, and potential uses.

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

14 Chapter 3 identifies roles, relationships, and responsibilities of stakeholders. It examines principal steps involved in planning an airport passenger-rate data collection effort. It begins with the ques- tion of whether the potential benefits of the proposed effort outweigh the anticipated cost; describes different types of research (i.e., exploratory, descriptive, inferential); summarizes the questions each type addresses; and notes the ends to which the data might be used. 3.1 Roles and Responsibilities When an airport data collection event is first mentioned, it invariably raises numerous ques- tions: Who is asking for the data? How will it be used? What’s the budget? What’s the schedule? What kind of resources can be made available? Without answers to these fundamental questions, the success of your research is in jeopardy. This section will help the researcher establish the role of key stakeholders and their interrelationships within the team. Many entities can sponsor a data collection study, including airports, airlines, manufacturers, and various agencies. Likewise, there are many ways of managing and staffing the event and pro- moting involvement with stakeholders. There are therefore myriad ways of organizing a study. Exhibit 3-1 is an example of how a study could be arranged with the airport as the sponsor. 3.1.1 Client/Sponsor For airports, oversight is guided by a board, commission, or an authority consisting of appointed or elected officials. While these agencies typically provide oversight to airport man- agement and approve long-term plans and large capital expenditures, usually it is the airport director or manager who makes day-to-day decisions. Depending on the size of the airport, there may be several departments, each having its own manager. In such cases, passenger terminal-related studies would typically fall within the purview of the planning and/or engineering department and would be managed by its director. Regardless of the affiliation of the project sponsor(s), it is essential that the following ques- tions be answered clearly and unambiguously as they pertain to the sponsor at the beginning of any project: • Who has primary responsibility for defining the questions the study is intended to address? • What preference does this person or group have regarding ongoing involvement with the project? – What information would they like to receive, in what format, and with what frequency? – Who should be the principal point-of-contact (POC) on the client’s side for questions that might emerge related to the study’s focus, direction, etc.? C H A P T E R 3 Defining the Research: Purpose, Focus, and Potential Uses

Defining the Research: Purpose, Focus, and Potential Uses 15 • Who is the designated project manager, and what information would he or she like to receive, in what format, and with what frequency? • If the person given responsibility for day-to-day issues pertaining to access, authorizations, etc. is different from the project manager, who is that person, and what is the scope of issues he or she is authorized to address? • If problems or obstacles arise in implementing the study, and the project manager is not able or authorized to resolve them, what is the chain of persons through which the issue should be escalated? 3.1.2 Study Team The size of the study team will depend on the team’s depth and organization, and the size, duration, and complexity of the study itself. For a typical medium- to large-scale study, the roles listed in the following sections are the most typical. Multiple roles might be assumed by a single person or distributed across multiple persons. Titles vary as well, but the functions are largely universal. Project Manager The project manager is typically a mid-level to senior person who has the long-term, day-to- day relationship with his or her client counterpart. The need for the passenger-related process- ing rate study may initially originate from discussions between the project manager and those within the airport or airline. Survey Manager The survey manager is usually a mid-level staff person. His/her role on the project would be to oversee the day-to-day management of the data processing rate study, including leading the development of the scope, schedule, and budget; developing the team; and assigning roles and responsibilities. The survey manager would have the responsibility of ensuring the survey goals were adequately defined and met. Decision Maker Survey Manager Admin. Support Staffing Source (e.g., airport personnel, mkt. research firm) Surveyor Surveyor Surveyor Sponsor/Client (Airport) (Large Airport: Dir./Mgr.) Project Manager (Large Airport: Dir. Planning/Eng.) (Small Airport: Apt. Mgr.) Project Manager (Typ. oversees multiple tasks of which survey is but one part) Study Team (Typically, Consultant) Statistical Technical Expert Survey Assistant Data Analyst IT Analyst Other Stakeholders • Airlines • Agencies • Concessionaires Exhibit 3-1. Typical sponsor and study team roles (assuming an airport is the sponsor).

16 Airport Passenger-Related Processing Rates Guidebook Research and Statistical Expert A person(s) with expertise in research methodology and quantitative/statistical analysis should be consulted to develop, or provide comments and recommendations about, the overall methodology, the sampling plan, and so forth. Most of this person’s input would occur at the project’s initiation. A distinction is sometimes drawn in the consulting literature among differ- ent approaches to consulting. One such approach, generally referred to as process consultation might be of particular appeal.1 When acting in this role, the consultant not only provides tech- nical expertise related to the specific project, but also works with the client to develop expertise. This arrangement has the goal of, over time, reducing the reliance on the consultant. Survey Assistant The survey assistant has primary responsibility for assisting the survey project manager and secondarily to assist others on the project team throughout the duration of the study. Typically, this staff person will be at a junior level. The degree of assistance this person can provide is based on his/her level of education and current skill sets. Data Analyst The data analyst should not only be well-versed in technical analysis, but should also have a strong familiarity with the airport terminal environment. This person could be a terminal or air- port planner or aviation architect. The analyst is often largely responsible for documenting results, and responsibilities might extend to presenting findings to the client. Administrative Support Data collection efforts are inherently complex and, as such, often require a significant level of coordination and administration. The staff person serving this function would be responsible for such things as making travel plans, scheduling visits to the airport’s security office, buying supplies, shipping and receiving materials, scheduling meetings, preparing invoices and con- tracts, and editing/proofing the report. Data Collection Staff For small studies (e.g., small airports where only a few functional elements are being observed for a limited time period), airport/airline or consultant staffing may be used. For larger studies, typically examining multiple functional elements of a medium or large airport over a multi-day period, a market-research firm is frequently employed. The data collection staff reports directly to the survey manager. 3.2 Is the Study Needed? While the need for data collection is often justifiable, the benefit of validating the need, and avoiding what might be a costly, and possibly unjustified, effort well exceeds the relatively minor cost of pausing to consider a few basic questions (see Appendix C for more information). Exhibit 3-2 illustrates these questions. 3.3 Research Fundamentals This section summarizes a number of fundamental issues and terms related to the research process. (Additional detail is included in Appendix C.) 1 Schein, E. H. (1999). Process Consultation Revisited: Building the Helping Relationship. NY: Addison Wesley.

Research is a dynamic process with both deductive and inductive dimensions. This differs in some ways from what some present as the “traditional” approach to research, i.e., that theory drives hypothesis testing. Sometimes it does, but sometimes it doesn’t work this way. 3.3.1 Theory, Hypotheses, and Evidence The word “theory” often implies a formal set of laws, propositions, variables, and the like, whose relationships are clearly defined. A related implication is that theory may not be particu- larly germane to the everyday world of work. This view of theory is not incorrect, but neither is it complete. While theory can be abstract and complex in its detail, it does not necessarily have to be abstract, complex, or formal. It can be thought of more broadly and simply as an explanation of “how the world works.” For exam- ple, an organization might develop a mission or a value statement (or both); engrave the words in a medium intended to last millennia; and prominently display the statement in the workplace with the intent of communicating to all its perspective clients on issues pertinent to its view. In Defining the Research: Purpose, Focus, and Potential Uses 17 Question Things to Consider Have relevant data been collected at this airport in the past that might be used rather than collecting new data? Might you be able to get data from another airport similar in key ways to this airport? Are there data available that might help answer the research question? Might access to the data be blocked due to proprietary or security issues? Sometimes the data are perceived to be so sensitive that the “owner” of the data may not give permission to share it. Has the decision already been made, and the data are being collected to legitimize the decision? Is there anything to suggest that the study is an attempt to “prove” something true or false? What role will the results play in the decision being considered? To what extent will the decision makers be persuaded by the results? What will the decision makers accept as credible evidence? Before collecting data, make certain that the research plan will result in data that the sponsors will accept. It is better to learn beforehand, for example, that the proposed sampling plan does not meet the sponsor’s criteria for rigor. What is the cost of the potential investment that the data will help inform? What is the cost of conducting the research? Does the benefit equal or outweigh the cost? Cost should be considered not only in economic terms, but as safety, inconvenience, and so forth. Exhibit 3-2. Considerations to determine need for data collection.

2008, British Airways announced a new venture: OpenSkies. The “theory” OpenSkies used to define its clients is reflected in its advertising as shown in Exhibit 3-3. So, how does this relate to airport processing rate studies? It relates in the following two ways: 1. The published research literature may well contain formal theories relevant to what data to collect and how to collect it. For example, Appendix B includes a bibliography of recent research articles related to passenger and baggage processing in airports. It is intended to illustrate the scope and diversity of research available on a given topic. Before embarking on an investigation, review the literature to see how it might enhance the quality of the planned research. The Internet provides access to numerous sources for such scholarly documents. 2. Informally, the key decisions about how to go about collecting data are grounded in assump- tions about how things work (i.e., one’s own theory). For example, you might choose to col- lect passenger security screening data between 6:00 a.m. and 8:00 a.m. on a Monday because your experience is that this time period reflects peak checkpoint activity. While this “theory” may be correct in some circumstances, it may also be wrong in others. For example, at many vacation-oriented airports, the peak at the checkpoint occurs in the late morning due to check-out times at hotels. Another common view of research is of the stereotypical scientist, objectively testing hypothe- ses (or an “educated guess”) arising from theory. Exhibit 3-4 reflects this general approach to research. This is certainly one way in which research proceeds, but, similar to theory, it is not the only way. Before considering an “evidence first” approach, we wish to mention a variation on the tra- ditional approach displayed in Exhibit 3-4 that has been gaining dominance in recent years. In particular, this is a confidence interval (CI) approach rather than a hypothesis driven approach. In a hypothesis driven approach, the researcher’s primary interest is in testing a population parameter, and uses a sample drawn from the population. When the researcher takes a CI approach, the intent is to calculate an interval within which the population parameter is likely 18 Airport Passenger-Related Processing Rates Guidebook Exhibit 3-3. OpenSkies advertisement. Question key assumptions, even if they seem to be “common sense,” by checking with informants, look- ing at the literature, etc.

to fall. Hypotheses are stated before data collection; CIs are calculated after data are collected.2 In conducting passenger-processing rate research in airport environments, the CI approach is going to be the most appropriate in most instances. A markedly different approach to those described above is shown in Exhibit 3-5. In contrast to beginning with a theory and then collecting evidence to test the theory or estimate a popula- tion parameter within some CI, this approach begins with evidence for which one seeks poten- tial explanations, or “theories” to explain the evidence. This approach is subsumed under the broad heading of Bayesian Law, so named after the 18th Century English clergyman, Thomas Bayes, credited with developing the approach. Depending on where one begins can result in potentially dramatic conclusions (see Exhibit 3-6). This is important because limiting oneself to a particular perspective of how research should be conducted and how data ought to be gathered may impose unnecessary constraints. What is important is that the research is executed systematically and with rigor. The documented ways in which science proceeds are often idealized: portraying what is inherently a very dynamic and nonlinear process as logical and linear. 3.3.2 Research Questions and Purposes A basic issue in research is specifying the question the research will help answer. Penning a specific question also helps in determining what approach might be best used in seeking an Defining the Research: Purpose, Focus, and Potential Uses 19 Theory Drives questions & hypotheses Hypothesis: Installing n kiosks will reduce the average time of passengers waiting in line by 10% over check-in agents. Leading to a conclusion Drives data collection Followed by analysis Exhibit 3-4. Hypothesis driven approach. Evidence leads to speculation about possible explanations Which may or may not drive more data collection & analysis Theory Exhibit 3-5. Bayesian approach. 2 While these approaches are presented here as mutually exclusive, they might be integrated in practice.

answer. One classic text in research methodology5 suggests that a research question should express a relationship between two or more variables, and it should imply an empirical approach, that is, it should lend itself to being measured using data. A variable is, not surprisingly, some- thing that can vary, or assume different values. In the next section, illustrative questions are given, categorized by the purpose of research with which they are best matched. The five research purposes are presented as the following: 1. Explore, 2. Describe, 3. Test, 4. Evaluate, and 5. Predict. The distinctions among these purposes are not absolute, nor are they necessarily exclusive of one another. A research initiative might be directed at answering questions with multiple pur- poses. Indeed, this is but one of many ways of classifying research. In addition, the reader whose practice lies primarily in the arena of modeling and simulation might note their absence from this list. Although modeling and simulation applications require input data, for example, to gen- erate distributions and parameters for use as stochastic varieties in modeling, the techniques used to collect data are largely independent of specific applications (such as simulation and model- ing). Those issues unique to modeling are beyond the scope of this guidebook. Explore (Exploratory Research) Exploratory research is sometimes defined as “what to do when you don’t know what you don’t know.” Its aim is discovery and to develop an understanding of relevant variables and their interactions in a real (field) environment. Exploratory research, as such, is appropriate when the 20 Airport Passenger-Related Processing Rates Guidebook If your intent is to… And take action based on… Use… Example Test a hypothesis regarding a population parameter Whether you reject or fail to reject the null hypothesis Hypothesis testing approach The proportion of coach passengers checking in more than 60 min prior to scheduled departure is 80% H A : p > .80 3 H 0 : p .804 Estimate a population parameter The confidence interval selected CI approach Plus or minus 5%, what is the average time coach passengers check in prior to scheduled departure? Determine the likelihood of an event given some evidence The calculated probability Bayesian approach What is the probability that a passenger’s carry on- luggage will be subject to secondary security screening given that the passenger is boarding an international flight? Exhibit 3-6. Research approaches. 3 This is the research, or Alternative, hypothesis. It reads: The proportion is greater than 80%. 4 This is the null hypothesis. It is what is tested, and reads: The proportion is less than or equal to 80%. 5 Kerlinger F. & Lee, H. (2000). Foundations of Behavioral Research, 4th ed. NY: Harcourt Brace.

problem is not well defined. For example, passenger complaints about signs within a facility might prompt the following exploratory question: • “Where should signage be located to minimize passenger confusion?” As another example, if a new security checkpoint configuration is proposed, it may be too novel to rely on variables used in other studies. The question, therefore, might then be the following: • “How does a given alternative security checkpoint configuration affect capacity?” This type of research is often qualitative rather than quantitative. That is, it employs verbal descriptors of observations, rather than counts of those observations (see Appendix C for more information). Describe (Descriptive Research) Descriptive research, as the name implies, is intended to describe phenomena. While descrip- tive research might involve collecting qualitative data by asking open-ended questions in an interview, it typically employs quantitative methods resulting in reporting frequencies, calculat- ing averages, and the like. The following two questions illustrate the nature of descriptive research. Each implies that the relevant variables have been identified as well as the conditions under which the data should be collected. • “What is the average number of passengers departing on international flights on weekday evenings in July at a given airport?” • “How many men use a given restroom at a particular location at a given time?” Test (Experimental and Quasi-experimental Research and Modeling) Often, the intent of the research is not simply to describe something, but to test the impact of some intervention. In an airport environment, such research might be initiated to evaluate the relative effectiveness of a security screening technology in accurately detecting contraband. It is similar in approach to research conducted to assess the relative effectiveness of an experimental drug in comparison to a control (placebo) or another drug. Variables are often manipulated and controlled. This research lies largely outside the scope of this guidebook and, as such, will not receive much attention. Examples of questions that might be asked in this type of research include the following: • “What is the impact of posting airline personnel near check-in waiting lines on the average passenger waiting time?” In addition to the classic “experiment,” simulation modeling might be used, employing rep- resentative data to help answer questions such as the following: • “What would be the impact on processing time of a new security measure being considered?” • “How many agents are needed to keep passenger waiting time below an average of 10 min?” Evaluate (Evaluative Research) Sometimes, the intent of the research is to assess performance against some standard or stated requirement. Basically, evaluation research is concerned with seeing how well something is work- ing, with an eye toward improving performance, as illustrated by the following two questions: • “Is the performance of a given piece of equipment in the field consistent with manufacturer’s specifications?” • “On average, what proportion of passengers waits in a security checkpoint line longer than the 10-minute maximum threshold specified by an airline?” Defining the Research: Purpose, Focus, and Potential Uses 21

Predict Finally, research might be initiated to attempt to predict or anticipate potential emerging pat- terns before they occur. This is related to environmental scanning, insofar as it represents a delib- erate attempt to monitor potential trends and their impact. For example, in the early 1970s, one might have posed the following question: • “What would be the impact of an increase in the number of women in the workforce on air- port design?” There are numerous documented approaches to answering questions such as these. While well beyond the scope of this guidebook, here is one as illustrative: scenario planning. This method involves convening persons with relevant expertise to identify those areas that might most impact the industry (e.g., regulation, fuel costs, demographic changes), and then to systemati- cally consider what the best, worst, and might likely scenarios might be. The principal value of such an approach is that it facilitates deliberate consideration of future trends, and in so doing, presumably leaves people better prepared. When the goal of the research is to predict, data from multiple sources might be sought. The scenario planning example relies, to an extent, on the judgments of experts. Probabilities can also be drawn from historical data to help identify patterns and trends. Exhibit 3-7 is a summary of the key characteristics of each research type. 3.4 Developing the Research Plan Large research studies, particularly when funding is being requested, often require the researchers to adhere to a specific set of technical requirements. The Research Team is aware that the ad hoc and short timeline of many airport-planning research efforts makes developing a “for- mal” research plan impracticable. Nonetheless, even though you might not have the “luxury” of 22 Airport Passenger-Related Processing Rates Guidebook Research Purpose Characteristics Explore Primary purpose: to better define or understand a situation. Data will help answer the research question. The benefit of conducting the research justifies the cost. Qualitative data are recorded, using observation. Describe Primary purpose: to provide descriptive information about something. Test Primary purpose: to assess the impact of a proposed change in procedure or policy. Evaluate Primary purpose: to assess performance against requirements. Predict Primary purpose: to consider possible future circumstances with the purpose of being better prepared for emerging trends. Exhibit 3-7. Summary of research types.

developing such a plan, there are benefits to considering the issues described in this section, as well as documenting basic information. The following are the three major elements the Research Team believes worth documenting, regardless of the size of the research endeavor.6 1. Goals or aims. 2. Background and significance. 3. Research design and methods. Each is described in the sections that follow. 3.4.1 Goals or Aims Specify the question the research is intended to help answer or the specific purpose of the research. The experience of having to translate an intended purpose into words can help clarify your intent. In addition, a written statement can serve as a way of ensuring that your understand- ing of the purpose of the research is consistent with that of the sponsor and other stakeholders. Two examples follow: Statement of Purpose—Example 1 The purpose of this study is to aid decision makers in determining if extending the dwell time of the airport’s automated guideway transit system (AGTS) vehicles from 30 sec to 35 sec at the Concourse C station might improve overall system capacity by providing more boarding time for passengers. Statement of Purpose—Example 2 The goal of this study is to provide airport management with recent data showing the percent- age of arriving flights whose first checked bag reaches the claim device within the airport’s goal of 15 min. 3.4.2 Background and Significance Document what is already known, and specify how the proposed research initiative will add to this knowledge. Consider a “devil’s advocate” perspective by asking what the consequences of not doing the research might be. 3.4.3 Research Design and Methods In this section, describe how you will go about collecting and analyzing data. Additional infor- mation about these issues, including sampling strategies and sample size, is presented in Chapter 5 and in Appendix C. The research plan does not need be lengthy. It should, however, capture key information that, were it not documented and those familiar with the research were not available, would be diffi- cult to ascertain. Defining the Research: Purpose, Focus, and Potential Uses 23 6 This section is partly based on guidelines published by the Agency for Healthcare Research and Quality, Department of Health and Human Services. http://www.ahrq.gov/fund/esstplan.htm.

TRB’s Airport Cooperative Research Program (ACRP) Report 23: Airport Passenger-Related Processing Rates Guidebook provides guidance on how to collect accurate passenger-related processing data for evaluating facility requirements to promote efficient and cost-effective airport terminal design.

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How to Write the Rationale of the Study in Research (Examples)

What is the Rationale of the Study?

The rationale of the study is the justification for taking on a given study. It explains the reason the study was conducted or should be conducted. This means the study rationale should explain to the reader or examiner why the study is/was necessary. It is also sometimes called the “purpose” or “justification” of a study. While this is not difficult to grasp in itself, you might wonder how the rationale of the study is different from your research question or from the statement of the problem of your study, and how it fits into the rest of your thesis or research paper. 

The rationale of the study links the background of the study to your specific research question and justifies the need for the latter on the basis of the former. In brief, you first provide and discuss existing data on the topic, and then you tell the reader, based on the background evidence you just presented, where you identified gaps or issues and why you think it is important to address those. The problem statement, lastly, is the formulation of the specific research question you choose to investigate, following logically from your rationale, and the approach you are planning to use to do that.

Table of Contents:

How to write a rationale for a research paper , how do you justify the need for a research study.

• Study Rationale Example: Where Does It Go In Your Paper?

The basis for writing a research rationale is preliminary data or a clear description of an observation. If you are doing basic/theoretical research, then a literature review will help you identify gaps in current knowledge. In applied/practical research, you base your rationale on an existing issue with a certain process (e.g., vaccine proof registration) or practice (e.g., patient treatment) that is well documented and needs to be addressed. By presenting the reader with earlier evidence or observations, you can (and have to) convince them that you are not just repeating what other people have already done or said and that your ideas are not coming out of thin air. 

Once you have explained where you are coming from, you should justify the need for doing additional research–this is essentially the rationale of your study. Finally, when you have convinced the reader of the purpose of your work, you can end your introduction section with the statement of the problem of your research that contains clear aims and objectives and also briefly describes (and justifies) your methodological approach. 

When is the Rationale for Research Written?

The author can present the study rationale both before and after the research is conducted. 

• Before conducting research : The study rationale is a central component of the research proposal . It represents the plan of your work, constructed before the study is actually executed.
• Once research has been conducted : After the study is completed, the rationale is presented in a research article or  PhD dissertation  to explain why you focused on this specific research question. When writing the study rationale for this purpose, the author should link the rationale of the research to the aims and outcomes of the study.

What to Include in the Study Rationale

Although every study rationale is different and discusses different specific elements of a study’s method or approach, there are some elements that should be included to write a good rationale. Make sure to touch on the following:

• A summary of conclusions from your review of the relevant literature
• What is currently unknown (gaps in knowledge)
• Inconclusive or contested results  from previous studies on the same or similar topic
• The necessity to improve or build on previous research, such as to improve methodology or utilize newer techniques and/or technologies

There are different types of limitations that you can use to justify the need for your study. In applied/practical research, the justification for investigating something is always that an existing process/practice has a problem or is not satisfactory. Let’s say, for example, that people in a certain country/city/community commonly complain about hospital care on weekends (not enough staff, not enough attention, no decisions being made), but you looked into it and realized that nobody ever investigated whether these perceived problems are actually based on objective shortages/non-availabilities of care or whether the lower numbers of patients who are treated during weekends are commensurate with the provided services.

In this case, “lack of data” is your justification for digging deeper into the problem. Or, if it is obvious that there is a shortage of staff and provided services on weekends, you could decide to investigate which of the usual procedures are skipped during weekends as a result and what the negative consequences are. 

In basic/theoretical research, lack of knowledge is of course a common and accepted justification for additional research—but make sure that it is not your only motivation. “Nobody has ever done this” is only a convincing reason for a study if you explain to the reader why you think we should know more about this specific phenomenon. If there is earlier research but you think it has limitations, then those can usually be classified into “methodological”, “contextual”, and “conceptual” limitations. To identify such limitations, you can ask specific questions and let those questions guide you when you explain to the reader why your study was necessary:

Methodological limitations

• Did earlier studies try but failed to measure/identify a specific phenomenon?
• Was earlier research based on incorrect conceptualizations of variables?
• Were earlier studies based on questionable operationalizations of key concepts?
• Did earlier studies use questionable or inappropriate research designs?

Contextual limitations

• Have recent changes in the studied problem made previous studies irrelevant?
• Are you studying a new/particular context that previous findings do not apply to?

Conceptual limitations

• Do previous findings only make sense within a specific framework or ideology?

Study Rationale Examples

Let’s look at an example from one of our earlier articles on the statement of the problem to clarify how your rationale fits into your introduction section. This is a very short introduction for a practical research study on the challenges of online learning. Your introduction might be much longer (especially the context/background section), and this example does not contain any sources (which you will have to provide for all claims you make and all earlier studies you cite)—but please pay attention to how the background presentation , rationale, and problem statement blend into each other in a logical way so that the reader can follow and has no reason to question your motivation or the foundation of your research.

Background presentation

Since the beginning of the Covid pandemic, most educational institutions around the world have transitioned to a fully online study model, at least during peak times of infections and social distancing measures. This transition has not been easy and even two years into the pandemic, problems with online teaching and studying persist (reference needed) . 

While the increasing gap between those with access to technology and equipment and those without access has been determined to be one of the main challenges (reference needed) , others claim that online learning offers more opportunities for many students by breaking down barriers of location and distance (reference needed) .  

Rationale of the study

Since teachers and students cannot wait for circumstances to go back to normal, the measures that schools and universities have implemented during the last two years, their advantages and disadvantages, and the impact of those measures on students’ progress, satisfaction, and well-being need to be understood so that improvements can be made and demographics that have been left behind can receive the support they need as soon as possible.

Statement of the problem

To identify what changes in the learning environment were considered the most challenging and how those changes relate to a variety of student outcome measures, we conducted surveys and interviews among teachers and students at ten institutions of higher education in four different major cities, two in the US (New York and Chicago), one in South Korea (Seoul), and one in the UK (London). Responses were analyzed with a focus on different student demographics and how they might have been affected differently by the current situation.

How long is a study rationale?

In a research article bound for journal publication, your rationale should not be longer than a few sentences (no longer than one brief paragraph). A  dissertation or thesis  usually allows for a longer description; depending on the length and nature of your document, this could be up to a couple of paragraphs in length. A completely novel or unconventional approach might warrant a longer and more detailed justification than an approach that slightly deviates from well-established methods and approaches.

Consider Using Professional Academic Editing Services

Now that you know how to write the rationale of the study for a research proposal or paper, you should make use of our free AI grammar checker , Wordvice AI, or receive professional academic proofreading services from Wordvice, including research paper editing services and manuscript editing services to polish your submitted research documents.

You can also find many more articles, for example on writing the other parts of your research paper , on choosing a title , or on making sure you understand and adhere to the author instructions before you submit to a journal, on the Wordvice academic resources pages.

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Purpose of the Study: Common Errors in Writing Your Purpose Statement

The Purpose of the Study is perhaps the single most important sentence in your dissertation. In conjunction with the Problem Statement, it guides the focus of your research. Your research questions, methodology, and data analysis are all guided by the purpose of the study.

The “Purpose of the Study” section consists of a few short paragraphs describing, aptly, the purpose of your study. Within this section is the “Purpose Statement,” which is a single sentence.

It’s the distillation of your study’s purpose, and that particular sentence will show up again and again in your paper. It generally includes (a) the research paradigm, (b) the intent of the study (such as describe, develop, explore, etc.), and (c) the phenomenon of interest.

It’s also a sentence that many students struggle with, and find themselves revising multiple times before it’s finally accepted. My goal here is to give you all the information you need to create a stellar purpose statement the first time around.

Purpose of the Study in a Single Sentence

Your purpose statement distills the purpose of your study into a single sentence. It indicates the study’s method and overarching goal. This sentence is contained in the “Purpose of the Study” section. It should be a logical, explicit research response to the stated problem (more on that later). 

Elements of the Purpose Statement: 

Include the following elements in your purpose statement:

• Identify the research method (qualitative, quantitative, or mixed-method. Usually this is as simple as saying, “the purpose of this qualitative study is…”).
• The stated purpose reflects the research questions (make sure to identify variables/constructs and the central phenomenon/concept/idea).
• Clearly state the research design.
• Ensure the purpose (as well as the method/design) is aligned with the problem statement.  
• Identify participants or other data sources. 
• Identify the geographic location of study (when relevant).

Purpose of the Study Template

For Qualitative Studies

The purpose of this quantitative study is to ___[describe, compare, explore, or develop] ____ [describe the study goal that directly reflects and encompasses the research questions] in [describe the population or data source and geographic location]. [Brief overview of how, with what instruments/data, with whom, and where]

For Quantitative Studies:

The purpose of this quantitative study is to ___[describe, compare, correlate, explore, or develop] ____ [describe the study goal that directly reflects and encompasses the research questions] in [describe the population or data source and geographic location]. [State the independent, dependent, and covariate variables]. [Brief overview of how, with what instruments/data, with whom, and where]

How Long Should the Purpose of the Study Section Be?

Speaking with a Dissertation Chair about the Purpose of the Study section, he said simply, “Don’t make it too long. State the purpose and go onto something else.” That’s good advice. 

Treat dissertation sections like testifying in court (anything you say can and will be used against you by your committee). If you’re asked, “Do you know what time it is?” the correct answer is “yes” or “no,” not “Oh yes, it’s 11:30 and I have a meeting with Charlie in half an hour.” 

Similarly, in the Statement of the Purpose section, just give the purpose, whatever is required by your university’s template, and not much else. This can be accomplished within a few pages at most.

Aligning the Purpose of the Study With the Rest of Your Paper

Keeping your paper in alignment is an extraordinarily important part of writing your dissertation. What this means is that your Problem Statement, Purpose Statement, and Research Questions all say essentially the same thing (just with different wording).

Aligning the Purpose Statement with the Problem Statement

Your problem statement should have two parts–a General Problem and a Specific Problem. The general problem is an overarching view of the problem you’re looking to address–this is what you would tell a curious person asking what you’re studying. The Specific Problem is always a gap in research. “The specific problem is that ___ is not known.”

The language that you use to fill in the blank is the same language you should use for the purpose statement. 

Problem : “The problem is that x isn’t known”

Purpose : “The purpose is to find x out”

• The problem is that we don’t know what factors influence parent involvement in schools.
• The purpose is to determine the factors that determine parent involvement in schools.
• The problem is that we don’t know the impact of Covid-19 unemployment on stock prices.
• The purpose is to determine the impact of Covid-19 unemployment on stock prices.

The professor I interviewed said, “Your committee wants to see you being consistent. ‘My problem is x. My purpose is to explore the problem.’ Period. Don’t have more than one purpose, and don’t stray from your problem statement.”

Aligning the Purpose Statement with the Research Questions

The research questions should arise directly from the purpose statement. For example:

What factors do parents report impact their involvement in schools?

To what degree is there a significant relationship between Covid-19 unemployment and stock prices?

There could be additional research questions for each of these studies, but you get the idea: ensure that your research question arises from the purpose statement and the purpose statement arises from the problem statement.  These steps create the foundation of your study, and doing it this way will ensure there is alignment.

Mistakes People Make When Writing Their Purpose Statement

• Writing the purpose statement apart from their problem statement, so the purpose doesn’t directly relate to the problem.
• Trying to take on too much in one study — too big a problem to study while you’re paying tuition. (Save those larger studies for when you’re being paid.)
• Trying to be creative with wording and thereby veering away from the problem statement.
• Creating multiple purpose statements. 

In short, you’re trying to find information that will help your field better understand a problem that’s important to you. Your job in your dissertation is to address the problem, and your purpose statement will tell us that.

Related posts:

Nicholas Tippins

Nicholas Tippins is the Founder & Executive Director of My Dissertation Editor. He has edited more dissertations than he can count. When not managing his business, he can be found playing the guitar or wandering around in the woods.

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9 Examples: How to Write a Purpose Statement

By Status.net Editorial Team on September 30, 2023 — 15 minutes to read

• Key Elements of a Purpose Statement Part 1
• How to Write a Purpose Statement Step-by-Step Part 2
• Identifying Your Goals Part 3
• Defining Your Audience Part 4
• Outlining Your Methods Part 5
• Stating the Expected Outcomes Part 6
• Purpose Statement Example for a Research Paper Part 7
• Purpose Statement Example For Personal Goals Part 8
• Purpose Statement Example For Business Objectives Part 9
• Purpose Statement Example For an Essay Part 10
• Purpose Statement Example For a Proposal Part 11
• Purpose Statement Example For a Report Part 12
• Purpose Statement Example For a Project Part 13
• Purpose Statement Templates Part 14

A purpose statement is a vital component of any project, as it sets the tone for the entire piece of work. It tells the reader what the project is about, why it’s important, and what the writer hopes to achieve.

Part 1 Key Elements of a Purpose Statement

When writing a purpose statement, there are several key elements that you should keep in mind. These elements will help you to create a clear, concise, and effective statement that accurately reflects your goals and objectives.

1. The Problem or Opportunity

The first element of a purpose statement is the problem or opportunity that you are addressing. This should be a clear and specific description of the issue that you are trying to solve or the opportunity that you are pursuing.

2. The Target Audience

The second element is the target audience for your purpose statement. This should be a clear and specific description of the group of people who will benefit from your work.

3. The Solution

The third element is the solution that you are proposing. This should be a clear and specific description of the action that you will take to address the problem or pursue the opportunity.

4. The Benefits

The fourth element is the benefits that your solution will provide. This should be a clear and specific description of the positive outcomes that your work will achieve.

5. The Action Plan

The fifth element is the action plan that you will follow to implement your solution. This should be a clear and specific description of the steps that you will take to achieve your goals.

Part 2 How to Write a Purpose Statement Step-by-Step

Writing a purpose statement is an essential part of any research project. It helps to clarify the purpose of your study and provides direction for your research. Here are some steps to follow when writing a purpose statement:

• Start with a clear research question: The first step in writing a purpose statement is to have a clear research question. This question should be specific and focused on the topic you want to research.
• Identify the scope of your study: Once you have a clear research question, you need to identify the scope of your study. This involves determining what you will and will not include in your research.
• Define your research objectives: Your research objectives should be specific, measurable, achievable, relevant, and time-bound. They should also be aligned with your research question and the scope of your study.
• Determine your research design: Your research design will depend on the nature of your research question and the scope of your study. You may choose to use a qualitative, quantitative, or mixed-methods approach.
• Write your purpose statement: Your purpose statement should be a clear and concise statement that summarizes the purpose of your study. It should include your research question, the scope of your study, your research objectives, and your research design.

Research question: What are the effects of social media on teenage mental health?

Scope of study: This study will focus on teenagers aged 13-18 in the United States.

Research objectives: To determine the prevalence of social media use among teenagers, to identify the types of social media used by teenagers, to explore the relationship between social media use and mental health, and to provide recommendations for parents, educators, and mental health professionals.

Research design: This study will use a mixed-methods approach, including a survey and interviews with teenagers and mental health professionals.

Purpose statement: The purpose of this study is to examine the effects of social media on teenage mental health among teenagers aged 13-18 in the United States. The study will use a mixed-methods approach, including a survey and interviews with teenagers and mental health professionals. The research objectives are to determine the prevalence of social media use among teenagers, to identify the types of social media used by teenagers, to explore the relationship between social media use and mental health, and to provide recommendations for parents, educators, and mental health professionals.

Part 3 Section 1: Identifying Your Goals

Before you start writing your purpose statement, it’s important to identify your goals. To do this, ask yourself the following questions:

• What do I want to achieve?
• What problem do I want to solve?
• What impact do I want to make?

Once you have a clear idea of your goals, you can start crafting your purpose statement. Your purpose statement should be a clear and concise statement that outlines the purpose of your work.

For example, if you’re writing a purpose statement for a business, your statement might look something like this:

“Our purpose is to provide high-quality products and services that improve the lives of our customers and contribute to the growth and success of our company.”

If you’re writing a purpose statement for a non-profit organization, your statement might look something like this:

“Our purpose is to improve the lives of underserved communities by providing access to education, healthcare, and other essential services.”

Remember, your purpose statement should be specific, measurable, and achievable. It should also be aligned with your values and goals, and it should inspire and motivate you to take action.

Part 4 Section 2: Defining Your Audience

Once you have established the purpose of your statement, it’s important to consider who your audience is. The audience for your purpose statement will depend on the context in which it will be used. For example, if you’re writing a purpose statement for a research paper, your audience will likely be your professor or academic peers. If you’re writing a purpose statement for a business proposal, your audience may be potential investors or clients.

Defining your audience is important because it will help you tailor your purpose statement to the specific needs and interests of your readers. You want to make sure that your statement is clear, concise, and relevant to your audience.

To define your audience, consider the following questions:

• Who will be reading your purpose statement?
• What is their level of knowledge or expertise on the topic?
• What are their needs and interests?
• What do they hope to gain from reading your purpose statement?

Once you have a clear understanding of your audience, you can begin to craft your purpose statement with their needs and interests in mind. This will help ensure that your statement is effective in communicating your goals and objectives to your readers.

For example, if you’re writing a purpose statement for a research paper on the effects of climate change on agriculture, your audience may be fellow researchers in the field of environmental science. In this case, you would want to make sure that your purpose statement is written in a way that is clear and concise, using technical language that is familiar to your audience.

Or, if you’re writing a purpose statement for a business proposal to potential investors, your audience may be less familiar with the technical aspects of your project. In this case, you would want to make sure that your purpose statement is written in a way that is easy to understand, using clear and concise language that highlights the benefits of your proposal.

The key to defining your audience is to put yourself in their shoes and consider what they need and want from your purpose statement.

Part 5 Section 3: Outlining Your Methods

After you have identified the purpose of your statement, it is time to outline your methods. This section should describe how you plan to achieve your goal and the steps you will take to get there. Here are a few tips to help you outline your methods effectively:

• Start with a general overview: Begin by providing a brief overview of the methods you plan to use. This will give your readers a sense of what to expect in the following paragraphs.
• Break down your methods: Break your methods down into smaller, more manageable steps. This will make it easier for you to stay organized and for your readers to follow along.
• Use bullet points: Bullet points can help you organize your ideas and make your methods easier to read. Use them to list the steps you will take to achieve your goal.
• Be specific: Make sure you are specific about the methods you plan to use. This will help your readers understand exactly what you are doing and why.
• Provide examples: Use examples to illustrate your methods. This will make it easier for your readers to understand what you are trying to accomplish.

Part 6 Section 4: Stating the Expected Outcomes

After defining the problem and the purpose of your research, it’s time to state the expected outcomes. This is where you describe what you hope to achieve by conducting your research. The expected outcomes should be specific and measurable, so you can determine if you have achieved your goals.

It’s important to be realistic when stating your expected outcomes. Don’t make exaggerated or false claims, and don’t promise something that you can’t deliver. Your expected outcomes should be based on your research question and the purpose of your study.

Here are some examples of expected outcomes:

• To identify the factors that contribute to employee turnover in the company.
• To develop a new marketing strategy that will increase sales by 20% within the next year.
• To evaluate the effectiveness of a new training program for improving customer service.
• To determine the impact of social media on consumer behavior.

When stating your expected outcomes, make sure they align with your research question and purpose statement. This will help you stay focused on your goals and ensure that your research is relevant and meaningful.

In addition to stating your expected outcomes, you should also describe how you will measure them. This could involve collecting data through surveys, interviews, or experiments, or analyzing existing data from sources such as government reports or industry publications.

Part 7 Purpose Statement Example for a Research Paper

If you are writing a research paper, your purpose statement should clearly state the objective of your study. Here is an example of a purpose statement for a research paper:

The purpose of this study is to investigate the effects of social media on the mental health of teenagers in the United States.

This purpose statement clearly states the objective of the study and provides a specific focus for the research.

Part 8 Purpose Statement Example For Personal Goals

When writing a purpose statement for your personal goals, it’s important to clearly define what you want to achieve and why. Here’s a template that can help you get started:

“I want to [goal] so that [reason]. I will achieve this by [action].”

Example: “I want to lose 10 pounds so that I can feel more confident in my body. I will achieve this by going to the gym three times a week and cutting out sugary snacks.”

Remember to be specific and realistic when setting your goals and actions, and to regularly review and adjust your purpose statement as needed.

Part 9 Purpose Statement Example For Business Objectives

If you’re writing a purpose statement for a business objective, this template can help you get started:

[Objective] [Action verb] [Target audience] [Outcome or benefit]

Here’s an example using this template:

Increase online sales by creating a more user-friendly website for millennial shoppers.

This purpose statement is clear and concise. It identifies the objective (increase online sales), the action verb (creating), the target audience (millennial shoppers), and the outcome or benefit (a more user-friendly website).

Part 10 Purpose Statement Example For an Essay

“The purpose of this essay is to examine the causes and consequences of climate change, with a focus on the role of human activities, and to propose solutions that can mitigate its impact on the environment and future generations.”

This purpose statement clearly states the subject of the essay (climate change), what aspects will be explored (causes, consequences, human activities), and the intended outcome (proposing solutions). It provides a clear roadmap for the reader and sets the direction for the essay.

Part 11 Purpose Statement Example For a Proposal

“The purpose of this proposal is to secure funding and support for the establishment of a community garden in [Location], aimed at promoting sustainable urban agriculture, fostering community engagement, and improving local access to fresh, healthy produce.”

Why this purpose statement is effective:

• The subject of the proposal is clear: the establishment of a community garden.
• The specific goals of the project are outlined: promoting sustainable urban agriculture, fostering community engagement, and improving local access to fresh produce.
• The overall objective of the proposal is evident: securing funding and support.

Part 12 Purpose Statement Example For a Report

“The purpose of this report is to analyze current market trends in the electric vehicle (EV) industry, assess consumer preferences and buying behaviors, and provide strategic recommendations to guide [Company Name] in entering this growing market segment.”

• The subject of the report is provided: market trends in the electric vehicle industry.
• The specific goals of the report are analysis of market trends, assessment of consumer preferences, and strategic recommendations.
• The overall objective of the report is clear: providing guidance for the company’s entry into the EV market.

Part 13 Purpose Statement Example For a Project

“The purpose of this project is to design and implement a new employee wellness program that promotes physical and mental wellbeing in the workplace.”

This purpose statement clearly outlines the objective of the project, which is to create a new employee wellness program. The program is designed to promote physical and mental wellbeing in the workplace, which is a key concern for many employers. By implementing this program, the company aims to improve employee health, reduce absenteeism, and increase productivity. The purpose statement is concise and specific, providing a clear direction for the project team to follow. It highlights the importance of the project and its potential benefits for the company and its employees.

Part 14 Purpose Statement Templates

When writing a purpose statement, it can be helpful to use a template to ensure that you cover all the necessary components:

Template 1: To [action] [target audience] in order to [outcome]

This template is a straightforward way to outline your purpose statement. Simply fill in the blanks with the appropriate information:

• The purpose of […] is
• To [action]: What action do you want to take?
• [Target audience]: Who is your target audience?
• In order to [outcome]: What outcome do you hope to achieve?

For example:

• The purpose of our marketing campaign is to increase brand awareness among young adults in urban areas, in order to drive sales and revenue growth.
• The purpose of our employee training program is to improve customer service skills among our frontline staff, in order to enhance customer satisfaction and loyalty.
• The purpose of our new product launch is to expand our market share in the healthcare industry, by offering a unique solution to the needs of elderly patients with chronic conditions.

Template 2: This [project/product] is designed to [action] [target audience] by [method] in order to [outcome].

This template is useful for purpose statements that involve a specific project or product. Fill in the blanks with the appropriate information:

• This [project/product]: What is your project or product?
• Is designed to [action]: What action do you want to take?
• By [method]: What method will you use to achieve your goal?
• This app is designed to provide personalized nutrition advice to athletes by analyzing their training data in order to optimize performance.

Frequently Asked Questions

What are the key elements of a purpose statement.

A purpose statement should clearly communicate the main goal or objective of your writing. It should be concise and specific, providing a clear direction for your work. The key elements of a purpose statement include the topic or subject matter, the intended audience, and the overall goal or objective of your writing.

How can a purpose statement benefit your writing?

A purpose statement can help you stay focused and on track when writing. It can also help you to avoid going off-topic or getting bogged down in unnecessary details. By clearly identifying the main goal or objective of your writing, a purpose statement can help you to stay organized and ensure that your writing is effective and impactful.

What are some common mistakes to avoid when writing a purpose statement?

One common mistake is being too vague or general in your purpose statement. Another mistake is making your purpose statement too long or complex, which can make it difficult to understand. Additionally, it’s important to avoid including unnecessary information or details that are not directly relevant to your main goal or objective.

How can you tailor your purpose statement to your audience?

When writing a purpose statement, it’s important to consider your audience and their needs. You should tailor your purpose statement to your audience by using language and terminology that they will understand. You should also consider their level of knowledge or expertise on the subject matter and adjust your purpose statement accordingly.

What are some effective templates for writing a purpose statement?

There are many effective templates for writing a purpose statement, but one common approach is to use the following structure: “The purpose of this writing is to [insert goal or objective] for [insert audience] regarding [insert topic or subject matter].”

Can you provide examples of successful purpose statements?

• “The purpose of this report is to provide an analysis of the current market trends and make recommendations for future growth strategies for our company.”
• “The purpose of this essay is to explore the impact of social media on modern communication and its implications for society.”
• “The purpose of this proposal is to secure funding for a new community center that will provide educational and recreational opportunities for local residents.”
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• v.37(16); 2022 Apr 25

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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The Purpose of the Study should b e a clear and accurate statement of the scientific purpose/objectives of the research.  

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The Purpose of the Study portion of the Consent Form should not reflect a potential benefit to the subject or be directed toward the subject in any way.   For example, “the purpose of this study is to compare the effectiveness of exercise A to exercise B as a method that can be used to increase quadriceps muscle” is acceptable.   However, a statement, “the purpose of this study is to compare the effectiveness of exercise A to exercise B as a method that can be used to increase your quadriceps muscle” is unacceptable.  

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Home » Background of The Study – Examples and Writing Guide

Background of The Study – Examples and Writing Guide

Table of Contents

Background of The Study

Definition:

Background of the study refers to the context, circumstances, and history that led to the research problem or topic being studied. It provides the reader with a comprehensive understanding of the subject matter and the significance of the study.

The background of the study usually includes a discussion of the relevant literature, the gap in knowledge or understanding, and the research questions or hypotheses to be addressed. It also highlights the importance of the research topic and its potential contributions to the field. A well-written background of the study sets the stage for the research and helps the reader to appreciate the need for the study and its potential significance.

How to Write Background of The Study

Here are some steps to help you write the background of the study:

Identify the Research Problem

Start by identifying the research problem you are trying to address. This problem should be significant and relevant to your field of study.

Provide Context

Once you have identified the research problem, provide some context. This could include the historical, social, or political context of the problem.

Review Literature

Conduct a thorough review of the existing literature on the topic. This will help you understand what has been studied and what gaps exist in the current research.

Identify Research Gap

Based on your literature review, identify the gap in knowledge or understanding that your research aims to address. This gap will be the focus of your research question or hypothesis.

State Objectives

Clearly state the objectives of your research . These should be specific, measurable, achievable, relevant, and time-bound (SMART).

Discuss Significance

Explain the significance of your research. This could include its potential impact on theory , practice, policy, or society.

Finally, summarize the key points of the background of the study. This will help the reader understand the research problem, its context, and its significance.

How to Write Background of The Study in Proposal

The background of the study is an essential part of any proposal as it sets the stage for the research project and provides the context and justification for why the research is needed. Here are the steps to write a compelling background of the study in your proposal:

• Identify the problem: Clearly state the research problem or gap in the current knowledge that you intend to address through your research.
• Provide context: Provide a brief overview of the research area and highlight its significance in the field.
• Review literature: Summarize the relevant literature related to the research problem and provide a critical evaluation of the current state of knowledge.
• Identify gaps : Identify the gaps or limitations in the existing literature and explain how your research will contribute to filling these gaps.
• Justify the study : Explain why your research is important and what practical or theoretical contributions it can make to the field.
• Highlight objectives: Clearly state the objectives of the study and how they relate to the research problem.
• Discuss methodology: Provide an overview of the methodology you will use to collect and analyze data, and explain why it is appropriate for the research problem.
• Conclude : Summarize the key points of the background of the study and explain how they support your research proposal.

How to Write Background of The Study In Thesis

The background of the study is a critical component of a thesis as it provides context for the research problem, rationale for conducting the study, and the significance of the research. Here are some steps to help you write a strong background of the study:

• Identify the research problem : Start by identifying the research problem that your thesis is addressing. What is the issue that you are trying to solve or explore? Be specific and concise in your problem statement.
• Review the literature: Conduct a thorough review of the relevant literature on the topic. This should include scholarly articles, books, and other sources that are directly related to your research question.
• I dentify gaps in the literature: After reviewing the literature, identify any gaps in the existing research. What questions remain unanswered? What areas have not been explored? This will help you to establish the need for your research.
• Establish the significance of the research: Clearly state the significance of your research. Why is it important to address this research problem? What are the potential implications of your research? How will it contribute to the field?
• Provide an overview of the research design: Provide an overview of the research design and methodology that you will be using in your study. This should include a brief explanation of the research approach, data collection methods, and data analysis techniques.
• State the research objectives and research questions: Clearly state the research objectives and research questions that your study aims to answer. These should be specific, measurable, achievable, relevant, and time-bound.
• Summarize the chapter: Summarize the chapter by highlighting the key points and linking them back to the research problem, significance of the study, and research questions.

How to Write Background of The Study in Research Paper

Here are the steps to write the background of the study in a research paper:

• Identify the research problem: Start by identifying the research problem that your study aims to address. This can be a particular issue, a gap in the literature, or a need for further investigation.
• Conduct a literature review: Conduct a thorough literature review to gather information on the topic, identify existing studies, and understand the current state of research. This will help you identify the gap in the literature that your study aims to fill.
• Explain the significance of the study: Explain why your study is important and why it is necessary. This can include the potential impact on the field, the importance to society, or the need to address a particular issue.
• Provide context: Provide context for the research problem by discussing the broader social, economic, or political context that the study is situated in. This can help the reader understand the relevance of the study and its potential implications.
• State the research questions and objectives: State the research questions and objectives that your study aims to address. This will help the reader understand the scope of the study and its purpose.
• Summarize the methodology : Briefly summarize the methodology you used to conduct the study, including the data collection and analysis methods. This can help the reader understand how the study was conducted and its reliability.

Examples of Background of The Study

Here are some examples of the background of the study:

Problem : The prevalence of obesity among children in the United States has reached alarming levels, with nearly one in five children classified as obese.

Significance : Obesity in childhood is associated with numerous negative health outcomes, including increased risk of type 2 diabetes, cardiovascular disease, and certain cancers.

Gap in knowledge : Despite efforts to address the obesity epidemic, rates continue to rise. There is a need for effective interventions that target the unique needs of children and their families.

Problem : The use of antibiotics in agriculture has contributed to the development of antibiotic-resistant bacteria, which poses a significant threat to human health.

Significance : Antibiotic-resistant infections are responsible for thousands of deaths each year and are a major public health concern.

Gap in knowledge: While there is a growing body of research on the use of antibiotics in agriculture, there is still much to be learned about the mechanisms of resistance and the most effective strategies for reducing antibiotic use.

Edxample 3:

Problem : Many low-income communities lack access to healthy food options, leading to high rates of food insecurity and diet-related diseases.

Significance : Poor nutrition is a major contributor to chronic diseases such as obesity, type 2 diabetes, and cardiovascular disease.

Gap in knowledge : While there have been efforts to address food insecurity, there is a need for more research on the barriers to accessing healthy food in low-income communities and effective strategies for increasing access.

Examples of Background of The Study In Research

Here are some real-life examples of how the background of the study can be written in different fields of study:

Example 1 : “There has been a significant increase in the incidence of diabetes in recent years. This has led to an increased demand for effective diabetes management strategies. The purpose of this study is to evaluate the effectiveness of a new diabetes management program in improving patient outcomes.”

Example 2 : “The use of social media has become increasingly prevalent in modern society. Despite its popularity, little is known about the effects of social media use on mental health. This study aims to investigate the relationship between social media use and mental health in young adults.”

Example 3: “Despite significant advancements in cancer treatment, the survival rate for patients with pancreatic cancer remains low. The purpose of this study is to identify potential biomarkers that can be used to improve early detection and treatment of pancreatic cancer.”

Examples of Background of The Study in Proposal

Here are some real-time examples of the background of the study in a proposal:

Example 1 : The prevalence of mental health issues among university students has been increasing over the past decade. This study aims to investigate the causes and impacts of mental health issues on academic performance and wellbeing.

Example 2 : Climate change is a global issue that has significant implications for agriculture in developing countries. This study aims to examine the adaptive capacity of smallholder farmers to climate change and identify effective strategies to enhance their resilience.

Example 3 : The use of social media in political campaigns has become increasingly common in recent years. This study aims to analyze the effectiveness of social media campaigns in mobilizing young voters and influencing their voting behavior.

Example 4 : Employee turnover is a major challenge for organizations, especially in the service sector. This study aims to identify the key factors that influence employee turnover in the hospitality industry and explore effective strategies for reducing turnover rates.

Examples of Background of The Study in Thesis

Here are some real-time examples of the background of the study in the thesis:

Example 1 : “Women’s participation in the workforce has increased significantly over the past few decades. However, women continue to be underrepresented in leadership positions, particularly in male-dominated industries such as technology. This study aims to examine the factors that contribute to the underrepresentation of women in leadership roles in the technology industry, with a focus on organizational culture and gender bias.”

Example 2 : “Mental health is a critical component of overall health and well-being. Despite increased awareness of the importance of mental health, there are still significant gaps in access to mental health services, particularly in low-income and rural communities. This study aims to evaluate the effectiveness of a community-based mental health intervention in improving mental health outcomes in underserved populations.”

Example 3: “The use of technology in education has become increasingly widespread, with many schools adopting online learning platforms and digital resources. However, there is limited research on the impact of technology on student learning outcomes and engagement. This study aims to explore the relationship between technology use and academic achievement among middle school students, as well as the factors that mediate this relationship.”

Examples of Background of The Study in Research Paper

Here are some examples of how the background of the study can be written in various fields:

Example 1: The prevalence of obesity has been on the rise globally, with the World Health Organization reporting that approximately 650 million adults were obese in 2016. Obesity is a major risk factor for several chronic diseases such as diabetes, cardiovascular diseases, and cancer. In recent years, several interventions have been proposed to address this issue, including lifestyle changes, pharmacotherapy, and bariatric surgery. However, there is a lack of consensus on the most effective intervention for obesity management. This study aims to investigate the efficacy of different interventions for obesity management and identify the most effective one.

Example 2: Antibiotic resistance has become a major public health threat worldwide. Infections caused by antibiotic-resistant bacteria are associated with longer hospital stays, higher healthcare costs, and increased mortality. The inappropriate use of antibiotics is one of the main factors contributing to the development of antibiotic resistance. Despite numerous efforts to promote the rational use of antibiotics, studies have shown that many healthcare providers continue to prescribe antibiotics inappropriately. This study aims to explore the factors influencing healthcare providers’ prescribing behavior and identify strategies to improve antibiotic prescribing practices.

Example 3: Social media has become an integral part of modern communication, with millions of people worldwide using platforms such as Facebook, Twitter, and Instagram. Social media has several advantages, including facilitating communication, connecting people, and disseminating information. However, social media use has also been associated with several negative outcomes, including cyberbullying, addiction, and mental health problems. This study aims to investigate the impact of social media use on mental health and identify the factors that mediate this relationship.

Purpose of Background of The Study

The primary purpose of the background of the study is to help the reader understand the rationale for the research by presenting the historical, theoretical, and empirical background of the problem.

More specifically, the background of the study aims to:

• Provide a clear understanding of the research problem and its context.
• Identify the gap in knowledge that the study intends to fill.
• Establish the significance of the research problem and its potential contribution to the field.
• Highlight the key concepts, theories, and research findings related to the problem.
• Provide a rationale for the research questions or hypotheses and the research design.
• Identify the limitations and scope of the study.

When to Write Background of The Study

The background of the study should be written early on in the research process, ideally before the research design is finalized and data collection begins. This allows the researcher to clearly articulate the rationale for the study and establish a strong foundation for the research.

The background of the study typically comes after the introduction but before the literature review section. It should provide an overview of the research problem and its context, and also introduce the key concepts, theories, and research findings related to the problem.

Writing the background of the study early on in the research process also helps to identify potential gaps in knowledge and areas for further investigation, which can guide the development of the research questions or hypotheses and the research design. By establishing the significance of the research problem and its potential contribution to the field, the background of the study can also help to justify the research and secure funding or support from stakeholders.

Advantage of Background of The Study

The background of the study has several advantages, including:

• Provides context: The background of the study provides context for the research problem by highlighting the historical, theoretical, and empirical background of the problem. This allows the reader to understand the research problem in its broader context and appreciate its significance.
• Identifies gaps in knowledge: By reviewing the existing literature related to the research problem, the background of the study can identify gaps in knowledge that the study intends to fill. This helps to establish the novelty and originality of the research and its potential contribution to the field.
• Justifies the research : The background of the study helps to justify the research by demonstrating its significance and potential impact. This can be useful in securing funding or support for the research.
• Guides the research design: The background of the study can guide the development of the research questions or hypotheses and the research design by identifying key concepts, theories, and research findings related to the problem. This ensures that the research is grounded in existing knowledge and is designed to address the research problem effectively.
• Establishes credibility: By demonstrating the researcher’s knowledge of the field and the research problem, the background of the study can establish the researcher’s credibility and expertise, which can enhance the trustworthiness and validity of the research.

Disadvantages of Background of The Study

Some Disadvantages of Background of The Study are as follows:

• Time-consuming : Writing a comprehensive background of the study can be time-consuming, especially if the research problem is complex and multifaceted. This can delay the research process and impact the timeline for completing the study.
• Repetitive: The background of the study can sometimes be repetitive, as it often involves summarizing existing research and theories related to the research problem. This can be tedious for the reader and may make the section less engaging.
• Limitations of existing research: The background of the study can reveal the limitations of existing research related to the problem. This can create challenges for the researcher in developing research questions or hypotheses that address the gaps in knowledge identified in the background of the study.
• Bias : The researcher’s biases and perspectives can influence the content and tone of the background of the study. This can impact the reader’s perception of the research problem and may influence the validity of the research.
• Accessibility: Accessing and reviewing the literature related to the research problem can be challenging, especially if the researcher does not have access to a comprehensive database or if the literature is not available in the researcher’s language. This can limit the depth and scope of the background of the study.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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• Open access
• Published: 17 May 2024

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial

• Elizabeth Lin 1 ,
• Mais Malhas 1 ,
• Emmanuel Bratsalis 1 ,
• Kendra Thomson 1 , 2 ,
• Fabienne Hargreaves 1 ,
• Kayle Donner 1 ,
• Heba Baig 1 ,
• Rhonda Boateng 1 ,
• Rajlaxmi Swain 1 ,
• Mary Benisha Benadict 1 &
• Louis Busch 1  

BMC Health Services Research volume  24 , Article number:  639 ( 2024 ) Cite this article

63 Accesses

Metrics details

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada’s largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting.

Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH’s training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140).

With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points.

Conclusions

The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Peer Review reports

Introduction

Violence in the healthcare workplace has been a global concern for over two decades. In 2002, a joint task force of the International Labour Office (ILO), World Health Organization, Public Services International, and the International Council of Nurses created an initiative to address this issue [ 1 ]. One result was the documentation of a high international prevalence of violence towards healthcare workers showing that as many as half or more experienced physical or psychological violence in the previous year [ 2 , 3 ]. Since then, workplace violence has become a healthcare quality indicator and been embedded in the quality improvement initiatives of many healthcare organizations (for example, Health Quality Ontario [ 4 ]). Conceptually, it is also reflected in the expansion of the Triple Aim framework to the Quintuple Aim to include staff work-life experience [ 5 ].

Despite these efforts, the high prevalence of workplace violence in healthcare persists [ 6 ]. Two meta-analyses, representing 393,344 healthcare workers, found a 19.3% pooled prevalence of workplace violence in the past year among which 24.4% and 42.5% reported physical and psychological violence experiences, respectively [ 7 , 8 ]. The literature also highlighted that workers in mental health settings were at particular risk [ 8 , 9 ]. A systematic review of violence in U.S. psychiatric hospitals found between 25 to 85 percent of staff encountering physical aggression in the past year [ 10 ]. Partial explanations for this wide range include methodological, population, and setting differences. For example, Gerberich and colleagues [ 11 ] surveyed nearly 4,000 Minnesota nurses and found 13 percent reporting physical assault and 38 percent reporting verbal or other non-physical violence in the previous year. Further analyses showed that nurses on psychiatric or behavioral units were twice as likely as those on medical/surgical units to experience physical violence and nearly three times as likely to experience non-physical violence. Ridenour, et al., [ 12 ] in a hospital-record study of acute locked psychiatric wards in U.S. Veteran’s Hospitals found that 85 percent of nurses had experienced aggression in a 30-day period (85 percent verbal; 81 percent physical). And, in a prospective study of a Canadian psychiatric hospital, Cooper and Mendonca [ 13 ] found over 200 physical assaults on nurses within 27 months. While they do not indicate what percentage of nurses were assaulted, their results are consistent with a frequency of between 1 and 2 assaults per week.

Workplace violence has been associated with negative psychological, physical, emotional, financial, and social consequences which impact staff’s ability to provide care and function at work [ 14 , 15 , 16 ]. A 7-year, population-based, follow-up study in Denmark highlighted the long-term impact of physical and psychological health issues owing to physical workplace violence [ 17 ]. Two studies, one in Italy [ 18 ] and one in Pakistan [ 19 ], have linked workplace violence to demoralization and declining quality of healthcare delivery and job satisfaction among healthcare workers.

Building on these efforts, the ILO published a 2020 report recommending the need for national and organizational work environment policies and workplace training “…on the identified hazards and risks of violence and harassment and the associated prevention and protection measures….” ([ 20 ], p. 55). Consequently, many countries [ 21 , 22 , 23 ] have committed to creating a safe work environment. In Ontario, Canada, the government has provided guidelines for preventing workplace violence in healthcare [ 4 , 24 ], and our institution, the Centre for Addiction and Mental Health, launched a major initiative in 2018 to address the physical and psychological safety of patients and staff [ 25 ]. A priority component of this initiative is mandatory training for all new clinical staff on trauma-informed crisis prevention, de-escalation skills, and, in particular, safe physical intervention skills [ 26 , 27 ].

However, the effects of such training, especially for managing aggressive behaviour, are only partially understood. A 2015 systematic review on training for mental health staff [ 28 ] and a more recent Cochrane review on training for healthcare staff [ 29 ] reported remarkably similar findings. Both noted the inconsistent evidence (due to methodological issues, small numbers of studies, heterogenous results) which made definitive conclusions about the merits and efficacy of training difficult. The more consistent impacts found by Price and colleagues [ 28 ] were improved knowledge and staff confidence in their ability to manage aggression. There was some evidence of improved de-escalation skills including the ability to deal with physical aggression [ 30 , 31 ] and verbal abuse [ 32 ]. However, these studies were limited because they used unvalidated scales or simulated, rather than real-world, scenarios. For outcomes such as assault rates, injuries, the incidence of aggressive events, and the use of physical restraints, the findings were mixed or difficult to generalize due to the inconsistent evidence.

Similarly, Geoffrion and colleagues [ 29 ] found some positive effect of skills-training on knowledge and attitudes, at least short-term, but noted that support for longer-term effects was less sure. The evidence for impacts on skills or the incidence of aggressive behaviour was even more uncertain. They also noted that the literature was limited because it focused largely on nurses. They concluded, “education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes” ([ 29 ], p. 2). Among their recommendations were the need to evaluate training in higher-risk settings such as mental healthcare, include other healthcare professionals who also have direct patient contact in addition to nurses, and use more robust study designs. In addition, the literature evaluating training procedures focussed on self-reported rather than objective measures of performance.

Given the concerns with demonstrating effectiveness, the violence prevention literature has tended to focus on training modalities and immediate post-training assessment rather than on skill retention over time. In a systematic review of prevention interventions in the emergency room, Wirth et al. [ 21 ] found only five out of 15 included studies that noted any kind of evaluation in the period after training (generally two to nine months post-training) while Geoffrion, et al. [ 29 ] identified only two among the nine studies in their meta-analysis that had follow-up skills assessments. However, for both of these reviews, the studies doing follow-up evaluations focused on subjective, self-reported outcomes (empathy, confidence, self-reported knowledge) with no objective behavioral skills measures. Both Wirth et al. [ 21 ] and Leach et al. [ 33 ] cite studies noting a loss of effectiveness of prevention skills (between three to six months post-training), but specific percentages of retention were not provided.

The present study sought to address these gaps by comparing two approaches to teaching safety skills for managing aggressive patient/client behaviour. The setting was a large psychiatric teaching hospital; the sample was drawn from all new clinical staff attending their mandated on-boarding training; and we used a pragmatic randomized control trial design. In addition, we added a 1-month post-training assessment to evaluate skill retention. Our control intervention was the current training-as-usual (TAU) in which trainers “describe” and “demonstrate”, and trainees “do” by practicing the demonstrated skill but without objective checklist-guided performance assessment by the trainer. Our test intervention was behavioural skills training (BST) [ 34 , 35 ] drawn from the field of applied behaviour analysis [ 36 ]. BST is a performance- and competency-based training model that uses an instructional, modeling, practice, and feedback loop to teach targeted skills to a predetermined performance level. Checklists guide the instructional sequence and the determination of whether or not the predetermined performance threshold has been reached. Considerable evidence indicates that BST can yield significant improvement in skills post-training, over time, and across different settings [ 37 , 38 , 39 ]. It has been used to train a wide range of participants, including behavior analysts, parents, and educators, to build safety-related skills and manage aggressive behavior [ 37 , 40 , 41 ].

As previously described [ 42 ], our objective was to compare the effectiveness of TAU against BST. Our hypotheses, stated in null form, were that these methods would not differ significantly in:

Observer assessment of self-protection and team-control physical skills.

Self-assessed confidence in using those skills.

Study participants were recruited from all newly-hired clinical staff attending a mandatory two-week orientation. Staff were required to register beforehand for a half-day, in-person, physical safety skills session. They were randomized to a session at the time of registration, and the sessions were then randomized to TAU or BST. All randomization was performed by RB using GraphPad software [ 43 ].

The physical skills training was scheduled for a 3.5 h session on one day of the mandatory onboarding. At the end of the previous day, attendees were introduced to the study (including the fact that it was a randomized study) and asked for consent to email them a copy of the informed consent. On the morning of the physical skills training, a research team member met with attendees to answer questions and then meet privately with each individual to ascertain if they wished to participate and sign the informed consent. The trainers and session attendees were thus unaware of who was or was not in the study. Recruitment began January 2021, after ethics approval, and continued until September 2021 when the target of at least 40 study participants completing all assessments for each training condition was reached. The target sample size was chosen to allow 80-percent power to detect a medium to large effect size [ 44 ].

Both methods taught the same 11 target skills for safely responding to patients/clients that may exhibit harm to self or others (e.g., aggressive behaviour) during their hospital admission. These skills, defined by the hospital as mandatory for all newly hired staff, included six self-protection and five team-control (physical restraint) skills (see Appendix A ). Each target skill had defined components and a specific sequence in which they were taught as outlined on performance checklists (see Appendix B for a checklist example).

The two methods differed in how these sequences were administered. For BST, the trainers used the performance checklists to guide the training sequence (instruction, modeling, rehearsal, and feedback) and to indicate when the trainee was ready to move on to the next skill [ 34 ] (see Appendix C for BST sequence). In BST, common practice is to define successful performance criteria a priori (e.g., up to three correct, consecutive executions at 100% [ 45 ]). However, because the physical skills training session in our study had to be completed within the scheduled 3.5 h, the criterion was lowered for practical reasons to one correct performance (defined as 80% of the components comprising that skill) with the added goal of aiming for up to 5 times in a row if time allowed before moving on to the next skill. In contrast, while TAU included elements of modeling, practice, and feedback, it did not systematically assess skill acquisition nor impose any specific level of success before proceeding to the next skill.

There were three outcome measures, two observer-based assessments of skill acquisition (competence and mastery) and one self-reported confidence measure. Competence was defined as the percentage of components comprising an individual skill that were correctly executed (e.g., if a skill had 10 components and only six were executed properly, the competence score for that skill would be 60%). Mastery was the threshold defining when a competence score was felt to indicate successful achievement of a skill and to indicate some degree of the durability of the skill acquisition [ 46 ]. For our study, we expanded mastery to apply to the two categories of self-protection and team-control (rather than to each individual skill) using the average competence scores for the skills within each category. Mastery was pre-defined as 80-percent, a commonly used threshold [ 28 , 47 ].

The outcome measures were assessed at three time points: immediately before training (baseline), immediately after training (post-training), and one month later (follow-up). The hospital provided limited descriptive information (professional role, department) for all registrants for administrative purposes but for confidentiality reasons did not provide personal information such as age or gender/sex. The research team elected not to collect personal information for two reasons. First, the primary study concern was to evaluate the main effect of training method rather than developing predictive models, and the expected result of the randomization process was that potential covariates would not be systematically biased in the two study groups. Second, we would not be able to use this information to compare participants with non-participants to identify biases in who consented to be in the study. We were able to compare them on department role and profession by subtracting the aggregated study-participant information from the aggregated hospital-provided information – the only form of the hospital-provided information available to the research team (see Table 1  below). In addition, since degree of patient contact was an important factor in the likelihood of needing to exercise safety skills, the research team also created an algorithm estimating which combinations of professional role and department were likely to have direct, less direct, or rare/low patient contact.

Participants were also asked at baseline and follow-up how many events they encountered in the previous month that required the use of these skills. This information was collected because of our interest in testing a post-hoc hypothesis that those with actual experience would score higher than those who did not.

All assessments were carried out following a standardized protocol. To ensure that registrants remained blinded to which colleagues were in the study, each registrant’s skill acquisition was assessed privately by a research team member at baseline and post-training using the performance checklists. Only assessments for those consenting to participate were videotaped. Study participants were then asked to return one month later for a follow-up assessment which was also videotaped. For the purposes of post-hoc analyses, participants completing all three assessments were defined as ‘completers’ while those completing baseline and post-training assessments but not the one-month follow-up were ‘non-completers.’

The same performance checklists used by the BST trainers were then used by trained observers blinded to the participant’s training method to assess the videotapes. As described previously [ 42 ], interobserver agreement (IOA) was routinely evaluated throughout the study with the final value being 96% across the 33% of the performance assessment videos scored for the IOA calculation.

Skill acquisition outcomes were calculated using the checklist-based observer assessments of the videotapes. The percentage of correctly executed components for each target skill was established. Then, these percentages were averaged across the six self-protection target skills and across the five team-control target skills to create competence scores. Finally, the predefined threshold of 80% was applied to the competence scores to determine which participants met the mastery threshold [ 47 , 48 ].

Self-reported confidence was assessed on a 10-point Likert scale (‘not at all’ to ‘extremely’ confident) using a version of our institution’s standard assessment questions adapted for this study (See Appendix D ).

Statistical analysis

R software was used to generate descriptive statistics (frequencies, percentages) and test our hypotheses [ 49 ]. Generalized linear mixed models (GLMM) were used to test nested main and interaction effects using likelihood-ratio chi-square statistics for the post-training and follow-up results as there were no baseline differences. GLMM was also used to evaluate BST-TAU differences at the three study time points [ 50 , 51 ]. For the BST-TAU comparisons, we used Cohen’s d as a guide for evaluating the practical significance of the differences for the continuous measures (competence, confidence). We used Cohen’s suggested thresholds [ 52 ] of 0.2, 0.5, and 0.8 for small, medium, and large effect sizes conservatively by applying them to both the point estimates and 95% confidence intervals. Thus, for example, a Cohen’s d where the confidence interval went below 0.2 would be interpreted as non-meaningful. For the categorical measure of mastery, we used BST-TAU risk ratios. Confidence intervals for all effect size measures were obtained using bootstrapping. Independent-samples t -tests were used for the post-hoc analyses and, along with chi-square tests, to compare the completers and non-completers.

One hundred ninety-nine staff consented to participate in the study out of a total of 360 session attendees (55%). Of these, 108 (54%) had been randomly assigned to a BST session and 91 (46%) to a TAU session. Half ( n  = 99) completed assessments at all three time points (44% TAU; 55% BST). These 99 (hereafter ‘study completers’) constituted 28 percent of all session attendees.

Among the non-completers, 53 had been assigned to BST and 47 to TAU. Eight were classified as incomplete because of technical software issues when video-recording one of their assessments and one (the first participant) because the IOA process prompted substantive changes to the assessment checklist. The primary reason for the remaining non-completers was missing the follow-up assessment (91 individuals: 50/53 BST, 41/47 TAU) largely due to difficulties scheduling a non-mandatory event during the pandemic (e.g., units restricting staff from leaving because of clinical staff shortages or patient outbreaks, staff illness).

Descriptive information for the expected degree of patient contact and for hospital department is shown in Table  1 for study participants (completers, non-completers), non-participants, and the total group of session attendees. No significant differences were found when comparing participants versus non-participants or study completers versus non-completers in terms of expected patient contact ( χ 2 (2) = 0.36, n.s.; χ 2 (2) = 2.22, n.s.; respectively) or department type ( χ 2 (3) = 4.40; ( χ 2 (3) = 1.00, n.s.; respectively).

Figure  1 depicts the self-protection and team-control competence scores for the study completers (left and right sides, respectively). The hypothesis-testing results showed a significant difference by training Method (self-protection: χ 2 (1) = 34.46, p  < 0.001; team-control: χ 2 (1) = 50.42, p  < 0.001). There was also a significant decline between post-training and follow-up (Time) for both skill categories independent of Method (self-protection: χ 2 (1) = 81.29, p  < 0.001; team-control: χ 2 (1) = 56.51, p  < 0.001), and a significant Method-by-Time interaction independent of Method and Time for team-control skills ( χ 2 (1) = 17.41, p  < 0.001). BST-TAU comparisons showed no difference at baseline for either type of skill (not shown). However, BST was significantly better than TAU at both post-training (self-protection: Cohen’s d  = 1.45 [1.02, 1.87], large effect size; team-control: Cohen’s d  = 2.55 [2.08, 3.02]; large effect size) and follow-up (respectively – Cohen’s d  = 0.82 [0.40, 1.23]; Cohen’s d  = 0.62 [0.21, 1.03], both small effect sizes). For both methods, competence scores dropped between post-training and follow-up although not to the original baseline levels.

Observer-rated self-protection and team-control competence skills in TAU and BST across time-points

The skill mastery results for the study completers are shown in Fig.  2 . The mastery patterns paralleled the competence patterns in that BST was significantly better than TAU (self protection: χ 2 (1) = 28.82, p  < 0.001; team-control: χ 2 (1) = 72.87, p  < 0.001). There was also a significant Time effect independent of Method (self-protection: χ 2 (1) = 27.54, p  < 0.001; team-control: χ 2 (1) = 33.03, p  < 0.001). There were no significant interactions for either type of skill once the effects of Method and Time were accounted for. BST-TAU comparisons showed no difference in percent achieving Mastery at baseline (not shown) but large risk ratios at both post-training (self-protection: 13.43 [4.01, > 1000]; team-control: 31.24 [8.45, > 1000] and follow-up [self-protection: 12.30 [1.58, > 1000]; team-control: 30.60 [6.75. > 1000]).

Observer-rated self-protection and team-control mastery (Predefined as 80% or better competence) by TAU and BST across time-points

Confidence scores for the study completers are shown in Fig.  3 . The only significant main effect was for Time (self-protection: χ 2 (1) = 36.87, p  < 0.001; team-control: χ 2 (1) = 21.08, p  < 0.001). For both skill categories, the scores increased between baseline and post-training and then dropped at follow-up but not to the original baseline levels.

Self-rated self-protection and team-control confidence in TAU and BST across time-points

To assess what impact the high no-show rate for the one-month follow-up could have had, we compared the completers and the non-completers on the six post-training outcomes (competence, mastery, and confidence for self-protection and for team-control). Non-completers had slightly lower scores than completers except for the two confidence measures where their self-assessments were higher (not shown). However, the only significant difference between the two groups was for self-protection competence means (0.70 vs 0.63, completers vs non- completers, t (195) = 2.40, p  = 0.017).

In terms of past-month experience, few study completers reported events requiring self-protection (19 at baseline, 9 at follow-up) or team-control skills (14 at baseline, 14 at follow-up). Consequently, we only examined the presence or absence of experience without breaking it down by training method. We found non-significant results for both competence and mastery (not shown) but a potential impact on confidence for self-protection skills at follow-up and for team-control skills at baseline and post-training (Fig.  4 ).

Self-rated self-protection and team-control confidence by occasion to use skills in the past month across time-points

4. Summary and discussion.

Our strongest finding was that BST was significantly better than TAU in improving the observed performance of self-protection and team-control skills. While follow-up scores decreased for both methods, BST scores remained higher than TAU scores. The impact of training on staff confidence differs from these patterns in that confidence scores improved noticeably at post-training and remained relatively high at follow-up. Further, our post-hoc analyses suggested that recent experience using safety skills might have a greater impact on confidence than on observed skill performance. We also found that training, regardless of method, was independently associated with improved observer-scored skills and self-reported confidence.

The better performance of BST is consistent with the fact that it incorporates training elements that are supported both by current educational and learning theories and evidence of effectiveness [ 46 , 53 , 54 , 55 ]. While both BST and TAU can be considered ‘outcomes based’ [ 54 ], the key difference is the BST’s use of the checklist. Based directly on the desired behavioral outcomes, this tool simultaneously creates a common understanding because it is shared with the trainees, ensures consistent and systematic training across all BST trainees, pinpoints where immediate and personalized feedback is needed to either correct or reinforce performance, and tracks the number of correct repetitions required to meet mastery criteria as well as support retention [ 46 , 56 , 57 ]. By contrast, TAU does not use a checklist and the kind and amount of feedback or practice repetitions is left to the trainer’s discretion.

However, there are at least two questions regarding whether BST produced the expected results. The BST framework requires continued rehearsal and feedback until a specified performance criterion is reached [ 34 ]. However, our mandatory safety training had practical, unmodifiable constraints. The institution required the safety-training sessions be completed in 3.5 h which meant that BST trainers were limited in their ability to use the more stringent performance criteria described in the literature. For example, it was not practical to set the performance criterion at higher than 80 percent. In addition, all BST completers were able to demonstrate 80-percent correct performance for each skill at least once, but not all were able to demonstrate five consecutive, correct executions within the allotted time. If the requirement of five in a row at 80% or higher had been implemented, then the post-training scores (and potentially the 1-month follow-up scores) for the BST completers could have been higher.

A second question is what level of skill retention should be expected at follow-up. The BST scores at one-month follow-up constituted 66% and 73% of the competence scores at post-training (self-protection and team-control, respectively) and 30% and 41% of the mastery percentages at post-training (self-protection and team-control, respectively). Although BST and elements of performance feedback models have been found to be effective in staff training with successful retention over time [ 58 , 59 , 60 , 61 , 62 ], finding appropriate comparators for our study was challenging because there are no studies where BST has been used for training such a large and diverse group of staff. Further, as noted above, the body of workplace violence prevention literature has not consistently focussed on retention. However, the broader training and education literature does suggest that our results are consistent with or somewhat lower than those from other studies. Offiah et al. [ 63 ] found that 45 percent of medical students retained the full set of clinical skills 18 months after completing simulation training, and Bruno and colleagues [ 64 ] found published retention rates ranging between 75 and 85 percent across time periods between four to 24 months and across diverse disciplinary fields. Regardless of the comparators, the loss in skill performance after one-month post-training is a concern.

Our interpretation is that reliance on a single session, even with highly structured and competency-based methods, is not adequate particularly in the context of managing distressing events. Efforts should be made to allow for flexibility with respect to setting higher thresholds for success despite organizational restraints for staff training. Furthermore, settings that require these skills to be performed more reliably for both patient and staff safety (e.g., emergency departments, acute care settings, security services) should consider on-the-job feedback or booster sessions based on objective assessments of skill rather than on pre-set amounts of time (e.g. annual refresher). This would be more consistent with the BST literature, as on-the-job training should occur based on an evidence-based approach.

Our finding of a differential impact of training on confidence versus demonstrable skills is consistent with a long-standing, substantial body of research examining the relationship between self-assessment and objective measures of learning [ 28 , 65 , 66 ]. The pattern of non-existent, weak, or even inverse relationships between the two has been shown for a variety of medical staff trainee and education learner groups [ 28 , 29 , 67 , 68 , 69 , 70 , 71 , 72 ]. Consequently, many researchers recommend either not using self-assessments at all or at least ensuring that objective measures are also collected (e.g.,[ 64 , 65 ]).

The literature does offer some hypotheses for why this discrepancy occurs and, further, why self-assessment continues to be used in medical education and training despite the robust evidence that it does not accurately reflect learning. Katowa-Mukwato and Banda [ 70 ] in a study of Zambian medical students suggest that fear of revealing their weaknesses led to a negative correlation between self- and objective-ratings. Persky, et al. [ 69 ] reference the theory of ‘metacognition’ – defined as ‘thinking about thinking’ (p. 993, [ 69 ] – and the ‘Dunning-Kruger’ effect that the ability to recognize competence (i.e., accurate metacognition) is unevenly distributed. There is also discussion as to why these measures continue to be used and suggestions of how best to use them. Yates et al. [ 65 ] suggest that ease of collecting this information is a factor. More complex and nuanced explanations are offered by Lu, et al. [ 66 ] and Tavares, et al. [ 73 ] who note that self-assessment is an important component in theories of learning and evaluation and that self-perception and self-reflection (particularly when objective findings are shared) are critical ingredients for supporting medical and continuing profession education in a self-regulating profession.

Because the goal of our study was to assess the effectiveness of two training methods, we did not collect information or have the opportunity to explore any of these potential reasons for why self-reported and objective measures are discrepant or to evaluate the best use of that discrepancy. The modest contributions that our study adds are that selecting a higher-risk setting, including non-nursing healthcare professionals, using a more rigorous study design (as recommended by Geoffrion, et al. [ 29 ]), and attempting to account for recent experience do not appear to alter this pattern.

The major strength of our study is its design. Currently, we have identified only one other study evaluating the impact of BST training for clinical staff using a randomized control trial design [ 41 ]. Other strengths are our inclusion of a large percentage of non-nursing, direct-care staff, our use of both self-reported and observer-assessed outcome measures, and our findings regarding retention. These strengths allow us to add to the evidence base already established in the literature.

However, interpretation of our results should consider several limitations. Conducting a research study on full-time clinical staff during a pandemic meant that a high percentage of those consenting to be in the study did not complete their 1-month follow-up assessment. The reported reasons for missing the third assessment (unit restrictions or short staffing because of the pandemic) are consistent with the demographic differences between completers and non-completers in that they were more likely to be nurses or working on inpatient units. Our comparison of the post-training scores of the completers and non-completers suggested that the no-shows had slightly lower post-training observed skill performance (but slightly better confidence ratings). If we had managed to assess the non-completers at follow-up, our reported findings may have been diluted although it is unlikely that this would have completely negated the large effect sizes.

The time constraints on the mandatory training meant that we were unable to fully apply either the BST mastery criteria commonly reported in the literature (i.e., three correct, consecutive executions [ 28 , 47 ] or the one we would have preferred (i.e., five correct executions). While this type of limitation is consistent with the pragmatic nature of our design, it likely had an impact on our findings in terms of potentially lowering the post-training BST competency and mastery scores and, perhaps more importantly, contributing to the lower retention rates at 1-month follow-up [ 56 ].

The 45-percent refusal rate by the training registrants is another concerning issue. Anecdotal reports from the training team were that the response rate was very low at the start of the study because many of the new hires were nervous about being videotaped (a specific comment reported was that it reminded some of the new graduates of ‘nursing school.’) and were unsure of the purpose of the study. The team then changed to a more informal, conversational introduction describing the need for the study as well as reassuring attendees that it was the training, not the participants, that was being evaluated. The team’s impression was that this improved the participation rate. The participants and non-participants were not statistically different in terms of their expected patient contact and department role. However, we cannot preclude that there may have been systematic biases for other unmeasured characteristics.

Another limitation, as identified by Price, et al. [ 28 ], is that we used artificial training scenarios, though this may be unavoidable given the low frequency of aggressive events and the ethics of deliberately exposing staff to these events. Also, we only measured the skills directly related to handling client/patient events. We were not able to access information on event frequency or severity, staff distress and complaints, or institutional-level measures such as lost workdays due to sick leave, staff turnover, or expenditures [ 29 , 33 ]. A further gap, which is important but difficult to assess, is whether there is any impact of staff safety training on the clients or patients who are involved.

Given these strengths and limitations, we see our study as adding one piece of evidence that needs to be a) confirmed or disconfirmed by other researchers in both the same and different settings and b) understood as part of a complex mix of ingredients. Specific areas for further research arising directly out of our findings include evaluating whether less constrained training time would improve attainment of skill mastery, exploration and evaluation of methods to increase skill retention over time, and, most importantly but also more difficult to assess, the impact on patients and clients of staff safety skills training. More evidence on these fronts will hopefully contribute to maintaining and improving workplace safety.

Availability of data and materials

The dataset generated and analysed during the current study is not publicly available due to the fact that it is part of a larger internal administrative data collection but is available from the corresponding author on reasonable request.

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Acknowledgements

We thank Sanjeev Sockalingam, Asha Maharaj, Katie Hodgson, Erin Ledrew, Sophie Soklaridis, and Stephanie Sliekers for their guidance and for dedicating the human and financial resources needed to support this study. We also want to express our sincere gratitude to the following individuals for facilitating physical skills sessions and for volunteering as actors in the physical skills demonstrations: Kate Van den Borre, Steven Hughes, Paul Martin Demers, Ross Violo, Genevieve Poulin, Stacy de Souza, Narendra Deonauth, Joanna Zygmunt, Tessa Donnelly, Lawren Taylor, and Bobby Bonner. Finally, we are grateful to Marcos Sanchez for statistical consultation and Quincy Vaz for research support.

This research was funded internally by the Centre for Addiction and Mental Health.

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Elizabeth Lin, Mais Malhas, Emmanuel Bratsalis, Kendra Thomson, Fabienne Hargreaves, Kayle Donner, Heba Baig, Rhonda Boateng, Rajlaxmi Swain, Mary Benisha Benadict & Louis Busch

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All authors were involved in the study design, monitoring and implementing the study, and review of manuscript drafts. EL was responsible for the original study design and drafting of the full manuscript. MM, EB, and FH led the implementation of the training sessions. EB, FH, HB, KT, and LB were involved in the reliability assessments (IOA). KD and HB were primarily responsible for data analysis. HB and RB monitored the data collection and the ongoing study procedures. RS and MBB assisted in the literature review.

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This study was approved by the Research Ethics Board of the Centre for Addiction and Mental Health (#101/2020). Informed consent was obtained from all subjects participating in the study. All interventions were performed in accordance with the Declaration of Helsinki. This study was registered with the ISRCTN registry on 06/01/2023 (ISRCTN18133140).

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Lin, E., Malhas, M., Bratsalis, E. et al. Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial. BMC Health Serv Res 24 , 639 (2024). https://doi.org/10.1186/s12913-024-10994-1

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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

INTRODUCTION

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

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

I.     Global Cultural Perspective of Embryonic Stem Cells

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

a.     US and Rights-Based Cultures

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

b.     Ubuntu and Collective Cultures

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

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

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

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

c.     Asia

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

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

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

d.     Middle East

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

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

e.     Europe

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

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

II.     Religious Perspectives on ESC

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

The Qur'an states:

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

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

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

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

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

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

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

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

III.     A Flexible Ethical Approach

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

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

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

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

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

IV.     Concerns

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

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

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

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

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

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

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

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

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

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

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

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

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

[12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics . 22. 10.1186/s12910-021-00678-4.

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

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

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

[16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa.  Stem Cell Res Ther   4 , 54 (2013). https://doi.org/10.1186/scrt204 ; Pew Research Center. (2014, May 1). Public health a major priority in African nations . Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/

[17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024 . National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf

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

[19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia . UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html

[20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

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

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

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

[24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction.  Frontiers in pharmacology ,  13 , 1013740. https://doi.org/10.3389/fphar.2022.1013740

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[28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine , 12 (6), 647–656. https://doi.org/10.2217/rme-2017-0035

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

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

[31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan.  Curr Stem Cell Rep   1 , 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6

[32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production . NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production

[33] Park, S. (2012). South Korea steps up stem-cell work.  Nature . https://doi.org/10.1038/nature.2012.10565

[34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned.  Accountability in research ,  13 (1), 101–109. https://doi.org/10.1080/08989620600634193 .

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

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

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

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

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

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

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

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

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

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

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

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

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

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

Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License .

• Open access
• Published: 14 May 2024

Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study

• Jocelyn Schroeder 1 ,
• Barbara Pesut 1 , 2 ,
• Lise Olsen 2 ,
• Nelly D. Oelke 2 &
• Helen Sharp 2  

BMC Nursing volume  23 , Article number:  326 ( 2024 ) Cite this article

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Metrics details

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. Canada’s legislation is the first to permit Nurse Practitioners (NP) to serve as independent MAiD assessors and providers. Registered Nurses’ (RN) also have important roles in MAiD that include MAiD care coordination; client and family teaching and support, MAiD procedural quality; healthcare provider and public education; and bereavement care for family. Nurses have a right under the law to conscientious objection to participating in MAiD. Therefore, it is essential to prepare nurses in their entry-level education for the practice implications and moral complexities inherent in this practice. Knowing what nursing students think about MAiD is a critical first step. Therefore, the purpose of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context.

The design was a mixed-method, modified e-Delphi method that entailed item generation from the literature, item refinement through a 2 round survey of an expert faculty panel, and item validation through a cognitive focus group interview with nursing students. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

During phase 1, a 56-item survey was developed from existing literature that included demographic items and items designed to measure experience with death and dying (including MAiD), education and preparation, attitudes and beliefs, influences on those beliefs, and anticipated future involvement. During phase 2, an expert faculty panel reviewed, modified, and prioritized the items yielding 51 items. During phase 3, a sample of nursing students further evaluated and modified the language in the survey to aid readability and comprehension. The final survey consists of 45 items including 4 case studies.

Systematic evaluation of knowledge-to-date coupled with stakeholder perspectives supports robust survey design. This study yielded a survey to assess nursing students’ attitudes toward MAiD in a Canadian context.

The survey is appropriate for use in education and research to measure knowledge and attitudes about MAiD among nurse trainees and can be a helpful step in preparing nursing students for entry-level practice.

Peer Review reports

Medical Assistance in Dying (MAiD) is permitted under an amendment to Canada’s Criminal Code which was passed in 2016 [ 1 ]. MAiD is defined in the legislation as both self-administered and clinician-administered medication for the purpose of causing death. In the 2016 Bill C-14 legislation one of the eligibility criteria was that an applicant for MAiD must have a reasonably foreseeable natural death although this term was not defined. It was left to the clinical judgement of MAiD assessors and providers to determine the time frame that constitutes reasonably foreseeable [ 2 ]. However, in 2021 under Bill C-7, the eligibility criteria for MAiD were changed to allow individuals with irreversible medical conditions, declining health, and suffering, but whose natural death was not reasonably foreseeable, to receive MAiD [ 3 ]. This population of MAiD applicants are referred to as Track 2 MAiD (those whose natural death is foreseeable are referred to as Track 1). Track 2 applicants are subject to additional safeguards under the 2021 C-7 legislation.

Three additional proposed changes to the legislation have been extensively studied by Canadian Expert Panels (Council of Canadian Academics [CCA]) [ 4 , 5 , 6 ] First, under the legislation that defines Track 2, individuals with mental disease as their sole underlying medical condition may apply for MAiD, but implementation of this practice is embargoed until March 2027 [ 4 ]. Second, there is consideration of allowing MAiD to be implemented through advanced consent. This would make it possible for persons living with dementia to receive MAID after they have lost the capacity to consent to the procedure [ 5 ]. Third, there is consideration of extending MAiD to mature minors. A mature minor is defined as “a person under the age of majority…and who has the capacity to understand and appreciate the nature and consequences of a decision” ([ 6 ] p. 5). In summary, since the legalization of MAiD in 2016 the eligibility criteria and safeguards have evolved significantly with consequent implications for nurses and nursing care. Further, the number of Canadians who access MAiD shows steady increases since 2016 [ 7 ] and it is expected that these increases will continue in the foreseeable future.

Nurses have been integral to MAiD care in the Canadian context. While other countries such as Belgium and the Netherlands also permit euthanasia, Canada is the first country to allow Nurse Practitioners (Registered Nurses with additional preparation typically achieved at the graduate level) to act independently as assessors and providers of MAiD [ 1 ]. Although the role of Registered Nurses (RNs) in MAiD is not defined in federal legislation, it has been addressed at the provincial/territorial-level with variability in scope of practice by region [ 8 , 9 ]. For example, there are differences with respect to the obligation of the nurse to provide information to patients about MAiD, and to the degree that nurses are expected to ensure that patient eligibility criteria and safeguards are met prior to their participation [ 10 ]. Studies conducted in the Canadian context indicate that RNs perform essential roles in MAiD care coordination; client and family teaching and support; MAiD procedural quality; healthcare provider and public education; and bereavement care for family [ 9 , 11 ]. Nurse practitioners and RNs are integral to a robust MAiD care system in Canada and hence need to be well-prepared for their role [ 12 ].

Previous studies have found that end of life care, and MAiD specifically, raise complex moral and ethical issues for nurses [ 13 , 14 , 15 , 16 ]. The knowledge, attitudes, and beliefs of nurses are important across practice settings because nurses have consistent, ongoing, and direct contact with patients who experience chronic or life-limiting health conditions. Canadian studies exploring nurses’ moral and ethical decision-making in relation to MAiD reveal that although some nurses are clear in their support for, or opposition to, MAiD, others are unclear on what they believe to be good and right [ 14 ]. Empirical findings suggest that nurses go through a period of moral sense-making that is often informed by their family, peers, and initial experiences with MAID [ 17 , 18 ]. Canadian legislation and policy specifies that nurses are not required to participate in MAiD and may recuse themselves as conscientious objectors with appropriate steps to ensure ongoing and safe care of patients [ 1 , 19 ]. However, with so many nurses having to reflect on and make sense of their moral position, it is essential that they are given adequate time and preparation to make an informed and thoughtful decision before they participate in a MAID death [ 20 , 21 ].

It is well established that nursing students receive inconsistent exposure to end of life care issues [ 22 ] and little or no training related to MAiD [ 23 ]. Without such education and reflection time in pre-entry nursing preparation, nurses are at significant risk for moral harm. An important first step in providing this preparation is to be able to assess the knowledge, values, and beliefs of nursing students regarding MAID and end of life care. As demand for MAiD increases along with the complexities of MAiD, it is critical to understand the knowledge, attitudes, and likelihood of engagement with MAiD among nursing students as a baseline upon which to build curriculum and as a means to track these variables over time.

Aim, design, and setting

The aim of this study was to develop a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in MAiD in the Canadian context. We sought to explore both their willingness to be involved in the registered nursing role and in the nurse practitioner role should they chose to prepare themselves to that level of education. The design was a mixed-method, modified e-Delphi method that entailed item generation, item refinement through an expert faculty panel [ 24 , 25 , 26 ], and initial item validation through a cognitive focus group interview with nursing students [ 27 ]. The settings were a University located in an urban area and a College located in a rural area in Western Canada.

Participants

A panel of 10 faculty from the two nursing education programs were recruited for Phase 2 of the e-Delphi. To be included, faculty were required to have a minimum of three years of experience in nurse education, be employed as nursing faculty, and self-identify as having experience with MAiD. A convenience sample of 5 fourth-year nursing students were recruited to participate in Phase 3. Students had to be in good standing in the nursing program and be willing to share their experiences of the survey in an online group interview format.

The modified e-Delphi was conducted in 3 phases: Phase 1 entailed item generation through literature and existing survey review. Phase 2 entailed item refinement through a faculty expert panel review with focus on content validity, prioritization, and revision of item wording [ 25 ]. Phase 3 entailed an assessment of face validity through focus group-based cognitive interview with nursing students.

Phase I. Item generation through literature review

The goal of phase 1 was to develop a bank of survey items that would represent the variables of interest and which could be provided to expert faculty in Phase 2. Initial survey items were generated through a literature review of similar surveys designed to assess knowledge and attitudes toward MAiD/euthanasia in healthcare providers; Canadian empirical studies on nurses’ roles and/or experiences with MAiD; and legislative and expert panel documents that outlined proposed changes to the legislative eligibility criteria and safeguards. The literature review was conducted in three online databases: CINAHL, PsycINFO, and Medline. Key words for the search included nurses , nursing students , medical students , NPs, MAiD , euthanasia , assisted death , and end-of-life care . Only articles written in English were reviewed. The legalization and legislation of MAiD is new in many countries; therefore, studies that were greater than twenty years old were excluded, no further exclusion criteria set for country.

Items from surveys designed to measure similar variables in other health care providers and geographic contexts were placed in a table and similar items were collated and revised into a single item. Then key variables were identified from the empirical literature on nurses and MAiD in Canada and checked against the items derived from the surveys to ensure that each of the key variables were represented. For example, conscientious objection has figured prominently in the Canadian literature, but there were few items that assessed knowledge of conscientious objection in other surveys and so items were added [ 15 , 21 , 28 , 29 ]. Finally, four case studies were added to the survey to address the anticipated changes to the Canadian legislation. The case studies were based upon the inclusion of mature minors, advanced consent, and mental disorder as the sole underlying medical condition. The intention was to assess nurses’ beliefs and comfort with these potential legislative changes.

Phase 2. Item refinement through expert panel review

The goal of phase 2 was to refine and prioritize the proposed survey items identified in phase 1 using a modified e-Delphi approach to achieve consensus among an expert panel [ 26 ]. Items from phase 1 were presented to an expert faculty panel using a Qualtrics (Provo, UT) online survey. Panel members were asked to review each item to determine if it should be: included, excluded or adapted for the survey. When adapted was selected faculty experts were asked to provide rationale and suggestions for adaptation through the use of an open text box. Items that reached a level of 75% consensus for either inclusion or adaptation were retained [ 25 , 26 ]. New items were categorized and added, and a revised survey was presented to the panel of experts in round 2. Panel members were again asked to review items, including new items, to determine if it should be: included, excluded, or adapted for the survey. Round 2 of the modified e-Delphi approach also included an item prioritization activity, where participants were then asked to rate the importance of each item, based on a 5-point Likert scale (low to high importance), which De Vaus [ 30 ] states is helpful for increasing the reliability of responses. Items that reached a 75% consensus on inclusion were then considered in relation to the importance it was given by the expert panel. Quantitative data were managed using SPSS (IBM Corp).

Phase 3. Face validity through cognitive interviews with nursing students

The goal of phase 3 was to obtain initial face validity of the proposed survey using a sample of nursing student informants. More specifically, student participants were asked to discuss how items were interpreted, to identify confusing wording or other problematic construction of items, and to provide feedback about the survey as a whole including readability and organization [ 31 , 32 , 33 ]. The focus group was held online and audio recorded. A semi-structured interview guide was developed for this study that focused on clarity, meaning, order and wording of questions; emotions evoked by the questions; and overall survey cohesion and length was used to obtain data (see Supplementary Material 2  for the interview guide). A prompt to “think aloud” was used to limit interviewer-imposed bias and encourage participants to describe their thoughts and response to a given item as they reviewed survey items [ 27 ]. Where needed, verbal probes such as “could you expand on that” were used to encourage participants to expand on their responses [ 27 ]. Student participants’ feedback was collated verbatim and presented to the research team where potential survey modifications were negotiated and finalized among team members. Conventional content analysis [ 34 ] of focus group data was conducted to identify key themes that emerged through discussion with students. Themes were derived from the data by grouping common responses and then using those common responses to modify survey items.

Ten nursing faculty participated in the expert panel. Eight of the 10 faculty self-identified as female. No faculty panel members reported conscientious objector status and ninety percent reported general agreement with MAiD with one respondent who indicated their view as “unsure.” Six of the 10 faculty experts had 16 years of experience or more working as a nurse educator.

Five nursing students participated in the cognitive interview focus group. The duration of the focus group was 2.5 h. All participants identified that they were born in Canada, self-identified as female (one preferred not to say) and reported having received some instruction about MAiD as part of their nursing curriculum. See Tables  1 and 2 for the demographic descriptors of the study sample. Study results will be reported in accordance with the study phases. See Fig.  1 for an overview of the results from each phase.

Fig. 1  Overview of survey development findings

Phase 1: survey item generation

Review of the literature identified that no existing survey was available for use with nursing students in the Canadian context. However, an analysis of themes across qualitative and quantitative studies of physicians, medical students, nurses, and nursing students provided sufficient data to develop a preliminary set of items suitable for adaptation to a population of nursing students.

Four major themes and factors that influence knowledge, attitudes, and beliefs about MAiD were evident from the literature: (i) endogenous or individual factors such as age, gender, personally held values, religion, religiosity, and/or spirituality [ 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ], (ii) experience with death and dying in personal and/or professional life [ 35 , 40 , 41 , 43 , 44 , 45 ], (iii) training including curricular instruction about clinical role, scope of practice, or the law [ 23 , 36 , 39 ], and (iv) exogenous or social factors such as the influence of key leaders, colleagues, friends and/or family, professional and licensure organizations, support within professional settings, and/or engagement in MAiD in an interdisciplinary team context [ 9 , 35 , 46 ].

Studies of nursing students also suggest overlap across these categories. For example, value for patient autonomy [ 23 ] and the moral complexity of decision-making [ 37 ] are important factors that contribute to attitudes about MAiD and may stem from a blend of personally held values coupled with curricular content, professional training and norms, and clinical exposure. For example, students report that participation in end of life care allows for personal growth, shifts in perception, and opportunities to build therapeutic relationships with their clients [ 44 , 47 , 48 ].

Preliminary items generated from the literature resulted in 56 questions from 11 published sources (See Table  3 ). These items were constructed across four main categories: (i) socio-demographic questions; (ii) end of life care questions; (iii) knowledge about MAiD; or (iv) comfort and willingness to participate in MAiD. Knowledge questions were refined to reflect current MAiD legislation, policies, and regulatory frameworks. Falconer [ 39 ] and Freeman [ 45 ] studies were foundational sources for item selection. Additionally, four case studies were written to reflect the most recent anticipated changes to MAiD legislation and all used the same open-ended core questions to address respondents’ perspectives about the patient’s right to make the decision, comfort in assisting a physician or NP to administer MAiD in that scenario, and hypothesized comfort about serving as a primary provider if qualified as an NP in future. Response options for the survey were also constructed during this stage and included: open text, categorical, yes/no , and Likert scales.

Phase 2: faculty expert panel review

Of the 56 items presented to the faculty panel, 54 questions reached 75% consensus. However, based upon the qualitative responses 9 items were removed largely because they were felt to be repetitive. Items that generated the most controversy were related to measuring religion and spirituality in the Canadian context, defining end of life care when there is no agreed upon time frames (e.g., last days, months, or years), and predicting willingness to be involved in a future events – thus predicting their future selves. Phase 2, round 1 resulted in an initial set of 47 items which were then presented back to the faculty panel in round 2.

Of the 47 initial questions presented to the panel in round 2, 45 reached a level of consensus of 75% or greater, and 34 of these questions reached a level of 100% consensus [ 27 ] of which all participants chose to include without any adaptations) For each question, level of importance was determined based on a 5-point Likert scale (1 = very unimportant, 2 = somewhat unimportant, 3 = neutral, 4 = somewhat important, and 5 = very important). Figure  2 provides an overview of the level of importance assigned to each item.

Ranking level of importance for survey items

After round 2, a careful analysis of participant comments and level of importance was completed by the research team. While the main method of survey item development came from participants’ response to the first round of Delphi consensus ratings, level of importance was used to assist in the decision of whether to keep or modify questions that created controversy, or that rated lower in the include/exclude/adapt portion of the Delphi. Survey items that rated low in level of importance included questions about future roles, sex and gender, and religion/spirituality. After deliberation by the research committee, these questions were retained in the survey based upon the importance of these variables in the scientific literature.

Of the 47 questions remaining from Phase 2, round 2, four were revised. In addition, the two questions that did not meet the 75% cut off level for consensus were reviewed by the research team. The first question reviewed was What is your comfort level with providing a MAiD death in the future if you were a qualified NP ? Based on a review of participant comments, it was decided to retain this question for the cognitive interviews with students in the final phase of testing. The second question asked about impacts on respondents’ views of MAiD and was changed from one item with 4 subcategories into 4 separate items, resulting in a final total of 51 items for phase 3. The revised survey was then brought forward to the cognitive interviews with student participants in Phase 3. (see Supplementary Material 1 for a complete description of item modification during round 2).

Phase 3. Outcomes of cognitive interview focus group

Of the 51 items reviewed by student participants, 29 were identified as clear with little or no discussion. Participant comments for the remaining 22 questions were noted and verified against the audio recording. Following content analysis of the comments, four key themes emerged through the student discussion: unclear or ambiguous wording; difficult to answer questions; need for additional response options; and emotional response evoked by questions. An example of unclear or ambiguous wording was a request for clarity in the use of the word “sufficient” in the context of assessing an item that read “My nursing education has provided sufficient content about the nursing role in MAiD.” “Sufficient” was viewed as subjective and “laden with…complexity that distracted me from the question.” The group recommended rewording the item to read “My nursing education has provided enough content for me to care for a patient considering or requesting MAiD.”

An example of having difficulty answering questions related to limited knowledge related to terms used in the legislation such as such as safeguards , mature minor , eligibility criteria , and conscientious objection. Students were unclear about what these words meant relative to the legislation and indicated that this lack of clarity would hamper appropriate responses to the survey. To ensure that respondents are able to answer relevant questions, student participants recommended that the final survey include explanation of key terms such as mature minor and conscientious objection and an overview of current legislation.

Response options were also a point of discussion. Participants noted a lack of distinction between response options of unsure and unable to say . Additionally, scaling of attitudes was noted as important since perspectives about MAiD are dynamic and not dichotomous “agree or disagree” responses. Although the faculty expert panel recommended the integration of the demographic variables of religious and/or spiritual remain as a single item, the student group stated a preference to have religion and spirituality appear as separate items. The student focus group also took issue with separate items for the variables of sex and gender, specifically that non-binary respondents might feel othered or “outed” particularly when asked to identify their sex. These variables had been created based upon best practices in health research but students did not feel they were appropriate in this context [ 49 ]. Finally, students agreed with the faculty expert panel in terms of the complexity of projecting their future involvement as a Nurse Practitioner. One participant stated: “I certainly had to like, whoa, whoa, whoa. Now let me finish this degree first, please.” Another stated, “I'm still imagining myself, my future career as an RN.”

Finally, student participants acknowledged the array of emotions that some of the items produced for them. For example, one student described positive feelings when interacting with the survey. “Brought me a little bit of feeling of joy. Like it reminded me that this is the last piece of independence that people grab on to.” Another participant, described the freedom that the idea of an advance request gave her. “The advance request gives the most comfort for me, just with early onset Alzheimer’s and knowing what it can do.” But other participants described less positive feelings. For example, the mature minor case study yielded a comment: “This whole scenario just made my heart hurt with the idea of a child requesting that.”

Based on the data gathered from the cognitive interview focus group of nursing students, revisions were made to 11 closed-ended questions (see Table  4 ) and 3 items were excluded. In the four case studies, the open-ended question related to a respondents’ hypothesized actions in a future role as NP were removed. The final survey consists of 45 items including 4 case studies (see Supplementary Material 3 ).

The aim of this study was to develop and validate a survey that can be used to track the growth of knowledge about MAiD among nursing students over time, inform training programs about curricular needs, and evaluate attitudes and willingness to participate in MAiD at time-points during training or across nursing programs over time.

The faculty expert panel and student participants in the cognitive interview focus group identified a need to establish core knowledge of the terminology and legislative rules related to MAiD. For example, within the cognitive interview group of student participants, several acknowledged lack of clear understanding of specific terms such as “conscientious objector” and “safeguards.” Participants acknowledged discomfort with the uncertainty of not knowing and their inclination to look up these terms to assist with answering the questions. This survey can be administered to nursing or pre-nursing students at any phase of their training within a program or across training programs. However, in doing so it is important to acknowledge that their baseline knowledge of MAiD will vary. A response option of “not sure” is important and provides a means for respondents to convey uncertainty. If this survey is used to inform curricular needs, respondents should be given explicit instructions not to conduct online searches to inform their responses, but rather to provide an honest appraisal of their current knowledge and these instructions are included in the survey (see Supplementary Material 3 ).

Some provincial regulatory bodies have established core competencies for entry-level nurses that include MAiD. For example, the BC College of Nurses and Midwives (BCCNM) requires “knowledge about ethical, legal, and regulatory implications of medical assistance in dying (MAiD) when providing nursing care.” (10 p. 6) However, across Canada curricular content and coverage related to end of life care and MAiD is variable [ 23 ]. Given the dynamic nature of the legislation that includes portions of the law that are embargoed until 2024, it is important to ensure that respondents are guided by current and accurate information. As the law changes, nursing curricula, and public attitudes continue to evolve, inclusion of core knowledge and content is essential and relevant for investigators to be able to interpret the portions of the survey focused on attitudes and beliefs about MAiD. Content knowledge portions of the survey may need to be modified over time as legislation and training change and to meet the specific purposes of the investigator.

Given the sensitive nature of the topic, it is strongly recommended that surveys be conducted anonymously and that students be provided with an opportunity to discuss their responses to the survey. A majority of feedback from both the expert panel of faculty and from student participants related to the wording and inclusion of demographic variables, in particular religion, religiosity, gender identity, and sex assigned at birth. These and other demographic variables have the potential to be highly identifying in small samples. In any instance in which the survey could be expected to yield demographic group sizes less than 5, users should eliminate the demographic variables from the survey. For example, the profession of nursing is highly dominated by females with over 90% of nurses who identify as female [ 50 ]. Thus, a survey within a single class of students or even across classes in a single institution is likely to yield a small number of male respondents and/or respondents who report a difference between sex assigned at birth and gender identity. When variables that serve to identify respondents are included, respondents are less likely to complete or submit the survey, to obscure their responses so as not to be identifiable, or to be influenced by social desirability bias in their responses rather than to convey their attitudes accurately [ 51 ]. Further, small samples do not allow for conclusive analyses or interpretation of apparent group differences. Although these variables are often included in surveys, such demographics should be included only when anonymity can be sustained. In small and/or known samples, highly identifying variables should be omitted.

There are several limitations associated with the development of this survey. The expert panel was comprised of faculty who teach nursing students and are knowledgeable about MAiD and curricular content, however none identified as a conscientious objector to MAiD. Ideally, our expert panel would have included one or more conscientious objectors to MAiD to provide a broader perspective. Review by practitioners who participate in MAiD, those who are neutral or undecided, and practitioners who are conscientious objectors would ensure broad applicability of the survey. This study included one student cognitive interview focus group with 5 self-selected participants. All student participants had held discussions about end of life care with at least one patient, 4 of 5 participants had worked with a patient who requested MAiD, and one had been present for a MAiD death. It is not clear that these participants are representative of nursing students demographically or by experience with end of life care. It is possible that the students who elected to participate hold perspectives and reflections on patient care and MAiD that differ from students with little or no exposure to end of life care and/or MAiD. However, previous studies find that most nursing students have been involved with end of life care including meaningful discussions about patients’ preferences and care needs during their education [ 40 , 44 , 47 , 48 , 52 ]. Data collection with additional student focus groups with students early in their training and drawn from other training contexts would contribute to further validation of survey items.

Future studies should incorporate pilot testing with small sample of nursing students followed by a larger cross-program sample to allow evaluation of the psychometric properties of specific items and further refinement of the survey tool. Consistent with literature about the importance of leadership in the context of MAiD [ 12 , 53 , 54 ], a study of faculty knowledge, beliefs, and attitudes toward MAiD would provide context for understanding student perspectives within and across programs. Additional research is also needed to understand the timing and content coverage of MAiD across Canadian nurse training programs’ curricula.

The implementation of MAiD is complex and requires understanding of the perspectives of multiple stakeholders. Within the field of nursing this includes clinical providers, educators, and students who will deliver clinical care. A survey to assess nursing students’ attitudes toward and willingness to participate in MAiD in the Canadian context is timely, due to the legislation enacted in 2016 and subsequent modifications to the law in 2021 with portions of the law to be enacted in 2027. Further development of this survey could be undertaken to allow for use in settings with practicing nurses or to allow longitudinal follow up with students as they enter practice. As the Canadian landscape changes, ongoing assessment of the perspectives and needs of health professionals and students in the health professions is needed to inform policy makers, leaders in practice, curricular needs, and to monitor changes in attitudes and practice patterns over time.

Availability of data and materials

The datasets used and/or analysed during the current study are not publicly available due to small sample sizes, but are available from the corresponding author on reasonable request.

Abbreviations

British Columbia College of Nurses and Midwives

Medical assistance in dying

Nurse practitioner

Registered nurse

University of British Columbia Okanagan

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We would like to acknowledge the faculty and students who generously contributed their time to this work.

JS received a student traineeship through the Principal Research Chairs program at the University of British Columbia Okanagan.

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JS made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. JS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. BP made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and drafting and substantively revising the work. BP has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. LO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. LO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. NDO made substantial contributions to the conception of the work; data acquisition, analysis, and interpretation; and substantively revising the work. NDO has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. HS made substantial contributions to drafting and substantively revising the work. HS has approved the submitted version and agreed to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

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Schroeder, J., Pesut, B., Olsen, L. et al. Developing a survey to measure nursing students’ knowledge, attitudes and beliefs, influences, and willingness to be involved in Medical Assistance in Dying (MAiD): a mixed method modified e-Delphi study. BMC Nurs 23 , 326 (2024). https://doi.org/10.1186/s12912-024-01984-z

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Research Writing and Analysis

• NVivo Group and Study Sessions
• SPSS This link opens in a new window
• Statistical Analysis Group sessions
• Using Qualtrics
• Dissertation and Data Analysis Group Sessions
• Defense Schedule - Commons Calendar This link opens in a new window
• Research Process Flow Chart
• Research Alignment Chapter 1 This link opens in a new window
• Step 1: Seek Out Evidence
• Step 2: Explain
• Step 3: The Big Picture
• Step 4: Own It
• Step 5: Illustrate
• Annotated Bibliography
• Literature Review This link opens in a new window
• Systematic Reviews & Meta-Analyses
• How to Synthesize and Analyze
• Synthesis and Analysis Practice
• Synthesis and Analysis Group Sessions
• Problem Statement
• Purpose Statement
• Conceptual Framework
• Theoretical Framework
• Quantitative Research Questions
• Qualitative Research Questions
• Trustworthiness of Qualitative Data
• Analysis and Coding Example- Qualitative Data
• Thematic Data Analysis in Qualitative Design
• Dissertation to Journal Article This link opens in a new window
• International Journal of Online Graduate Education (IJOGE) This link opens in a new window
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Jump to DSE Guide

Purpose statement overview.

The purpose statement succinctly explains (on no more than 1 page) the objectives of the research study. These objectives must directly address the problem and help close the stated gap. Expressed as a formula:

Good purpose statements:

• Flow from the problem statement and actually address the proposed problem
• Are concise and clear
• Answer the question ‘Why are you doing this research?’
• Match the methodology (similar to research questions)
• Have a ‘hook’ to get the reader’s attention
• Set the stage by clearly stating, “The purpose of this (qualitative or quantitative) study is to ...

In PhD studies, the purpose usually involves applying a theory to solve the problem. In other words, the purpose tells the reader what the goal of the study is, and what your study will accomplish, through which theoretical lens. The purpose statement also includes brief information about direction, scope, and where the data will come from.

A problem and gap in combination can lead to different research objectives, and hence, different purpose statements. In the example from above where the problem was severe underrepresentation of female CEOs in Fortune 500 companies and the identified gap related to lack of research of male-dominated boards; one purpose might be to explore implicit biases in male-dominated boards through the lens of feminist theory. Another purpose may be to determine how board members rated female and male candidates on scales of competency, professionalism, and experience to predict which candidate will be selected for the CEO position. The first purpose may involve a qualitative ethnographic study in which the researcher observes board meetings and hiring interviews; the second may involve a quantitative regression analysis. The outcomes will be very different, so it’s important that you find out exactly how you want to address a problem and help close a gap!

The purpose of the study must not only align with the problem and address a gap; it must also align with the chosen research method. In fact, the DP/DM template requires you to name the  research method at the very beginning of the purpose statement. The research verb must match the chosen method. In general, quantitative studies involve “closed-ended” research verbs such as determine , measure , correlate , explain , compare , validate , identify , or examine ; whereas qualitative studies involve “open-ended” research verbs such as explore , understand , narrate , articulate [meanings], discover , or develop .

A qualitative purpose statement following the color-coded problem statement (assumed here to be low well-being among financial sector employees) + gap (lack of research on followers of mid-level managers), might start like this:

In response to declining levels of employee well-being, the purpose of the qualitative phenomenology was to explore and understand the lived experiences related to the well-being of the followers of novice mid-level managers in the financial services industry. The levels of follower well-being have been shown to correlate to employee morale, turnover intention, and customer orientation (Eren et al., 2013). A combined framework of Leader-Member Exchange (LMX) Theory and the employee well-being concept informed the research questions and supported the inquiry, analysis, and interpretation of the experiences of followers of novice managers in the financial services industry.

A quantitative purpose statement for the same problem and gap might start like this:

In response to declining levels of employee well-being, the purpose of the quantitative correlational study was to determine which leadership factors predict employee well-being of the followers of novice mid-level managers in the financial services industry. Leadership factors were measured by the Leader-Member Exchange (LMX) assessment framework  by Mantlekow (2015), and employee well-being was conceptualized as a compound variable consisting of self-reported turnover-intent and psychological test scores from the Mental Health Survey (MHS) developed by Johns Hopkins University researchers.

Both of these purpose statements reflect viable research strategies and both align with the problem and gap so it’s up to the researcher to design a study in a manner that reflects personal preferences and desired study outcomes. Note that the quantitative research purpose incorporates operationalized concepts  or variables ; that reflect the way the researcher intends to measure the key concepts under study; whereas the qualitative purpose statement isn’t about translating the concepts under study as variables but instead aim to explore and understand the core research phenomenon.  

Best Practices for Writing your Purpose Statement

Always keep in mind that the dissertation process is iterative, and your writing, over time, will be refined as clarity is gradually achieved. Most of the time, greater clarity for the purpose statement and other components of the Dissertation is the result of a growing understanding of the literature in the field. As you increasingly master the literature you will also increasingly clarify the purpose of your study.

The purpose statement should flow directly from the problem statement. There should be clear and obvious alignment between the two and that alignment will get tighter and more pronounced as your work progresses.

The purpose statement should specifically address the reason for conducting the study, with emphasis on the word specifically. There should not be any doubt in your readers’ minds as to the purpose of your study. To achieve this level of clarity you will need to also insure there is no doubt in your mind as to the purpose of your study.

Many researchers benefit from stopping your work during the research process when insight strikes you and write about it while it is still fresh in your mind. This can help you clarify all aspects of a dissertation, including clarifying its purpose.

Your Chair and your committee members can help you to clarify your study’s purpose so carefully attend to any feedback they offer.

The purpose statement should reflect the research questions and vice versa. The chain of alignment that began with the research problem description and continues on to the research purpose, research questions, and methodology must be respected at all times during dissertation development. You are to succinctly describe the overarching goal of the study that reflects the research questions. Each research question narrows and focuses the purpose statement. Conversely, the purpose statement encompasses all of the research questions.

Identify in the purpose statement the research method as quantitative, qualitative or mixed (i.e., “The purpose of this [qualitative/quantitative/mixed] study is to ...)

Avoid the use of the phrase “research study” since the two words together are redundant.

Follow the initial declaration of purpose with a brief overview of how, with what instruments/data, with whom and where (as applicable) the study will be conducted. Identify variables/constructs and/or phenomenon/concept/idea. Since this section is to be a concise paragraph, emphasis must be placed on the word brief. However, adding these details will give your readers a very clear picture of the purpose of your research.

Developing the purpose section of your dissertation is usually not achieved in a single flash of insight. The process involves a great deal of reading to find out what other scholars have done to address the research topic and problem you have identified. The purpose section of your dissertation could well be the most important paragraph you write during your academic career, and every word should be carefully selected. Think of it as the DNA of your dissertation. Everything else you write should emerge directly and clearly from your purpose statement. In turn, your purpose statement should emerge directly and clearly from your research problem description. It is good practice to print out your problem statement and purpose statement and keep them in front of you as you work on each part of your dissertation in order to insure alignment.

It is helpful to collect several dissertations similar to the one you envision creating. Extract the problem descriptions and purpose statements of other dissertation authors and compare them in order to sharpen your thinking about your own work.  Comparing how other dissertation authors have handled the many challenges you are facing can be an invaluable exercise. Keep in mind that individual universities use their own tailored protocols for presenting key components of the dissertation so your review of these purpose statements should focus on content rather than form.

Once your purpose statement is set it must be consistently presented throughout the dissertation. This may require some recursive editing because the way you articulate your purpose may evolve as you work on various aspects of your dissertation. Whenever you make an adjustment to your purpose statement you should carefully follow up on the editing and conceptual ramifications throughout the entire document.

In establishing your purpose you should NOT advocate for a particular outcome. Research should be done to answer questions not prove a point. As a researcher, you are to inquire with an open mind, and even when you come to the work with clear assumptions, your job is to prove the validity of the conclusions reached. For example, you would not say the purpose of your research project is to demonstrate that there is a relationship between two variables. Such a statement presupposes you know the answer before your research is conducted and promotes or supports (advocates on behalf of) a particular outcome. A more appropriate purpose statement would be to examine or explore the relationship between two variables.

Your purpose statement should not imply that you are going to prove something. You may be surprised to learn that we cannot prove anything in scholarly research for two reasons. First, in quantitative analyses, statistical tests calculate the probability that something is true rather than establishing it as true. Second, in qualitative research, the study can only purport to describe what is occurring from the perspective of the participants. Whether or not the phenomenon they are describing is true in a larger context is not knowable. We cannot observe the phenomenon in all settings and in all circumstances.

Writing your Purpose Statement

It is important to distinguish in your mind the differences between the Problem Statement and Purpose Statement.

The Problem Statement is why I am doing the research

The Purpose Statement is what type of research I am doing to fit or address the problem

The Purpose Statement includes:

• Method of Study
• Specific Population

Remember, as you are contemplating what to include in your purpose statement and then when you are writing it, the purpose statement is a concise paragraph that describes the intent of the study, and it should flow directly from the problem statement.  It should specifically address the reason for conducting the study, and reflect the research questions.  Further, it should identify the research method as qualitative, quantitative, or mixed.  Then provide a brief overview of how the study will be conducted, with what instruments/data collection methods, and with whom (subjects) and where (as applicable). Finally, you should identify variables/constructs and/or phenomenon/concept/idea.

Qualitative Purpose Statement

Creswell (2002) suggested for writing purpose statements in qualitative research include using deliberate phrasing to alert the reader to the purpose statement. Verbs that indicate what will take place in the research and the use of non-directional language that do not suggest an outcome are key. A purpose statement should focus on a single idea or concept, with a broad definition of the idea or concept. How the concept was investigated should also be included, as well as participants in the study and locations for the research to give the reader a sense of with whom and where the study took place. 

Creswell (2003) advised the following script for purpose statements in qualitative research:

“The purpose of this qualitative_________________ (strategy of inquiry, such as ethnography, case study, or other type) study is (was? will be?) to ________________ (understand? describe? develop? discover?) the _________________(central phenomenon being studied) for ______________ (the participants, such as the individual, groups, organization) at __________(research site). At this stage in the research, the __________ (central phenomenon being studied) will be generally defined as ___________________ (provide a general definition)” (pg. 90).

Quantitative Purpose Statement

Creswell (2003) offers vast differences between the purpose statements written for qualitative research and those written for quantitative research, particularly with respect to language and the inclusion of variables. The comparison of variables is often a focus of quantitative research, with the variables distinguishable by either the temporal order or how they are measured. As with qualitative research purpose statements, Creswell (2003) recommends the use of deliberate language to alert the reader to the purpose of the study, but quantitative purpose statements also include the theory or conceptual framework guiding the study and the variables that are being studied and how they are related. 

Creswell (2003) suggests the following script for drafting purpose statements in quantitative research:

“The purpose of this _____________________ (experiment? survey?) study is (was? will be?) to test the theory of _________________that _________________ (compares? relates?) the ___________(independent variable) to _________________________(dependent variable), controlling for _______________________ (control variables) for ___________________ (participants) at _________________________ (the research site). The independent variable(s) _____________________ will be generally defined as _______________________ (provide a general definition). The dependent variable(s) will be generally defined as _____________________ (provide a general definition), and the control and intervening variables(s), _________________ (identify the control and intervening variables) will be statistically controlled in this study” (pg. 97).

Sample Purpose Statements

• The purpose of this qualitative study was to determine how participation in service-learning in an alternative school impacted students academically, civically, and personally.  There is ample evidence demonstrating the failure of schools for students at-risk; however, there is still a need to demonstrate why these students are successful in non-traditional educational programs like the service-learning model used at TDS.  This study was unique in that it examined one alternative school’s approach to service-learning in a setting where students not only serve, but faculty serve as volunteer teachers.  The use of a constructivist approach in service-learning in an alternative school setting was examined in an effort to determine whether service-learning participation contributes positively to academic, personal, and civic gain for students, and to examine student and teacher views regarding the overall outcomes of service-learning.  This study was completed using an ethnographic approach that included observations, content analysis, and interviews with teachers at The David School.
• The purpose of this quantitative non-experimental cross-sectional linear multiple regression design was to investigate the relationship among early childhood teachers’ self-reported assessment of multicultural awareness as measured by responses from the Teacher Multicultural Attitude Survey (TMAS) and supervisors’ observed assessment of teachers’ multicultural competency skills as measured by the Multicultural Teaching Competency Scale (MTCS) survey. Demographic data such as number of multicultural training hours, years teaching in Dubai, curriculum program at current school, and age were also examined and their relationship to multicultural teaching competency. The study took place in the emirate of Dubai where there were 14,333 expatriate teachers employed in private schools (KHDA, 2013b).
• The purpose of this quantitative, non-experimental study is to examine the degree to which stages of change, gender, acculturation level and trauma types predicts the reluctance of Arab refugees, aged 18 and over, in the Dearborn, MI area, to seek professional help for their mental health needs. This study will utilize four instruments to measure these variables: University of Rhode Island Change Assessment (URICA: DiClemente & Hughes, 1990); Cumulative Trauma Scale (Kira, 2012); Acculturation Rating Scale for Arabic Americans-II Arabic and English (ARSAA-IIA, ARSAA-IIE: Jadalla & Lee, 2013), and a demographic survey. This study will examine 1) the relationship between stages of change, gender, acculturation levels, and trauma types and Arab refugees’ help-seeking behavior, 2) the degree to which any of these variables can predict Arab refugee help-seeking behavior.  Additionally, the outcome of this study could provide researchers and clinicians with a stage-based model, TTM, for measuring Arab refugees’ help-seeking behavior and lay a foundation for how TTM can help target the clinical needs of Arab refugees. Lastly, this attempt to apply the TTM model to Arab refugees’ condition could lay the foundation for future research to investigate the application of TTM to clinical work among refugee populations.
• The purpose of this qualitative, phenomenological study is to describe the lived experiences of LLM for 10 EFL learners in rural Guatemala and to utilize that data to determine how it conforms to, or possibly challenges, current theoretical conceptions of LLM. In accordance with Morse’s (1994) suggestion that a phenomenological study should utilize at least six participants, this study utilized semi-structured interviews with 10 EFL learners to explore why and how they have experienced the motivation to learn English throughout their lives. The methodology of horizontalization was used to break the interview protocols into individual units of meaning before analyzing these units to extract the overarching themes (Moustakas, 1994). These themes were then interpreted into a detailed description of LLM as experienced by EFL students in this context. Finally, the resulting description was analyzed to discover how these learners’ lived experiences with LLM conformed with and/or diverged from current theories of LLM.
• The purpose of this qualitative, embedded, multiple case study was to examine how both parent-child attachment relationships are impacted by the quality of the paternal and maternal caregiver-child interactions that occur throughout a maternal deployment, within the context of dual-military couples. In order to examine this phenomenon, an embedded, multiple case study was conducted, utilizing an attachment systems metatheory perspective. The study included four dual-military couples who experienced a maternal deployment to Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) when they had at least one child between 8 weeks-old to 5 years-old.  Each member of the couple participated in an individual, semi-structured interview with the researcher and completed the Parenting Relationship Questionnaire (PRQ). “The PRQ is designed to capture a parent’s perspective on the parent-child relationship” (Pearson, 2012, para. 1) and was used within the proposed study for this purpose. The PRQ was utilized to triangulate the data (Bekhet & Zauszniewski, 2012) as well as to provide some additional information on the parents’ perspective of the quality of the parent-child attachment relationship in regards to communication, discipline, parenting confidence, relationship satisfaction, and time spent together (Pearson, 2012). The researcher utilized the semi-structured interview to collect information regarding the parents' perspectives of the quality of their parental caregiver behaviors during the deployment cycle, the mother's parent-child interactions while deployed, the behavior of the child or children at time of reunification, and the strategies or behaviors the parents believe may have contributed to their child's behavior at the time of reunification. The results of this study may be utilized by the military, and by civilian providers, to develop proactive and preventive measures that both providers and parents can implement, to address any potential adverse effects on the parent-child attachment relationship, identified through the proposed study. The results of this study may also be utilized to further refine and understand the integration of attachment theory and systems theory, in both clinical and research settings, within the field of marriage and family therapy.

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Metabolic Responses to an Acute Glucose Challenge: The Differential Effects of Eight Weeks of Almond vs. Cracker Consumption in Young Adults

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This study investigated the dynamic responses to an acute glucose challenge following chronic almond versus cracker consumption for 8 weeks (clinicaltrials.gov ID: NCT03084003 ). Seventy-three young adults (age: 18-19 years, BMI: 18-41 kg/m2) participated in an 8-week randomized, controlled, parallel-arm intervention and were randomly assigned to consume either almonds (2 oz/d, n=38) or an isocaloric control snack of graham crackers (325 kcal/d, n=35) daily for 8 weeks. Twenty participants from each group underwent a 2-hour oral glucose tolerance test (oGTT) at the end of the 8-week intervention. Metabolite abundances in the oGTT serum samples were quantified using untargeted metabolomics, and targeted analyses for free PUFAs, total fatty acids, oxylipins, and endocannabinoids. Multivariate, univariate, and chemical enrichment analyses were conducted to identify significant metabolic shifts. Findings exhibit a biphasic lipid response distinguished by higher levels of unsaturated triglycerides in the earlier periods of the oGTT followed by lower levels in the latter period in the almond versus cracker group (p-value<0.05, chemical enrichment analyses). Almond (vs. cracker) consumption was also associated with higher AUC120 min of aminomalonate, and oxylipins (p-value<0.05), but lower AUC120 min of L-cystine, N-acetylmannosamine, and isoheptadecanoic acid (p-value<0.05). Additionally, the Matsuda Index in the almond group correlated with AUC120 min of CE 22:6 (r=-0.46; p-value<0.05) and 12,13 DiHOME (r=0.45; p-value<0.05). Almond consumption for 8 weeks leads to dynamic, differential shifts in response to an acute glucose challenge, marked by alterations in lipid and amino acid mediators involved in metabolic and physiological pathways.

Competing Interest Statement

RMO and JD disclose grant support from Almond Board of California. SP, OF, and JWN have no conflicts of interest.

Clinical Trial

NCT03084003

Funding Statement

The present study was supported by the Almond Board of California (PI: RMO). JD was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under award numbers K99MD012815 and R00MD012815, and by a separate Almond Board of California grant at the time of this work. Additional support was provided by USDA Project 2032-51530-025-00D (JWN). The USDA is an equal opportunity provider and employer. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Moreover, mention of commercial products is solely for the purpose of providing specific information and does not imply recommendation or endorsement by the USDA or NIH. The funders had no role in the study design and implementation, data collection, data analysis, or interpretation of results.

Author Declarations

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

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

IRB of University of California, Merced gave ethical approval for this work

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

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

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

Data Availability

Data is available upon request

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