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Articles in 2021

research study articles 2021

Audio long-read: The secret lives of cells — as never seen before

Imaging techniques are revealing unprecedented details about the inner workings of cells.

  • Benjamin Thompson

research study articles 2021

Activity of convalescent and vaccine serum against SARS-CoV-2 Omicron

Sera from unvaccinated, vaccinated, and previously infected and vaccinated individuals show reduced neutralizing and spike protein-binding activity towards the Omicron (B.1.1.529) variant of SARS-CoV-2 compared to other variants.

  • Juan Manuel Carreño
  • Hala Alshammary
  • Florian Krammer

research study articles 2021

Our podcast highlights of 2021

The Nature Podcast team select some of their favourite stories from the past 12 months.

  • Shamini Bundell
  • Nick Petrić Howe

research study articles 2021

Webb telescope blasts off successfully — launching a new era in astronomy

Hundreds of engineering steps must now take place as the observatory unfurls and travels to its new home.

  • Alexandra Witze

research study articles 2021

A ‘chisel’ of light carves solid shapes out of a liquid

Ultraviolet light controls the emergence of solid particles from a fluid, creating coral- and blossom-shaped structures.

research study articles 2021

Mars mission is China’s ‘first step’ in planetary exploration

Nature talks to Zhang Rongqiao, architect of the China National Space Administration’s Tianwen-1 mission, which landed the Zhurong rover on Mars.

  • Smriti Mallapaty

research study articles 2021

Researchers fear growing COVID vaccine hesitancy in developing nations

Scientists worry that pools of unvaccinated people could be a source of new variants, such as Omicron.

research study articles 2021

Cardiovascular diseases disrupt the bone-marrow niche

The production of blood cells, including some immune cells, relies heavily on the bone-marrow microenvironment. Cardiovascular diseases are now found to corrupt this niche, leading to imbalances in blood-cell production.

  • Tomer Itkin
  • Shahin Rafii

research study articles 2021

A grave matter of ancient kinship in Neolithic Britain

An investigation into the nature of genetic connections between individuals interred in the same chambers of an ancient tomb in Britain about 5,700 years ago sheds light on kinship in an early society.

  • Neil Carlin

research study articles 2021

Omicron escapes the majority of existing SARS-CoV-2 neutralizing antibodies

A high-throughput yeast display platform is used to analyse the profiles of mutations in the SARS-CoV-2 receptor-binding domain (RBD) that enable escape from antibodies, and suggests that most anti-RBD antibodies can be escaped by the Omicron variant.

  • Yunlong Cao
  • Xiaoliang Sunney Xie

research study articles 2021

Striking antibody evasion manifested by the Omicron variant of SARS-CoV-2

The B.1.1.529/Omicron variant of SARS-CoV-2 is resistant to neutralization by serum not only from patients who recovered from COVID-19, but also from individuals vaccinated with one of the four widely used COVID-19 vaccines.

  • Sho Iketani
  • David D. Ho

research study articles 2021

Time-resolved structural analysis of an RNA-cleaving DNA catalyst

Using high-resolution NMR characterization, the kinetics and dynamics of the catalytic function of a DNAzyme are shown.

  • Jan Borggräfe
  • Julian Victor
  • Manuel Etzkorn

research study articles 2021

Evolution of enhanced innate immune evasion by SARS-CoV-2

The SARS-CoV-2 Alpha variant suppresses innate immune responses more effectively than isolates of first-wave SARS-CoV-2, and this is a result of mutations outside of the spike coding region that lead to upregulation of viral innate immune antagonists.

  • Lucy G. Thorne
  • Mehdi Bouhaddou
  • Nevan J. Krogan

research study articles 2021

Broadly neutralizing antibodies overcome SARS-CoV-2 Omicron antigenic shift

Pseudovirus assays and surface plasmon resonance show that the Omicron receptor-binding domain binds to human ACE2 with increased affinity relative to the ancestral virus, and that most neutralizing antibodies are considerably less potent against Omicron.

  • Elisabetta Cameroni
  • John E. Bowen
  • Davide Corti

research study articles 2021

SARS-CoV-2 infection in free-ranging white-tailed deer

More than one-third of wild deer tested in northeast Ohio showed evidence of SARS-CoV-2 infection of human origin.

  • Vanessa L. Hale
  • Patricia M. Dennis
  • Andrew S. Bowman

research study articles 2021

Considerable escape of SARS-CoV-2 Omicron to antibody neutralization

An isolate of the Omicron variant of SARS-COV-2 was completely or partially resistant to neutralization by all nine clinically approved monoclonal antibodies tested.

  • Delphine Planas
  • Nell Saunders
  • Olivier Schwartz

research study articles 2021

Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization

Plasma from individuals vaccinated with BNT162b2 exhibits 22-fold less neutralization capacity against Omicron (B.1.1.529) than against an ancestral SARS-CoV-2 strain but residual neutralization is maintained in those with high levels of neutralization of ancestral virus.

  • Sandile Cele
  • Laurelle Jackson

research study articles 2021

Broadly neutralizing antibodies target a haemagglutinin anchor epitope

A distinct class of broadly neutralizing antibodies to the influenza virus target a membrane-proximal anchor epitope of the haemagglutinin stalk domain.

  • Jenna J. Guthmiller
  • Julianna Han
  • Patrick C. Wilson

research study articles 2021

The future of global health, and mapping the unseen: Books in brief

Andrew Robinson reviews five of the week’s best science picks.

  • Andrew Robinson

research study articles 2021

Single-year radiocarbon dating anchors Viking Age trade cycles in time

Disturbances in the radiocarbon record anchor a precisely dated archaeological stratigraphy of a medieval trading emporium in Denmark in time, revealing that the Viking expansion was associated with competition for trade routes rather than with raids.

  • Bente Philippsen
  • Claus Feveile
  • Søren M. Sindbæk

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research study articles 2021

Best of JAMA Network

Most viewed articles 2021 – jama.

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Read the most popular JAMA articles in 2021 covering coronavirus pandemic science, cancer screening guidelines, heart disease treatment and prevention, and more.

  • Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19: A Randomized Clinical Trial JAMA Original Investigation April 13, 2021
  • The Leading Causes of Death in the US for 2020 JAMA Viewpoint May 11, 2021
  • Sperm Parameters Before and After COVID-19 mRNA Vaccination JAMA Research Letter July 20, 2021
  • Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2 JAMA JAMA Insights March 9, 2021
  • Myocarditis and Pericarditis After Vaccination for COVID-19 JAMA Research Letter September 28, 2021
  • Reports of Anaphylaxis After Receipt of mRNA COVID-19 Vaccines in the US—December 14, 2020-January 18, 2021 JAMA JAMA Insights March 16, 2021
  • Necessity of 2 Doses of the Pfizer and Moderna COVID-19 Vaccines JAMA JAMA Patient Page March 2, 2021
  • COVID-19 Vaccines vs Variants—Determining How Much Immunity Is Enough JAMA Medical News & Perspectives April 6, 2021
  • Surveillance for Adverse Events After COVID-19 mRNA Vaccination JAMA Original Investigation October 12, 2021
  • Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy JAMA Research Letter October 26, 2021
  • Effect of 2 Inactivated SARS-CoV-2 Vaccines on Symptomatic COVID-19 Infection in Adults: A Randomized Clinical Trial JAMA Original Investigation July 6, 2021
  • SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women JAMA Research Letter May 18, 2021


  • Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial JAMA Original Investigation September 7, 2021
  • Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement JAMA US Preventive Services Task Force March 9, 2021
  • Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review JAMA Review March 16, 2021
  • Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement JAMA US Preventive Services Task Force May 18, 2021
  • Evaluation of Aducanumab for Alzheimer Disease: Scientific Evidence and Regulatory Review Involving Efficacy, Safety, and Futility JAMA Viewpoint May 4, 2021
  • Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement JAMA US Preventive Services Task Force April 13, 2021
  • Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial JAMA Original Investigation April 13, 2021
  • Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review JAMA Review February 9, 2021
  • Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial JAMA Original Investigation February 16, 2021
  • Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events Among Patients With Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial JAMA Original Investigation February 9, 2021
  • Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement JAMA US Preventive Services Task Force August 24, 2021
  • Effect of Marine Omega-3 Fatty Acid and Vitamin D Supplementation on Incident Atrial Fibrillation: A Randomized Clinical Trial JAMA Original Investigation March 16, 2021

Most Read JAMA Network Articles of 2020

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The Ten Most Significant Science Stories of 2021

Thrilling discoveries, hurdles in the fight against Covid and advancements in space exploration defined the past year

Associate Editor, Science

Top ten science stories illustration

Covid-19 dominated science coverage again in 2021, and deservedly so. The disease garnered two entries on this list of our picks for the most important science stories of the year. But other key discoveries and achievements marked the year in science too, and they deserve more attention. NASA and private companies notched firsts in space. Scientists discovered more about the existence of early humans. And researchers documented how climate change has impacted everything from coral reefs to birds. Covid-19 will continue to garner even more attention next year as scientists work to deal with new variants and develop medical advances to battle the virus. But before you let stories about those topics dominate your reading in 2022, it’s worth it to take a look back at the biggest discoveries and accomplishments of this past year. To that end, here are our picks for the most important science stories of 2021.

The Covid Vaccine Rollout Encounters Hurdles

Covid Vaccine Being Administered

Last year the biggest science story of the year was that scientists developed two mRNA Covid vaccines in record time. This year the biggest Covid story is that the rollout of those vaccines by Pfizer and Moderna, and one other by Johnson and Johnson, haven’t made their way into a large proportion of the United States population and a significant portion of the world. As of this writing on December 21 , roughly 73 percent of the U.S. population has received one dose, and roughly 61 percent of the U.S. population has been fully vaccinated. An incomplete rollout allowed for a deadly summer surge, driven by the highly contagious Delta variant . Experts pointed out that vaccination rates lagged due to widespread disinformation and misinformation campaigns . It didn’t help that some popular public figures —like Packers’ quarterback Aaron Rodgers , musician Nick Minaj , podcast host Joe Rogan and rapper Ice Cube —chose not to get vaccinated. Luckily, by November, U.S. health officials had approved the Pfizer vaccine for children as young as five, providing another barrier against the deadly disease’s spread, and Covid rates declined. But while the wall against the disease in the U.S. is growing, it is not finished. As cases surge as the Omicron variant spreads around the country, building that wall and reinforcing it with booster shots is critically important. In much of the rest of the world, the wall is severely lacking where populations haven’t been given decent access to the vaccine. Only 8 percent of individuals in low-income countries have received at least one dose of the vaccine, and a WHO Africa report from this fall said that on that continent, less than 10 percent of countries would hit the goal of vaccinating at least 40 percent of their citizens by the end of the year. Globally, less than 60 percent of the population has been vaccinated. The holes in vaccination coverage will allow the virus to continue to kill a large number of individuals, and allow an environment where possibly other dangerous variants can emerge.

Perseverance Notches Firsts on Mars

Illustration of Perseverance Rover of Mars

NASA took a huge step forward in exploring the Red Planet after the rover Perseverance landed safely on Mars in February. Scientists outfitted the vehicle with an ultralight helicopter that successfully flew in the thin Martian atmosphere , a toaster-sized device called MOXIE that successfully converted carbon dioxide to oxygen , and sampling elements that successfully collected rocks from the planet’s floor. All of the achievements will lend themselves to a better understanding of Mars, and how to investigate it in the future. The flight success will give scientists clues on how to build larger helicopters, the oxygen creation will help scientists come up with grander plans for conversion devices, and the rocks will make their way back to Earth for analysis when they are picked up on a future mission. In addition to the rover’s triumphs, other countries notched major firsts too. The United Arab Emirates Hope space probe successfully entered orbit around the planet and is studying the Martian atmosphere and weather. China’s Zhurong rover landed on Mars in May and is exploring the planet’s geology and looking for signs of water. With these ongoing missions, scientists around the world are learning more and more about what the planet is like and how we might better explore it, maybe one day in person.

Is “Dragon Man” a New Species of Human?

Dragon Man Recreation

The backstory of the skull that scientists used to suggest there was a new species of later Pleistocene human—to join Homo sapiens and Neanderthals—garnered a lot of ink. After the fossil was discovered at a construction site in China nearly 90 years ago, a family hid it until a farmer gave it to a university museum in 2018. Since then, scientists in China pored over the skull—analyzing its features, conducting uranium series dating, and using X-ray fluorescence to compare it to other fossils—before declaring it a new species of archaic human. They dubbed the discovery Homo longi , or “Dragon Man.” The skull had a large cranium capable of holding a big brain, a thick brow and almost square eye sockets—details scientists used to differentiate it from other Homo species. Some scientists questioned whether the find warranted designation as a new species. “It’s exciting because it is a really interesting cranium, and it does have some things to say about human evolution and what’s going on in Asia. But it’s also disappointing that it’s 90 years out from discovery, and it is just an isolated cranium, and you’re not quite sure exactly how old it is or where it fits,” Michael Petraglia of the Smithsonian Institution’s Human Origins Initiative told Smithsonian magazine back in June. Other scientists supported the new species designation, and so the debate continues, and likely will until more fossils are discovered that help to fill in the holes of human history.

Climate Change Wreaks Havoc on Coral Reefs

Bleached Coral Reef

Increasing natural disasters—forest fires, droughts and heat waves—may be the most noticeable events spurred by climate change; a warming Earth has helped drive a five-fold uptick in such weather-related events over the last 50 years according the a 2021 report by the World Meteorological Organization . But one of the biggest impacts wrought by climate change over the past decade has occurred underwater. Warming temps cause coral reefs to discard the symbiotic algae that help them survive, and they bleach and die. This year a major report from the Global Coral Reef Monitoring Network announced that the oceans lost about 14 percent of their reefs in the decade after 2009, mostly because of climate change. In November, new research showed that less than 2 percent of the coral reefs on the Great Barrier Reef—the world’s largest such feature—escaped bleaching since 1998. That news came just two months after a different study stated that half of coral reefs have been lost since the 1950s , in part due to climate change. The reef declines impact fisheries, local economies based on tourism and coastal developments—which lose the offshore buffer zone from storms the living structures provide. Scientists say if temperatures continue to rise, coral reefs are in serious danger. But not all hope is lost—if humans reduce carbon emissions rapidly now, more reefs will have a better chance of surviving .

The Space Tourism Race Heats Up

Blue Origen Rocket

This year the famous billionaires behind the space tourism race completed successful missions that boosted more than just their egos. They put a host of civilians in space. Early in July, billionaire Richard Branson and his employees flew just above the boundary of space—a suborbital flight—in Virgin Galactic’s first fully crewed trip. (But Virgin Galactic did delay commercial missions until at least late next year.) Just over a week after Branson’s mission, the world’s richest person, Jeff Bezos, completed Blue Origin’s first crewed suborbital flight with the youngest and oldest travelers to reach space. In October, his company Blue Origin repeated the feat when it took Star Trek actor William Shatner up. A month before that, a crew of four became the first all-civilian crew to circle the Earth from space in Elon Musk’s SpaceX Dragon capsule Resilience. More ambitious firsts for civilians are in the works. In 2022, SpaceX plans to send a retired astronaut and three paying passengers to the International Space Station. And beyond that, Bezos announced Blue Origin hopes to deploy a private space station fit for ten—called “Orbital Reef”—sometime between 2025 and 2030.

WHO Approves First Vaccine Against Malaria

Malaria Vaccine Being Administered

In October, the World Health Organization approved the first vaccine against malaria. The approval was not only a first for that disease, but also for any parasitic disease. The moment was 30 years in the making, as Mosquirix—the brand name of the drug— cost more than $750 million since 1987 to develop and test. Malaria kills nearly a half million individuals a year, including 260,000 children under the age of five. Most of these victims live in sub-Saharan Africa. The new vaccine fights the deadliest of five malaria pathogens and the most prevalent in Africa, and is administered to children under five in a series of four injections. The vaccine is not a silver bullet; it prevents only about 30 percent of severe malaria cases. But one modeling study showed that still could prevent 5.4 million cases and 23,000 deaths in children under five each year. Experts say the vaccine is a valuable tool that should be used in conjunction with existing methods—such as drug combination treatments and insecticide-treated bed nets—to combat the deadly disease.

Discoveries Move Key Dates Back for Humans in the Americas

Fossilized Human Footprints at White Sands

Two very different papers in two of the world’s most prestigious scientific journals documented key moments of human habitation in the Americas. In September, a study in Science dated footprints found at White Sands National Park to between 21,000 and 23,000 years ago. Researchers estimated the age of the dried tracks known as “ghost prints” using radiocarbon dating of dried ditchgrass seeds found above and below the impressions. Previously, many archaeologists placed the start of human life in the Americas at around 13,000 years ago, at the end of the last Ice Age, based on tools found in New Mexico. The new paper, whose results have been debated , suggests humans actually lived on the continent at the height of the Ice Age. A month after that surprising find, a study in Nature published evidence showing that Vikings lived on North America earlier than previously thought. Researchers examined cut wood left by the explorers at a site in Newfoundland and found evidence in the samples of a cosmic ray event that happened in 993 C.E. The scientists then counted the rings out from that mark and discovered the wood had been cut in 1021 C.E. The find means that the Norse explorers completed the first known crossing of the Atlantic from Europe to the Americas.

Humans Are Affecting the Evolution of Animals

Bird in the Amazon

New research published this year shows that humans have both directly and indirectly affected how animals evolve. In probably the starkest example of humans impacting animal evolution, a Science study found a sharp increase in tuskless African elephants after years of poaching. During the Mozambican Civil War from 1977 to 1992, poachers killed so many of the giant mammals with tusks that those females without the long ivory teeth were more likely to pass on their genes. Before the war, 20 percent were tuskless. Now, roughly half of the female elephants are tuskless. Males who have the genetic make-up for tusklessness die , likely before they are born. And killing animals isn’t the only way humans are impacting evolution. A large study in Trends in Ecology and Evolution found that animals are changing shape to deal with rising temps. For example, over various time periods bats grew bigger wings and rabbits sprouted longer ears—both likely to dissipate more heat into the surrounding air. More evidence along those lines was published later in the year in Science Advances . A 40-year-study of birds in a remote, intact patch of Amazon rainforest showed 77 species weighed less on average, and many had longer wings, than they used to. Scientists said the changes likely occurred due to rising temperatures and changes in rainfall.

Antiviral Pills That Fight Covid Show Promising Results


Almost a year after scientists released tests showing the success of mRNA vaccines in fighting Covid, Merck released promising interim test results from a Phase III trial of an antiviral pill. On October 1, the pharmaceutical giant presented data that suggested molnupiravir could cut hospitalizations in half. Ten days later, the company submitted results to the FDA in hopes of gaining emergency use. In mid-November, the U.K. jumped ahead of the U.S. and granted approval for the treatment. By late November, advisers to the FDA recommended emergency authorization of the pill, though it was shown by this time to reduce death or disease by 30—not 50—percent. The drug should be taken —four pills a day for five days—starting within five days of the appearance of symptoms. It works by disrupting SARS-CoV-2’s ability to replicate effectively inside a human cell.

Molnupiravir isn’t the only viral drug with positive results. In November, Pfizer announced its antiviral pill, Paxlovid, was effective against severe Covid. By December, the pharmaceutical giant shared final results that it reduced the risk of hospitalization and death by 88 percent in a key group. News about both pills was welcome , as they are expected to work against all versions of the virus, including Omicron. Though the drugs aren’t as big of a breakthrough as the vaccines, a doctor writing for the New Yorker called them “the most important pharmacologic advance of the pandemic.” Many wealthy countries have already agreed to contracts for molnupiravir, and the Gates Foundation pledged $120 million to help get the pill to poor countries. If approved and distributed fast enough, the oral antivirals can be prescribed in places, like Africa, where vaccines have been lacking. The pills represent another crucial tool, in addition to masks and vaccines, in the fight against Covid.

The James Webb Space Telescope May Finally Launch

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MIT’s top research stories of 2021

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Despite the pandemic’s disruptions, MIT’s research community still found a way to generate a number of impressive research breakthroughs in 2021. In the spirit of reflection that comes with every new orbit around the sun, below we count down 10 of the most-viewed research stories on MIT News from the past year.

We’ve also rounded up the year’s top MIT community-related stories .

10. Giving cancer treatment a recharge . In October, researchers discovered a way to jump-start the immune system to attack tumors. The method combines chemotherapy and immunotherapy to spur immune cells into action. The researchers hope it could allow immunotherapy to be used against more types of cancer.

9. Generating 3D holograms in real-time . Computer scientists developed a deep-learning-based system that allows computers to create holograms almost instantly. The system could be used to create holograms for virtual reality, 3D printing, medical imaging, and more — and it’s efficient enough to run on a smartphone.

8. Creating inhalable vaccines . Scientists at the Koch Institute developed a method for delivering vaccines directly to the lungs through inhalation. The new strategy induced a strong immune response in the lungs of mice and could offer a quicker response to viruses that infect hosts through mucosal surfaces.

7. Assessing Covid-19 transmission risk . Two MIT professors proposed a new approach to estimating the risks of exposure to Covid-19 in different indoor settings. The guidelines suggest a limit for exposure based on factors such as the size of the space, the number of people, the kinds of activity, whether masks are worn, and ventilation and filtration rates.

6. Teaching machine learning models to adapt . Researchers in CSAIL developed a new type of neural network that can change its underlying equations to continuously adapt to new data. The advance could improve models’ decision-making based on data that changes over time, such as in medical diagnosis and autonomous driving.

5. Programming fibers . In June, a team created the first fabric fiber with digital capabilities. The fibers can sense, store, analyze, and infer data and activity after being sewn into a shirt. The researchers say the fibers could be used to monitor physical performance, to detect diseases, and for a variety of medical purposes.

4. Examining the limitations of data visualizations . A collaboration between anthropologists and computer scientists found that coronavirus skeptics have used sophisticated data visualizations to argue against public health orthodoxy like wearing a mask. The researchers concluded that data visualizations aren’t sufficient to convey the urgency of the Covid-19 pandemic because even the clearest graphs can be interpreted through a variety of belief systems.

3. Developing a Covid-detecting face mask . Engineers at MIT and Harvard University designed a prototype face mask that can diagnose the person wearing the mask with Covid-19 in about 90 minutes. The masks are embedded with tiny, disposable sensors that can be fitted into other face masks and could also be adapted to detect other viruses.

2. Confirming Hawking’s black hole theorem . Using observations of gravitational waves, physicists from MIT and elsewhere confirmed a major theorem created by Stephen Hawking in 1971. The theorem states that the area of a black hole’s event horizon — the boundary beyond which nothing can ever escape — will never shrink.

1. Advancing toward fusion energy . In September, researchers at MIT and the MIT spinout Commonwealth Fusion Systems ramped up a high-temperature superconducting electromagnet to a field strength of 20 tesla, the most powerful magnetic field of its kind ever created on Earth. The demonstration was three years in the making and is believed to resolve one of greatest remaining points of uncertainty in the quest to build the world’s first fusion power plant that produces more energy than it consumes.

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Criteria for Good Qualitative Research: A Comprehensive Review

  • Regular Article
  • Open access
  • Published: 18 September 2021
  • Volume 31 , pages 679–689, ( 2022 )

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research study articles 2021

  • Drishti Yadav   ORCID: 1  

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This review aims to synthesize a published set of evaluative criteria for good qualitative research. The aim is to shed light on existing standards for assessing the rigor of qualitative research encompassing a range of epistemological and ontological standpoints. Using a systematic search strategy, published journal articles that deliberate criteria for rigorous research were identified. Then, references of relevant articles were surveyed to find noteworthy, distinct, and well-defined pointers to good qualitative research. This review presents an investigative assessment of the pivotal features in qualitative research that can permit the readers to pass judgment on its quality and to condemn it as good research when objectively and adequately utilized. Overall, this review underlines the crux of qualitative research and accentuates the necessity to evaluate such research by the very tenets of its being. It also offers some prospects and recommendations to improve the quality of qualitative research. Based on the findings of this review, it is concluded that quality criteria are the aftereffect of socio-institutional procedures and existing paradigmatic conducts. Owing to the paradigmatic diversity of qualitative research, a single and specific set of quality criteria is neither feasible nor anticipated. Since qualitative research is not a cohesive discipline, researchers need to educate and familiarize themselves with applicable norms and decisive factors to evaluate qualitative research from within its theoretical and methodological framework of origin.

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Good Qualitative Research: Opening up the Debate

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research study articles 2021

What is Qualitative in Research

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“… It is important to regularly dialogue about what makes for good qualitative research” (Tracy, 2010 , p. 837)

To decide what represents good qualitative research is highly debatable. There are numerous methods that are contained within qualitative research and that are established on diverse philosophical perspectives. Bryman et al., ( 2008 , p. 262) suggest that “It is widely assumed that whereas quality criteria for quantitative research are well‐known and widely agreed, this is not the case for qualitative research.” Hence, the question “how to evaluate the quality of qualitative research” has been continuously debated. There are many areas of science and technology wherein these debates on the assessment of qualitative research have taken place. Examples include various areas of psychology: general psychology (Madill et al., 2000 ); counseling psychology (Morrow, 2005 ); and clinical psychology (Barker & Pistrang, 2005 ), and other disciplines of social sciences: social policy (Bryman et al., 2008 ); health research (Sparkes, 2001 ); business and management research (Johnson et al., 2006 ); information systems (Klein & Myers, 1999 ); and environmental studies (Reid & Gough, 2000 ). In the literature, these debates are enthused by the impression that the blanket application of criteria for good qualitative research developed around the positivist paradigm is improper. Such debates are based on the wide range of philosophical backgrounds within which qualitative research is conducted (e.g., Sandberg, 2000 ; Schwandt, 1996 ). The existence of methodological diversity led to the formulation of different sets of criteria applicable to qualitative research.

Among qualitative researchers, the dilemma of governing the measures to assess the quality of research is not a new phenomenon, especially when the virtuous triad of objectivity, reliability, and validity (Spencer et al., 2004 ) are not adequate. Occasionally, the criteria of quantitative research are used to evaluate qualitative research (Cohen & Crabtree, 2008 ; Lather, 2004 ). Indeed, Howe ( 2004 ) claims that the prevailing paradigm in educational research is scientifically based experimental research. Hypotheses and conjectures about the preeminence of quantitative research can weaken the worth and usefulness of qualitative research by neglecting the prominence of harmonizing match for purpose on research paradigm, the epistemological stance of the researcher, and the choice of methodology. Researchers have been reprimanded concerning this in “paradigmatic controversies, contradictions, and emerging confluences” (Lincoln & Guba, 2000 ).

In general, qualitative research tends to come from a very different paradigmatic stance and intrinsically demands distinctive and out-of-the-ordinary criteria for evaluating good research and varieties of research contributions that can be made. This review attempts to present a series of evaluative criteria for qualitative researchers, arguing that their choice of criteria needs to be compatible with the unique nature of the research in question (its methodology, aims, and assumptions). This review aims to assist researchers in identifying some of the indispensable features or markers of high-quality qualitative research. In a nutshell, the purpose of this systematic literature review is to analyze the existing knowledge on high-quality qualitative research and to verify the existence of research studies dealing with the critical assessment of qualitative research based on the concept of diverse paradigmatic stances. Contrary to the existing reviews, this review also suggests some critical directions to follow to improve the quality of qualitative research in different epistemological and ontological perspectives. This review is also intended to provide guidelines for the acceleration of future developments and dialogues among qualitative researchers in the context of assessing the qualitative research.

The rest of this review article is structured in the following fashion: Sect.  Methods describes the method followed for performing this review. Section Criteria for Evaluating Qualitative Studies provides a comprehensive description of the criteria for evaluating qualitative studies. This section is followed by a summary of the strategies to improve the quality of qualitative research in Sect.  Improving Quality: Strategies . Section  How to Assess the Quality of the Research Findings? provides details on how to assess the quality of the research findings. After that, some of the quality checklists (as tools to evaluate quality) are discussed in Sect.  Quality Checklists: Tools for Assessing the Quality . At last, the review ends with the concluding remarks presented in Sect.  Conclusions, Future Directions and Outlook . Some prospects in qualitative research for enhancing its quality and usefulness in the social and techno-scientific research community are also presented in Sect.  Conclusions, Future Directions and Outlook .

For this review, a comprehensive literature search was performed from many databases using generic search terms such as Qualitative Research , Criteria , etc . The following databases were chosen for the literature search based on the high number of results: IEEE Explore, ScienceDirect, PubMed, Google Scholar, and Web of Science. The following keywords (and their combinations using Boolean connectives OR/AND) were adopted for the literature search: qualitative research, criteria, quality, assessment, and validity. The synonyms for these keywords were collected and arranged in a logical structure (see Table 1 ). All publications in journals and conference proceedings later than 1950 till 2021 were considered for the search. Other articles extracted from the references of the papers identified in the electronic search were also included. A large number of publications on qualitative research were retrieved during the initial screening. Hence, to include the searches with the main focus on criteria for good qualitative research, an inclusion criterion was utilized in the search string.

From the selected databases, the search retrieved a total of 765 publications. Then, the duplicate records were removed. After that, based on the title and abstract, the remaining 426 publications were screened for their relevance by using the following inclusion and exclusion criteria (see Table 2 ). Publications focusing on evaluation criteria for good qualitative research were included, whereas those works which delivered theoretical concepts on qualitative research were excluded. Based on the screening and eligibility, 45 research articles were identified that offered explicit criteria for evaluating the quality of qualitative research and were found to be relevant to this review.

Figure  1 illustrates the complete review process in the form of PRISMA flow diagram. PRISMA, i.e., “preferred reporting items for systematic reviews and meta-analyses” is employed in systematic reviews to refine the quality of reporting.

figure 1

PRISMA flow diagram illustrating the search and inclusion process. N represents the number of records

Criteria for Evaluating Qualitative Studies

Fundamental criteria: general research quality.

Various researchers have put forward criteria for evaluating qualitative research, which have been summarized in Table 3 . Also, the criteria outlined in Table 4 effectively deliver the various approaches to evaluate and assess the quality of qualitative work. The entries in Table 4 are based on Tracy’s “Eight big‐tent criteria for excellent qualitative research” (Tracy, 2010 ). Tracy argues that high-quality qualitative work should formulate criteria focusing on the worthiness, relevance, timeliness, significance, morality, and practicality of the research topic, and the ethical stance of the research itself. Researchers have also suggested a series of questions as guiding principles to assess the quality of a qualitative study (Mays & Pope, 2020 ). Nassaji ( 2020 ) argues that good qualitative research should be robust, well informed, and thoroughly documented.

Qualitative Research: Interpretive Paradigms

All qualitative researchers follow highly abstract principles which bring together beliefs about ontology, epistemology, and methodology. These beliefs govern how the researcher perceives and acts. The net, which encompasses the researcher’s epistemological, ontological, and methodological premises, is referred to as a paradigm, or an interpretive structure, a “Basic set of beliefs that guides action” (Guba, 1990 ). Four major interpretive paradigms structure the qualitative research: positivist and postpositivist, constructivist interpretive, critical (Marxist, emancipatory), and feminist poststructural. The complexity of these four abstract paradigms increases at the level of concrete, specific interpretive communities. Table 5 presents these paradigms and their assumptions, including their criteria for evaluating research, and the typical form that an interpretive or theoretical statement assumes in each paradigm. Moreover, for evaluating qualitative research, quantitative conceptualizations of reliability and validity are proven to be incompatible (Horsburgh, 2003 ). In addition, a series of questions have been put forward in the literature to assist a reviewer (who is proficient in qualitative methods) for meticulous assessment and endorsement of qualitative research (Morse, 2003 ). Hammersley ( 2007 ) also suggests that guiding principles for qualitative research are advantageous, but methodological pluralism should not be simply acknowledged for all qualitative approaches. Seale ( 1999 ) also points out the significance of methodological cognizance in research studies.

Table 5 reflects that criteria for assessing the quality of qualitative research are the aftermath of socio-institutional practices and existing paradigmatic standpoints. Owing to the paradigmatic diversity of qualitative research, a single set of quality criteria is neither possible nor desirable. Hence, the researchers must be reflexive about the criteria they use in the various roles they play within their research community.

Improving Quality: Strategies

Another critical question is “How can the qualitative researchers ensure that the abovementioned quality criteria can be met?” Lincoln and Guba ( 1986 ) delineated several strategies to intensify each criteria of trustworthiness. Other researchers (Merriam & Tisdell, 2016 ; Shenton, 2004 ) also presented such strategies. A brief description of these strategies is shown in Table 6 .

It is worth mentioning that generalizability is also an integral part of qualitative research (Hays & McKibben, 2021 ). In general, the guiding principle pertaining to generalizability speaks about inducing and comprehending knowledge to synthesize interpretive components of an underlying context. Table 7 summarizes the main metasynthesis steps required to ascertain generalizability in qualitative research.

Figure  2 reflects the crucial components of a conceptual framework and their contribution to decisions regarding research design, implementation, and applications of results to future thinking, study, and practice (Johnson et al., 2020 ). The synergy and interrelationship of these components signifies their role to different stances of a qualitative research study.

figure 2

Essential elements of a conceptual framework

In a nutshell, to assess the rationale of a study, its conceptual framework and research question(s), quality criteria must take account of the following: lucid context for the problem statement in the introduction; well-articulated research problems and questions; precise conceptual framework; distinct research purpose; and clear presentation and investigation of the paradigms. These criteria would expedite the quality of qualitative research.

How to Assess the Quality of the Research Findings?

The inclusion of quotes or similar research data enhances the confirmability in the write-up of the findings. The use of expressions (for instance, “80% of all respondents agreed that” or “only one of the interviewees mentioned that”) may also quantify qualitative findings (Stenfors et al., 2020 ). On the other hand, the persuasive reason for “why this may not help in intensifying the research” has also been provided (Monrouxe & Rees, 2020 ). Further, the Discussion and Conclusion sections of an article also prove robust markers of high-quality qualitative research, as elucidated in Table 8 .

Quality Checklists: Tools for Assessing the Quality

Numerous checklists are available to speed up the assessment of the quality of qualitative research. However, if used uncritically and recklessly concerning the research context, these checklists may be counterproductive. I recommend that such lists and guiding principles may assist in pinpointing the markers of high-quality qualitative research. However, considering enormous variations in the authors’ theoretical and philosophical contexts, I would emphasize that high dependability on such checklists may say little about whether the findings can be applied in your setting. A combination of such checklists might be appropriate for novice researchers. Some of these checklists are listed below:

The most commonly used framework is Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al., 2007 ). This framework is recommended by some journals to be followed by the authors during article submission.

Standards for Reporting Qualitative Research (SRQR) is another checklist that has been created particularly for medical education (O’Brien et al., 2014 ).

Also, Tracy ( 2010 ) and Critical Appraisal Skills Programme (CASP, 2021 ) offer criteria for qualitative research relevant across methods and approaches.

Further, researchers have also outlined different criteria as hallmarks of high-quality qualitative research. For instance, the “Road Trip Checklist” (Epp & Otnes, 2021 ) provides a quick reference to specific questions to address different elements of high-quality qualitative research.

Conclusions, Future Directions, and Outlook

This work presents a broad review of the criteria for good qualitative research. In addition, this article presents an exploratory analysis of the essential elements in qualitative research that can enable the readers of qualitative work to judge it as good research when objectively and adequately utilized. In this review, some of the essential markers that indicate high-quality qualitative research have been highlighted. I scope them narrowly to achieve rigor in qualitative research and note that they do not completely cover the broader considerations necessary for high-quality research. This review points out that a universal and versatile one-size-fits-all guideline for evaluating the quality of qualitative research does not exist. In other words, this review also emphasizes the non-existence of a set of common guidelines among qualitative researchers. In unison, this review reinforces that each qualitative approach should be treated uniquely on account of its own distinctive features for different epistemological and disciplinary positions. Owing to the sensitivity of the worth of qualitative research towards the specific context and the type of paradigmatic stance, researchers should themselves analyze what approaches can be and must be tailored to ensemble the distinct characteristics of the phenomenon under investigation. Although this article does not assert to put forward a magic bullet and to provide a one-stop solution for dealing with dilemmas about how, why, or whether to evaluate the “goodness” of qualitative research, it offers a platform to assist the researchers in improving their qualitative studies. This work provides an assembly of concerns to reflect on, a series of questions to ask, and multiple sets of criteria to look at, when attempting to determine the quality of qualitative research. Overall, this review underlines the crux of qualitative research and accentuates the need to evaluate such research by the very tenets of its being. Bringing together the vital arguments and delineating the requirements that good qualitative research should satisfy, this review strives to equip the researchers as well as reviewers to make well-versed judgment about the worth and significance of the qualitative research under scrutiny. In a nutshell, a comprehensive portrayal of the research process (from the context of research to the research objectives, research questions and design, speculative foundations, and from approaches of collecting data to analyzing the results, to deriving inferences) frequently proliferates the quality of a qualitative research.

Prospects : A Road Ahead for Qualitative Research

Irrefutably, qualitative research is a vivacious and evolving discipline wherein different epistemological and disciplinary positions have their own characteristics and importance. In addition, not surprisingly, owing to the sprouting and varied features of qualitative research, no consensus has been pulled off till date. Researchers have reflected various concerns and proposed several recommendations for editors and reviewers on conducting reviews of critical qualitative research (Levitt et al., 2021 ; McGinley et al., 2021 ). Following are some prospects and a few recommendations put forward towards the maturation of qualitative research and its quality evaluation:

In general, most of the manuscript and grant reviewers are not qualitative experts. Hence, it is more likely that they would prefer to adopt a broad set of criteria. However, researchers and reviewers need to keep in mind that it is inappropriate to utilize the same approaches and conducts among all qualitative research. Therefore, future work needs to focus on educating researchers and reviewers about the criteria to evaluate qualitative research from within the suitable theoretical and methodological context.

There is an urgent need to refurbish and augment critical assessment of some well-known and widely accepted tools (including checklists such as COREQ, SRQR) to interrogate their applicability on different aspects (along with their epistemological ramifications).

Efforts should be made towards creating more space for creativity, experimentation, and a dialogue between the diverse traditions of qualitative research. This would potentially help to avoid the enforcement of one's own set of quality criteria on the work carried out by others.

Moreover, journal reviewers need to be aware of various methodological practices and philosophical debates.

It is pivotal to highlight the expressions and considerations of qualitative researchers and bring them into a more open and transparent dialogue about assessing qualitative research in techno-scientific, academic, sociocultural, and political rooms.

Frequent debates on the use of evaluative criteria are required to solve some potentially resolved issues (including the applicability of a single set of criteria in multi-disciplinary aspects). Such debates would not only benefit the group of qualitative researchers themselves, but primarily assist in augmenting the well-being and vivacity of the entire discipline.

To conclude, I speculate that the criteria, and my perspective, may transfer to other methods, approaches, and contexts. I hope that they spark dialog and debate – about criteria for excellent qualitative research and the underpinnings of the discipline more broadly – and, therefore, help improve the quality of a qualitative study. Further, I anticipate that this review will assist the researchers to contemplate on the quality of their own research, to substantiate research design and help the reviewers to review qualitative research for journals. On a final note, I pinpoint the need to formulate a framework (encompassing the prerequisites of a qualitative study) by the cohesive efforts of qualitative researchers of different disciplines with different theoretic-paradigmatic origins. I believe that tailoring such a framework (of guiding principles) paves the way for qualitative researchers to consolidate the status of qualitative research in the wide-ranging open science debate. Dialogue on this issue across different approaches is crucial for the impending prospects of socio-techno-educational research.

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Yadav, D. Criteria for Good Qualitative Research: A Comprehensive Review. Asia-Pacific Edu Res 31 , 679–689 (2022).

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The 10 Most Significant Education Studies of 2021

From reframing our notion of “good” schools to mining the magic of expert teachers, here’s a curated list of must-read research from 2021.

It was a year of unprecedented hardship for teachers and school leaders. We pored through hundreds of studies to see if we could follow the trail of exactly what happened: The research revealed a complex portrait of a grueling year during which persistent issues of burnout and mental and physical health impacted millions of educators. Meanwhile, many of the old debates continued: Does paper beat digital? Is project-based learning as effective as direct instruction? How do you define what a “good” school is?

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The researchers hypothesize that the “generation of errors” was a key to the strategy’s success, spurring student curiosity and priming them to “search for the correct answers” when they finally explored the new material—and adding grist to a 2018 study that found that making educated guesses helped students connect background knowledge to new material.

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While immigrants initially “face challenges in assimilation that may require additional school resources,” the researchers concluded, hard work and resilience may allow them to excel and thus “positively affect exposed U.S.-born students’ attitudes and behavior.” But according to teacher Larry Ferlazzo, the improvements might stem from the fact that having English language learners in classes improves pedagogy , pushing teachers to consider “issues like prior knowledge, scaffolding, and maximizing accessibility.”

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The study looked at over 150,000 ninth-grade students who attended Chicago public schools and concluded that emphasizing the social and emotional dimensions of learning—relationship-building, a sense of belonging, and resilience, for example—improves high school graduation and college matriculation rates for both high- and low-income students, beating out schools that focus primarily on improving test scores.⁣

“Schools that promote socio-emotional development actually have a really big positive impact on kids,” said lead researcher C. Kirabo Jackson in an interview with Edutopia . “And these impacts are particularly large for vulnerable student populations who don’t tend to do very well in the education system.”

The findings reinforce the importance of a holistic approach to measuring student progress, and are a reminder that schools—and teachers—can influence students in ways that are difficult to measure, and may only materialize well into the future.⁣

6. Teaching Is Learning

One of the best ways to learn a concept is to teach it to someone else. But do you actually have to step into the shoes of a teacher, or does the mere expectation of teaching do the trick?

In a 2021 study , researchers split students into two groups and gave them each a science passage about the Doppler effect—a phenomenon associated with sound and light waves that explains the gradual change in tone and pitch as a car races off into the distance, for example. One group studied the text as preparation for a test; the other was told that they’d be teaching the material to another student.

The researchers never carried out the second half of the activity—students read the passages but never taught the lesson. All of the participants were then tested on their factual recall of the Doppler effect, and their ability to draw deeper conclusions from the reading.

The upshot? Students who prepared to teach outperformed their counterparts in both duration and depth of learning, scoring 9 percent higher on factual recall a week after the lessons concluded, and 24 percent higher on their ability to make inferences. The research suggests that asking students to prepare to teach something—or encouraging them to think “could I teach this to someone else?”—can significantly alter their learning trajectories.

7. A Disturbing Strain of Bias in Kids’ Books

Some of the most popular and well-regarded children’s books—Caldecott and Newbery honorees among them—persistently depict Black, Asian, and Hispanic characters with lighter skin, according to new research .

Using artificial intelligence, researchers combed through 1,130 children’s books written in the last century, comparing two sets of diverse children’s books—one a collection of popular books that garnered major literary awards, the other favored by identity-based awards. The software analyzed data on skin tone, race, age, and gender.

Among the findings: While more characters with darker skin color begin to appear over time, the most popular books—those most frequently checked out of libraries and lining classroom bookshelves—continue to depict people of color in lighter skin tones. More insidiously, when adult characters are “moral or upstanding,” their skin color tends to appear lighter, the study’s lead author, Anjali Aduki,  told The 74 , with some books converting “Martin Luther King Jr.’s chocolate complexion to a light brown or beige.” Female characters, meanwhile, are often seen but not heard.

Cultural representations are a reflection of our values, the researchers conclude: “Inequality in representation, therefore, constitutes an explicit statement of inequality of value.”

8. The Never-Ending ‘Paper Versus Digital’ War

The argument goes like this: Digital screens turn reading into a cold and impersonal task; they’re good for information foraging, and not much more. “Real” books, meanwhile, have a heft and “tactility”  that make them intimate, enchanting—and irreplaceable.

But researchers have often found weak or equivocal evidence for the superiority of reading on paper. While a recent study concluded that paper books yielded better comprehension than e-books when many of the digital tools had been removed, the effect sizes were small. A 2021 meta-analysis further muddies the water: When digital and paper books are “mostly similar,” kids comprehend the print version more readily—but when enhancements like motion and sound “target the story content,” e-books generally have the edge.

Nostalgia is a force that every new technology must eventually confront. There’s plenty of evidence that writing with pen and paper encodes learning more deeply than typing. But new digital book formats come preloaded with powerful tools that allow readers to annotate, look up words, answer embedded questions, and share their thinking with other readers.

We may not be ready to admit it, but these are precisely the kinds of activities that drive deeper engagement, enhance comprehension, and leave us with a lasting memory of what we’ve read. The future of e-reading, despite the naysayers, remains promising.

9. New Research Makes a Powerful Case for PBL

Many classrooms today still look like they did 100 years ago, when students were preparing for factory jobs. But the world’s moved on: Modern careers demand a more sophisticated set of skills—collaboration, advanced problem-solving, and creativity, for example—and those can be difficult to teach in classrooms that rarely give students the time and space to develop those competencies.

Project-based learning (PBL) would seem like an ideal solution. But critics say PBL places too much responsibility on novice learners, ignoring the evidence about the effectiveness of direct instruction and ultimately undermining subject fluency. Advocates counter that student-centered learning and direct instruction can and should coexist in classrooms.

Now two new large-scale studies —encompassing over 6,000 students in 114 diverse schools across the nation—provide evidence that a well-structured, project-based approach boosts learning for a wide range of students.

In the studies, which were funded by Lucas Education Research, a sister division of Edutopia , elementary and high school students engaged in challenging projects that had them designing water systems for local farms, or creating toys using simple household objects to learn about gravity, friction, and force. Subsequent testing revealed notable learning gains—well above those experienced by students in traditional classrooms—and those gains seemed to raise all boats, persisting across socioeconomic class, race, and reading levels.

10. Tracking a Tumultuous Year for Teachers

The Covid-19 pandemic cast a long shadow over the lives of educators in 2021, according to a year’s worth of research.

The average teacher’s workload suddenly “spiked last spring,” wrote the Center for Reinventing Public Education in its January 2021 report, and then—in defiance of the laws of motion—simply never let up. By the fall, a RAND study recorded an astonishing shift in work habits: 24 percent of teachers reported that they were working 56 hours or more per week, compared to 5 percent pre-pandemic.

The vaccine was the promised land, but when it arrived nothing seemed to change. In an April 2021 survey  conducted four months after the first vaccine was administered in New York City, 92 percent of teachers said their jobs were more stressful than prior to the pandemic, up from 81 percent in an earlier survey.

It wasn’t just the length of the work days; a close look at the research reveals that the school system’s failure to adjust expectations was ruinous. It seemed to start with the obligations of hybrid teaching, which surfaced in Edutopia ’s coverage of overseas school reopenings. In June 2020, well before many U.S. schools reopened, we reported that hybrid teaching was an emerging problem internationally, and warned that if the “model is to work well for any period of time,” schools must “recognize and seek to reduce the workload for teachers.” Almost eight months later, a 2021 RAND study identified hybrid teaching as a primary source of teacher stress in the U.S., easily outpacing factors like the health of a high-risk loved one.

New and ever-increasing demands for tech solutions put teachers on a knife’s edge. In several important 2021 studies, researchers concluded that teachers were being pushed to adopt new technology without the “resources and equipment necessary for its correct didactic use.” Consequently, they were spending more than 20 hours a week adapting lessons for online use, and experiencing an unprecedented erosion of the boundaries between their work and home lives, leading to an unsustainable “always on” mentality. When it seemed like nothing more could be piled on—when all of the lights were blinking red—the federal government restarted standardized testing .

Change will be hard; many of the pathologies that exist in the system now predate the pandemic. But creating strict school policies that separate work from rest, eliminating the adoption of new tech tools without proper supports, distributing surveys regularly to gauge teacher well-being, and above all listening to educators to identify and confront emerging problems might be a good place to start, if the research can be believed.

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Am Fam Physician. 2022;106(1):61-69

Published online June 1, 2022.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor’s Note. Dr. Grad has no relevant financial relationships.

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.

Annually for 23 years, a team of clinicians has systematically reviewed English-language medical journals to identify the research most likely to change and improve primary care. The team includes experts in family medicine, pharmacology, hospital medicine, and women’s health. 1 , 2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if the results were applied in practice, some physicians would change what they do by adopting a new practice or discontinuing an old one shown to be ineffective or harmful. Adopting POEMs in clinical practice should improve patient outcomes. Of more than 20,000 research studies published in 2021 in the journals reviewed by the POEMs team, only 260 met criteria for validity, relevance, and practice change. These POEMs are emailed daily to subscribers of Essential Evidence Plus (Wiley-Blackwell, Inc.).

The Canadian Medical Association purchases a POEMs subscription for its members, many of whom receive the daily POEM. As these physicians read each POEM, they can rate it using a validated questionnaire. This process is called the Information Assessment Method ( ). POEM ratings address the domains of clinical relevance, cognitive impact, use in practice, and expected health benefits if that POEM is applied to a specific patient. 2 , 3 In 2021, each of the 260 daily POEMs were rated by an average of 1,189 physicians.

In this article, the 11th installment of our annual series ( ), we present the 20 most clinically relevant POEMs of 2021 as determined by Canadian Medical Association members. Looking beyond COVID-19, our patients continue to face the usual (and unusual) health problems of everyday life. Thus, we summarize the clinical questions and bottom-line answers for research studies about a variety of topics that were identified as top 20 POEMs, followed by a brief discussion. This set of 20 POEMs includes the most relevant practice guidelines of the year. The full POEMs are available online at .

The five most highly rated POEMs in 2021, and eight of the top 15, were about the COVID-19 vaccines and their effectiveness in different populations. Because of the emergence of variants and widespread endorsement of the vaccine by family physicians, these POEMs are not as likely to lead to practice changes as they were when originally published. One additional COVID-19 POEM reported the incidence of myocarditis following vaccination with the Pfizer BioNTech and Moderna mRNA vaccines in U.S. military personnel. The incidence of approximately 4 more cases than expected per 100,000 patients is significantly lower than the more than 300 per 100,000 patients seen among those with SARS-CoV-2 infection. 4 The rest of this article includes POEMs not related to the COVID-19 pandemic.

Type 2 Diabetes Mellitus

The first three POEMs in this category are about the management of type 2 diabetes ( Table 1 ) . 5 – 8 The first study identified 2,482 adults with a mean age of 75 years who had prediabetes (defined as an A1C level between 5.7% and 6.4%, a fasting glucose level between 100 and 125 mg per dL [5.55 and 6.94 mmol per L], or both). 5 Over an average of 6.5 years, only 8% to 9% of patients progressed to diabetes, many regressed to normoglycemia, and the remainder stayed at prediabetic levels. These results will help reassure physicians and avoid overtreatment of older patients with prediabetes. Of note, the U.S. Preventive Services Task Force does not recommend screening for prediabetes or type 2 diabetes beyond 70 years of age. 9

A study in the United Kingdom identified 6,288 people 70 years and older with type 2 diabetes and three consecutive A1C measurements of less than 7%. 6 Approximately 90% were taking a sulfonylurea. Compared with a similar group of people with type 2 diabetes who did not have A1C levels of less than 7% and were not taking a sulfonylurea, those with tight control were 2.5 times more likely to be hospitalized for severe hypoglycemia, with a 1 in 7 risk of hospitalization over 10 years. Use of a sulfonylurea or insulin was associated with severe hypoglycemia and death. A more relaxed A1C target of 7.0% to 8.0% is more appropriate, especially for older patients, and sulfonylureas should be used with caution.

A systematic review assessed the effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes. 7 The authors did not receive pharmaceutical funding. Both classes of drugs reduced all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, and kidney failure. SGLT-2 inhibitors were more effective at reducing hospital admission, whereas GLP-1 receptor agonists were more likely to reduce nonfatal stroke. The absolute benefit of treatment increased with a patient’s cardiac risk. For example, over five years, there were 2 to 5 fewer deaths per 1,000 patients at low cardiac risk compared with 24 to 48 fewer deaths per 1,000 patients at the highest risk. A useful calculator that allows estimates of benefit at various risk levels is available at .

The final study is a meta-analysis that examined the effect of SGLT-2 inhibitors in patients with and without type 2 diabetes or heart failure. 8 These drugs similarly reduced all-cause and cardiovascular mortality in patients with or without type 2 diabetes and with or without heart failure (overall hazard ratio for all-cause mortality = 0.84 [95% CI, 0.78 to 0.91]). SGLT-2 inhibitors reduced the progression of renal disease in all patients.

Musculoskeletal Conditions

The next, and largest, category of POEMs addresses musculoskeletal conditions ( Table 2 ) . 10 – 14 The first three present research on low back pain, one of the most challenging conditions in primary care. The first POEM is a systematic review of a broad range of therapies for chronic low back pain. 10 The review included 63 randomized controlled trials (RCTs) reporting a clinical response, generally a reduction in pain of at least 30%, to any one of 15 interventions. Exercise was effective at reducing pain (number needed to treat [NNT] = 7) and had a sustained benefit. Although other medical therapies such as oral nonsteroidal anti-inflammatory drugs (NNT = 6), duloxetine (Cymbalta; NNT = 10), and opioids (NNT = 16) also reduced pain, they did not have sustained benefits and were associated with adverse effects. Lower-quality data suggest that manipulation and topical capsaicin are also effective.

Another systematic review, this time looking at muscle relaxants for nonspecific low back pain, found small reductions in pain intensity that were not clinically important and not seen when only the highest-quality studies were included. 11 We have said it before—it is inappropriate to routinely prescribe muscle relaxants for low back pain.

The next study showed the power of language on health outcomes. 12 Patients with low back pain and no red flags on magnetic resonance imaging (MRI) or indications for surgery were randomized to receive their MRI results in one of two ways: by stating that all findings were normal and incidental or age-related or by stating that all findings were normal and incidental or age-related but also including words such as degeneration, tears, ruptures, and neural compression. Patients receiving the easily misinterpreted version of the report that used alarming words had more pain, lower self-efficacy, and less function over six weeks of follow-up compared with patients who were essentially told their findings were normal. Physicians should develop their own script for sharing results that avoids catastrophizing language.

The next POEM studied several types of musculoskeletal pain other than back pain. 13 Patients presenting in the emergency department with acute musculoskeletal pain were randomized to one of five single-dose pain regimens: (1) acetaminophen, 1,000 mg, with ibuprofen, 400 mg; (2) acetaminophen, 1,000 mg, with ibuprofen, 800 mg; (3) acetaminophen, 300 mg, with codeine, 30 mg; (4) acetaminophen, 300 mg, with hydrocodone, 5 mg; or (5) acetaminophen, 325 mg, with oxycodone, 5 mg. Pain scores decreased by about 3 points on a 10-point scale in all five groups at one hour and by about 4.5 points at two hours, with no significant difference between groups. About 1 out of 4 patients in each group required rescue pain medication, again with no difference. Nausea and vomiting were more common in patients receiving an opioid. Thus, a good choice is acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, or even acetaminophen alone, without an opioid. 15

A large systematic review asked the question: Which nondrug therapies are effective for chronic musculoskeletal pain? 14 For chronic low back pain, exercise, massage, yoga, cognitive behavior therapy, mindfulness-based stress reduction, acupuncture, spinal manipulation, low-level laser therapy, and rehabilitation all reduced pain and/or improved function. There was evidence for the use of exercise, massage, low-level laser therapy, acupuncture, and Pilates in the treatment of chronic neck pain. Only exercise and cognitive behavior therapy were helpful for knee osteoarthritis. There is evidence only for the use of exercise and manual therapies for the treatment of hip osteoarthritis. Patients with fibromyalgia benefited from cognitive behavior therapy, myofascial release massage, tai chi, qi gong, acupuncture, rehabilitation, and exercise.


The next set of POEMs addresses colorectal cancer screening, constipation treatment, and vague abdominal symptoms ( Table 3 ) . 16 – 18 Most countries screen for colorectal cancer using fecal immunochemical testing (FIT) as the initial method. Canada includes flexible sigmoidoscopy as an option, and the United States most commonly uses colonoscopy. The first POEM on gastrointestinal conditions is a Norwegian RCT that invited previously unscreened adults 50 to 74 years of age to undergo flexible sigmoidoscopy (52% had the procedure) or FIT every two years (68% had at least one test). 16 Although flexible sigmoidoscopy initially identified more cancers and advanced adenomas, FIT surpassed it over time, with a cancer detection rate of 0.49% after three rounds of FIT testing vs. 0.27% with flexible sigmoidoscopy. This is a very important point—screening programs must be compared over time, not just after a single round, using different tests. RCTs comparing FIT with colonoscopy over time are underway.

In a systematic review of over-the-counter treatments for chronic constipation, polyethylene glycol (Miralax) and senna were the most effective initial options. 17 Fiber supplements, other stimulant laxatives, magnesium-based products, and fruit-based products were also effective.

The final POEM evaluated the predictive value of common abdominal symptoms for cancer or inflammatory bowel disease. 18 Combinations of symptoms, such as change in bowel habits with rectal bleeding, were more predictive but varied by age and sex. Dysphagia or changes in bowel habits in men and rectal bleeding in women should prompt referral for further workup to exclude cancer or inflammatory bowel disease. Dyspepsia was largely unhelpful, except in patients older than 60 years. The severity and duration of gastrointestinal symptoms and whether they appear to be progressive were not part of this study but are important additional factors.

Cardiovascular Disease

Four POEMs about cardiovascular disease made the top 20 list ( Table 4 ) . 19 – 22 The first two addressed prevention. One was a large pragmatic trial that randomized 15,076 patients with established arteriosclerotic cardiovascular disease to 81 mg or 325 mg of aspirin daily and evaluated the likelihood of death, nonfatal myocardial infarction, or nonfatal stroke after a median of two years. 19 There was no difference between groups for these outcomes (7.3% for 81 mg and 7.5% for 325 mg) and no difference in hospitalization for major bleeding. The trial was a bit messy, with 7% in the 81-mg group switching to 325 mg and 42% in the 325-mg group switching to the lower dose. It is not clear why so many switched to the lower dose, but, for whatever reason, there is no advantage with the higher dose.

U.S. guidelines for cardiovascular prevention all begin with an assessment of cardiovascular risk using the Pooled Cohort Equations. The second cardiovascular POEM warns us that this score significantly overestimates risk. The Canadian researchers identified more than 80,000 people 40 to 79 years of age and estimated their risk using the Framingham Risk Score and the Pooled Cohort Equations. 20 Cardiovascular risk estimates from both tools were about twice as high as the real-world risk. The overestimates occurred in all groups regardless of age and sex but tended to be larger in younger patients. This is important for shared decision-making. For example, an estimated risk of 10% based on the Pooled Cohort Equations might lead to prescribing a statin, but the true cardiovascular risk may be significantly lower.

The U.S. Preventive Services Task Force draft guidelines recommend prescribing a statin for adults 40 to 75 years of age with at least one cardiovascular risk factor (dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year cardiovascular risk of 10% or greater. Statins should be selectively offered to those with a risk factor and a risk between 7.5% and 10% because the benefits are smaller than those at higher risk. 23

Another calibration issue was addressed by the third POEM. The researchers compared the blood pressure measurements used by researchers in SPRINT (Systolic Blood Pressure Intervention Trial) with those recorded by the patients’ regular primary care physicians. 21 The physician-recorded systolic blood pressure measurements were about 5 to 7 mm Hg higher; therefore, the SPRINT recommendations to lower systolic blood pressure to less than 120 mm Hg need to be interpreted accordingly—in the real world, achieving a level of 130 mm Hg is probably similar to 120 mm Hg in the trial setting.

The next POEM made our day, as egg lovers. This systematic review included 23 observational studies with nearly 1.4 million patients. 22 Eating more eggs was not shown to increase the risk of cardiovascular events. In fact, compared with eating one or no eggs per day, those eating more than one egg per day had a decreased risk of coronary disease (hazard ratio = 0.89; 95% CI, 0.86 to 0.93).


Four top POEMs do not fall easily into a single category ( Table 5 ) . 24 – 27 A systematic review addressed treatment of chronic pain caused by diabetic neuropathy or postherpetic neuralgia. 24 It included only studies reporting an outcome of clinically meaningful response, defined as a 30% improvement on a pain or function score. Moderate-quality evidence supported the use of the anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) and the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine, and low-quality evidence supported the use of rubefacients (usually salicylates). The NNT was 7 or 8 for all the identified therapies. Opioid studies were of low quality and also showed more harms (number needed to harm = 12). Only a few trials with low-certainty evidence studied acupuncture and tricyclic antidepressants.

A systematic review identified RCTs that compared treatment of moderate to severe depression using the minimum licensed dose of a selective serotonin reuptake inhibitor, venlafaxine, or mirtazapine (Remeron) with a dosing regimen that allowed titration to higher doses. 25 There was no improvement in the balance of effectiveness and harms between taking the minimum dose and titrating to higher doses, although patients taking venlafaxine may respond to a higher dose if they show no response to the minimum dose.

The next POEM identified 436 children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media whose treating physician had reasonable doubts about the need for an antibiotic. 26 Patients were randomized to no antibiotics; an immediate antibiotic; or an antibiotic prescription to be filled only if the child had fever, felt much worse after 24 hours, or was not improving after a longer period (varied by type of infection). Only 25% of children in the delayed antibiotic group and 12% in the no antibiotic group ultimately filled a prescription, and there was no difference between these groups and the immediate antibiotic group in the duration of symptoms (eight days) or complications. Gastrointestinal symptoms and cost were higher in those receiving an antibiotic.

Finally, clinicians have long recommended that people taking iron supplements also take vitamin C because it theoretically improves absorption. A study tested the theory by randomizing 440 adults with iron deficiency anemia to ferrous succinate, 100 mg, plus vitamin C, 200 mg, or to ferrous succinate alone, each given every eight hours. There was no difference in hemoglobin or serum ferritin levels at three months. 27

Practice Guidelines

POEMs sometimes summarize high-impact clinical practice guidelines. Key messages from the three highest-rated guidelines, which address antibiotics for common infections, non–low back musculoskeletal injuries, and tobacco screening and cessation, are summarized in Table 6 . 28 – 30

Editor's Note: This article was cowritten by Dr. Mark Ebell, deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Because of Dr. Ebell’s dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP ’s medical editors. In addition, the article underwent peer review and editing by four of AFP ’s medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Sumi Sexton, MD, Editor-in-Chief

The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia for their work as peer reviewers; Canadian Medical Association Joule for supporting the POEMs CME program in Canada; Pierre Pluye, PhD, for codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499.

Ebell MH, Barry HC, Slawson DC, et al. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355.

Grad RM, Pluye P, Mercer J, et al. Impact of research-based synopses delivered as daily e-mail: a prospective observational study. J Am Med Inform Assoc. 2008;15(2):240-245.

Montgomery J, Ryan M, Engler R, et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military. JAMA Cardiol. 2021;6(10):1202-1206.

  • Rooney MR, Rawlings AM, Pankow JS, et al. Risk of progression to diabetes among older adults with prediabetes [published correction appears in JAMA Intern Med . 2021;181(4):570]. JAMA Intern Med. 2021;181(4):511-519.

Ling S, Zaccardi F, Lawson C, et al. Glucose control, sulfonylureas, and insulin treatment in elderly people with type 2 diabetes and risk of severe hypoglycemia and death: an observational study. Diabetes Care. 2021;44(4):915-924.

  • Palmer SC, Tendal B, Mustafa RA, et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials [published correction appears in BMJ . 2022;376:o109]. BMJ. 2021;372:m4573.
  • Salah HM, Al'Aref SJ, Khan MS, et al. Effect of sodium-glucose cotransporter 2 inhibitors on cardiovascular and kidney outcomes. Systematic review and meta-analysis of randomized placebo-controlled trials. Am Heart J. 2021;232:10-22.

U.S. Preventive Services Task Force. Final recommendation statement. Prediabetes and type 2 diabetes: screening. August 24, 2021. Accessed March 15, 2022.

Kolber MR, Ton J, Thomas B, et al. PEER systematic review of randomized controlled trials: management of chronic low back pain in primary care. Can Fam Physician. 2021;67(1):e20-e30.

Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. 2021;374:n1446.

Rajasekaran S, Dilip Chand Raja S, Pushpa BT, et al. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J. 2021;30(7):2069-2081.

Bijur PE, Friedman BW, Irizarry E, et al. A randomized trial comparing the efficacy of five oral analgesics for treatment of acute musculoskeletal extremity pain in the emergency department. Ann Emerg Med. 2021;77(3):345-356.

Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Comparative Effectiveness Review no. 227. Agency for Healthcare Research and Quality; 2020. Accessed May 13, 2022.

Gong J, Colligan M, Kirkpatrick C, et al. Oral paracetamol versus combination oral analgesics for acute musculoskeletal injuries. Ann Emerg Med. 2019;74(4):521-529.

Randel KR, Schult AL, Botteri E, et al. Colorectal cancer screening with repeated fecal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial. Gastroenterology. 2021;160(4):1085-1096.e5.

Rao SSC, Brenner DM. Efficacy and safety of over-the-counter therapies for chronic constipation: an updated systematic review. Am J Gastroenterol. 2021;116(6):1156-1181.

Herbert A, Rafiq M, Pham TM, et al. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: a cohort study. PLoS Med. 2021;18(8):e1003708.

Jones WS, Mulder H, Wruck LM, et al.; ADAPTABLE Team. Comparative effectiveness of aspirin dosing in cardiovascular disease. N Engl J Med. 2021;384(21):1981-1990.

Ko DT, Sivaswamy A, Sud M, et al. Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations. CMAJ. 2020;192(17):E442-E449.

Drawz PE, Agarwal A, Dwyer JP, et al. Concordance between blood pressure in the systolic blood pressure intervention trial and in routine clinical practice. JAMA Intern Med. 2020;180(12):1655-1663.

Krittanawong C, Narasimhan B, Wang Z, et al. Association between egg consumption and risk of cardiovascular outcomes: a systematic review and meta-analysis. Am J Med. 2021;134(1):76-83.e2.

U.S. Preventive Services Task Force. Draft recommendation statement. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. February 22, 2022. Accessed March 10, 2022.

Falk J, Thomas B, Kirkwood J, et al. PEER systematic review of randomized controlled trials: management of chronic neuropathic pain in primary care. Can Fam Physician. 2021;67(5):e130-e140.

Furukawa TA, Salanti G, Cowen PJ, et al. No benefit from flexible titration above minimum licensed dose in prescribing antidepressants for major depression: systematic review. Acta Psychiatr Scand. 2020;141(5):401-409.

Mas-Dalmau G, Villanueva López C, Gorrotxategi PG, et al.; DAP Pediatrics Group. Delayed antibiotic prescription for children with respiratory infections: a randomized trial. Pediatrics. 2021;147(3):e20201323.

Li N, Zhao G, Wu W, et al. The efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: A randomized clinical trial. JAMA Netw Open. 2020;3(11):e2023644.

Lee RA, Centor RM, Humphrey LL, et al. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Ann Intern Med. 2021;174(6):822-827.

Qaseem A, McLean RM, O'Gurek D, et al. Nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults: a clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. 2020;173(9):739-748.

Krist AH, Davidson KW, Mangione CM, et al. Interventions for tobacco smoking cessation in adults, including pregnant persons. US Preventive Services Task Force recommendation statement. JAMA. 2021;325(3):265-279.

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

Edward barroga.

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

Glafera Janet Matanguihan

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

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


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.


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


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


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


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.


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 .

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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.

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  • 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


  • 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


  • 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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  • Social Media Use in 2021

A majority of Americans say they use YouTube and Facebook, while use of Instagram, Snapchat and TikTok is especially common among adults under 30.

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  • Acknowledgments
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To better understand Americans’ use of social media, online platforms and messaging apps, Pew Research Center surveyed 1,502 U.S. adults from Jan. 25 to Feb. 8, 2021, by cellphone and landline phone. The survey was conducted by interviewers under the direction of Abt Associates and is weighted to be representative of the U.S. adult population by gender, race, ethnicity, education and other categories. Here are the  questions used for this report , along with responses, and  its methodology .

Despite a string of controversies and the public’s relatively negative sentiments about aspects of social media, roughly seven-in-ten Americans say they ever use any kind of social media site – a share that has remained relatively stable over the past five years, according to a new Pew Research Center survey of U.S. adults.

Growing share of Americans say they use YouTube; Facebook remains one of the most widely used online platforms among U.S. adults

Beyond the general question of overall social media use, the survey also covers use of individual sites and apps. YouTube and Facebook continue to dominate the online landscape, with 81% and 69%, respectively, reporting ever using these sites. And YouTube and Reddit were the only two platforms measured that saw statistically significant growth since 2019 , when the Center last polled on this topic via a phone survey.

When it comes to the other platforms in the survey, 40% of adults say they ever use Instagram and about three-in-ten report using Pinterest or LinkedIn. One-quarter say they use Snapchat, and similar shares report being users of Twitter or WhatsApp. TikTok – an app for sharing short videos – is used by 21% of Americans, while 13% say they use the neighborhood-focused platform Nextdoor.

Even as other platforms do not nearly match the overall reach of YouTube or Facebook, there are certain sites or apps, most notably Instagram, Snapchat and TikTok, that have an especially strong following among young adults. In fact, a majority of 18- to 29-year-olds say they use Instagram (71%) or Snapchat (65%), while roughly half say the same for TikTok.

These findings come from a nationally representative survey of 1,502 U.S. adults conducted via telephone Jan. 25-Feb.8, 2021.

With the exception of YouTube and Reddit, most platforms show little growth since 2019

YouTube is the most commonly used online platform asked about in this survey, and there’s evidence that its reach is growing. Fully 81% of Americans say they ever use the video-sharing site, up from 73% in 2019. Reddit was the only other platform polled about that experienced statistically significant growth during this time period – increasing from 11% in 2019 to 18% today. 

Facebook’s growth has leveled off over the last five years, but it remains one of the most widely used social media sites among adults in the United States: 69% of adults today say they ever use the site, equaling the share who said this two years prior.  

Similarly, the respective shares of Americans who report using Instagram, Pinterest, LinkedIn, Snapchat, Twitter and WhatsApp are statistically unchanged since 2019 . This represents a broader trend that extends beyond the past two years in which the rapid adoption of most of these sites and apps seen in the last decade has slowed. (This was the first year the Center asked about TikTok via a phone poll and the first time it has surveyed about Nextdoor.)

Adults under 30 stand out for their use of Instagram, Snapchat and TikTok

When asked about their social media use more broadly – rather than their use of specific platforms – 72% of Americans say they ever use social media sites.

In a pattern consistent with past Center studies on social media use, there are some stark age differences. Some 84% of adults ages 18 to 29 say they ever use any social media sites, which is similar to the share of those ages 30 to 49 who say this (81%). By comparison, a somewhat smaller share of those ages 50 to 64 (73%) say they use social media sites, while fewer than half of those 65 and older (45%) report doing this.

These age differences generally extend to use of specific platforms, with younger Americans being more likely than their older counterparts to use these sites – though the gaps between younger and older Americans vary across platforms.

Age gaps in Snapchat, Instagram use are particularly wide, less so for Facebook

Majorities of 18- to 29-year-olds say they use Instagram or Snapchat and about half say they use TikTok, with those on the younger end of this cohort – ages 18 to 24 – being especially likely to report using Instagram (76%), Snapchat (75%) or TikTok (55%). 1 These shares stand in stark contrast to those in older age groups. For instance, while 65% of adults ages 18 to 29 say they use Snapchat, just 2% of those 65 and older report using the app – a difference of 63 percentage points.

Additionally, a vast majority of adults under the age of 65 say they use YouTube. Fully 95% of those 18 to 29 say they use the platform, along with 91% of those 30 to 49 and 83% of adults 50 to 64. However, this share drops substantially – to 49% – among those 65 and older.

By comparison, age gaps between the youngest and oldest Americans are narrower for Facebook. Fully 70% of those ages 18 to 29 say they use the platform, and those shares are statistically the same for those ages 30 to 49 (77%) or ages 50 to 64 (73%). Half of those 65 and older say they use the site – making Facebook and YouTube the two most used platforms among this older population.

Other sites and apps stand out for their demographic differences:

  • Instagram: About half of Hispanic (52%) and Black Americans (49%) say they use the platform, compared with smaller shares of White Americans (35%) who say the same. 2
  • WhatsApp: Hispanic Americans (46%) are far more likely to say they use WhatsApp than Black (23%) or White Americans (16%). Hispanics also stood out for their WhatsApp use in the Center’s previous surveys on this topic.
  • LinkedIn: Those with higher levels of education are again more likely than those with lower levels of educational attainment to report being LinkedIn users. Roughly half of adults who have a bachelor’s or advanced degree (51%) say they use LinkedIn, compared with smaller shares of those with some college experience (28%) and those with a high school diploma or less (10%).
  • Pinterest: Women continue to be far more likely than men to say they use Pinterest when compared with male counterparts, by a difference of 30 points (46% vs. 16%).
  • Nextdoor: There are large differences in use of this platform by community type. Adults living in urban (17%) or suburban (14%) areas are more likely to say they use Nextdoor. Just 2% of rural Americans report using the site.

Use of online platforms, apps varies – sometimes widely – by demographic group

A majority of Facebook, Snapchat and Instagram users say they visit these platforms on a daily basis

Seven-in-ten Facebook users say they visit site daily

While there has been much written about Americans’ changing relationship with Facebook , its users remain quite active on the platform. Seven-in-ten Facebook users say they use the site daily, including 49% who say they use the site several times a day. (These figures are statistically unchanged from those reported in the Center’s 2019 survey about social media use.)  

Smaller shares – though still a majority – of Snapchat or Instagram users report visiting these respective platforms daily (59% for both). And being active on these sites is especially common for younger users. For instance, 71% of Snapchat users ages 18 to 29 say they use the app daily, including six-in-ten who say they do this multiple times a day. The pattern is similar for Instagram: 73% of 18- to 29-year-old Instagram users say they visit the site every day, with roughly half (53%) reporting they do so several times per day.

YouTube is used daily by 54% if its users, with 36% saying they visit the site several times a day. By comparison, Twitter is used less frequently, with fewer than half of its users (46%) saying they visit the site daily.

  • Due to a limited sample size, figures for those ages 25 to 29 cannot be reported on separately. ↩
  • There were not enough Asian American respondents in the sample to be broken out into a separate analysis. As always, their responses are incorporated into the general population figures throughout this report. ↩

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Internet use statistically associated with higher wellbeing, finds new global Oxford study

Internet use statistically associated with higher wellbeing, finds new global Oxford study

Links between internet adoption and wellbeing are likely to be positive, despite popular concerns to the contrary, according to a major new international study from researchers at the Oxford Internet Institute, part of the University of Oxford.

The study encompassed more than two million participants psychological wellbeing from 2006-2021 across 168 countries, in relation to internet use and psychological well-being across 33,792 different statistical models and subsets of data, 84.9% of associations between internet connectivity and wellbeing were positive and statistically significant. 

The study analysed data from two million individuals aged 15 to 99 in 168 countries, including Latin America, Asia, and Africa and found internet access and use was consistently associated with positive wellbeing.   

Assistant Professor Matti Vuorre, Tilburg University and Research Associate, Oxford Internet Institute and Professor Andrew Przybylski, Oxford Internet Institute carried out the study to assess how technology relates to wellbeing in parts of the world that are rarely studied.

Professor Przybylski said: 'Whilst internet technologies and platforms and their potential psychological consequences remain debated, research to date has been inconclusive and of limited geographic and demographic scope. The overwhelming majority of studies have focused on the Global North and younger people thereby ignoring the fact that the penetration of the internet has been, and continues to be, a global phenomenon'. 

'We set out to address this gap by analysing how internet access, mobile internet access and active internet use might predict psychological wellbeing on a global level across the life stages. To our knowledge, no other research has directly grappled with these issues and addressed the worldwide scope of the debate.' 

The researchers studied eight indicators of well-being: life satisfaction, daily negative and positive experiences, two indices of social well-being, physical wellbeing, community wellbeing and experiences of purpose.   

Commenting on the findings, Professor Vuorre said, “We were surprised to find a positive correlation between well-being and internet use across the majority of the thousands of models we used for our analysis.”

Whilst the associations between internet access and use for the average country was very consistently positive, the researchers did find some variation by gender and wellbeing indicators: The researchers found that 4.9% of associations linking internet use and community well-being were negative, with most of those observed among young women aged 15-24yrs.

Whilst not identified by the researchers as a causal relation, the paper notes that this specific finding is consistent with previous reports of increased cyberbullying and more negative associations between social media use and depressive symptoms among young women. 

Adds Przybylski, 'Overall we found that average associations were consistent across internet adoption predictors and wellbeing outcomes, with those who had access to or actively used the internet reporting meaningfully greater wellbeing than those who did not'.

'We hope our findings bring some greater context to the screentime debate however further work is still needed in this important area.  We urge platform providers to share their detailed data on user behaviour with social scientists working in this field for transparent and independent scientific enquiry, to enable a more comprehensive understanding of internet technologies in our daily lives.' 

In the study, the researchers examined data from the Gallup World Poll, from 2,414,294 individuals from 168 countries, from 2006-2021.  The poll assessed well-being with face-to-face and phone surveys by local interviewers in the respondents’ native languages.  The researchers applied statistical modelling techniques to the data using wellbeing indicators to test the association between internet adoption and wellbeing outcomes. 

Watch the  American Psychological Association (APA) video  highlighting the key findings from the research.

Download the paper ‘ A multiverse analysis of the associations between internet use and well-being ’ published in the journal Technology, Mind and Behaviour, American Psychological Association.

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Patients love telehealth—physicians are not so sure

IRL or URL? Many physicians and patients used to see medical care as something best done in-person (in real life, or IRL). But the pandemic has spurred a massive transition to virtual (or URL) care. According to our recent surveys of consumers and physicians, opinions are split on what happens next (see sidebar, “Our methodology”). As the pandemic evolves, consumers still prefer the convenience of digital engagement and virtual-care options, according to our recent McKinsey Consumer Health Insights Survey. This preference could help more patients access care, while also helping providers to grow.

Our methodology

To help our clients understand responses to COVID-19, McKinsey launched a research effort to gather insights from physicians into how the pandemic is affecting their ability to provide care, their financial situation, and their level of stress, as well as what kind of support would interest them. Nationwide surveys were conducted online in 2020 from April 27–May 5 (538 respondents), July 22–27 (150 respondents), and September 22–27 (303 respondents), as well as from March 25–April 5, 2021 (379 respondents).

The participants were US physicians in a variety of practice types and sizes, and a range of employment types. The specialties included general practice and family practice; cardiology; orthopedics, sports medicine and musculoskeletal; dermatology; general surgery; obstetrics and gynecology; oncology; ophthalmology; otorhinolaryngology and ENT; pediatrics; plastic surgery; physical medicine and rehabilitation; psychiatry and behavioral health; emergency medicine; and urology. These surveys built on a prior one of 1,008 primary-care, cardiology, and orthopedic-surgery physicians in April 2019.

To provide timely insights on the reported behaviors, concerns, and desired support of adult consumers (18 years and older) in response to COVID-19, McKinsey launched consumer surveys in 2020 (March 16–17, March 27–29, April 11–13, April 25–27, May 15–18, June 4–8, July 11–14, September 5–7, October 22–26, and November 20–December 6) and 2021 (January 4–11, February 8–12, March 15–22, April 24–May 2, June 4–13, and August 13–23). These surveys represent the stated perspectives of consumers and are not meant to indicate or predict their actual future behavior. (In these surveys, we asked consumers about “Coronavirus/COVID-19,” given the general public’s colloquial use of coronavirus to refer to COVID-19.)

Many digital start-ups and tech and retail giants are rising to the occasion, but our most recent (2021) McKinsey Physician Survey indicates that physicians may prefer a return to pre-COVID-19 norms. In this article, we explore the trends creating disconnects between consumers and physicians and share ideas on how providers could offer digital services that work not only for them but also for patients. Bottom line: a seamless IRL/URL offering could retain patients while delivering high-quality care. Everybody benefits.

The rise of telehealth

These materials reflect general insight based on currently available information, which has not been independently verified and is inherently uncertain. Future results may differ materially from any statements of expectation, forecasts, or projections. These materials are not a guarantee of results and cannot be relied upon. These materials do not constitute legal, medical, policy, or other regulated advice and do not contain all the information needed to determine a future course of action.

At the onset of the COVID-19 pandemic, both physicians and patients embraced telehealth: in April 2020, the number of virtual visits was a stunning 78 times higher than it had been two months earlier, accounting for nearly one-third of outpatient visits. In May 2021, 88 percent of consumers said that they had used telehealth services at some point since the COVID-19 pandemic began. Physicians also felt dramatically more comfortable with virtual care. Eighty-three percent of those surveyed in the 2021 McKinsey Physician Survey offered virtual services, compared with only 13 percent in 2019. 1 See sidebar on methodology; McKinsey Physician Surveys conducted nationally in five waves between May 2019 and April 2021; May 1, 2019, n = 1,008; May 5, 2020, n = 500; July 2, 2020, n = 150; September 27, 2020, n = 500; April 5, 2021, n = 379.

However, as of mid-2021, consumers’ embrace of telehealth appeared to have dimmed a bit  from its early COVID-19 peak: utilization was down to 38 times pre-COVID-19 levels. Also, more physicians were offering telehealth but recommending in-person care when possible in 2021, which could suggest that physicians are gravitating away from URL and would prefer a return to IRL care delivery (Exhibit 1).

Three trends from the late-stage pandemic

As COVID-19 continues, three emerging trends could set the stage for the next few years.

The number of virtual-first players keeps growing, and physicians struggle to keep up

The growth (and valuations) of virtual-first care providers suggest that demand by patients is persistent and growing. Teladoc increased the number of its visits by 156 percent in 2020, and its revenues jumped by 107 percent year over year. Amwell increased its supply of providers by 950 percent in 2020. 2 “Teladoc Health reports fourth-quarter and full-year 2020 results,” Teledoc Health, February 24, 2021; “Amwell announces results for the fourth quarter and full year 2020,” Amwell, March 24, 2021. By contrast, only 45 percent of physicians have been able to invest in telehealth during the pandemic, and only 16 percent have invested in other digital tools. Just 41 percent believe that they have the technology to deliver telehealth seamlessly. 3 McKinsey Physician Survey, April 5, 2021.

Some workflows, for example, require physicians to log into disparate systems that do not integrate seamlessly with an electronic health record (EHR). Audiovisual failures during virtual appointments continue to occur. To make these models work, providers may need to determine how to design operational workflows to make IRL/URL care as seamless as possible for both providers and patients. The workflows and care team models may need to vary, depending on the physician’s specialty and the amount of time they plan to devote to URL versus IRL care.

Patient–physician relationships are shifting

In McKinsey’s April 2021 Physician Survey, 58 percent of the respondents reported that they had lost patients to other physicians or to other health systems since the start of the COVID-19 pandemic. Corroborating those findings, our August 2021 survey of consumers showed that of those who had a primary-care physician (PCP), 15 percent had switched in the past year. Thirty-five percent of all consumers reported seeing a new healthcare provider who was not their regular PCP or specialist in the past year. Among consumers who had switched PCPs, 35 percent cited one or more reasons related to the patient experience—the desire for a PCP who better understood their needs (15 percent of respondents), a better experience (10 percent), or more convenient appointments (6 percent). Just half (50 percent) of consumers with a PCP say they are very satisfied. What’s more, Medicare regulations now give patients more ownership over their health data, and that could make it easier for them to switch physicians. 4 “Policies and technology for interoperability and burden reduction,” Centers for Medicare & Medicaid Services, December 9, 2021.

Physicians and patients see telehealth differently

Our surveys show that doctors and patients have starkly different opinions about telehealth and broader digital engagement (Exhibit 2). Take convenience: while two-thirds of physicians and 60 percent of patients said they agreed that virtual health is more convenient than in-person care for patients, only 36 percent of physicians find it more convenient for themselves.

This perception may be leading physicians to rethink telehealth. Most said they expect to return to a primarily in-person delivery model over the next year. Sixty-two percent said they recommend in-person over virtual care to patients. Physicians also expect telehealth to account for one-third less of their visits a year from now than it does today.

These physicians may be underestimating patient demand. Forty percent of patients in May 2021 said they believe they will continue to use telehealth in the pandemic’s aftermath. 5 McKinsey Consumer Health Insights Survey , May 7, 2021.

In November 2021, 55 percent of patients said they were more satisfied with telehealth/virtual care visits than with in-person appointments. 6 McKinsey Consumer Health Insights Survey , November 19, 2021. Thirty-five percent of consumers are currently using other digital services, such as ordering prescriptions online and home delivery. Of these, 42 percent started using these services during the pandemic and plan to keep using them, and an additional 15 percent are interested in starting digital services. 7 McKinsey Consumer Health Insights Survey , June 24, 2021.

Convenience is not the only concern. Physicians also worry about reimbursement. At the height of the COVID-19 pandemic in the United States, the Centers for Medicare & Medicaid Services (CMS) and several other payers switched to at-parity (equal) reimbursement for virtual and in-person visits. More than half of physician respondents said that if virtual rates were 15 percent lower than in-person rates, they would be less likely to offer telehealth. Telehealth takes investment: traditional providers may need time to transition their capital and operating expenses to deliver virtual care at a cost lower than that of IRL.

Four critical actions for providers to consider

Providers may want to define their IRL/URL care strategy to identify the appropriate places for various types of care—balancing clinical appropriateness with the preferences of physicians and patients.

Determine the most clinically appropriate setting

Clinical appropriateness may be the most crucial variable for deciding how and where to increase the utilization of telehealth. Almost half of physicians said they regard telehealth as appropriate for treatment of ongoing chronic conditions, and 38 percent said they believe it is appropriate when patients have an acute change in health—increases of 26 and 17 percentage points, respectively, since May 2019.

However, physicians remain conservative in their view of telehealth’s effectiveness compared with in-person care. Their opinions vary by visit type (Exhibit 3). Health systems may consider asking their frontline clinical-care delivery teams to determine the clinically appropriate setting for each type of care, taking into account whether physicians are confident that they can deliver equally high-quality care for both IRL and URL appointments.

Assess patient wants and needs in relevant markets and segments

Patient demand for telehealth remains high, but expectations appear to vary by age and income group, payer status, and type of care. Our survey shows that younger people (under the age of 55 ), people in higher income brackets (annual household income of $100,000 or more), and people with individual or employer-sponsored group insurance are more likely to use telehealth (Exhibit 4). Patient demand also is higher for virtual mental and behavioral health. Sixty-two percent of mental-health patients completed their most recent appointments virtually, but only 20 percent of patients logged in to see their primary-care provider, gynecologist, or pediatrician.

To meet market demand effectively, it may be crucial to base care delivery models on a deep understanding of the market, with a range of both IRL and URL options to meet the needs of multiple patient segments.

Partner with physicians to define a new operating model

Many physicians are turning away from the virtual operating model: 62 percent recommended in-person care in April 2021, up five percentage points since September 2020. As physicians evaluate their processes for 2022, 46 percent said they prefer to offer, at most, a couple of hours of virtual care each day. Twenty-nine percent would like to offer none at all—up ten percentage points from September 2020. Just 11 percent would dedicate one full day a week to telehealth, and almost none would want to offer virtual care full time (Exhibit 5).

To adapt to these views, care providers can try to meet the needs and the expectations of physicians. They could offer highly virtualized schedules to physicians who prefer telehealth, while allowing other physicians to remain in-person only. Matching the preferences of physicians may create the best experience both for them and for patients. Greater flexibility and greater control over decisions about when and how much virtual care to offer may also help address chronic physician burnout issues (Exhibit 6). Digital-first solutions (for example, online scheduling, digital registration, and virtual communications with providers) could also increase the reach of in-person-only care providers to the 60 percent of consumers interested in using these digital solutions after the pandemic abates.

Communicate clearly to patients and others

Physicians consistently emerge as the most trusted source of clinical information by patients: 90 percent consider providers  trustworthy for healthcare-related issues. 8 McKinsey Consumer Survey, May 2020. Providers could play a pivotal role in counseling patients on the importance of continuity of care, as well as what can be done safely and effectively by IRL and URL, respectively. The goal is to help patients receive the care that they need in a timely manner and in the most clinically appropriate setting.

Potential benefits to providers

The strategic, purposeful design of a hybrid IRL/URL healthcare delivery model that respects the preferences of patients and physicians and offers virtual care when it is appropriate clinically may allow healthcare providers to participate in the near term, retain clinical talent, offer better value-based care, and differentiate themselves strategically for the future.

Telehealth and broader digital engagement tools have enjoyed persistent patient demand throughout the pandemic. That demand may persist well after it. Investment in digital health companies has grown rapidly—reaching $21.6 billion in 2020, a 103 percent year-over-year increase—which also suggests that this approach to medicine has staying power. 9 Q4 and annual 2020 digital health (healthcare IT) funding and M&A report , Executive Summary, Digital Health Funding and M&A, Mercom Capital Group.

That level of demand offers the potential for growth when physicians can meet it. If only new entrants fully meet consumer demand, traditional providers who do not offer URL options may risk losing market share over time as a result of patients’ initial visit and downstream care decisions. What’s more, as healthcare reimbursement continues to move toward value, virtual-delivery options could become a strategic differentiator that helps providers better manage costs. 10 Brian W. Powers, MD, et al., “Association between primary care payment model and telemedicine use for Medicare Advantage enrollees during the COVID-19 pandemic,” JAMA Network , July 16, 2021.

In all likelihood, one of the critical steps in the process will be engaging physicians in the design of new virtual-care models—for example, determining clinical appropriateness, how and where physicians prefer to deliver care, and the workflows that will maximize their productivity. This has the added benefit of potentially also addressing the problem of physician burnout by offering a range of options for how and where clinicians practice.

Most important, virtual care can offer an opportunity to improve outcomes for patients meaningfully by delivering timely care to those who might otherwise delay it or who live in areas with provider shortages. In addition, patients’ most trusted advisers on care decisions are physicians, so virtual care gives them a meaningful opportunity to help patients access the care they need in a way that both parties may find convenient and appropriate. 11 “Public & physician trust in the U.S. healthcare system,” ABIM Foundation, surveys conducted on December 29, 2020 and February 5, 2021.

Physicians are evaluating a variety of factors for delivering care to patients during and, eventually, after the COVID-19 pandemic. The strategic, purposeful design of a hybrid IRL/URL healthcare delivery model offers a triple unlock: improving the value of healthcare while better meeting consumer demand and improving physicians’ engagement. The full unlock is not easy—it requires deep engagement and cooperation between administrators, clinicians, and frontline staff, as well as focused investment. But it will yield dividends for patients and providers alike in the long run.

Jenny Cordina is a partner in McKinsey’s Detroit office,  Jennifer Fowkes is a partner in the Washington, DC, office,  Rupal Malani, MD , is a partner in the Cleveland office, and  Laura Medford-Davis, MD , is an associate partner in the Houston office.

The article was edited by Elizabeth Newman, an executive editor in the Chicago office.

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Enhancing research accessibility and reuse: new study outlines strategic measures

Today, the European Commission published a study aimed at improving access to and reuse of research results, including publications and data for scientific purposes. This marks a significant step under the European Research Area Policy Agenda 2022-2024 on an EU copyright and data legislative and regulatory framework fit for research. 

The study has identified barriers and challenges to access and reuse of publicly funded research results, evaluated effects of the EU copyright framework on research, and identified relevant provisions for research in EU data and digital legislation. On this basis, it presents options for legislative and non-legislative measures to strengthen the free circulation of knowledge and thereby contribute to reinforce the  European Research Area .

Iliana Ivanova , Commissioner for Innovation, Research, Culture, Education and Youth, said: 

“The European Union has been pioneering open science policies and actions for over a decade. At the heart of our ambitious open science policy lies a simple but powerful belief: Publicly funded research should be a public resource. In our ongoing efforts under the European Research Area and its Policy Agenda, we collaborate closely with Member States, Associated Countries and stakeholders to create an environment where knowledge flows freely to benefit the society”.

The most common barriers encountered by researchers include lack of subscriptions by their organisations, inability to get permissions from the copyright owner, and fear of copyright infringement. Research performing organisations report challenges emerging from copyright law, not only in accessing and re-using publicly funded research results, but also in making results available in open access. 

Special focus has been placed in investigating the situation in EU Member States that had introduced a Secondary Publication Right (SPR), including Germany, France, Netherlands, Belgium and Austria. SPR grants authors the right to freely share their published articles under certain conditions, alongside the initial publication in scientific journals. The study found that most research performing organisations in these Member States consider SPR to have at least a moderate impact on their research activities, including the share of research publications in open access. However, the study indicates that many researchers remain unaware of this right and a majority of research performing organisations consider certain provisions of national SPR legislation to be limiting factors. For example, the need to respect embargo periods and the fact that SPR is applicable only to the author-accepted manuscript, not the version of record, for publication. 

The study presents options for legislative and non-legislative measures. It also outlines a diversity of stakeholders’ perspectives on the options proposed, indicating the need for further analysis and discussions. Measures explored encompass the introduction of an EU-wide Secondary Publication Right and provisions that could be included in such legislation, spanning from the type of scientific output to the embargo period to be allowed. Other proposed measures focus on strengthening open-ended and flexible research exceptions. This could be achieved by introducing a fully harmonised, mandatory, and general exemption for scientific research, by clarifying lawful forms of access, and by removing excessive barriers posed by technological protection measures. Lastly, options explored also include giving guidance on current text and data mining provisions, to raise awareness and facilitate implementation by the research community. 

Finally, the study provides an analysis of provisions relevant to researchers and research organisations in EU data and digital legislation, examine the interplay against different legislative instruments, and present the main opportunities and challenges. The findings identify a growing entanglement of provisions relating to research activities and put forward recommendations. 

The study was commissioned as part of Action 2 of the  ERA Policy Agenda 2022-2024 . It has been carried out by a consortium led by PPMI Group, and including as partners the Institute for Information Law of the University of Amsterdam, the Centre for IT & IP Law at KU Leuven, and the Sant'Anna School of Advanced Studies.

It also responds to the  Council Conclusions of May 2023 on ‘High-quality, transparent, open, trustworthy and equitable scholarly publishing’, which encouraged the Commission to examine and propose measures at EU level.

More information  

Study: Improving access to and reuse of research results, publications and data for scientific purposes

Executive Summary 

European Research Area Platform

EU open science policy

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Summer of 2023 was hottest in 2,000 years, study finds

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An extreme summer marked by deadly heat waves, explosive wildfires and record warm ocean temperatures will go down as among the hottest in the last 2,000 years, new research has found.

The summer of 2023 saw the temperature in the Northern Hemisphere soar 3.72 degrees above the average from 1850 to 1900, when modern instrumental recordkeeping began, according to a study published Tuesday in the journal Nature. The study focused on surface air temperatures across the extra-tropical region, which sits at 30 to 90 degrees north latitude and includes most of Europe and North America.

June, July and August last year were also 3.96 degrees warmer than the average from the years 1 through 1890, which the researchers calculated by combining observed records with tree ring records from nine global regions.

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Aggressive and impactful reporting on climate change, the environment, health and science.

Jan Esper, the study’s lead author and a professor of climate geography at Johannes Gutenberg University in Germany, said that he was not expecting summer last year to be quite so anomalous, but that he was ultimately not surprised by the findings. The high temperatures built on an overall warming trend driven by greenhouse gas emissions and were further amplified by the onset of El Niño in the tropical Pacific.

“It’s no surprise — this really, really outstanding 2023 — but it was also, step-wise, a continuation of a trend that will continue,” Esper told reporters Monday. “Personally I’m not surprised, but I am worried.”

He said it was important to place 2023’s temperature extreme in a long-term context. The difference between the region’s previous warmest summer, in the year 246, and the summer of 2023 is 2.14 degrees, the study found.

The heat is even more extreme when compared with the region’s coldest summers — the majority of which were influenced by volcanic eruptions that spewed heat-blocking sulfur into the stratosphere. According to the study, 2023’s summer was 7.07 degrees warmer than the coldest reconstructed summer from this period, in the year 536.

“Although 2023 is consistent with a greenhouse gases-induced warming trend that is amplified by an unfolding El Niño event, this extreme emphasizes the urgency to implement international agreements for carbon emission reduction,” the study says.

The sweltering summer temperatures contributed to scores of heat illnesses and deaths, including at least 645 heat-associated deaths in Maricopa County, Ariz., where Phoenix saw temperatures of 110 degrees or hotter for a record 31 consecutive days.

Wildfires exacerbated by high temperatures raged across Canada and sent hazardous smoke down the East Coast of the United States and across the Atlantic. Meanwhile, ocean temperatures off Florida soared above 101 degrees , the temperature of a hot tub.

A vendor prepares his umbrella as hot days continue in Manila, Philippines on Monday, April 29, 2024. Millions of students in all public schools across the Philippines were ordered to stay home Monday after authorities cancelled in-person classes for two days as an emergency step due to the scorching heat and a public transport strike. (AP Photo/Aaron Favila)

Climate & Environment

Warmest April on record extends planet’s hot streak to 11 months

With an average surface temperature of 59.05 degrees, the month was about 0.25 of a degree warmer than the previous hottest April, in 2016.

May 8, 2024

Multiple climate agencies, including the National Oceanic and Atmospheric Administration and the European Union’s Copernicus Climate Change Service, have declared 2023 the hottest year on record globally.

Notably, Copernicus found that the summer months of June, July and August last year measured 1.18 degrees warmer than average — still hot, but not nearly as warm as the study’s findings for the Northern Hemisphere’s extra-tropical region.

That region was especially hot in part because it is home to so much land, which warms faster than oceans, said Karen McKinnon, an assistant professor of statistics and the environment at UCLA who did not work on the study. (June, July and August are also winter months in the Southern Hemisphere.)

McKinnon said the study’s findings are not unexpected, as there was already good evidence that the summer of 2023 was record-breaking when compared with measurable data going back to the mid-1800s. But by going back 2,000 years, the researchers also helped illuminate “the full range of natural variability that could have occurred in the past,” she said.

She noted that tree rings can serve as a helpful proxy for climate conditions in the past, as trees tend to grow more in a given year if they receive the right amount of warmth, water and sunshine. But although last year’s heat was undeniable, the study also underscores that the summer temperature in this region was notably higher than the global target of 2.7 degrees — or 1.5 degrees Celsius — of warming over the preindustrial period, which was established by the Intergovernmental Panel on Climate Change in 2015.

It also notes that some recent research has found the data used to calculate that baseline may be off by several tenths of a degree, meaning it could need to be recalibrated, with the target landing closer to an even more challenging 1.6 or 1.7 degrees.

“I don’t think we should use the proxy instead of the instrumental data, but there’s a good indication that there’s a warm bias,” Esper said. “Further research is needed.”

Glendora, CA - January 03: Storm clouds move on over downtown Los Angeles after rainfall totals of a quarter to one half inch of precipitation overnight on Wednesday, Jan. 3, 2024 in Glendora, CA. (Brian van der Brug / Los Angeles Times)

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The planet is dangerously close to this climate threshold. Here’s what 1.5°C really means

Every bit of planetary warming will have impacts beyond those already occurring, including biodiversity loss, longer heat waves and extreme rainfall.

Feb. 1, 2024

McKinnon said there is always going to be some degree of uncertainty when comparing present-day temperatures to past temperatures, but that the 1.5-degree limit is as symbolic as it is literal. Many effects of climate change, including worsening heat waves, have already begun.

“There are definitely tipping points in the climate system, but we don’t understand the climate system well enough to say 1.5 C is the temperature for certain tipping points,” she said. “This is just a policy goal that gives you a temperature change that maybe would be consistent with averting some damages.”

In fact, the study’s publication comes days after a survey of 380 leading scientists from the IPCC revealed deep concerns about the world’s ability to limit global warming to 1.5 degrees. That report, published last week in the Guardian , found that only 6% of surveyed scientists think the 1.5-degree limit will be met. Nearly 80% said they foresee at least 2.5 degrees Celsius of warming.

The report caused a stir among the scientific community, with some saying it focused too heavily on pessimism and despair. But Daniel Swain, a climate scientist with UCLA who participated in the survey, said its findings are worthy of consideration.

“There are many kinds of scientists, myself included, who are very worried and concerned and increasingly alarmed by what is going on and what the data is showing,” Swain said during a briefing Friday . “But if anything, I think that really results in a stronger sense of resolve and urgency to do even more, and to do better.”

Indeed, while scientists continue to weigh in on whether — or how quickly — humanity can alter the planet’s worsening warming trajectory, Esper said he hopes the latest study will serve as motivation for changing outdated modes of energy consumption that contribute to planet-warming greenhouse gases.

“I am concerned about global warming — I think it’s one of the biggest threats out there,” he said.

He added that he is particularly worried for his children and for younger generations who will bear the brunt of adverse climate outcomes. There is a strong likelihood that the summer of 2024 will be even hotter, the study says.

“The longer we wait, the more extensive it will be, and the more difficult it will be to mitigate or even stop that process and reverse it,” Esper said. “It’s just so obvious: We should do as much as possible, as soon as possible.”

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Flooding in Americas, brutal heat in Asia and Africa: Extreme weather across the globe

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Hayley Smith is an environment reporter for the Los Angeles Times, where she covers the many ways climate change is reshaping life in California, including drought, floods, wildfires and deadly heat.

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  1. 15 Trending Nutrition Research Articles from 2021

    research study articles 2021

  2. Vol. 2 No. 01 (2021): Journal of Health Sciences and Innovative

    research study articles 2021


    research study articles 2021

  4. The Total Quality Framework: 8 Articles in RDR in 2021 on Research

    research study articles 2021

  5. The number of annual research articles from 1992 to 2021. The number of

    research study articles 2021

  6. (PDF) How to Write an Original Research Article: A Guide for

    research study articles 2021


  1. New studies look into cardiovascular risk factors

  2. Research nexus 2024| What is research

  3. What is Questionnaire in Research Study

  4. Why do research proposals get rejected?

  5. This BITEs


  1. Articles in 2021

    A 'chisel' of light carves solid shapes out of a liquid. Ultraviolet light controls the emergence of solid particles from a fluid, creating coral- and blossom-shaped structures. Research ...

  2. Most Read Articles in 2021 from JAMA

    February 9, 2021. JAMA. US Preventive Services Task Force. August 24, 2021. JAMA. Original Investigation. March 16, 2021. See the most popular articles, videos, and podcasts from previous years. JAMA Network Articles of the Year 2021.

  3. The Ten Most Significant Science Stories of 2021

    Joe Spring. Associate Editor, Science. December 23, 2021. From amazing firsts on Mars to the impacts of climate change on Earth, these science stories stood out as the most important of 2021 Photo ...

  4. MIT's top research stories of 2021

    The year's popular research stories include a promising new approach to cancer immunotherapy, the confirmation of a 50-year-old theorem, and a major fusion breakthrough. In 2021, MIT researchers made advances toward fusion energy, confirmed Stephen Hawking's black hole theorem, developed a Covid-detecting face mask, and created a ...

  5. The New England Journal of Medicine

    The New England Journal of Medicine (NEJM) is a weekly general medical journal that publishes new medical research and review articles, and editorial opinion on a wide variety of topics of ...

  6. Criteria for Good Qualitative Research: A Comprehensive Review

    This review aims to synthesize a published set of evaluative criteria for good qualitative research. The aim is to shed light on existing standards for assessing the rigor of qualitative research encompassing a range of epistemological and ontological standpoints. Using a systematic search strategy, published journal articles that deliberate criteria for rigorous research were identified. Then ...

  7. HBR's Most-Read Research Articles of 2021

    In this end-of-year roundup, we share key insights and trends from our most-read research articles of 2021. Post. Post. Share. Annotate. Save. Get PDF. Buy Copies. Print.

  8. Once-Weekly Semaglutide in Adults with Overweight or Obesity

    This article was published on February 10, 2021, at A data sharing statement provided by the authors is available with the full text of this article at Supported by Novo Nordisk .

  9. Findings from the Global Burden of Disease Study 2021

    In The Lancet, we have published the findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 in a series of six Articles.1-6 GBD began in 1991 and has continued over the past three decades to provide a comprehensive empirical assessment of health around the world.7 With each iteration GBD has become more detailed, including more causes, risks, and locations ...

  10. Trends in Diabetes Treatment and Control in U.S. Adults, 1999-2018

    In addition, our study showed a decrease in blood-pressure control that emerged after 2014, paralleling a recent decline in blood-pressure control in the general U.S. population. 20 Suboptimal ...

  11. Striking findings from 2021

    As 2021 draws to a close, here are some of Pew Research Center's most striking research findings from the past year. These 15 findings cover subjects ranging from extreme weather to the COVID-19 pandemic and ongoing demographic shifts in the United States. And they represent just a small slice of the year's full list of research publications.

  12. 15 Trending Nutrition Research Articles from 2021

    January 5, 2022 by ASN Staff. 2021 has come to a close, take a look back at some trending nutrition research articles from ASN's four journals: The Journal of Nutrition, The American Journal of Clinical Nutrition, Advances in Nutrition, and Current Developments in Nutrition. Here are 15 articles that were mentioned the most in news and social ...

  13. New Aspects of Diabetes Research and Therapeutic Development

    The downsides, however, are that 1) hypoglycemia is a constant threat, 2) proper insulin doses are not trivial to calculate, 3) compliance can vary especially in children and young adults, and 4) there can be side effects of a variety of types. Nonetheless, insulin therapy remains a mainstay treatment of diabetes.

  14. The 10 Most Significant Education Studies of 2021

    3. The Surprising Power of Pretesting. Asking students to take a practice test before they've even encountered the material may seem like a waste of time—after all, they'd just be guessing. But new research concludes that the approach, called pretesting, is actually more effective than other typical study strategies.

  15. Top 20 Research Studies of 2021 for Primary Care Physicians

    Continue Reading. This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium ...

  16. Update on Hypertension Research in 2021

    Here, we reviewed studies related to RDN published in Hypertension Research in 2021 (Fig. 10). The antihypertensive effect of RDN is mediated by interrupting both the efferent outputs from the brain to the kidney and the afferent inputs from the kidney to the brain, suppressing systemic sympathetic outflow [165, 166].

  17. A Practical Guide to Writing Quantitative and Qualitative Research

    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 ...

  18. The top 10 journal articles

    1. COVID-19 disruption on college students: Academic and socioemotional implications. Tasso, A. F., Hisli Sahin, N., San Roman, G. J. This study in Psychological Trauma: Theory, Research, Practice, and Policy (Vol. 13, No. 1) reveals that college students experienced emotional distress on many levels during the COVID-19 pandemic. Researchers surveyed 257 students at a U.S. college who all ...

  19. Social Media Use in 2021

    In a pattern consistent with past Center studies on social media use, there are some stark age differences. Some 84% of adults ages 18 to 29 say they ever use any social media sites, which is similar to the share of those ages 30 to 49 who say this (81%). By comparison, a somewhat smaller share of those ages 50 to 64 (73%) say they use social ...

  20. The top 10 journal articles of 2020

    Students with high emotional intelligence get better grades and score higher on standardized tests, according to the research presented in this article in Psychological Bulletin (Vol. 146, No. 2). Researchers analyzed data from 158 studies representing more than 42,529 students—ranging in age from elementary school to college—from 27 countries.

  21. Journal of Health Psychology: Sage Journals

    Journal of Health Psychology is a leading international peer reviewed journal that aims to support and help shape research in health psychology from around the world.It provides a platform for traditional empirical analyses as well as more qualitative and/or critically oriented approaches.

  22. Internet use statistically associated with higher wellbeing, finds new

    The study encompassed more than two million participants psychological wellbeing from 2006-2021 across 168 countries, in relation to internet use and psychological well-being across 33,792 different statistical models and subsets of data, 84.9% of associations between internet connectivity and wellbeing were positive and statistically significant.

  23. Patients love telehealth—physicians are not so sure

    To help our clients understand responses to COVID-19, McKinsey launched a research effort to gather insights from physicians into how the pandemic is affecting their ability to provide care, their financial situation, and their level of stress, as well as what kind of support would interest them. Nationwide surveys were conducted online in 2020 from April 27-May 5 (538 respondents), July 22 ...

  24. Enhancing research accessibility and reuse: new study outlines

    The study found that most research performing organisations in these Member States consider SPR to have at least a moderate impact on their research activities, including the share of research publications in open access. However, the study indicates that many researchers remain unaware of this right and a majority of research performing ...

  25. Summer of 2023 was hottest in 2,000 years, study finds

    In fact, the study's publication comes days after a survey of 380 leading scientists from the IPCC revealed deep concerns about the world's ability to limit global warming to 1.5 degrees.

  26. Virome Sequencing Identifies H5N1 Avian Influenza in Wastewater from

    Avian influenza (serotype H5N1) is a highly pathogenic virus that emerged in domestic waterfowl in 1996. Over the past decade, zoonotic transmission to mammals, including humans, has been reported. Although human to human transmission is rare, infection has been fatal in nearly half of patients who have contracted the virus in past outbreaks. The increasing presence of the virus in ...