uses of research findings

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts
• Submit your manuscript

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Implementing research findings into practice

Frameworks and guidance.

Kent, Bridie PhD, RN

Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK

Correspondence: Bridie Kent, PhD, RN, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK. E-mail: [email protected]

Background: 

Health services across the world are constantly introducing changes into their workplaces and these affect many people. As new robust and reliable evidence becomes available, it is important that changes to practice are made. As health professionals, we have to be flexible and accommodate this change; for some this means disruption, challenge and having to learn new ways of doing things. Barriers exist that prevent or delay changes being made to established practice in all organizations, whatever the culture. This is a world-wide problem. It is important to understand the barriers to change so that solutions can be found. Some changes that are needed don’t occur, because clinicians are unaware of the new evidence, while for others there needs to be something introduced to drive forward the change. This process is not a passive one; active involvement is needed for the change to be successful. Individual attitudes and beliefs play a significant part in change, and their influences are often underestimated, so these also need to be explored. Practice change may require new skills to be learnt – another obstacle for change.

In this short communication, the science behind evidence implementation is introduced and then some of the factors that impact on change are explored, drawing on three useful models and frameworks.

Conclusion: 

Ultimately there remains a gap between interventions that research has shown to be effective and their translation into practice; this has to be closed.

In 2012, Grimshaw et al. 1 reported that consistently, research findings fail to be translated in a timely manner into practice and policy. Consequently there has been a growing interest in how this can be rectified. The science related to implementation of evidence into practice has been evolving as a means of identifying the methods and approaches to address these problems, driving both small and large-scale change. Implementation should be seen as a process, rather than an outcome, however, and as May commented, this is a complex mix of actions and activities 2 , all aimed at securing behaviour change.

The use of terminology to explain the process of implementation has created some confusion, because across the world different disciplines use different terms for the same concept. Health has favoured Knowledge Translation with the key influence being from Canada, while the United Kingdom has been moving towards using the words Knowledge Mobilization. Other terms include research translation, knowledge exchange and implementation science. To complicate matters further, more recently the term ’improvement science’ has been introduced, and is found primarily in the UK and US literature. It provides another framework for health research and other activities based on healthcare improvement 3 . Miltner et al. 4 argue that the ‘Lack of consensus adds to the tension about the core of quality improvement research (QIR)/Improvement Science’ and that the inability to clearly define QIR and improvement science slows down the speed of change.

The aim of this article is to explore how the use of frameworks can help to guide and inform implementation activities. Three of these will be drawn up to highlight how they have been used to bring about practice change.

When considering theories or frameworks related to the science of implementation, there are largely three broad groups:

• Motivational: explain behaviour of people who have not yet established intention – for example Theory of Planned Behaviour. 5
• Action: explain behaviour of people who have identified a need to change – for example Operant Conditioning. 6
• Organizational: explain ‘institution’ level change – for example Diffusion of Innovations theory. 7

When deciding what theory to use, a pragmatic choice is best, in that it is important to explore the key focus of attention for the change that is planned and find the theory that has the best fit or alignment with this.

For the purpose of this communication, three approaches to implementation have been singled out, as these are ones that have been shown to be useful in a number of countries throughout the world. These are The Theoretical Domains Framework (TDF) 8 ; the Integrated (i) PARIHS framework 9 ; and the Knowledge to Action framework (KTA). 10 Each of these will be outlined briefly and its use in practice highlighted.

The Theoretical Domains Framework

The TDF 8 was developed using an expert consensus process and validation (led by Susan Michie, from University College London) to identify psychological and organizational theory relevant to health practitioner clinical behaviour change. The framework consisted, initially, of a set of 12 domains covering the main factors influencing practitioner clinical behaviour and behaviour change, then a further two were added, making 14 in total. For more information about the domains, please see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743963/pdf/v014p00026.pdf (accessed 18 October 2018). Each of these domains contains a number of concepts ( http://www.implementationscience.com/content/7/1/37/table/T2 ). The approach was informed by the development of the COM-B model, ( http://www.ktcanada.ohri.ca/workshop_tdf/TDF_Michie.pdf ), which also led to the development of the Behaviour Change Wheel. 11

The TDF has been widely used in implementation studies across the world, and there is a collection of articles, all open access, in Implementation Science ( http://www.implementationscience.com/series/TDF ).

The model was developed originally by nurse academics/researchers 12 at the United Kingdom's Royal College of Nursing to aid the implementation of research evidence into practice. In its original form, there were three main areas of activity to assess ranging from weak to strong: Evidence, Context and Facilitation.

More recently, the model has been revisited by two of the original team 9 and the concepts revised to more accurately reflect successful implementation. This activity includes:

• Achievement of agreed implementation/project goals.
• The uptake and embedding of the innovation in practice.
• Individuals, teams and stakeholders are engaged, motivated and ‘own’ the innovation.
• Variation related to context is minimized across implementation settings.

A number of factors are identified for consideration under each of the three headings: Innovation, Recipients, Context.

For an example of the use of i-PARiHS, see Harvey and Kitson's work. 9,13

Knowledge to Action Framework

This framework was developed in Canada by Graham et al. 10 at the Canadian Institutes for Health Research. It focuses on two main areas of activity: knowledge creation and knowledge tailoring ( Fig. 1 ). The first phase explores the creation of knowledge tools or products, such as an intervention or a clinical guideline that is informed by evidence. The second phase guides the implementation of the product, including the exploration of barriers and enablers to implementation, any tailoring that may be required and the evaluation of the implementation process.

The KTA framework has been used in small scale and large-scale implementation studies; an example of the latter is the WHO study aimed at combatting maternal and perinatal health problems ( http://www.who.int/reproductivehealth/topics/best_practices/greatproject_KTAframework/en/ ).

There is a growing recognition of the need to do things differently and embrace change to facilitate improvements for our patients.

We need to understand the factors that impact, positively and negatively, on our individual practice.

Alone we can achieve small changes, but together we can drive forward significant change – we can’t allow the translation of research findings into any change in clinical practice to take at least 17 years. 14

Acknowledgements

Conflict of interest.

The author is the Editorial Board member for Implementation Science; Director of The University of Plymouth Centre for Innovations in Health and Social Care: A Joanna Briggs Institute Centre of Excellence.

evidence-based healthcare; implementation science; Joanna Briggs Institute; knowledge translation

• + Favorites
• View in Gallery

• - Google Chrome

Intended for healthcare professionals

• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• Making better use of...

Making better use of research findings

• Related content
• Peer review
• Andrew Haines , professor of primary health care ([email protected]) a ,
• Anna Donald , lecturer. b
• a Department of Primary Care and Population Sciences, Royal Free and University College London Schools of Medicine, London NW3 2PF
• b Department of Epidemiology and Public Health, University College London Medical School
• Correspondence to: Professor Haines

This is the first in a series of eight articles analysing the gap between research and practice

Series editors: Andrew Haines and Anna Donald

There is increasing interest in implementing research findings in practice both because of a growing awareness of the gap between clinical practice and the findings of research and also because of the need to show that public investment in research results in benefits for patients. Improved understanding of the reasons for the uptake of research findings requires insights from a range of disciplines. In order to promote the uptake of research findings it is necessary to identify potential barriers to implementation and to develop strategies to overcome them. Specific interventions that can be used to promote change in practice include using clinical guidelines and computerised decision support systems, developing educational programmes, communicating research findings to patients, and developing strategies for organisational change.

Interest in how best to promote the uptake of research findings has been fuelled by a number of factors including the well documented disparities between clinical practice and research evidence of effective interventions. Examples include interventions in the management of cardiac failure, secondary prevention of heart disease, 1 atrial fibrillation, 2 menorrhagia, 3 and pregnancy and childbirth. 4 In the United Kingdom the advent of the NHS research and development programme has led to greater involvement of NHS personnel in setting priorities 5 and to the establishment of a programme to evaluate different methods of promoting the implementation of research findings. 6 The concept of pay back on research 7 has also been developed, resulting in a framework that can be used to assess the benefits arising from research.

Relying on the passive diffusion of information to keep health professionals' knowledge up to date is doomed to failure in a global environment in which …

Log in using your username and password

BMA Member Log In

If you have a subscription to The BMJ, log in:

• Need to activate
• Log in via institution
• Log in via OpenAthens

Log in through your institution

Subscribe from £184 *.

Subscribe and get access to all BMJ articles, and much more.

* For online subscription

Access this article for 1 day for: £50 / $60/ €56 ( excludes VAT )

You can download a PDF version for your personal record.

Buy this article

• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

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

The results section is where you report the findings of your study based upon the methodology [or methodologies] you applied to gather information. The results section should state the findings of the research arranged in a logical sequence without bias or interpretation. A section describing results should be particularly detailed if your paper includes data generated from your own research.

Annesley, Thomas M. "Show Your Cards: The Results Section and the Poker Game." Clinical Chemistry 56 (July 2010): 1066-1070.

Importance of a Good Results Section

When formulating the results section, it's important to remember that the results of a study do not prove anything . Findings can only confirm or reject the hypothesis underpinning your study. However, the act of articulating the results helps you to understand the problem from within, to break it into pieces, and to view the research problem from various perspectives.

The page length of this section is set by the amount and types of data to be reported . Be concise. Use non-textual elements appropriately, such as figures and tables, to present findings more effectively. In deciding what data to describe in your results section, you must clearly distinguish information that would normally be included in a research paper from any raw data or other content that could be included as an appendix. In general, raw data that has not been summarized should not be included in the main text of your paper unless requested to do so by your professor.

Avoid providing data that is not critical to answering the research question . The background information you described in the introduction section should provide the reader with any additional context or explanation needed to understand the results. A good strategy is to always re-read the background section of your paper after you have written up your results to ensure that the reader has enough context to understand the results [and, later, how you interpreted the results in the discussion section of your paper that follows].

Bavdekar, Sandeep B. and Sneha Chandak. "Results: Unraveling the Findings." Journal of the Association of Physicians of India 63 (September 2015): 44-46; Brett, Paul. "A Genre Analysis of the Results Section of Sociology Articles." English for Specific Speakers 13 (1994): 47-59; Go to English for Specific Purposes on ScienceDirect;Burton, Neil et al. Doing Your Education Research Project . Los Angeles, CA: SAGE, 2008; Results. The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Kretchmer, Paul. Twelve Steps to Writing an Effective Results Section. San Francisco Edit; "Reporting Findings." In Making Sense of Social Research Malcolm Williams, editor. (London;: SAGE Publications, 2003) pp. 188-207.

Structure and Writing Style

I.  Organization and Approach

For most research papers in the social and behavioral sciences, there are two possible ways of organizing the results . Both approaches are appropriate in how you report your findings, but use only one approach.

• Present a synopsis of the results followed by an explanation of key findings . This approach can be used to highlight important findings. For example, you may have noticed an unusual correlation between two variables during the analysis of your findings. It is appropriate to highlight this finding in the results section. However, speculating as to why this correlation exists and offering a hypothesis about what may be happening belongs in the discussion section of your paper.
• Present a result and then explain it, before presenting the next result then explaining it, and so on, then end with an overall synopsis . This is the preferred approach if you have multiple results of equal significance. It is more common in longer papers because it helps the reader to better understand each finding. In this model, it is helpful to provide a brief conclusion that ties each of the findings together and provides a narrative bridge to the discussion section of the your paper.

NOTE:   Just as the literature review should be arranged under conceptual categories rather than systematically describing each source, you should also organize your findings under key themes related to addressing the research problem. This can be done under either format noted above [i.e., a thorough explanation of the key results or a sequential, thematic description and explanation of each finding].

II.  Content

In general, the content of your results section should include the following:

• Introductory context for understanding the results by restating the research problem underpinning your study . This is useful in re-orientating the reader's focus back to the research problem after having read a review of the literature and your explanation of the methods used for gathering and analyzing information.
• Inclusion of non-textual elements, such as, figures, charts, photos, maps, tables, etc. to further illustrate key findings, if appropriate . Rather than relying entirely on descriptive text, consider how your findings can be presented visually. This is a helpful way of condensing a lot of data into one place that can then be referred to in the text. Consider referring to appendices if there is a lot of non-textual elements.
• A systematic description of your results, highlighting for the reader observations that are most relevant to the topic under investigation . Not all results that emerge from the methodology used to gather information may be related to answering the " So What? " question. Do not confuse observations with interpretations; observations in this context refers to highlighting important findings you discovered through a process of reviewing prior literature and gathering data.
• The page length of your results section is guided by the amount and types of data to be reported . However, focus on findings that are important and related to addressing the research problem. It is not uncommon to have unanticipated results that are not relevant to answering the research question. This is not to say that you don't acknowledge tangential findings and, in fact, can be referred to as areas for further research in the conclusion of your paper. However, spending time in the results section describing tangential findings clutters your overall results section and distracts the reader.
• A short paragraph that concludes the results section by synthesizing the key findings of the study . Highlight the most important findings you want readers to remember as they transition into the discussion section. This is particularly important if, for example, there are many results to report, the findings are complicated or unanticipated, or they are impactful or actionable in some way [i.e., able to be pursued in a feasible way applied to practice].

NOTE:   Always use the past tense when referring to your study's findings. Reference to findings should always be described as having already happened because the method used to gather the information has been completed.

III.  Problems to Avoid

When writing the results section, avoid doing the following :

• Discussing or interpreting your results . Save this for the discussion section of your paper, although where appropriate, you should compare or contrast specific results to those found in other studies [e.g., "Similar to the work of Smith [1990], one of the findings of this study is the strong correlation between motivation and academic achievement...."].
• Reporting background information or attempting to explain your findings. This should have been done in your introduction section, but don't panic! Often the results of a study point to the need for additional background information or to explain the topic further, so don't think you did something wrong. Writing up research is rarely a linear process. Always revise your introduction as needed.
• Ignoring negative results . A negative result generally refers to a finding that does not support the underlying assumptions of your study. Do not ignore them. Document these findings and then state in your discussion section why you believe a negative result emerged from your study. Note that negative results, and how you handle them, can give you an opportunity to write a more engaging discussion section, therefore, don't be hesitant to highlight them.
• Including raw data or intermediate calculations . Ask your professor if you need to include any raw data generated by your study, such as transcripts from interviews or data files. If raw data is to be included, place it in an appendix or set of appendices that are referred to in the text.
• Be as factual and concise as possible in reporting your findings . Do not use phrases that are vague or non-specific, such as, "appeared to be greater than other variables..." or "demonstrates promising trends that...." Subjective modifiers should be explained in the discussion section of the paper [i.e., why did one variable appear greater? Or, how does the finding demonstrate a promising trend?].
• Presenting the same data or repeating the same information more than once . If you want to highlight a particular finding, it is appropriate to do so in the results section. However, you should emphasize its significance in relation to addressing the research problem in the discussion section. Do not repeat it in your results section because you can do that in the conclusion of your paper.
• Confusing figures with tables . Be sure to properly label any non-textual elements in your paper. Don't call a chart an illustration or a figure a table. If you are not sure, go here .

Annesley, Thomas M. "Show Your Cards: The Results Section and the Poker Game." Clinical Chemistry 56 (July 2010): 1066-1070; Bavdekar, Sandeep B. and Sneha Chandak. "Results: Unraveling the Findings." Journal of the Association of Physicians of India 63 (September 2015): 44-46; Burton, Neil et al. Doing Your Education Research Project . Los Angeles, CA: SAGE, 2008;  Caprette, David R. Writing Research Papers. Experimental Biosciences Resources. Rice University; Hancock, Dawson R. and Bob Algozzine. Doing Case Study Research: A Practical Guide for Beginning Researchers . 2nd ed. New York: Teachers College Press, 2011; Introduction to Nursing Research: Reporting Research Findings. Nursing Research: Open Access Nursing Research and Review Articles. (January 4, 2012); Kretchmer, Paul. Twelve Steps to Writing an Effective Results Section. San Francisco Edit ; Ng, K. H. and W. C. Peh. "Writing the Results." Singapore Medical Journal 49 (2008): 967-968; Reporting Research Findings. Wilder Research, in partnership with the Minnesota Department of Human Services. (February 2009); Results. The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Schafer, Mickey S. Writing the Results. Thesis Writing in the Sciences. Course Syllabus. University of Florida.

Writing Tip

Why Don't I Just Combine the Results Section with the Discussion Section?

It's not unusual to find articles in scholarly social science journals where the author(s) have combined a description of the findings with a discussion about their significance and implications. You could do this. However, if you are inexperienced writing research papers, consider creating two distinct sections for each section in your paper as a way to better organize your thoughts and, by extension, your paper. Think of the results section as the place where you report what your study found; think of the discussion section as the place where you interpret the information and answer the "So What?" question. As you become more skilled writing research papers, you can consider melding the results of your study with a discussion of its implications.

Driscoll, Dana Lynn and Aleksandra Kasztalska. Writing the Experimental Report: Methods, Results, and Discussion. The Writing Lab and The OWL. Purdue University.

• << Previous: Insiderness
• Next: Using Non-Textual Elements >>
• Last Updated: Sep 4, 2024 9:40 AM
• URL: https://libguides.usc.edu/writingguide

Communicating and Disseminating Research Findings

• First Online: 23 September 2017

Cite this chapter

• Amber E. Budden 3 &
• William K. Michener 3  

2200 Accesses

1 Citations

This chapter provides guidance on approaches and best practices for communicating and disseminating research findings to technical audiences via scholarly publications such as peer-reviewed journal articles, abstracts, technical reports, books and book chapters. We also discuss approaches for communicating findings to more general audiences via newspaper and magazine articles and highlight best practices for designing effective figures that explain and support the research findings that are presented in scientific and general audience publications. Research findings may also be presented verbally to educate, change perceptions and attitudes, or influence policy and resource management. Key topics include simple steps for giving effective presentations and best practices for designing slide text and graphics, posters and handouts. Websites and social media are increasingly important mechanisms for communicating science. We discuss forms of commonly used social media, identify simple steps for effectively using social media, and highlight ways to track and understand your social media and overall research impact using various metrics and altmetrics.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

How to Write and Publish an Empirical Report

Types of Dissemination

Alred GJ, Brusaw CT, Oliu WE (2011) Handbook of technical writing, 10th edn. St. Martin’s Press, Bedford

Google Scholar  

Altmetric (2016) Altmetric. https://www.altmetric.com . Accessed 18 Aug 2016

Bale R, Neveln ID, Bhalla APS et al (2015) Convergent evolution of mechanically optimal locomotion in aquatic invertebrates and vertebrates. PLoS Biol 13(4):e1002123. doi: 10.1371/journal.pbio.1002123

Article   Google Scholar  

Bergou AJ, Swartz SM, Vejdani H et al (2015) Falling with style: bats perform complex aerial rotations by adjusting wing inertia. PLoS Biol 13(11):e1002297. doi: 10.1371/journal.pbio.1002297

Bornmann L, Mutz R (2015) Growth rates of modern science: a bibliometric analysis based on the number of publications and cited references. J Assn Inf Sci Technol 66:2215–2222. doi: 10.1002/asi.23329

Article   CAS   Google Scholar  

Bourne PE (2005) Ten simple rules for getting published. PLoS Comput Biol 1(5):e57. doi: 10.1371/journal.pcbi.0010057

Bourne PE (2007) Ten simple rules for making good oral presentations. PLoS Comput Biol 3(4):e77. doi: 10.1371/journal.pcbi.0030077

Brody T, Harnad S, Carr L (2006) Earlier web usage statistics as predictors of later citation impact. J Am Soc Inf Sci Technol 57:1060–1072. doi: 10.1002/asi.20373

Chaves ÓM, Bicca-Marques JC (2016) Feeding strategies of brown howler monkeys in response to variations in food availability. PLoS One 11(2):e0145819. doi: 10.1371/journal.pone.0145819

Cho M (2013) The science behind fonts (and how they make you feel). http://thenextweb.com/dd/2013/12/23/science-behind-fonts-make-feel/ . Accessed 1 Aug 2016

Cleveland WS, McGill R (1985) Graphical perception and graphical methods for analyzing scientific data. Science 229(4716):828–833

Cook RB, Wie Y, Hook LA et al (2017) Preserve: protecting data for long-term use, Chapter 6. In: Recknagel F, Michener W (eds) Ecological informatics. Data management and knowledge discovery. Springer, Heidelberg

Cornell University (2016) The Cornell Lab of Ornithology. http://www.birds.cornell.edu/ . Accessed 18 Aug 2016

Croxall B (2014) Ten tips for tweeting at conferences. http://chronicle.com/blogs/profhacker/ten-tips-for-tweeting-at-conferences/54281 . Accessed 15 June 2016

CTAN (2016) CTAN: Package tufte-latex. http://www.ctan.org/pkg/tufte-latex . Accessed 26 Jul 2016

DataONE (2016) DataONE. https://www.facebook.com/DataONEorg/ . Accessed 25 Nov 2016

Duarte N (2008) slide:ology: the art and science of creating great presentations. O’Reilly Media, Sebastopol, CA

Duarte N (2010) Resonate: present visual stories that transform audiences. Wiley, Hoboken, NJ

Duckett J (2011) HTML and CSS: design and build websites, 1st edn. Wiley, Indianapolis

Ekins S, Perlstein EO (2014) Ten simple rules of live tweeting at scientific conferences. PLoS Comput Biol 10(8):e1003789. doi: 10.1371/journal.pcbi.1003789

Erren TC, Bourne PE (2007) Ten simple rules for a good poster presentation. PLoS Comput Biol 3(5):e102. doi: 10.1371/journal.pcbi.0030102

Eysenbach G (2011) Can tweets predict citations? Metrics of social impact based on Twitter and correlation with traditional metrics of scientific impact. J Med Internet Res 13(4):e123

Faulkes Z (2016) Better posters. http://betterposters.blogspot.com/ . Accessed 26 Jul 2016

Few S (2009) Now you see it: simple visualization techniques for quantitative analysis. Analytics Press, Oakland, CA

Few S (2012) Show me the numbers: designing tables and graphs to enlighten, 2nd edn. Analytics Press, Burlingame, CA

Few S (2016) Perceptual edge – examples. http://www.perceptualedge.com/examples.php . Accessed 26 Jul 2016

Forant T (2013) 10 social media best practices for brand engagement. https://www.marketingcloud.com/blog/social-media-best-practices-for-brand-engagement/ . Accessed 16 May 2016

GLEON (2016) GLEON: global lake ecological observatory network. http://gleon.org . Accessed 18 Aug 2016

Hampton SE, Anderson SS, Bagby SC et al (2015) The Tao of open science for ecology. Ecosphere 6(7):1–13. doi: 10.1890/ES14-00402.1

Hines K (2015) All of the social media metrics that matter. http://sproutsocial.com/insights/social-media-metrics-that-matter/ . Accessed 26 Jul 2016

Hirsch JE (2005) An index to quantify an individual’s scientific research output. Proc Natl Acad Sci U S A 102:16569–16572

Impactstory (2016) Impactstory. https://impactstory.org . Accessed 18 Aug 2016

Klout Inc. (2015) Klout. https://klout.com . Accessed 10 Aug 2016

Kronick DA (1976) A history of scientific & technical periodicals: the origins and development of the scientific and technical press, 1665-1790. Scarecrow Press, Metuchen, NJ

Krug S (2014) Don’t make me think, revisited: a common sense approach to web usability, 3rd edn. New Riders, San Francisco

Leek J (2016) How to be a modern scientist. Lean Publishing, Victoria, BC

Lin J, Fenner M (2013) Altmetrics in evolution: defining and redefining the ontology of article-level metrics. Inf Stand Q 25:20–26

Lister AL, Datta RS, Hofmann O et al (2010) Live coverage of scientific conferences using web technologies. PLoS Comput Biol 6(1). doi: 10.1371/journal.pcbi.1000563

LTER (2016) The long term ecological research network. http://www.lternet.edu . Accessed 18 Aug 2016

Malson G (2015) Preparing a research poster for a conference. Clin Pharm 7(3). doi: 10.1211/CP.2015.20068193

Michener WK (2017) Data discovery, Chapter 7. In: Recknagel F, Michener W (eds) Ecological informatics. Data management and knowledge discovery. Springer, Heidelberg

NEON (2016) National Ecological Observatory Network. https://www.facebook.com/NEONScienceData/ . Accessed 25 Nov 2016

NSF (2016) National Science Foundation. https://www.facebook.com/US.NSF/ . Accessed 25 Nov 2016

NutNet (2016) Nutrient network: a global research cooperative. http://www.nutnet.umn.edu . Accessed 18 Aug 2016

Piwowar H (2013) Altmetrics: value all research products. Nature 493:159. doi: 10.1038/493159a

CAS   Google Scholar  

Piwowar H, Priem J (2013) The power of altmetrics on a CV. Bull Am Soc Inf Sci Technol 39:10–13

Plunkett S (2016) Tips on poster presentations at professional conference. http://www.csun.edu/plunk/documents/poster_presentation.pdf . Accessed 1 Jun 2016

Priem J, Piwowar HA, Hemminger BM (2012) Altmetrics in the wild: using social media to explore scholarly impact. ArXiv.org . http://arxiv.org/abs/1203.4745 . Accessed 5 Feb 2016

Purrington CB (2016) Designing conference posters. http://colinpurrington.com/tips/poster-design . Accessed 24 May 2016

R Markdown (2016) Tufte handouts. http://rmarkdown.rstudio.com/tufte_handout_format.html . Accessed 26 Jul 2016

Robbins JN (2012) Learning web design: a beginner’s guide to HTML, CSS, JavaScript, and web graphics, 4th edn. O’Reilly Media, Sebastopol, CA

Robbins NB (2013) Creating more effective graphs. Wiley, Hoboken, NJ

Robbins NB (2016) http://www.nbr-graphs.com/examples/ . Accessed 26 Jul 2016

Rose PM, Kennard MJ, Moffatt DB et al (2016) Testing three species distribution modelling strategies to define fish assemblage reference conditions for stream bioassessment and related applications. PLoS One 11(1):e0146728. doi: 10.1371/journal.pone.0146728

Rougier NP, Droettboom M, Bourne PE (2014) Ten simple rules for better figures. PLoS Comput Biol 10(9):e1003833. doi: 10.1371/journal.pcbi.1003833

Statista (2016) Leading social networks worldwide as of April 2016, ranked by number of active users (in millions). http://www.statista.com/statistics/272014/global-social-networks-ranked-by-number-of-users/ . Accessed 05 May 2016

Strunk W Jr, White EB (1999) The elements of style, 4th edn. Longman, New York

Sullivan C (2011) Strata 2011 [day 1]: communicating data clearly. http://infosthetics.com/archives/2011/02/strata_2011_communicating_data_clearly.html Accessed 10 Aug 2016

Thelwall M, Haustein S, Larivière V et al (2013) Do altmetrics work? Twitter and ten other social web services. PLoS ONE 8(5):e64841. doi: 10.1371/journal.pone.0064841

Tufte EG (1983) The visual display of quantitative information. Graphics Press, Cheshire, CT

Tufte ER (1990) Envisioning information. Graphics Press, Cheshire, CT

Tufte ER (1997) Visual explanations: images and quantities, evidence and narrative. Graphics Press, Cheshire, CT

Tufte ER (2003) The cognitive style of Powerpoint. Graphics Press, Cheshire, CT

Tufte ER (2006) Beautiful evidence. Graphics Press, Cheshire, CT

Tufte E (2016) The work of Edward Tufte and Graphics Press. https://www.edwardtufte.com/tufte/ . Accessed 26 Jul 2016

University of Chicago Press Staff (2010) The Chicago manual of style, 16th edn. University of Chicago Press, Chicago

Weinberger CJ, Evans JA, Allesina S (2015) Ten simple (empirical) rules for writing science. PLoS Comput Biol 11(4):e1004205. doi: 10.1371/journal.pcbi.1004205

Widrich L (2013) 5 essential social media metrics to track and how to improve them. https://blog.bufferapp.com/social-media-metrics-improve . Accessed 26 Jul 2016

Witt C (2016) Effective handouts. http://wittcom.com/effective-handouts/ . Accessed 26 Jul 2016

Wong DM (2013) The Wall Street Journal guide to information graphics: the dos and don'ts of presenting data, facts, and figures. Norton, New York

Zhang W (2014) Ten simple rules for writing research papers. PLoS Comput Biol 10(1):e1003453. doi: 10.1371/journal.pcbi.1003453

Zinsser W (2006) On writing well: the classic guide to writing nonfiction, 30th edn. Harper Perennial, New York

Download references

Author information

Authors and affiliations.

University of New Mexico, Albuquerque, NM, USA

Amber E. Budden & William K. Michener

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Amber E. Budden .

Editor information

Editors and affiliations.

School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia

Friedrich Recknagel

College of University Libraries, University of New Mexico, Albuquerque, New Mexico, USA

William K. Michener

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Budden, A.E., Michener, W.K. (2018). Communicating and Disseminating Research Findings. In: Recknagel, F., Michener, W. (eds) Ecological Informatics. Springer, Cham. https://doi.org/10.1007/978-3-319-59928-1_14

Download citation

DOI : https://doi.org/10.1007/978-3-319-59928-1_14

Published : 23 September 2017

Publisher Name : Springer, Cham

Print ISBN : 978-3-319-59926-7

Online ISBN : 978-3-319-59928-1

eBook Packages : Earth and Environmental Science Earth and Environmental Science (R0)

Share this chapter

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• Privacy Policy

Home » Research Summary – Structure, Examples and Writing Guide

Research Summary – Structure, Examples and Writing Guide

Table of Contents

Research Summary

Definition:

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

Structure of Research Summary

The Structure of a Research Summary typically include:

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

How to Write Research Summary

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

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

Example of Research Summary

Here is an example of a research summary:

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

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

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

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

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

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

References :

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

Purpose of Research Summary

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

Research summaries serve several purposes, including:

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

Characteristics of Research Summary

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

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

When to write Research Summary

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

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

Advantages of Research Summary

Research summaries offer several advantages, including:

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

Limitations of Research Summary

Limitations of the Research Summary are as follows:

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

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Research Project – Definition, Writing Guide and...

Survey Instruments – List and Their Uses

Research Report – Example, Writing Guide and...

Table of Contents – Types, Formats, Examples

Research Design – Types, Methods and Examples

References in Research – Types, Examples and...

• Open access
• Published: 28 May 2015

Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh

• David Roger Walugembe 1 , 2 ,
• Suzanne N. Kiwanuka 1 ,
• Joseph K. B. Matovu 1 ,
• Elizeus Rutebemberwa 1 &
• Laura Reichenbach 2  

Health Research Policy and Systems volume  13 , Article number:  26 ( 2015 ) Cite this article

19k Accesses

12 Citations

3 Altmetric

Metrics details

In striving to contribute towards improved health outcomes, health research institutions generate and accumulate huge volumes of relevant but often underutilized data. This study explores activities undertaken by researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), an international research institution that promotes the utilization of their findings in the policymaking processes in Bangladesh.

The study used an exploratory case study design and employed qualitative methods to explore activities implemented to promote research utilization and the extent to which researchers felt that their findings contributed to the policymaking process. Data were collected between September and December 2011 through key informant interviews, focus group discussions with study investigators, and database and document reviews. We reviewed findings from 19 reproductive health studies conducted and completed by icddr,b researchers between 2001 and 2011. We interviewed 21 key informants, including 13 researchers, two policy makers, and six programme implementers. Data were entered into Microsoft Word and analyzed manually following a thematic framework approach. Following the World Health Organization/Turning Research into Practice (WHO/TRIP) framework, three case studies of how research findings were utilized in the policymaking processes in Bangladesh were documented.

Activities implemented to promote research utilization included conducting dissemination workshops, publishing scientific papers, developing policy briefs, providing technical assistance to policymakers and programme implementers, holding one-on-one meetings, and joining advocacy networks. The majority of the researchers (12 of 13) reported that their study findings were utilized to influence policymaking processes at different levels. However, some researchers reported being unaware of whether and how their findings were utilized. As regards actual utilization of research findings, the evidence from the three case studies indicate that research findings can be utilized instrumentally, conceptually and symbolically, and at different stages within the policymaking process, including agenda setting and policy formulation and implementation.

Conclusions

The results show that research findings from icddr,b were promoted and utilized in health policymaking processes in Bangladesh using a variety of utilization approaches. These results suggest a need for using multiple approaches to promote utilization of research findings in health policymaking processes.

Peer Review reports

Research utilization refers to “making decisions concerning policy, advocacy and resource allocation, planning and management, and program systems development and strengthening, using information generated from research” [ 1 ]. The concept of research utilization has been described using a variety of terminologies, including ‘knowledge translation’, ‘knowledge management’, ‘knowledge utilization’, and ‘research dissemination’, among others. However, research utilization differs from all these terminologies in that it focuses on purposes and impact of the study rather than mere knowledge management or dissemination of results. More specifically, research utilization focuses on what researchers want people to receive from their research results, how they want people to make use of the ideas, information, or products resulting from their research, and how people are actually using these [ 2 ]. Many models have been suggested to explain the concept of research utilization in policymaking, some of which include frameworks for knowledge transfer as well as knowledge-driven, problem solving, interactive, enlightenment, and tactical models [ 3 – 6 ].

Research utilization can enhance policy decisions about resource allocation for services and programmes and decisions about how to deliver and finance those services [ 7 , 8 ]. It can facilitate innovative changes that lead to improved client outcomes and promote critical thinking and reflective practice. In addition to ensuring that provision of safe and effective care practice is based on current, scientifically sound knowledge, effective research utilization validates researcher efforts, motivates scholars to continue to discover new knowledge, and reinforces professional accountability [ 9 ].

According to Weiss [ 10 ], research findings may be utilized in policymaking in three main forms: as data and findings, as ideas and criticism, or as briefs and arguments for action. Hanney et al. [ 4 ] argue that utilization of research findings in policymaking is sometimes instrumental, conceptual, or symbolic. Instrumental use involves the use of research findings directly in policy formulation; conceptual use refers to the gradual sedimentation of insight, theories, concepts, and perspectives; and symbolic use refers to use of research to support continuation of an already established position [ 4 , 11 ]. Therefore, there are three phases of policymaking where research utilization might occur, namely agenda setting, policy formulation, and policy implementation [ 12 ].

Although previous studies have been conducted on health research utilization [ 13 – 20 ], there is limited data on how health research institutions promote utilization of their research findings to inform policy development and strategic planning. In striving to contribute towards improved health outcomes, health research institutions generate and accumulate huge volumes of potentially relevant results that remain largely underutilized, with limited movement from the research community to the practice community. Hanney et al. [ 4 ] note that, whereas “research centres undertake large scale dissemination, this does not necessarily guarantee that their research findings will be utilized”. This is further exacerbated by the fact that many dissemination practices remain based on “a mechanistic, linear conception of dissemination as a process of getting the word out” [ 2 ]. As a result, there is a fundamental gap between what is known about what works based on relevant knowledge and what is actually done with it; this is referred to as the “know-do gap” [ 21 – 24 ]. This know-do gap contributes to a relatively unchanged overall disease burden among low- and middle-income countries [ 15 ]. Collectively, these findings suggest that the concept of research utilization, including what is actually done to promote it, remains an area that is worth further consideration.

This study aims to (1) explore the activities implemented by researchers to promote research utilization and the extent to which they felt that their findings contributed to the policymaking process and (2) to document case studies of how research findings were actually utilized in the policymaking and strategic planning processes in Bangladesh. These study findings offer insights for a better understanding of the role that research institutions can play to promote utilization of their findings in policymaking and strategic planning processes.

Study design

The study used an exploratory case study design and relied on qualitative methods, including key informant interviews (KIIs), focus group discussions with study investigators, and database and document reviews. The study adapted the World Health Organization/Turning Research into Practice (WHO/TRIP) conceptual framework (Fig.  1 ) [ 25 ] to guide the documentation of case studies of research utilization in policymaking and strategic planning processes in Bangladesh. We conducted KIIs and focus group discussions with the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) researchers engaged in reproductive health-related research and policymakers, program implementers, and service providers involved in reproductive health research and service delivery within and immediately surrounding Dhaka, Bangladesh. A review of publications, documents and research databases was carried out for research studies registered and approved at icddr,b between 2001 and 2011. Data collection was conducted between September and December 2011.

Adapted WHO/TRIP research utilization framework

Study setting

The icddr,b, is an international health research institution, located in Dhaka, Bangladesh [ 26 ], dedicated to saving lives through research. It addresses a range of health areas, including child health, HIV/AIDs, communicable diseases, and reproductive health. In collaboration with academic and research institutions throughout the world, icddr,b conducts research, training and extension activities, as well as programme-based activities, to develop and share knowledge for global lifesaving solutions. Since 1978, icddr,b has shared its knowledge with the world, training more than 27,000 health professionals from over 78 countries.

Study procedures

We used icddr,b’s database that tracks all approved study protocols carried out at icddr,b to search for research protocols of reproductive health studies conducted between 2001 and 2011 using the following search terms: ‘reproductive health’, ‘protocols’. This generated a list of 165 approved reproductive health research protocols conducted by icddr,b researchers. The protocols spanned a period of 18 years (1993–2011). These protocols were then screened using a checklist with an inclusion criteria focused on research that was conducted and completed between 2001 and 2011 as illustrated in Fig.  2 . This time frame was picked based on the need to strike a balance between including protocols that were not too old to ensure we could interview the principal investigator (PI) or were not too recent allowing enough time for research findings to be utilized. Overall, 19 protocols met the inclusion criteria. Interviews were conducted with all researchers (n = 13) involved in the 19 selected protocols. Following the interviews with the study investigators, we established contact with the programme implementers who were involved in the implementation of these studies. A total of 15 KIIs were done (with researchers, programme implementers and policymakers) to explore a number of aspects relevant to research utilization, including how the research questions were identified; which stakeholders were involved at different stages of the research process; what communication and dissemination activities were undertaken by researchers; and what macro-contextual factors, such as the broader political, legal and programmatic climate, sensitivity of research topics, and cost considerations, may have impacted the utilization of the research findings. Three focus group discussions were also conducted to compare the perspectives of the researchers with those of the implementers and service providers involved in the implementation of the study protocols. All interviews (KIIs and focus group discussions) were conducted at convenient venues in the community, lasted between 30 and 90 minutes, and were audio-recorded after obtaining informed consent. We adapted the WHO/TRIP framework (Fig.  1 ) to examine the following factors that could have affected the utilization of study findings from the selected protocols, including the research process, stakeholder engagement, communication and dissemination, as well as macro contextual factors. Based on the WHO/TRIP framework and triangulation of information from the interviews, we documented three case studies in which research findings were utilized to inform policymaking and practice in Bangladesh.

Study flow diagram

Data analysis

All qualitative data, including recordings were transcribed verbatim. Framework analysis [ 27 ], involving familiarization with data, development of a coding schedule, data coding, description of main themes, linking themes, and developing explanations of their relationship to each other was employed. Based on the codes, data were grouped into categories and thematic analysis was performed to facilitate identification of similar and divergent perspectives. The first author (DRW) undertook the coding of the interviews and read through them to ensure that all key themes were captured.

Ethical considerations

Ethical approval and authorization to conduct the study was granted by the James P Grant School of Public Health Ethics Committee and the management of icddr,b. Informed consent was obtained from all respondents for their participation as well as permission to tape record all the interviews. Confidentiality and anonymity were assured for all participants, including their right to withdraw from the study at any time without offering a reason.

Description of the reproductive health research protocols and participants’ characteristics

The 19 research protocols that met the inclusion criteria addressed five key thematic reproductive health areas, including sexually transmitted/reproductive tract infections (n = 6), maternal newborn and child health (n = 8), family planning (n = 2), adolescent and reproductive health (n = 2), and violence against women (n = 1). Nine protocols were led by three PIs (each had three protocols), four were led by two PI’s (each had two protocols), while six were led by seven different PIs. Out of the 21 participants interviewed for this study, four were female (three researchers, one programme implementer) and 17 were male (10 researchers, five programme implementers/service providers and two policymakers). The majority of the researchers had worked at icddr,b for over 5 years and held post-graduate qualifications in various disciplines. The response rate was 100 %.

Activities undertaken to promote utilization of research findings

Twelve (92 %) out of the 13 researchers reported that they had conducted dissemination workshops, 7 (53 %) published scientific papers, 6 (46 %) developed policy briefs, 3 (23 %) provided technical assistance to policymakers, 3 (23 %) held one-on-one meetings with policymakers, 3 (23 %) produced reports, and 2 (15 %) engaged the media. All researchers reported engaging in several other activities to package their findings and to ensure that their key findings were picked up by their stakeholders. These included production of fact sheets, sharing findings on the website, engaging service providers, joining advocacy networks, and producing wind banners, among others:

“ We have fact sheets, one pager per topic, so that at a glance someone can get the messages. During disseminations we had face tools and wind banners with messages so that they are visible and they catch eyes. We had great media coverage, the dailies reported on this dissemination seminar and people got to know about some of these findings from there. ” (KII009) “ One [study] was published in Social Science and Medicine and another one is in Sexually Transmitted Infections [Journal] and then in this field we also developed a review paper which was not only based on this study but rather partner notification in developing country settings. That was the kind of title that I published in BMC and we also developed a research brief from this partner notification study… ” (Focus Group Discussion 001)

When asked why they preferred the kind of activities they engaged in to facilitate the uptake of their research findings, researchers indicated that they based their decisions on the relative importance of each activity in terms of its ability to engage with the intended target audiences, impact and contribution to the researchers’ profile. One of the informants had this to say:

“ As you can see my 3 to 4 years previous works but you can't see the dissemination that I gave in the 3 years. And scientific papers obviously will have some scientific value for one’s career because these policy briefs have little weight on your career as a researcher…. These are not counted as scientific papers. So researchers are less interested in developing policy briefs, they would be more interested to write and publish papers. ” (KII002)

Utilization of research findings

The majority of the researchers (12 out of 13) reported that findings from their studies were utilized and influenced policymaking processes at different levels. Fig.  3 shows the different ways in which researchers felt that findings from their studies were utilized. The researchers’ perspectives regarding the ways in which their findings were utilized were triangulated with responses from policymakers, programme implementers and service providers. Below are some of the responses from researchers, program implementers and service providers.

Perceptions of researchers regarding the utilization of their research findings

Scaling up interventions

One program implementer acknowledged the use of research findings from one of the studies to scale up the use of misoprostol for the prevention of postpartum haemorrhage (PPH) in Bangladesh [ 28 ].

“ … for the misoprostol one [Scaling up the use of misoprostol for the prevention of postpartum haemorrhage study] , findings were incorporated into the health system plans, both the operational one and the government has taken it up and has been scaling up in the 3 districts. So they have started the scaling up efforts in phases. They have also initiated the process to buy the tablet; they have allocated the money and have initiated the process to buy. Its moving it's not happening fast but it is happening. ” (KII012)

Generating new evidence and service delivery

Findings from two studies [ 29 , 30 ] were reported to have instigated more research and hence contributed to generation of new evidence that influenced the decisions of program implementers to provide services to most at risk populations, including injecting drug users.

“ We just completed another study on injecting drug users and some of which was in that area and we are evaluating the ongoing outreach services and the services are being provided by Save the Children for the drug users ” (KII008)

The generation and subsequent use of new knowledge was reported to have influenced decisions that contributed to improved service delivery as noted by one of the program implementers in the quote below.

“ As a result of the [Injecting Drug Users Dhaka City Study] , service delivery was enhanced, we provided services in two shifts for seven days a week, so we intensified the programme and that has really helped. ” (KII013)

These findings suggest that research evidence was used at different levels of policymaking and implementation, including program implementation and further research. They also illustrate the co-production process in which researchers actively engaged and specifically sought the input of programme implementers to generate appropriate and relevant findings that facilitated the decision-making process.

Case studies on processes of research utilization

Based on the WHO/TRIP research utilization framework, the study used the qualitative data collected to document three case studies of how research findings were utilized in the policymaking and strategic planning processes in Bangladesh. The three case studies were conducted between 2001 and 2008. Two of them used a quasi-experimental design and cohort study design, respectively, while one was a secondary analysis of longitudinal data from rural Bangladesh; they all reported policy-relevant findings [ 28 , 30 – 35 ] (Table  1 ). For each case-study, we examined how the research questions were identified, which stakeholders were involved, the communication process, and the macro-contextual factors, as well as activities undertaken to ensure utilization of the findings.

The research questions for the selected case studies were identified through a review of available literature, conducting exploratory case studies and analysis of secondary and surveillance data. Several stakeholders, including fellow researchers, professional organizations, non-governmental organizations (NGOs), civil society organizations, and government agencies, were involved during the research process in each of the three selected case studies. All researchers reported holding dissemination workshops involving the stakeholders described above. In addition to developing policy briefs and producing reports, they all reported publishing their findings in peer reviewed journals and providing technical assistance to the policymakers, programme implementers, and service providers. Two of the three researchers held one-on-one meetings with service providers and programme implementers, while one of them joined an advocacy network, produced wind banners and engaged the media.

When asked about the extra efforts researchers undertook to promote utilization of their findings in the policymaking process in Bangladesh, the researchers involved in the selected case studies reported having provided both research evidence and technical expertise to inform the drafting of policy:

“ We took a temporary permission from the Drug Administration of Bangladesh to conduct the research and subsequently, after we found that it is effective and useful for prevention of postpartum haemorrhage (PPH) and in collaboration with the drug companies and the Pharmaceutical Licensure of Bangladesh we requested them to extend the registration of the use of misoprostol for the prevention of PPH. We informed them that we will provide all the papers and any technical assistance you need and they did it and now misoprostol is registered in Bangladesh for use in the prevention of PPH and that’s happened because of our research findings .” KII001 “ So what I was able to do was to sort of guide them in fine tuning the focus, and then provide input in defining different forms of violence which was not possible for them, because for the bill you have to get them [forms of violence] pinned down. So that was the contribution from icddr,b based on our research. ” KII009

However, some program implementers perceived inadequate efforts on the part of the institution icddr,b to engage the government in order to promote effective utilization of research findings.

“… icddr,b if they want their results implemented in the public sector they should involve the government from the very beginning…maybe in a smaller role, the appropriate government person would be involved and that is lacking. ” (KII012)

Whereas the majority of the researchers reported about the activities and efforts undertaken to promote utilization of their research findings, only a few of them knew how and at what stages of the policymaking process their findings were utilized. For example, researchers reported that as a result of their constant engagement with policymakers and programme implementers, the Ministry of Health and Family Welfare and other key agencies committed to integrate misoprostol use into government policies and plans. Misoprostol was included in the program of activities for community health workers and family welfare agents as well as the Essential Drug List of Bangladesh. In the enactment of Bangladesh Domestic Bill 2010, upon conducting an exploratory study and understanding the magnitude of domestic violence in Bangladesh, researchers from icddr,b reported joining the Citizen’s Initiative against Domestic Violence (CIDV). This is a coalition of women’s organizations and human rights groups in Bangladesh that had already recognized the need for a legal framework to tackle domestic violence. However, they required technical input from researchers who, based on their research findings, supported CIDV to define the different forms of domestic violence and frame the challenge of domestic violence in Bangladesh. With this support, CIDV was able to lobby and engage the Ministry of Women and Children’s Affairs. As a result, both institutions refined the bill which was eventually placed on the agenda for the Bangladesh Parliament, which subsequently passed it into law.

Our study of the utilization of research findings to inform policy and practice in Bangladesh found the majority of researchers engaged in a variety of activities to inform the utilization process, including holding dissemination workshops, publishing in scientific journals, developing policy briefs, providing technical assistance, and holding one-on-one meetings with service providers and programme implementers. The majority of researchers also believed that their research findings had been utilized and had contributed towards influencing policy and practice within Bangladesh. Studies show that effective utilization of research findings can be enhanced through continuous stakeholder engagement before, during, and after the research process, making research findings more accessible, relevant, and easy to use, and with increased advocacy and communication efforts such as use of multiple channels to reach same audiences many times [ 8 , 12 , 20 , 36 , 37 ]. The researchers at icddr,b engaged in almost all these processes, which likely explains why their research findings were utilized in policymaking and strategic planning processes.

Dissemination seminars and scientific papers provide an opportunity for reaching out to the intended audiences with the message, and depict an attitude that has been described by the RUSH Project 2009 as “getting the word out” [ 2 ]. However, the limited number of researchers engaging in activities such as one-on-one meetings, media engagement, and advocacy highlights the limited efforts by researchers to strategically reach out to policymakers with their findings. Although budgetary and time constraints were cited as major limitations to engaging in such activities, promoting utilization of research findings requires explicit planning and resource allocation as well as monitoring and evaluation efforts [ 1 , 25 , 36 , 37 ]. Additionally, the lack of incentives and institutionalized mechanisms by icddr,b to promote utilization of research findings hinders the research utilization process. To effectively contribute to the bridging of the know-do-gap, researchers need to strategically plan, allocate sufficient resources, and institute mechanisms to monitor and evaluate the utilization of their study findings. These strategic efforts should be institutionalized and implemented right from the pre-research, research and post-research stages of the research process.

Almost all researchers (12 out of 13) that reported utilization of evidence from their studies provided insights into the range of ways that research evidence can be utilized in the policymaking process. Results from the case studies show that research findings can be utilized as data and findings (instrumental), as ideas and criticism (conceptual), or as briefs and arguments for action (symbolic) [ 4 , 10 , 11 ]. For example, the enactment of the Bangladesh Domestic Relations Bill 2010 highlights the symbolic use of research findings. The input of the researchers helped to shape the advocacy efforts of the women networks which were then able to persuade the policymakers and legislators to eventually enact the Domestic Relations Bill 2010. Scaling up the use of misoprostol in the treatment of PPH points to the conceptual use of research evidence in policymaking. Knowledge generated from the study findings on assessing the feasibility, acceptability and program effectiveness of misoprostol in preventing PPH in rural Bangladesh helped to change the mindsets of the policymakers, programme implementers and service providers. The use of surveillance data in supporting decisions to provide outreach services to injecting drug users is an example of instrumental use of research findings in policymaking.

The results from this study also demonstrate that research findings can be utilized at different stages within the policymaking process, including during agenda setting, policy formulation and policy implementation [ 5 , 12 , 20 ]. For example, in the scaling up of the use of misoprostol and providing outreach services to injecting drug user case studies, findings were utilized at the policy implementation stage. Through the synthesis of available local and global evidence researchers were able to devise contextually acceptable interventions that not only contributed to accelerating the benefits of local innovation in strengthening the Bangladesh health system but also improved people’s health. In the enactment of Bangladesh Domestic Bill 2010, findings were effectively utilized at the agenda setting stage.

The engagement of several stakeholders, such as women’s advocacy networks, policymakers, NGOs and professional organizations, points to the on-going, iterative and complex nature of the policymaking process. It also emphasizes the reality that research findings are just one of the many ingredients that influence the process of policymaking [ 38 ]. Therefore, to effectively influence policymaking, it is important for researchers to acquaint themselves with the different stages and dynamics of the process. Familiarization with the policymaking process would not only enable researchers to engage the policymakers at the right time but also to identify which stage of the process they wish to or are most likely to influence with their results; this would also provide insights into which strategies and tools to use during these engagements.

There are various ways through which research findings can be utilized to inform the policymaking process, including documentation, analysis and prescription [ 12 ]. However, determining the contribution of a particular piece of research in the development of certain policies remains a challenge [ 20 ]. As such, a key limitation of this study was that few research end users were interviewed, which made triangulation of information collected from the researchers involved in the 19 studies rather challenging. Nonetheless, the three selected case studies provided additional insight into the activities, efforts to promote, and actual utilization of research findings into policy and practice. Future research could, however, benefit from employing methods to verify perceived impacts of research. Additionally, there may also have been some recall bias due to the duration between completion of the studies and the time this study was conducted. However, the engagement of the researchers, programme implementers and service providers that were directly involved in these studies gives credence to the study findings as these provided first-hand information and experiences.

Effective and timely research utilization has the potential to facilitate innovative changes that can lead to improved client outcomes and promotes critical thinking and reflective practice. In addition to ensuring that provision of safe and effective healthcare practice is based on current, scientifically sound knowledge, research utilization validates the efforts of the researcher, motivates scholars to continue to discover new knowledge, and reinforces professional accountability [ 9 ]. These benefits can only be accrued if health research organizations, such as icddr,b, can devise and implement strategic efforts to promote the utilization of research findings in policymaking and strategic planning processes.

The study results show that active and continuous stakeholder engagement through multiple channels of communication is critical to ensuring utilization of research findings in policymaking. Additionally, promoting research utilization requires paying attention to the micro- and macro-contextual factors such as the existence of global policies that support accelerated uptake of locally generated evidence.

Abbreviations

Citizen’s Initiative against Domestic Violence

International Centre for Diarrhoeal Disease Research, Bangladesh

Key informant interviews

Non-governmental organizations

Principal investigator

Prevention of postpartum haemorrhage

World Health Organization/Turning Research into Practice

Population Council. Maximizing utilization of research. FRONTIERS Legacy Series. 2008. http://www.popcouncil.org/uploads/pdfs/frontiers/legacy/08ResearchUtilization.pdf . Last accessed June 2013

RUSH Project. Welcome to research utilization. 2009. http://www.sedl.org/expertise/historical/rush.html# #. Last accessed September 6, 2013

Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J. Knowledge Transfer Study Group. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q. 2003;81(2):221–48. 171–2.

Article   PubMed   PubMed Central   Google Scholar  

Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M. The utilisation of health research in policy-making: concepts, examples and methods of assessment. Health Res Policy Syst. 2003;1(1):2.

Weiss CH. The many meanings of research utilization. Public Adm Rev. 1979;39(5):426–31.

Article   Google Scholar  

Logan J, Graham ID. Toward a comprehensive interdisciplinary model of health care research use. Sci Commun. 1998;20(2):227–46.

Garner P, Kale R, Dickson R, Dans T, Salinas R. Getting research findings into practice: implementing research findings in developing countries. BMJ. 1998;317(7157):531–5.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Hennink M, Stephenson R. Using research to inform health policy: barriers and strategies in developing countries. J Health Commun. 2005;10(2):163–80.

Article   PubMed   Google Scholar  

Gillis A, Jackson W. Research for Nurses: Methods and Interpretation. Philadelphia: F.A. Davis Company; 2002.

Google Scholar  

Weiss CH, Bucuvalas MJ. Social Science Research and Decision-Making. New York: Columbia University Press; 1980.

Squires J, Estabrooks CA, Newburn-Cook CV, Gierl M. Validation of the conceptual research utilization scale: an application of the standards for educational and psychological testing in healthcare. BMC Health Serv Res. 2011;11(1):107.

Almeida C, Báscolo E. Use of research results in policy decision-making, formulation, and implementation: a review of the literature. Cadernos de Saúde Pública. 2006;22:S7–19.

PubMed   Google Scholar  

Bennett G, Jessani N. The knowledge translation toolkit. Bridging the know-do gap: a resource for researchers. Sage India, IDRC; 2011. http://ajpp-online.org/resources/downloads/04-TheKnowledgeTranslationToolkit.pdf .

Ssengooba F, Atuyambe L, Kiwanuka SN, Puvanachandra P, Glass N, Hyder AA. Research translation to inform national health policies: learning from multiple perspectives in Uganda. BMC Int Health Hum Rights. 2011;11 Suppl 1:S13.

Canadian Coalition for Global Health Research. Knowledge translation in low & middle income countries: a learning module. 2010. http://www.ccghr.ca . Last accessed September 6, 2013

Woelk G, Daniels K, Cliff J, Lewin S, Sevene E, Fernandes B, et al. Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries. Health Res Policy Syst. 2009;7(1):31.

Koehlmoos T, Rahman Z, Rashid M, Cravioto A, Hanney S. Developing a Knowledge Translation Platform in Bangladesh. 2010. http://www.who.int/alliance-hpsr/projects/alliancehpsr_snpreport2bang10.pdf .

Majdzadeh R, Sadighi J, Nejat S, Mahani AS, Gholami J. Knowledge translation for research utilization: design of a knowledge translation model at Tehran University of Medical Sciences. J Contin Educ Health Prof. 2008;28(4):270–7.

Albert M, Fretheim A, Maiga D. Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali’s essential medicines. Health Res Policy Syst. 2007;5(1):2.

Orton L, Lloyd-Williams F, Taylor-Robinson D, O'Flaherty M, Capewell S. The use of research evidence in public health decision making processes: systematic review. PLoS One. 2011;6(7), e21704.

Lang ES, Wyer PC, Haynes RB. Knowledge translation: closing the evidence-to-practice gap. Ann Emerg Med. 2007;49(3):355–63.

Pablos-Mendez A, Shademani R. Knowledge translation in global health. J Contin Educ Health Prof. 2006;26(1):81–6.

Santesso N, Tugwell P. Knowledge translation in developing countries. J Contin Educ Health Prof. 2006;26(1):87–96.

Oliver K, Innvar S, Lorenc T, Woodman J, Thomas J. A systematic review of barriers to and facilitators of the use of evidence by policymakers. BMC Health Serv Res. 2014;14(1):2.

Nath S. Frontiers in Reproductive Health. Final Report: Getting Research Into Policy and Practice (GRIPP). Frontiers in Reproductive Health. New York: Population Council; 2007.

International Centre for Diarrhoeal Disease Research Bangladesh. About us. 2011. http://www.icddrb.org/who-we-are . Last accessed June 2013

Gale N, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117.

Quaiyum A, Gazi R, Hossain S, Wirtz A, Saha NC. Feasibility, acceptability, and programme effectiveness of misoprostol for prevention of postpartum haemorrhage in rural Bangladesh: a quasiexperimental study. Int J Reprod Med. 2014;2014:8.

Uddin J, Koehlmoos TP, Saha NC, Islam Z, Khan IA, Quaiyum MA. Strategies for providing healthcare services to street-dwellers in Dhaka city: evidence from an operations research. Health Res Policy Syst. 2012;10(1):19.

Azim T, Hussein N, Kelly R. Effectiveness of harm reduction programmes for injecting drug users in Dhaka city. Harm Reduction J. 2005;2(1):22.

Prata N, Bell S, Quaiyum M. Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention. BMC Pregnancy Childbirth. 2014;14(1):78.

Asling-Monemi K, Tabassum Naved R, Persson LA. Violence against women and the risk of under-five mortality: analysis of community-based data from rural Bangladesh. Acta Paediatr. 2008;97(2):226–32.

Potts M et al. Empowering women to control post-partum haemorrhage. Lancet. 2010;375(9713):459–60.

Potts M, Prata N, El Refaey H, Sanghvi H, Darney P, Ades V, et al. Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births. Soc Sci Med. 2012;75(11):2021–7.

Azim T, Khan SI, Haseen F, Huq NL, Henning L, Pervez MM, et al. HIV and AIDS in Bangladesh. J Health Popul Nutr. 2008;26(3):311–24.

PubMed   PubMed Central   Google Scholar  

Squires J, Estabrooks CA, Gustavsson P, Wallin L. Individual determinants of research utilization by nurses: a systematic review update. Implement Sci. 2011;6:1.

Scott S, Albrecht L, O'Leary K, Ball GD, Hartling L, Hofmeyer A, et al. Systematic review of knowledge translation strategies in the allied health professions. Implement Sci. 2012;7:70.

Milat A, King L, Newson R, Wolfenden L, Rissel C, Bauman A, et al. Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers. Health Res Policy Syst. 2014;12:18.

Download references

Acknowledgements

The authors are thankful to the management and staff of icddr,b for providing access to the research database. Additionally, the authors like to thank the staff of Makerere University School of Public Health and the CDC Fellowship Program staff for reviewing and editing the manuscript. Finally, the authors would like to thank all the colleagues from James P Grant School of Public Health and all staff.

Author information

Authors and affiliations.

Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda

David Roger Walugembe, Suzanne N. Kiwanuka, Joseph K. B. Matovu & Elizeus Rutebemberwa

International Centre for Diarrhoeal Disease Research (icddr,b), P.O.Box 128, Dhaka, 1000, Bangladesh

David Roger Walugembe & Laura Reichenbach

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to David Roger Walugembe .

Additional information

Competing interests.

All authors declare that they have no competing interests.

Authors’ contributions

DRW contributed to all stages of research, including conception of the research, proposal writing, data analysis, and manuscript writing. SK JKBM, and ER significantly contributed to manuscript writing. LR contributed to the conception of the research, data analysis and reviewing of the manuscript. All authors read and approved the final manuscript.

Authors’ information

DRW was formerly a student at the James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh. Currently he is a research fellow with the Makerere University School of Public Health CDC Fellowship Program, Kampala Uganda. LR was formerly Social Scientist and Director of the Center for Reproductive Health at icddr,b. She is currently Senior Associate and Deputy Director of Research for the Evidence Project, Population Council, Washington, DC.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Walugembe, D.R., Kiwanuka, S.N., Matovu, J.K.B. et al. Utilization of research findings for health policy making and practice: evidence from three case studies in Bangladesh. Health Res Policy Sys 13 , 26 (2015). https://doi.org/10.1186/s12961-015-0015-x

Download citation

Received : 06 September 2014

Accepted : 04 May 2015

Published : 28 May 2015

DOI : https://doi.org/10.1186/s12961-015-0015-x

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Policymaking
• Research uptake
• Research utilization

Health Research Policy and Systems

ISSN: 1478-4505

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• Write for Us
• BMJ Journals

You are here

• Volume 22, Issue 3
• Triangulation in research, with examples
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Helen Noble 1 ,
• Roberta Heale 2
• 1 School of Nursing and Midwifery , Queens University Belfast , Belfast , UK
• 2 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
• Correspondence to Dr Helen Noble, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; helen.noble{at}qub.ac.uk

https://doi.org/10.1136/ebnurs-2019-103145

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

What is triangulation

Triangulation is a method used to increase the credibility and validity of research findings. 1 Credibility refers to trustworthiness and how believable a study is; validity is concerned with the extent to which a study accurately reflects or evaluates the concept or ideas being investigated. 2 Triangulation, by combining theories, methods or observers in a research study, can help ensure that fundamental biases arising from the use of a single method or a single observer are overcome. Triangulation is also an effort to help explore and explain complex human behaviour using a variety of methods to offer a more balanced explanation to readers. 2 It is a procedure that enables validation of data and can be used in both quantitative and qualitative studies.

Four types of triangulation are proposed by Denzin (p.301): 5 (1) data triangulation, which includes matters such as periods of time, space and people; (2) investigator triangulation, which includes the use of several researchers in a study; (3) theory triangulation, which encourages several theoretical schemes to enable interpretation of a phenomenon and (4) methodological triangulation, which promotes the use of several data collection methods such as interviews and observations.

Examples of studies using triangulation

Below, we offer two examples of triangulation within research studies, providing a context for each study and a description of how triangulation was used and successfully implemented to ensure an in-depth and more unbiased set of findings.

Johnson et al ,s 6 qualitative study aimed to identify system influences on decision making in a pre-hospital setting with paramedics. Several data sets were included and comprised exploratory interviews with ambulance service staff (n=16); document review observations of paramedic shifts (n=34); paramedic accounts (n=10) via audio-recorded ‘digital diaries’; staff focus groups (n=3) and service user focus groups (n=3) to explore a range of experiences and perceptions. The approach followed Denzin’s 5 multiple triangulation approach, which encourages several methods to collect data and multiple investigators with varied expertise.

Phase I of the study focused on understanding the context of the study and included interviews with ambulance service staff and the collection of demographics and local policies. The second phase involved observation of paramedics’ daily work in order to throw light on decisions related to transporting patients. Focus groups with paramedics, followed by focus groups with service users were then completed in order to share personal experiences of the decisions made by the ambulance service in practice. The final phase included workshops to feed back findings.

Data were coded and thematically analysed. The observations of paramedic shifts identified the complexities of the decision-making process related to the context. The observations were supplemented by the interviews and focus groups. Each research method exposed one aspect of reality. 5 This multimethod, multidisciplinary collaborative research was insightful. It permitted cross-validation, and facilitated exploration, of issues that influenced the decision making of paramedics and concerns and experiences of service users.

A study was undertaken to explore the quality of care for patients in a unique model of primary healthcare in Ontario, Canada: the Nurse Practitioner-Led Clinic (NPLC) 7 . The focus was on the care of patients with diabetes and at least one additional chronic condition, with the assumption that this group of patients represents those with the most complex clinical presentations managed in family practice settings. A multiple case study design was chosen for this research because with this approach, analysis of a variety of data arising from several NPLCs allowed for assumptions to be made about the model as a whole. 7 Additionally, both qualitative and quantitative research methods were used in the study. Mixing methods is a form of triangulation in research seen as mitigating the weaknesses found in single methods. 8

The first research method was a chart audit, conducted on randomly selected charts of adult patients in five NPLCs who had diabetes and at least one additional chronic condition. The variables included demographic items as well as clinical data related to the care of patients with diabetes. The data were analysed to determine the completeness of the care of diabetes for the subjects. 9

The second research method was interviews with nurse practitioners (NPs) working at the five NPLCs to determine their perceptions of the quality of care delivered in the NPLC model for patients with diabetes and other chronic conditions. Data from the interviews were analysed using the processes related to an integrative description design. 10 The draft themes arising from the analysis were forwarded to the participants for their feedback and were confirmed through a review of literature. Finally, a detailed document search was undertaken, including but not limited to academic articles, media releases and articles, letters to editor, government policy statements and publications released from the NPLCs. These data were used to confirm and support the findings of the chart review and NP interviews, representing triangulation.

With analysis completed separately for the qualitative and quantitative parts of the study, the final step was analysis of the NPLCs individually and then as a group. An extensive analysis process arising from Stake’s multiple case methodology was implemented. 11 This process included coding and identification of themes for individual NPLCs, then across the NPLC model as a whole. The final product represented triangulation in that each final theme represented analysis of data from at least two data sources, and literature was used to further support these conclusions.

Limitations of triangulation

Triangulation offers richness and clarity to research studies 8 but also has limitations. It adds to the complexity of the research making it more time-consuming. 6 When used as a method for combining research methodologies, triangulation may not be achieved in a uniform or consistent manner. Additionally, researchers may not adequately explain their techniques for blending results. 12 In addition, theremay be times when comparison of the findings of two sources is inconsistent or conflicting. Triangulation does not always adequately mitigate problems in a chosen research methodology. The processes of triangulation are complex and require a skilled analyst. Finally, the value of triangulation may be overestimated in some studies. 13

• Carvalho S ,
• Rothbauer P
• Johnson M ,
• Hirst E , et al
• Wenghofer E ,
• James S , et al
• Wenghofer E , et al
• Thurmond VA

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

Patient consent for publication Not required.

Read the full text or download the PDF:

Community Blog

Keep up-to-date on postgraduate related issues with our quick reads written by students, postdocs, professors and industry leaders.

What is Research? – Purpose of Research

• By DiscoverPhDs
• September 10, 2020

The purpose of research is to enhance society by advancing knowledge through the development of scientific theories, concepts and ideas. A research purpose is met through forming hypotheses, collecting data, analysing results, forming conclusions, implementing findings into real-life applications and forming new research questions.

What is Research

Simply put, research is the process of discovering new knowledge. This knowledge can be either the development of new concepts or the advancement of existing knowledge and theories, leading to a new understanding that was not previously known.

As a more formal definition of research, the following has been extracted from the Code of Federal Regulations :

While research can be carried out by anyone and in any field, most research is usually done to broaden knowledge in the physical, biological, and social worlds. This can range from learning why certain materials behave the way they do, to asking why certain people are more resilient than others when faced with the same challenges.

The use of ‘systematic investigation’ in the formal definition represents how research is normally conducted – a hypothesis is formed, appropriate research methods are designed, data is collected and analysed, and research results are summarised into one or more ‘research conclusions’. These research conclusions are then shared with the rest of the scientific community to add to the existing knowledge and serve as evidence to form additional questions that can be investigated. It is this cyclical process that enables scientific research to make continuous progress over the years; the true purpose of research.

What is the Purpose of Research

From weather forecasts to the discovery of antibiotics, researchers are constantly trying to find new ways to understand the world and how things work – with the ultimate goal of improving our lives.

The purpose of research is therefore to find out what is known, what is not and what we can develop further. In this way, scientists can develop new theories, ideas and products that shape our society and our everyday lives.

Although research can take many forms, there are three main purposes of research:

• Exploratory: Exploratory research is the first research to be conducted around a problem that has not yet been clearly defined. Exploration research therefore aims to gain a better understanding of the exact nature of the problem and not to provide a conclusive answer to the problem itself. This enables us to conduct more in-depth research later on.
• Descriptive: Descriptive research expands knowledge of a research problem or phenomenon by describing it according to its characteristics and population. Descriptive research focuses on the ‘how’ and ‘what’, but not on the ‘why’.
• Explanatory: Explanatory research, also referred to as casual research, is conducted to determine how variables interact, i.e. to identify cause-and-effect relationships. Explanatory research deals with the ‘why’ of research questions and is therefore often based on experiments.

Characteristics of Research

There are 8 core characteristics that all research projects should have. These are:

• Empirical  – based on proven scientific methods derived from real-life observations and experiments.
• Logical  – follows sequential procedures based on valid principles.
• Cyclic  – research begins with a question and ends with a question, i.e. research should lead to a new line of questioning.
• Controlled  – vigorous measures put into place to keep all variables constant, except those under investigation.
• Hypothesis-based  – the research design generates data that sufficiently meets the research objectives and can prove or disprove the hypothesis. It makes the research study repeatable and gives credibility to the results.
• Analytical  – data is generated, recorded and analysed using proven techniques to ensure high accuracy and repeatability while minimising potential errors and anomalies.
• Objective  – sound judgement is used by the researcher to ensure that the research findings are valid.
• Statistical treatment  – statistical treatment is used to transform the available data into something more meaningful from which knowledge can be gained.

Finding a PhD has never been this easy – search for a PhD by keyword, location or academic area of interest.

Types of Research

Research can be divided into two main types: basic research (also known as pure research) and applied research.

Basic Research

Basic research, also known as pure research, is an original investigation into the reasons behind a process, phenomenon or particular event. It focuses on generating knowledge around existing basic principles.

Basic research is generally considered ‘non-commercial research’ because it does not focus on solving practical problems, and has no immediate benefit or ways it can be applied.

While basic research may not have direct applications, it usually provides new insights that can later be used in applied research.

Applied Research

Applied research investigates well-known theories and principles in order to enhance knowledge around a practical aim. Because of this, applied research focuses on solving real-life problems by deriving knowledge which has an immediate application.

Methods of Research

Research methods for data collection fall into one of two categories: inductive methods or deductive methods.

Inductive research methods focus on the analysis of an observation and are usually associated with qualitative research. Deductive research methods focus on the verification of an observation and are typically associated with quantitative research.

Qualitative Research

Qualitative research is a method that enables non-numerical data collection through open-ended methods such as interviews, case studies and focus groups .

It enables researchers to collect data on personal experiences, feelings or behaviours, as well as the reasons behind them. Because of this, qualitative research is often used in fields such as social science, psychology and philosophy and other areas where it is useful to know the connection between what has occurred and why it has occurred.

Quantitative Research

Quantitative research is a method that collects and analyses numerical data through statistical analysis.

It allows us to quantify variables, uncover relationships, and make generalisations across a larger population. As a result, quantitative research is often used in the natural and physical sciences such as engineering, biology, chemistry, physics, computer science, finance, and medical research, etc.

What does Research Involve?

Research often follows a systematic approach known as a Scientific Method, which is carried out using an hourglass model.

A research project first starts with a problem statement, or rather, the research purpose for engaging in the study. This can take the form of the ‘ scope of the study ’ or ‘ aims and objectives ’ of your research topic.

Subsequently, a literature review is carried out and a hypothesis is formed. The researcher then creates a research methodology and collects the data.

The data is then analysed using various statistical methods and the null hypothesis is either accepted or rejected.

In both cases, the study and its conclusion are officially written up as a report or research paper, and the researcher may also recommend lines of further questioning. The report or research paper is then shared with the wider research community, and the cycle begins all over again.

Although these steps outline the overall research process, keep in mind that research projects are highly dynamic and are therefore considered an iterative process with continued refinements and not a series of fixed stages.

There’s no doubt about it – writing can be difficult. Whether you’re writing the first sentence of a paper or a grant proposal, it’s easy

The title page of your dissertation or thesis conveys all the essential details about your project. This guide helps you format it in the correct way.

Impostor Syndrome is a common phenomenon amongst PhD students, leading to self-doubt and fear of being exposed as a “fraud”. How can we overcome these feelings?

Join thousands of other students and stay up to date with the latest PhD programmes, funding opportunities and advice.

Browse PhDs Now

This article will answer common questions about the PhD synopsis, give guidance on how to write one, and provide my thoughts on samples.

The Thurstone Scale is used to quantify the attitudes of people being surveyed, using a format of ‘agree-disagree’ statements.

Dr Day gained her PhD Physical Chemistry at the University of Nottingham in 2000. She is now a Science & Fiction writer, an Associate Editor at PseudoPod.org and runs the blog ‘The Chronicle Flask’ about all things chemistry.

Fabian’s in the final year of his PhD research at Maastricht University. His project is about how humans learn numbers and how hands might help that process; this is especially useful for children developing their maths skills.

Join Thousands of Students

• Affiliate Program

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

How to Write the Results/Findings Section in Research

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

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

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

What is included in the Results section?

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

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

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

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

How are the results organized?

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

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

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

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

Attitudes towards postoperative care in patients over the age of 55

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Captioning and Referencing Tables and Figures

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

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

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

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

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

Steps for Composing the Results Section

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wordvice Resources

• How to Write a Research Paper Introduction 
• Which Verb Tenses to Use in a Research Paper
• How to Write an Abstract for a Research Paper
• How to Write a Research Paper Title
• Useful Phrases for Academic Writing
• Common Transition Terms in Academic Papers
• Active and Passive Voice in Research Papers
• 100+ Verbs That Will Make Your Research Writing Amazing
• Tips for Paraphrasing in Research Papers

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

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Open access
• Published: 29 June 2022

How can funders promote the use of research? Three converging views on relational research

• Vivian Tseng   ORCID: orcid.org/0000-0001-9936-4995 1 ,
• Angela Bednarek 2 &
• Kristy Faccer 3  

Humanities and Social Sciences Communications volume  9 , Article number:  219 ( 2022 ) Cite this article

2509 Accesses

10 Citations

25 Altmetric

Metrics details

• Environmental studies
• Social policy

Although funders are generally acknowledged as important actors in the evidence ecosystem, there has been insufficient analysis of the how and why behind funders’ decisions. This article examines the decision-making of three funders in their support of relational approaches to improve the usefulness and use of research evidence. They compare their work across the disparate policy sectors of education and environmental sustainability in order to bridge the silos that have caused unnecessary duplication of work and obstructed advancements in research utilization. The authors (1) provide individual narratives of their funding experiences including why they prioritized relational approaches and how they supported them; (2) discuss their lessons learned for supporting and promoting relational approaches; and (3) offer recommendations to the broader funding community for strengthening and expanding these approaches. The authors hope the paper provides useful insights into ways funders and their partners can build a stronger and better coordinated evidence ecosystem in which research regularly contributes to improved societal outcomes.

Similar content being viewed by others

Mapping the community: use of research evidence in policy and practice

Expertise in research integration and implementation for tackling complex problems: when is it needed, where can it be found and how can it be strengthened?

Insights from a cross-sector review on how to conceptualise the quality of use of research evidence

Introduction.

Much has been written about strengthening the connections between researchers, policymakers, and practitioners to improve the usefulness and use of research evidence (e.g., Boaz et al., 2021 ; Bartunek and Rynes, 2014 ; Lemos et al., 2018 ), but less attention has focused on funders’ roles in the evidence ecosystem. This oversight belies funders’ influence on what research is conducted and whether policymakers and other stakeholders are engaged in the research (Arnott et al., 2020 ; Arnott, 2021 ; Flinders, 2020 ; Sharma and Bansal, 2020 , Landrum et al., 2022 ).

This is not to say there isn’t information on what funders support (e.g., fellowships, training, partnerships, etc.). That information is often publicly available and has been a focus of the academic and gray literature. However, very little analysis exists of why funders prioritize certain approaches to evidence use and how they go about supporting those approaches (Arnott et al., 2020 ). A second limitation of the funder literature is its dispersal across diverse policy sectors such as education (Tseng and Coburn, 2019 ), environmental sustainability (Arnott et al., 2020 ), healthcare (McLean et al., 2018 ), business (Hamann and Faccer, 2018 ), and international development (Neupane et al., 2016 ). Despite the transferability of lessons across policy areas, funders working in environmental policy, for example, have few opportunities to learn from and with their counterparts in education and human services, and vice versa (Arnott et al., 2020 ; Farley-Ripple et al., 2020 ; Oliver and Boaz, 2019 ). Yet, if such connections were commonplace, funders could more efficiently build on lessons learned in other sectors and even align their efforts to accelerate progress.

In this article, we contribute to filling these two gaps in the literature by pulling back the curtain on funders’ work. While the gray literature includes some external analysis of how funders could improve their work (Flinders, 2020 ; Tazzyman et al., 2020 ; Nurse, 2015 ), we offer insights from our “insider” positions in funding programs and organizations. Specifically, we discuss how and why we forged our funding approaches, our analysis of the challenges we faced in our work in different policy sectors (environmental sustainability and education), and recommendations for how the broader funding community can build a stronger evidence ecosystem by leveraging connections between policy arenas.

This article is based on the experiences of the three authors who, despite working for different funding programs and organizations in distinct policy areas, found remarkable similarities in our funding approaches to support research use. The first author works for the William T. Grant Foundation to support research to improve education and other youth-serving systems; the second for the Lenfest Ocean Program at the Pew Charitable Trusts to address the need for sustainable oceans; and the third for the Pacific Institute for Climate Solutions (PICS) to produce climate mitigation and adaptation solutions. In addition to different policy arenas, our work spans different geographic ranges from regional (PICS) to national (William T. Grant) to global (Lenfest). By drawing together our disparate experiences, we developed a cross-cutting analysis of how funders can work collectively to transform the evidence ecosystem.

Early on, we found commonality in our concern that research funders (including ourselves) had been stuck in thinking about research-based knowledge as a product that simply needed to be disseminated from researchers to decision-makers. Linear approaches fueled interest in one-way science communication in environmental policy and other fields, and investments in scaling up evidence-based programs in education policy (Lubchenco, 1998 , Tseng and Coburn, 2019 ). We shared a dissatisfaction with these dissemination approaches that failed to appreciate decision-makers’ needs and their goals and contexts for using research (Nutley et al., 2007 ; Sarewitz and Pielke, 2007 ).

The literature suggested that relational approaches represented a new generation of efforts to pave stronger paths between research knowledge and social action (Best and Holmes, 2010 ). Relational approaches consider research valuable when it meets the needs and contexts of its would-be users. Rather than seeing research as an antidote to information deficits on the part of decision-makers, relational approaches envision a two-way street, wherein policy informs research as much as research informs policy (Tseng, 2012 ; Bednarek et al., 2018 ; Hamann and Faccer, 2018 ). Relational approaches can build bridges between the separate worlds that researchers and decision-makers inhabit—each with its own priorities, languages, and goals (Caplan, 1979 ; Bogenschneider and Corbett, 2021 ). Scholarship on relational approaches shows its value for building trusting relationships and fostering iterative knowledge exchange (Cash et al., 2003 ; Nutley et al., 2007 ; Dilling and Lemos, 2011 ; Tseng, 2012 ). Collaboration can be forged at different points in the research production and use process from problem definition to interpretation of findings to application of research in decision-making (Lemos et al., 2018 ).

Our approach

Borrowing from Dennis Gioia and colleagues’ concept of “knowledgeable agents,” we have developed narratives of our funding programs and organizations in order to explain “what (we) are trying to do” as well as our “thoughts, intentions and actions” (Gioia, et al., 2013 , p. 17, see also Chapman et al., 2004 ; Yeo and Dopson, 2018 ) in our grantmaking. Knowing that funder decision-making can appear opaque to those outside our programs and organizations, we sought to describe what happens “behind the scenes” (Zawadzki and Jensen, 2020 ).

Our process has borrowed from approaches that aim to turn personal experience (Cunliffe, 2018 ) and narrative exposition (Jarzabkowski et al., 2014 ) into a self-conscious, analytical, and strategic interpretation of relevance to a broader community—in this case, funders. In most ethnographic representations, examinations of particular communities, cultures, or settings are done by relative “outsiders” able to claim a critical distance from the objects of study. However, we were inspired by autoethnographic and collaborative autoethnographic approaches that provide a means of combining insider and outsider perspectives into opportunities for individual and joint reflection (Zawadzki and Jensen, 2020 ; Vesa and Vaara, 2014 ).

We first crafted separate texts narrating each of our program or organization’s journeys of improving research use, not knowing how much, if any of the information would make it into the final version (Nordbäck et al., 2021 ). We agreed on a set of guiding questions that would allow for comparison between our respective texts. Without setting out any other parameters (e.g., on length), we agreed that the following points should be addressed in each narrative: (i) What did the landscape look like when each funding initiative began? (ii) How did funding change over time? (iii) Where did each of us appear in these stories? and (iv) What changes did we observe in how research was produced and used, and to what did we attribute those changes?

As the first and second authors have worked in their organizations for almost two decades, their narratives were written as thick descriptions of personal and programmatic histories (Jarzabkowski et al., 2014 ). The third author’s experience was a bit different, having joined her organization more recently. Although she had been involved in shaping and informing renewed programmatic practices at PICS, her narrative required more attention to archival materials and information-checking with other organizational members.

The narratives were developed as part of an iterative process, in which we read each other’s texts and raised issues, dilemmas, and questions regarding each other’s funding strategies and practices. This process enabled us to bring some outsider perspective to each other’s work and to identify and then refine potential themes. In our shared sense-making, key themes were discussed and particular elements were probed, such as how we defined our role as funders (funding others to do the work versus hiring staff internally) and how we approached field-building. We used this recursive process of reflection to determine how best to move beyond the personal and joint reflections in order to offer a more meaningful analysis of how funders can improve research use and impact. We present our individual narratives below, followed by the themes we identified and their implications for the broader funding community.

Our journeys

William t. grant foundation.

The William T. Grant Foundation is a private, national foundation that supports research to improve the lives of young people in the United States. I (first author) came to the foundation in 2004, with the goal of improving the connections between research, policy, and practice in order to achieve social change. Trained as a community psychologist, with a background in ethnic studies, I was frustrated that research and social change too often occurred on different planes, and I was seeking ways to bring them together.

The Foundation’s interest in research-practice partnerships (RPPs) grew out of our initiative on studying the use of research evidence in policy and practice (Tseng, 2012 ). Early in the effort, partnerships between researchers, practitioners, and policymakers emerged as “opportunities to learn about the mechanisms and conditions that facilitate the successful use of research” (Tseng, 2010 ). Research across diverse sectors had uniformly found that relationships were critical for fostering research uptake. Education practitioners prized studies conducted in their local contexts, with their students and schools. Thus, when researchers and practitioners collaborated to develop research agendas, the research was more useful to practitioners and more likely to be used. We believed that studying partnerships would provide broader lessons for the field about what it takes to improve the usefulness and use of research evidence.

While the premise underlying partnerships seems like common sense today, the ideas were fairly radical compared to the then-dominant dissemination approach of “moving research to practice.” In U.S. education, the first decade of the twenty-first century was dominated by a “What Works” agenda that focused on testing and then scaling up effective programs across communities. Those goals led some funders to privilege randomized-controlled trials as “gold standard” research and to equate rigor with experiments. Moreover, the What Works agenda was largely top down, supported by the federal government and philanthropies who used their dollars to incentivize communities to adopt evidence-based programs.

As this linear approach ascended in federal policy, a bottom-up movement was brewing at the local level. Researchers and school districts across the U.S. were forming long-term partnerships to improve education (Tseng and Coburn, 2019 ). Unlike What Works initiatives, these local efforts embraced a relational approach. Research and practice partners believed that sustained relationships would enable them to tackle more complex and challenging problems over time. In developing enduring collaborations, they would avoid the trend of one-off projects that came and went with grant funding and failed to make significant change.

When the Foundation became interested in partnerships, we encountered a diffuse group of organizations and projects that had not yet cohered into the field of research-practice partnerships (RPPs) as we know it today. These relational approaches seemed promising but challenging to pull off well. Thus, we took a two-prong strategy to increase our learning and that of the field. First, we commissioned a paper (Coburn et al., 2013 ) that reviewed the landscape of RPPs and provided a conceptual framework and common language to understand and talk about partnership work. Second, we invited nine partnerships to form a 3-year learning community. The network’s goals were to explore ways to build and sustain strong RPPs, produce research that is useful to school districts, and support districts in using research to improve education. The foundation hoped that the learning community would help individual partnerships strengthen their work, build relationships and collaborations with one another, and yield lessons for us, other funders, and the broader field about how to improve the usefulness and use of research.

An initial concern was whether the different types of partnerships would see themselves as part of a community. Others had convened partnerships in the past, and we heard mixed reports about the success of those interactions. There was tension, and sometimes competition, between partnerships that came from different intellectual traditions and employed contrasting research approaches (see Tseng and Coburn, 2019 ). The term research-practice partnerships was rarely heard, and instead groups identified themselves as design research partnerships , networked improvement communities , or partnerships based on the Chicago Consortium on School Research (later called Research Alliances by Coburn et al., 2013 ). New partnerships were also emerging via the Regional Education Labs funded by the U.S. Institute of Education Sciences, and some questioned whether they were authentic partnerships committed to long-term work.

The RPP paper and learning community created mechanisms for partnerships to explore their shared goal of transforming research-practice relationships. They all eschewed drive-by research wherein researchers dropped into schools to collect data, but failed to leave behind valuable contributions for educators or communities. As partnerships learned more about each other, a common RPP identity emerged and the lines between partnership types blurred as they adopted each other’s practices.

As the foundation’s commitment to the network drew to an end, the group expressed a desire to share their lessons learned with others. This demand from the field led to our creation of an RPP resource website (rpp.wtgrantfdn.org), which shares guiding tips, work samples, and other resources from the learning community and well beyond it. The RPPs also raised the need for an ongoing network. We thus supported Ruth Lopez-Turley, the founder of a Houston RPP, to establish what would become the National Network of Education Research-Practice Partnerships (NNERPP). In addition to providing general operating support for NNERPP’s establishment, I co-facilitated the initial meeting, and we recruited other funders to support the network. In 2022, NNERPP has 59 members, provides a community for partnerships, and offers training and resources to support the field’s expansion and success.

Our funder role has largely been to help forge a united RPP field and build its capacity to transform the relationships between research and practice. As a mid-size foundation, this role suited us because we could invest modest dollars for convenings, publications (academic- and practitioner-focused), and resources that complemented the much larger government and philanthropic dollars that supported the start-up and ongoing operational costs for RPPs across the country.

Faithful to our interest in studying research use, we also supported research on RPPs. We funded theory-driven, empirically rigorous research on RPPs on topics such as role and identity negotiations within partnerships, how partnership research influences policy, and the organizational capacity needed to use partnership research (Allen et al., 2018 ; Farrell et al., 2019a ; Farrell et al., 2019b ). As the field matured and faced greater demands for evidence of effectiveness, we also funded the development of a conceptual framework for what constitutes RPP “success” (Henrick et al., 2017 ) and the development of measurement tools to assess effectiveness.

In addition, Foundation staff committed considerable time to raising RPP visibility. I estimate giving over 80 presentations and publishing 15 papers and blog posts on RPPs between 2011 and 2021. In one paper co-authored with funder colleagues (Tseng et al., 2017 ), we outlined five necessary elements of successful RPPs:

partnership structures, including a governance system, agreed upon roles and responsibilities, and staffing;

shared commitments, including both a long-term research agenda and discrete projects;

activities for producing and using research, including the ground rules for how research will be carried out and plans for iterative communication as the work proceeded;

capacity building efforts to shore up the ability of researchers and practitioners to collaborate, as well as to strengthen the partnership itself (i.e., collaboration tools, relationship-building activities, etc.); and

funding, both for projects and the partnership infrastructure.

We argued that when those elements came together, a partnership identity emerged wherein the research and practice partners shared a common narrative about what the partnership is and what it does. Key to success was the ability to weather constant change, particularly frequent turnover in district leadership and the need to build bridges with new leaders.

Over time, our attention turned to sustainable funding models because funders were more apt to support projects than operating costs. Infrastructure and staffing costs were crucial for building relationships, maintaining robust data systems, supporting research use when policy windows opened serendipitously, communicating findings to diverse stakeholders, and scoping new projects (Tseng et al., 2017 ). We argued that a sustainable funding model would require a mix of government and philanthropic support, and advised a growing group of funders interested in RPPs, encouraged investments in the National Network of Education Research-Practice Partnerships, and convened education funders in a learning community affectionately called the Nerd Herd.

Lenfest Ocean Program at The Pew Charitable Trusts

The Lenfest Ocean Program’s (LOP) focus on relational research began with developing a model for meeting its mission: to support policy-relevant research about critical issues in ocean conservation. This narrative reflects my (second author) experiences in leading the science-policy engagement efforts of the program. I joined the program after working in academia to generate policy-relevant science and in government trying to access policy-relevant research. Seeing gaps in the connections between research and policy, I was eager to join a program that could focus explicitly on making research more useful and used.

When I joined the program early in its development, we relied mostly on science communication techniques that dominated the conservation field at the time (Smith et al., 2013 ). The idea was that decision-makers did not have sufficient access or understanding of science so research needed to be packaged and disseminated more effectively. Even in its early stages, however, we expanded on a linear approach. Our model was not guided by a particular body of scholarship on research use (we didn’t know about that scholarship yet), but rather a desire to more efficiently address policy information needs. We identified policy-relevant projects by scanning fisheries management decision-making to pinpoint issues that research could address. Early projects focused on synthesizing research to inform policy issues and meet decision-making timelines. We then developed communication materials to facilitate access to the findings for fisheries managers and to amplify the results for other stakeholders, for example by partnering with local advocacy groups to relay research to resource managers via factsheets and briefings and through the media (Bednarek et al., 2016 ).

Over time, we began to support more extensive and bidirectional engagement between decision-makers and researchers, and hired a growing team of boundary-spanning staff to undergird it (Bednarek et al., 2016 ). This evolution grew out of several key turning points. First, as the number and variety of projects that we funded increased, we found it more efficient to ask decision-makers directly about their knowledge gaps and research needs. Second, as projects focused on more complex policy issues, we saw a need for researchers and decision-makers to engage directly in order to develop projects that could sufficiently address complex policy needs while building trust in the findings. Third, even after we began to support more active engagement early in the project, we realized the need to remain heavily involved in facilitating the engagement process in order to ensure the project remained relevant for policy. Funded scientists didn’t have the time or background to do this work themselves (Bednarek et al., 2016 ).

As the program evolved, we faced challenges in refining and scaling the work. As science-policy outreach lead, I found tracking outcomes difficult, especially over the time periods when detectable shifts in decision-making and policy were likely to occur. In addition, direct policy changes (e.g., in regulations or legislation) were uncommon, and we began to observe a much wider array of outcomes, including changing the way policymakers or practitioners viewed the feasibility of various management options, opening new policy windows for research, and increasing decision-maker interest in long-term relationships with researchers to address other policy questions (Bednarek et al., 2018 ). It was equally challenging to disentangle how the science interventions, versus other forces (e.g., advocacy by environmental NGOs), contributed to those changes.

In my quest to find practical ways to help us track the impacts in our engagement work, I began to seek models or peer organizations to guide us and scholarship and practical guidance that could provide a framework for our work. I found scholarship on relational research approaches, primarily coproduction and boundary spanning. These approaches matched our intent to transform the science-policy interface by beginning with relevant research to solve problems with and for decision-makers and making knowledge production and exchange more dynamic, and thus evidence use more likely (Bednarek et al., 2018 ). The theoretical framework of coproduction also provided us with principles to guide our work: maximizing the credibility, saliency, and legitimacy of research in policy (Cash et al., 2003 ). Part of our role as funders was to be boundary spanners, who were actively involved in facilitating engagement. Boundary spanning is a concept that originally emerged from the business and organizational management literature (see Carlile, 2002 ; 2004 ) as an expertize needed to manage the boundaries between those involved in relational approaches, translate and exchange knowledge efficiently, find and negotiate common understandings, and identify paths forward.

Using these frameworks, we were able to unpack specific steps to follow in funding relational research (Bednarek et al., 2016 ; Landrum et al., 2022 ), including:

Supporting research projects in which researchers work closely with users to identify relevant or salient research questions;

Seeding and facilitating relationships with key decision-making partners by supporting engagement early and often;

Supporting and encouraging sustained engagement throughout the research process to maximize legitimacy and buy-in;

Tailoring communication and dissemination for user needs throughout the project process to maintain relevancy and saliency (factsheets to describe the potential project, intermediate findings, and final ones; engagement workshops; policy briefings);

Requiring peer-reviewed publications as one product of the research process to maximize credibility for multiple stakeholders (scientists, policy-makers, etc.). While research relevance was critical for policy stakeholders, scientific credibility was also important. We found decision-makers in the fisheries sector were more likely to consider research findings if they had been published in the peer-reviewed literature. However, we also included a deliverable (with sufficient time) in each grant that required the grantee to engage with LOP staff in outreach and engagement;

Using boundary spanners employed by the Program to support the entire process, from scoping the research and policy contexts to identifying potential projects and partnerships, matching researchers and decision-makers who could work together, ensuring and facilitating active knowledge exchange, and translating knowledge throughout the process for all actors involved.

Within this framework, grants supported researcher time, research costs, and when needed, meetings between the research team, with policymakers, and with other stakeholders.

Despite becoming more granular about our process, we still hadn’t solved our practical needs—how best to expand and scale this work, and measure progress and outcomes. We began to seek like-minded organizations (in the beginning, mostly environmental or conservation ones) with whom to share insights. With our theoretical grounding in mind, I also began to write and present widely about the Program’s work, to help us explain our approach and the practical challenges we faced to external audiences (Bednarek et al., 2016 ; Bednarek et al., 2018 ). Similar to WTG’s efforts to build a learning community around RPPs, I began to convene these organizations and thought leaders to find lessons to guide the Program’s work and to tackle critical issues, such as impact tracking (Bednarek et al., 2016 ; Bednarek et al., 2018 ).

We also used our dive into the scholarship about coproduction and our learning from peer organizations to create a measurement system for the program that tracked multiple kinds of uses of our funded research, rather than just policy change. Developing this framework required expanding our peer network to other sectors, including education, public health, and international development. I began to convene a larger array of sectors in order to identify practical ways to implement these frameworks, including specific indicators of research use (Tseng and Bednarek, 2019 ). I also developed collaborative relationships with research use scholars who could help guide and implement our forays into measurement and assessment (see Louder et al., 2020 ; Cvitanovic et al., 2022 ).

Through our work to improve our funding practices and define success for the Program, we found many promising outcomes and growing interest in relational research (Bednarek et al., 2018 ). We also found persistent challenges. With little capacity for researchers or dedicated experts at the grantees’ institutions to help with the engagement and boundary spanning, our work was often limited by our own staff time and resources. Finally, while our measurement framework captures a wider variety of kinds of research use, we still struggled with practical ways to measure and track impacts in real time during a funded project and over the longer time periods required for policy changes.

The Pacific Institute for Climate Solutions (PICS)

The Canada-based Pacific Institute for Climate Solutions (PICS) was established in 2009 through an endowment of the British Columbia (BC) provincial government. PICS is a unique entity in the region—an independent funding and research consortium delivered in partnership between four research-intensive universities, the University of Victoria, University of British Columbia, University of Northern British Columbia and Simon Fraser University. The organization was created to support climate research and to develop cutting-edge solutions to mitigate global warming and adapt to its unavoidable consequences (Government of BC, 2008 ).

In its early years, PICS built the organization’s foundation and a network to deliver on its mandate, funding new academic research projects on a range of topics and providing opportunities for students. In the second half of its first decade, PICS turned its thematic and investment focus to the “Big Five” sources of greenhouse gasses and potential for decarbonization in the region. Like the LOP, the research approaches employed were consistent with convention at the time and focused on providing academic insight into policy options, assessment needs, and technical knowledge on particular topics and connecting with those that could benefit from this information. The organization also hosted regular public events and lectures on topics relating to climate change, which helped PICS and its network earn recognition for its climate expertize and a reputation for relevant and necessary thought-leadership. By the end of the first decade, PICS had supported 24 post-doctoral fellows, over 140 graduate researchers and the production of more than 120 journal articles and 100 policy briefs, white papers and specialist reports. Internally, communications staff synthesized knowledge, made it publicly available via websites and newsletters, and translated it into key outputs solicited by policymakers in the PICS network.

While improvements were continually being made, particularly in science communications, this period ended with a sense that the goals of promoting interdisciplinarity and impact beyond academia had not been fully realized. While funding supported rigorous climate research for academic ends and helped drive general awareness on climate themes, knowledge exchange with potential users remained limited, and PICS projects continued to be underpinned by a dominant logic of information-deficit rather than solution-orientation.

In late-2015 PICS welcomed a new leader who assembled a diverse taskforce to co-develop a new strategic plan for PICS’ next 5 years. Involving members of government, academia, indigenous communities, and civil society, the plan development process pointed to ways that PICS could achieve greater influence and impact. It also highlighted the challenges of serving these different groups, including differences in values and interests. For instance, when one of the scientific reviewers cautioned that a stronger emphasis on knowledge mobilization could position PICS too closely to policy advocacy, another argued that the disproportionate emphasis on knowledge production and academic publications—to the detriment of investments in mobilization and translation—was holding PICS back. This second reviewer, an academic who works closely with practitioners, reinforced this argument by saying that the name of the organization is the Pacific Institute for Climate Solutions , not the Pacific Institute for Climate Research .

Instead of handing off research results to others with the implicit expectation that the knowledge produced would be mobilized for impact, the review proposed that PICS play a more hands-on role in future research projects (PICS, 2016 ). The organization adjusted its work to align more closely with the emerging global consensus around actionable research on climate solutions (Lemos et al., 2018 ; Meadow et al., 2015 ) and centered its activities around engagement with key climate solutions stakeholders beyond academia. The review also highlighted ways PICS could build internal capacity to deliver on these goals, including by redirecting and adding team capacity in boundary spanning and in-house climate solutions expertize. Partnerships were also seen as a key tool for improving dialog with potential knowledge users and understanding the context in which evidence could make a difference (Pidgeon and Fischoff, 2011 ; Wolf and Moser, 2011 ).

PICS leadership and staff explored a new Theory of Change and the PICS’ Research Engagement model or “PICS way” emerged as a means of embedding collaboration and coproduction into all its work (PICS, 2017 ). By 2018, PICS had initiated new programs and began recruiting experts interested in working at the interface of research and practice. I (third author) joined as the first in this new group and was immediately involved in an effort to adapt the Pew Lenfest Ocean Program’s impact framework for PICS and collaborative discussions with both Pew and the W.T. Grant Foundation. I came to PICS after working for another organization facilitating and funding academic-practitioner partnerships as a means of enhancing knowledge, cross-community learning and exchange, and ultimately, co-created sustainability outcomes.

All funded research is now conducted in hands-on partnerships between PICS as boundary spanner; researchers as lead knowledge agents, and practitioners or policymakers as users or what PICS calls “solution seekers.” In-depth collaboration throughout the research process—from the delineation of the problem from research and practical perspectives to the mapping of stakeholders and pathways to impact—helps create a better “fit” between knowledge generation and intended use, while mobilizing partners (PICS, 2017 ). Collaboration also creates the conditions for a greater and ongoing focus on the two-way process of knowledge exchange and the ultimate goal of a new form of translated or transformed knowledge co-produced by the different partners (Hamann and Faccer, 2018 ; Carlile, 2004 ).

In these partnerships, at least half of the funding is devoted to the time of emerging researchers and students, with the remaining funds available for any additional costs to meet the objectives of the projects, including meetings, research activities, communications costs, or research materials. PICS provides boundary-spanning support to all funded projects through the regular involvement of one member of the PICS expert staff (including myself) as well as occasional support of PICS-employed communications and administrative professionals. For large flagship projects, a full-time staff member is hired to oversee the coproduction process and lead major aspects of boundary spanning.

In addition to the boundary-spanning models built into each research project, PICS develops longer-term relationships with agents of change, such as the ministry responsible for climate in the province, the private sector, or university administrations. In funded projects and strategic relationship development, PICS devotes staff time and maintains smaller budgets available for convenings and shorter-term developmental opportunities (e.g., pilots, needs assessments, or internships). PICS’ Theme Partnership Program allows collaborators more time (4–5 years) and resources ($1 million) to address more complex research problems and with more diverse stakeholder communities. This allows research projects to plan and account, not only for shorter-term outcomes such as early-stage climate technologies, but also the enabling environment, for instance the investment industry, which enables these technologies to reach the market.

The “PICS way” or theoretical framework includes:

External scholar and practitioner reviewers for project funding applications to ensure that theoretical and practical aims are both sufficiently well-defined and considered at the concept stage;

Dedicated support for researchers and solution seekers in addressing review-identified needs and opportunities for the most promising projects;

An embedded member of the PICS team into both smaller (2–3 year, small group) and larger (4–5 year, large group) research projects;

An outline of non-scholarly and scholarly impacts, and pathways to achieving them at the project outset, as well as revisiting these intentions throughout the project;

Encouraging all types of knowledge (academic, indigenous, practitioner, etc.) to be brought to bear on the project as it unfolds;

Providing implementation support, including ensuring regular engagement such as monthly meetings with all partners;

Facilitating project-led convenings aimed at facilitating extended awareness, engagement, and knowledge mobilization among potential decision-makers beyond the project team;

Seeding and stewarding relationships with key decision-making partners (e.g., government departments, priority sectors) at an institutional (PICS) level;

Working with academic and other funding institutions to improve researcher capacity and opportunities for impact;

Ongoing support by PICS staff for project communications and outputs to inform stakeholders beyond project teams;

Tracking and considering all types of impact throughout the project—from relational to scholarly.

Converging paths and the implications for field-building

Despite traveling along different paths to improve the usefulness and use of research evidence, we observed a set of common barriers that funders could address to improve and expand relational approaches. First, we discovered that relational approaches require a specialized skill set and expertise that don’t easily fit traditional research or practice roles. While we each identified ways to fill those needs in our funding portfolios, we see a need to address these staffing and infrastructure issues on a wider scale. Second, while informed by research on research use, we need stronger theory and more robust empirical methods to yield credible and critical insight on how well relational approaches are faring and how to improve them. Third, relational research is not generally fostered in universities, and we saw an important opportunity for funders to engage academia in reshaping its norms and incentive systems to support relational research.

We discuss each of these needs below and offer recommendations for our funder colleagues (see Table 1 ). Some recommendations can be addressed by individual funders, but others will require funders to come together to share learning, align funding, and collaborate. Thus our fourth recommendation is funder coordination across policy sectors and countries.

Boundary spanner capacity

We found that relational approaches require specialized expertise and practical collaboration experience. Facilitating relational approaches benefits from knowledge of multiple research disciplines and policy issues in order to bring partners together around a common goal and to manage diverse needs and interests, as well as skills in facilitation, negotiation, and conflict resolution (see Cairney, 2016 ; Bernstein et al., 2017 ; Wentworth et al., 2021 ). Relational approaches also require the ability to identify and navigate a complex web of interests, perspectives, needs, and values (Penuel et al., 2015 ; Hamann and Faccer, 2018 ). This intensive and time-consuming work has led to the rise of boundary spanners, sometimes called expert intermediaries, who have the skills and time to “enabl[e] exchange between the production and use of knowledge to support evidence-informed decision-making in a specific context” (Bednarek et al., 2018 ; Cash et al., 2003 ; Guston, 2001 ).

Each of our funding programs has recognized the value of boundary spanners. Indeed, we have found that relational research is constrained by lack of funding and capacity. Thus, we have each sought to build the capacity and resources to support these specialized roles. For Lenfest and PICS, building capacity has meant hiring staff that possess the skills and expertise to understand the research and policy landscape and to support relationships between research grantees, their policy and practice partners, and other stakeholders. As a grantmaking foundation, William T. Grant supports boundary-spanning within partnership grants.

Despite their value, boundary spanners are not broadly supported yet. There are various barriers to overcome. First, their work tends to be behind-the-scenes bridging activities that are “invisible” to the researchers, decision-makers and others with whom they work (Meagher and Lyall, 2013 ; Farrell et al., 2019 ). Second, boundary spanners are not yet common roles, nor are there consistent job titles, institutional homes, or training programs for them, making it challenging to hire staff for these roles even when there is a recognized need (Neal et al., 2020 ). Third, knowledge about effective boundary-spanning practice is scattered across sectors, and there are key knowledge gaps, such as defining ethical practice and dealing with power relations between funders and non-funders (York et al., 2020 ). These challenges will require funders and others to support boundary spanners more explicitly, within funded projects and funding organizations as well as through training and professionalization (see Table 1 ).

Research on relational models

Our journeys also reveal the need for rigorous studies of whether, how, and under what conditions relational approaches are successful (Bednarek et al., 2016 ; Tseng, 2017 ). As research funders it made sense to turn a rigorous empirical gaze on our own work: both to evaluate our initiatives and to inform our future work. The Lenfest Ocean Program faced a dearth of relevant scholarship that could guide their attempts to evolve and scale their work, so they supported research to synthesize available frameworks and produce case study analyses (Cvitanovic et al., 2022 ; Latchford and Fox, 2013 ; Louder et al., 2020 ). The William T. Grant Foundation, in contrast, began with an interest in building stronger theory and empirical evidence about ways to improve the use and usefulness of research, and then homed in on partnerships as promising initiatives to study (Tseng, 2012 ; Tseng, 2017 ). The foundation’s more academic orientation led us to value theory as a way to codify conjectures about what it takes to improve research use, which could then be empirically supported or refuted, thereby enhancing theory and empirical knowledge on improving research use.

Despite different initial goals for our research investments, we recognized the need to clarify what “effectiveness” looks like in boundary spanning and RPPs (see Table 1 ). Two popular frameworks—one for assessing boundary spanning in environmental science (Posner and Cvitanovic, 2019 ) and another for RPPs in education research (Henrick et al., 2017 )—suggest that effectiveness can be judged by whether these collaborations achieve: (1) trusting relationships and iterative knowledge exchange between researchers and decision-makers, (2) the use of research in decision-making, (3) strengthened capacity of decision-makers to use research, and (4) strengthened capacity of researchers to collaborate with decision-makers. Henrick et al. ( 2017 ) also propose a fifth dimension that is implicit in Posner and Cvitanovic’s ( 2019 ) framework: whether partnerships produce more useful research.

We also agreed that conceptual frameworks for what to measure must be matched with robust methods for how to measure them. Rigorous methods are important because prior assessments of research impact on policy have often relied on easy-to-collect data such as the number of website hits, downloads, or citations—data that yield little insight into whether the research was used in decision-making or whether it even changed anyone’s thinking. More rigorous methods for studying relational approaches require more time and resources for data collection and analysis, but they offer stronger evidence of whether and how research actually reached decision-makers and, if so, how the research was used (Gitomer and Crouse, 2019 ; Posner and Cvitanovic, 2019 ). For example, funders might consider social network analysis to assess how research flows between individuals and organizations to reach policy actors (Cvitanovic et al., 2015 ; Finnigan et al., 2013 ). Interviews and surveys provide unique insight into decision-makers’ perceptions of their collaborations and the usefulness of the research produced. Observation, discourse, and document analyses of data sources such as policy documents, meeting proceedings, or recordings of legislative sessions can provide evidence of how research was framed and used in policy deliberations in situ.

Transforming academia

Our journeys also converged on a shared need to expand academic incentives and norms. An evidence ecosystem in which academics can routinely and successfully partner with policymakers and communities will require significant change in universities (Gamoran, 2018 ). In our current system, academic culture and incentives too often insulate faculty within ivory towers (Bogenschneider and Corbett, 2021 ; Lam, 2010 ; Hart and Silka, 2020 ). Faculty are rewarded for their influence on academia by university tenure and promotion systems that privilege academic publications and citations by other academics, not for the research’s influence on policymakers, communities, or the broader public (Tseng and Gamoran, 2017 ). Academic culture also holds policy-relevant research with less esteem, often casting it as less intellectually rigorous or as a community service (rather than scholarly) contribution. Moreover, graduate students and faculty generally receive little mentoring, guidance, and skill-building opportunities for conducting partnership-oriented research (Bednarek et al., 2018 ).

Funders can raise the visibility of these issues, provide incentives for university change, and support faculty and university leaders who are working to transform their institutions (see Table 1 ). For example, the Carnegie Corporation and the William T. Grant Foundation’s staff have written essays arguing that “the future of higher education is social impact” and calling on universities to recognize the policy impact of research in tenure and promotion decisions (Del Rosso 2015 ; Gamoran, 2018 , Tseng and Gamoran, 2017 ). From our relatively protected position as funders, we are in a safe position to argue that universities must change or be left behind as antiquated, socially irrelevant institutions.

Funders can also use their grantmaking to incentivize academic transformation. For example, the Carnegie Corporation of New York’s Rigor and Relevance Initiative gives special funding consideration to universities that “count” policy-relevant activities in promotion and tenure reviews and that stop tenure clocks for “periods of immersion in policy work.” The Institutional Challenge Grant (supported by the William T. Grant, Doris Duke and Spencer Foundations, and American Institutes for Research) program encourages universities to reward faculty’s partnerships with policymakers and practitioners. In one early success, the University of California, Berkeley’s leadership issued new guidelines that raised the visibility of community-engaged research in the faculty evaluation process and provided “specific guidance to deans, department chairs, and faculty about how to credit non-peer-reviewed products of community-engaged scholarship as scholarship rather than as service” (Ozer, 2021 ). Notably, the grant review process advanced this cause when reviewers asked for “evidence that Berkeley is genuinely committed to make changes in faculty evaluation.” That request emboldened Ozer and her colleagues, the university’s Associate Vice Chancellor for Research, Deans from three colleges, and the Chairs of the Academic Senate and the Budget Committee to detail their commitments to institutional change. Within 1 week, the powerful Budget Committee Chair wrote a memo that would become the adopted guidelines.

Coordinating funders

Our experiences also suggest that funders can harness their collective resources, expertise, and influence to address these and other challenges to research production and use (Oliver and Boaz, 2019 ; Arnott et al., 2020 ). Without collective action, we and our research, policy, and community partners will continually work against the grain of dominant orthodoxy. We can have greater collective influence and set our sights on strengthening the evidence ecosystem so that it becomes normative for researchers to collaborate with governments and communities to solve pressing social problems and universities have incentive and support systems to bolster those efforts.

With these ideas in mind, Pew and William T. Grant have joined forces with other funders to establish the Transforming Evidence Funders Network (TEFN) (Bednarek and Tseng, 2022 ). The network unites public and private funders across the world, including PICS, to learn from each other, align our efforts, and grow a field focused on improving our evidence ecosystem. Just as the three of us have learned from each other, the network provides a forum for funders to transparently share their funding practices and identify ways to improve them. Our interactions break down the silos that have walled us off from learning from and with each other across policy areas, disciplines, and countries (Oliver and Boaz, 2019 ). Already, TEFN participants have begun identifying promising grantmaking practices to support collaborative research, including shared expectations about what constitutes strong partnership proposals.

We also hope our investments can complement or supplement each other’s efforts to meet the needs we detail in this paper, while avoiding duplicative work and wheel reinventions. One promising step is the launch of our sister network, the Transforming Evidence Network. While TEFN brings together funders, this broader community of researchers, policymakers, intermediaries, funders, and other stakeholders across countries and policy sectors will enable all of us to learn from each other, build upon each other’s work, and expand the field’s capacity to produce and use research evidence to meet societal needs.

In the longer term, we hope that funders can jointly fund larger scale projects than any of us could support alone. These might include establishing an international network of research on research use centers, support for institutional transformations across a university system, development of fair and robust systems for assessing the social impact of research, or a workforce development initiative to scale and professionalize the practice of boundary spanning.

Despite working in vastly disparate sectors, we have found remarkable similarity in our journeys. In our individual funding efforts, we adopted relational models because they provided better ways for our research investments to inform policy and practice. Dissatisfied with linear models, we invested in field-building activities for research-practice partnerships in education (William T. Grant) and created the infrastructure within our funding programs to enable research grantees to undertake relational research (Lenfest and PICS). Moreover, as we have engaged with a larger group of funders, we have observed an even broader convergence. Funders across sectors (healthcare, international development, education, environment, sustainability, foreign policy), funding strategies (operating vs. grantmaking foundations, project vs. operating grants), and geography (US, UK, Canada, Germany, South Africa) are moving past dissemination to support relational approaches to research production and use.

As funders, we now face a critical opportunity: to further expand our learning together, to align our efforts, and to grow the field in order to achieve the impact we all seek. To meet our ambitious goals, we’ll need to increase our transparency about our funding strategies, be willing to invest in rigorous research about whether our efforts are successful, and consider our own roles in the evidence ecosystem. We must be willing to broaden our understanding of research impact (Wickert et al., 2021 ), embrace a new dynamic between science and society (Gamoran, 2018 ; Sarewitz, 2009 ; Howard-Grenville, 2021 ), and recognize the nuances and challenges facing those who do this work (Boaz et al., 2021 ).

Having found fellow travelers on our journey, we are optimistic that our growing group of funders can tackle the challenges detailed in this paper. We welcome additional funder colleagues to join us. We also welcome researchers and other stakeholders to help us critically reflect on our work, so that we can confront our own assumptions and follies, follow the evidence, and zero in on the critical levers for progress. If we seize the opportunity before us, funders can be better partners to researchers, policymakers, and communities in catalyzing a stronger evidence ecosystem where research is routinely useful to and used in policy and practice to improve society.

Data availability

All data analyzed are included in the paper.

Allen A, Penuel WR (2018) How educational leaders see MIST: a case for long-term, mutualistic partnerships between educators and researchers. In: Cobb P, Jackson K, Henrick E, Smith TM and the MIST Team (eds). Systems for instructional improvement: creating coherence from the classroom to the district office. Harvard Education Press, Cambridge, MA. pp. 234–252

Arnott JC, Kirchoff CJ, Meyer RM et al. (2020) Sponsoring actionable science: what public science funders can do to advance sustainability and the social contract for science. Curr Opin Environ Sustain https://doi.org/10.1016/j.cosust.2020.01.006

Arnott JC (2021) Pens and purse strings: Exploring the opportunities and limits to funding actionable sustainability science. Res Policy 50(10):104362

Article   Google Scholar  

Bartunek JM, Rynes SL (2014) Academics and practitioners are alike and unlike: the paradoxes of academic-practitioner relationships. J Manag 40(5):1181–1201. https://doi.org/10.1177/0149206314529160

Bednarek AT, Shouse B, Hudson CG et al. (2016) Science-policy intermediaries from a practitioner’s perspective: The Lenfest Ocean Program experience. Sci Pub Policy. https://doi.org/10.1093/scipol/scv008

Bednarek AT, Wyborn C, Cvitanovic C et al. (2018) Boundary spanning at the science–policy interface: the practitioners’ perspectives. Sustain Sci 13:1175–1183

Article   CAS   Google Scholar  

Bednarek AT, Tseng V (2022) A global movement for engaged research. Issues in Science and Technology 38(3):53–56

Google Scholar  

Bernstein MJ, Reifschneider K, Bennett I, Wetmore JM (2017) Science outside the lab: helping graduate students in science and engineering understand the complexities of science policy. Science Engineering and Ethics 23:861–882. https://doi.org/10.1007/s11948-016-9818-6

Best A, Holmes B (2010) System thinking, knowledge and action: towards better models and methods. Evid Policy 6(2):145–159. https://doi.org/10.1332/174426410X502284

Boaz A, Borst R, Kok M et al. (2021) How far does an emphasis on stakeholder engagement and co-production in research present a threat to academic identity and autonomy? A prospective study across five European countries. Res Eval 2021:1–9. https://doi.org/10.1093/reseval/rvab013

Bogenschneider K, Corbett TJ (2021) Evidence-based policymaking: envisioning a new era of theory, research, and practice. Routledge

Cairney P (2016) The politics of evidence-based policy making. Palgrave Macmillan, London

Carlile PR (2002) A pragmatic view of knowledge and boundaries: Boundary objects in new product development. Organ Sci 13(4):442–455

Carlile PR (2004) Transferring, translating, and transforming: An integrative framework for managing knowledge across boundaries. Organ Science 15(5):555–568

Caplan N (1979) The two-communities theory and knowledge utilization. Am Behav Sci 22(3):459–470. https://doi.org/10.1177/000276427902200308

Cash DW, Clark WC, Alcock F et al. (2003) Knowledge systems for sustainable development. Proc Natl Acad Sci USA 100:8086–91

Article   ADS   CAS   Google Scholar  

Chapman M, Gajewska-De Mattos H, Antoniou C (2004). The ethnographic international business researcher: Misfit or trailblazer. In: Piekkari R, Welch C (eds). Handbook of qualitative research methods for international business. Edward Elgar Publishing Limited Glensanda House Montpellier Parade Cheltenham Glos GUO I VA UK. pp. 287–305

Coburn CE, Penuel WR, Geil K (2013) Research-practice partnerships at the district level: a new strategy for leveraging research for educational improvement. William T. Grant Foundation, New York, NY

Cunliffe AL (2018) Alterity: the passion, politics, and ethics of self and scholarship. Manag Learn 49(1):8–22

Cvitanovic C, Wyborn C, Glenn E, et al. (2022) Ten considerations for research funders seeking to enhance the impact of marine science on policy and practice. Front Marine Policy (in press)

Cvitanovic C, Cunningham R, Dowd A et al (2017) Using Social Network Analysis to Monitor and Assess the Effectiveness of Knowledge Brokers at Connecting Scientists and Decision-Makers: An Australian case study. Environ Policy Gov 27(3):256–269

Cvitanovic C, Hobday AJ, van Kerkhoff L et al. (2015) Improving knowledge exchange among scientists and decision-makers to facilitate the adaptive governance of marine resources: A review of knowledge and research needs. Ocean Coast Manag 112:25–35. https://doi.org/10.1016/j.ocecoaman.2015.05.002

Del Rosso S (2015) Our new three rs: rigor, relevance, and readability. Governance 28(2):127–130

Dilling L, Lemos MC (2011) Creating usable science: opportunities and constraints for climate knowledge use and their implications for science policy. Glob Environ Chang 21 (2): https://doi.org/10.1016/j.gloenvcha.2010.11.006

Farley-Ripple E, Oliver K, Boaz A (2020) Mapping the community: use of research evidence in policy and practice. Humanit Soc Sci Commun 7:83

Farrell CC, Coburn CE, Chong S (2019a) Under what conditions do school districts learn from external partners? The role of absorptive capacity. Am Educ Res J 56(3):955–994. https://doi.org/10.3102/0002831218808219

Farrell CC, Harrison C, Coburn CE (2019b) What the hell is this, and who the hell are you?” Role and identity negotiation in research-practice partnerships. AERA Open 5:1–13. https://doi.org/10.1177/2332858419849595

Finnigan KS, Daly AJ, Che J (2013) Systemwide reform in districts under pressure: the role of social networks in defining, acquiring, using, and diffusing research evidence. J Educ Admin 51(4):476–497. https://doi.org/10.1108/09578231311325668

Flinders, M (2020) Fit for the future: research leadership matters. a review of research leadership in the social sciences. final report, June 2020. Economic and Social Research Council. Accessed Jan 28, 2022: https://www.ukri.org/wp-content/uploads/2021/10/ESRC-12102021-FitFortheFuture-ResearchLeadershipMatters.pdf

Gamoran A (2018) Evidence-based policy in the real world: a cautionary view. Ann Am Acad Polit Soc Sci 678(1):180–191. https://doi.org/10.1177/0002716218770138

Gioia DA, Corley KG, Hamilton AL (2013) Seeking qualitative rigor in inductive research: Notes on the Gioia methodology. Organ Res Methods 16(1):15–31

Gitomer DH, Crouse K (2019) Studying the use of research evidence: a review of methods. William T. Grant Foundation, New York, NY

Government of British Columbia (2008) Speech from the Throne, The Honourable Steven L. Point, Lieutenant-Governor at the Opening of the Fourth Session, Thirty Eighth Parliament of the Province of British Columbia, February 12, 2008. https://www.leg.bc.ca/content/legacy/web/38th4th/Throne_Speech_2008.pdf Accessed Jun 28, 2021

Guston D (2001) Boundary organizations in environmental policy and science: an introduction. Sci Tech Hum Values 16:399–408. https://doi.org/10.1177/016224390102600401

Hamann R, Faccer K (2018) Mind the transformation gap: knowledge exchange, interests and identity in research-practice collaboration. In: Bartunek JM, McKenzie J (eds) Academic-practitioner relationships: developments, complexities and opportunities. Routledge, New York, NY, pp. 234–252

Hart D, Silka L (2020) Rebuilding the ivory tower: a bottom-up experiment in aligning research with societal needs. Issues in Science and Technology 36(4):64–70

Henrick EC, Cobb P, Penuel WR, Jackson K, Clark T (2017) Assessing research-practice partnerships: five dimensions of effectiveness. William T. Grant Foundation, New York, NY

Hering J (2015) Do we need “more research” orbetter implementation through knowledge brokering? Sustain Sci, https://doi.org/10.1007/s11625-015-0314-8

Howard-Grenville J (2021) Caring, courage and curiosity: Reflections on our roles as scholars in organizing for a sustainable future. Organ Theory 2(1):1–16. https://doi.org/10.1177/2631787721991143

Jarzabkowski P, Bednarek R, Lê JK (2014) Producing persuasive findings: demystifying ethnographic textwork in strategy and organization research. Strateg Organ 12(4):274–287

Lam A (2010) From ‘ivory tower traditionalists’ to ‘entrepreneurial scientists’? Academic scientists in fuzzy university—industry boundaries. Social Stud Sci 40(2):307–340

Landrum, JP, Hudson CG, Close SL, Knight E, Paquin R, Bell V, Ripple K (2022) Grant-making criteria for developing useful and usable marine science: a philanthropic perspective. Front Mar Sci, https://doi.org/10.3389/fmars.2021.809953

Latchford L, Fox D (2013) Assessing the effectiveness of the Lenfest Forage Fish Task Force report: Little Fish, Big Impact. Lenfest Ocean Program report

Lemos MC, Arnott JC, Ardoin NM, Baja K, Bednarek AT, Dewulf A, Fieseler C, Goodrich KA, Jagannathan K, Klenk N, Mach KJ, (2018) To coproduce or not to coproduce. Nat Sustain https://www.nature.com/articles/s41893-018-0191-0

Louder E, Wyborn C, Cvitanovic C, Bednarek AT (2020) A synthesis of the frameworks available to guide evaluations of research impact at the interface of environmental science, policy and practice. Environ Sci Policy. https://doi.org/10.1016/j.envsci.2020.12.006

Lubchenco J (1998) Entering the century of the environment: a new social contract for science. Science 279(5350):491–497

Meagher L, Lyall C (2013) The invisible made visible: using impact evaluations to illuminate and inform the role of knowledge intermediaries. Evid Policy 9(3):409–418

Meadow AM, Ferguson DB, Guido Z, Horangic A, Owen G, Wall T (2015) Moving toward the deliberate coproduction of climate science knowledge. Weath Clim Society 7(2):179–19. https://doi.org/10.1175/WCAS-D-14-00050.1

Article   ADS   Google Scholar  

McLean RK, Graham ID, Tetroe JM, Volmink JA (2018) Translating research into action: an international study of the role of research funders. Health Res Policy Syst 16:44. https://doi.org/10.1186/s12961-018-0316-y

Article   PubMed   PubMed Central   Google Scholar  

Neal JW, Neal Z, Brutzman B (2020) Defining brokers, intermediaries, and boundary spanners: a systematic review. Evid Policy. https://doi.org/10.1332/174426420X16083745764324

Neupane S, Boulanger F, Taylor P (2016) The role of development research funders in promoting equity in research consortia. American J Bioethics 16(10):62–64. https://doi.org/10.1080/15265161.2016.1214316

Nordbäck E, Hakonen M, Tienari J (2021) Academic identities and sense of place: a collaborative autoethnography in the neoliberal university. Manag Learn https://doi.org/10.1177/13505076211006543

Nurse P (2015) Ensuring a successful UK research endeavour: a review of the UK research councils. Department for Business Innovation and Skills (BIS)

Nutley S, Walter I, Davies HTO (2007) Using evidence: how research can inform public services. Policy Press, Bristol

Book   Google Scholar  

Oliver K, Boaz A (2019) Transforming evidence for policy and practice: creating space for new conversations. Pal Commun 5:60. https://doi.org/10.1057/s41599-019-0266-1

Ozer E (2021) How we embraced the challenge of institutional change to pave the way for community-engaged research. William T. Grant Foundation, New York, NY

Pandya RE (2014) Community-Driven Research in the Anthropocene. In Future Earth—Advancing Civic Understanding of the Anthropocene (eds Dalbotten D, Roehrig G, Hamilton P). https://doi.org/10.1002/9781118854280.ch6

Pacific Institute for Climate Solutions (2016) Organizational review. Internal document. University of Victoria, Victoria

Pacific Institute for Climate Solutions (2017). Strategic plan 2017–2021. https://pics.uvic.ca/sites/default/files/2019-06/2017%20Annual%20Report.pdf Accessed Jun 29, 2021

Penuel WR, Allen A, Coburn CE, Farrell C (2015) Conceptualizing research–practice partnerships as joint work at boundaries. J Educ Stud Placed Risk (JESPAR) 20(1-2):182–197. https://doi.org/10.1080/10824669.2014.988334

Pidgeon N, Fischhoff B (2011) The role of social and decision sciences in communicating uncertain climate risks. Nat Clim Chang 1(35-41):345–358. https://doi.org/10.1038/nclimate1080

Posner SM, Cvitanovic C (2019) Evaluating the impacts of boundary-spanning activities at the interface of environmental science and policy: a review of progress and future research needs. Environ Sci Policy 92:141–151. https://doi.org/10.1016/j.envsci.2018.11.006

Sarewitz D (2009) World view: a tale of two sciences. Nature 462:566. https://doi.org/10.1038/462566a

Article   CAS   PubMed   Google Scholar  

Sarewitz D, Pielke Jr RA (2007) The neglected heart of science policy: Reconciling supply of and demand for science. Environ Sci Policy 10:5–16

Sharma G, Bansal P (2020) Partnering up: Including managers as research partners in systematic reviews. Organ Res Methods. https://doi.org/10.1177/1094428120965706

Smith B, Baron N, English C, Galindo H, Goldman E, McLeod K, Miner M, Neeley E (2013) COMPASS: navigating the rules of scientific engagement. PLoS Biol 11(4):e1001552. https://doi.org/10.1371/journal.pbio.1001552

Article   CAS   PubMed   PubMed Central   Google Scholar  

Tazzyman S, Moreton R, Bowes L, Wakeling P, Stutz, A (2020) Review of the PhD in the Social Sciences. Report, October 2021. Economic and Social Research Council. Accessed Jan 28, 2022: https://www.ukri.org/wp-content/uploads/2022/03/ESRC-020322-Review-of-the-PhD-in-the-Social-Sciences.pdf

Tseng V (2010) Learning about the use of research to inform evidence-based policy and practice: early lessons and future directions. William T. Grant Foundation 2009 Annual Report. William T. Grant Foundation, New York, NY

Tseng V (2012) The uses of research in policy and practice and commentaries. Soc Policy Rep 26(2):1–24. https://doi.org/10.1002/j.2379-3988.2012.tb00071.x

Tseng V (2017) The next big leap for research-practice partnerships: Building and testing theories to improve research use. William T. Grant Foundation, New York, NY

Tseng V, Easton J, Supplee L (2017) Research-practice partnerships: building two-way streets of engagement. Soc Policy Report. https://doi.org/10.1002/j.2379-3988.2017.tb00089.x

Tseng V, Gamoran A (2017) Bringing rigor to relevant questions: how social science research can improve youth outcomes in the real world. William T. Grant Foundation Annual Digest

Tseng V, Coburn C (2019) Using evidence in the US. In: Boaz A, Davis H, Fraser A, Nutley S (eds) What works now? Evidence-informed policy and practice. Policy Press, Bristol, pp. 351–368

Tseng V, Bednarek AT (2019) Working together to enhance the use of research in policy and practice: http://wtgrantfoundation.org/working-together-to-enhance-the-use-of-research-in-policy-and-practice

Vesa M, Vaara E (2014) Strategic ethnography 2.0: Four methods for advancing strategy process and practice research. Strateg Organ 12(4):288–298

Wentworth L, Conaway C, Shewchuk S, Arce-Trigatti P (2021) RPP brokers handbook: a guide to brokering in education research-practice partnerships. National Network of Education Research-Practice Partnerships (NNERPP), Houston, TX

Wickert C, Post C, Doh JP, Prescott JE, Prencipe A (2021) Management research that makes a difference: Broadening the meaning of impact. J Manag Stud 58(2):297–320. https://doi.org/10.1111/joms.12666

Wolf J, Moser SC (2011) Individual understandings, perceptions, and engagement with climate change: insights from in‐depth studies across the world. Wiley Interdiscip Rev Clim Change 2(4):547–569. https://doi.org/10.1002/wcc.120

Yeo R, Dopson S (2018) Getting lost to be found: the insider−outsider paradoxes in relational ethnography. Qual Res Organ Manag 13(4):333–355

York A, Valladares S, Valladares MR, Snyder J, Garcia M (2020) Community Research Collaboratives. Boulder, CO: National Education Policy Center. Retrieved Jun 2021 from http://nepc.colorado.edu/publication/crc

Zawadzki M, Jensen T (2020) Bullying and the neoliberal university: a co-authored autoethnography. Manag Learn 51(4):398–413

Download references

Acknowledgements

The authors express their deep gratitude to Annette Boaz, Anna Hopkins, and Chris Cvitanovic for their research comparing our theories of change for partnerships and boundary spanning, which inspired this paper. We also thank Sybil Seitzinger, Ami Nagle, and Charlotte Hudson for their input on this article.

Author information

Authors and affiliations.

William T Grant Foundation, New York, NY, USA

Vivian Tseng

Pew Charitable Trusts, Philadelphia, PA, USA

Angela Bednarek

University of Toronto, Toronto, Ontario, Canada

Kristy Faccer

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Vivian Tseng .

Ethics declarations

Competing interests.

The authors declare no competing interests

Ethical approval

This paper does not involve human participants.

Informed consent

Additional information.

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

Rights and permissions

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

Reprints and permissions

About this article

Cite this article.

Tseng, V., Bednarek, A. & Faccer, K. How can funders promote the use of research? Three converging views on relational research. Humanit Soc Sci Commun 9 , 219 (2022). https://doi.org/10.1057/s41599-022-01157-w

Download citation

Received : 01 July 2021

Accepted : 31 March 2022

Published : 29 June 2022

DOI : https://doi.org/10.1057/s41599-022-01157-w

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

Quick links

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

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base

Methodology

Triangulation in Research | Guide, Types, Examples

Published on January 3, 2022 by Pritha Bhandari . Revised on June 22, 2023.

Triangulation in research means using multiple datasets, methods, theories, and/or investigators to address a research question . It’s a research strategy that can help you enhance the validity and credibility of your findings and mitigate the presence of any research biases in your work.

Triangulation is mainly used in qualitative research , but it’s also commonly applied in quantitative research . If you decide on mixed methods research , you’ll always use methodological triangulation.

• Qualitative research: You conduct in-depth interviews with different groups of stakeholders, such as parents, teachers, and children.
• Quantitative research: You run an eye-tracking experiment and involve three researchers in analyzing the data.
• Mixed methods research: You conduct a quantitative survey, followed by a few (qualitative) structured interviews.

Table of contents

Types of triangulation in research, what is the purpose of triangulation, pros and cons of triangulation in research, other interesting articles, frequently asked questions about triangulation.

There are four main types of triangulation:

• Data triangulation: Using data from different times, spaces, and people
• Investigator triangulation: Involving multiple researchers in collecting or analyzing data
• Theory triangulation: Using varying theoretical perspectives in your research
• Methodological triangulation : Using different methodologies to approach the same topic

We’ll walk you through the four types of triangulation using an example. This example is based on a real study .

Methodological triangulation

When you use methodological triangulation, you use different methods to approach the same research question.

This is the most common type of triangulation, and researchers often combine qualitative and quantitative research methods in a single study.

Methodological triangulation is useful because you avoid the flaws and research bias that come with reliance on a single research technique.

Data triangulation

In data triangulation, you use multiple data sources to answer your research question. You can vary your data collection across time, space, or different people.

When you collect data from different samples, places, or times, your results are more likely to be generalizable to other situations.

Investigator triangulation

With investigator triangulation, you involve multiple observers or researchers to collect, process, or analyze data separately.

They review video recordings of your participants playing team games in pairs and analyze and note down any cooperative behaviors. You check that their code sheets line up with each other to ensure high interrater reliability.

Investigator triangulation helps you reduce the risk of observer bias and other experimenter biases.

Theory triangulation

Triangulating theory means applying several different theoretical frameworks in your research instead of approaching a research question from just one theoretical perspective.

• People cooperate for a sense of reward: they cooperate to feel good.
• People cooperate to avoid guilt: they cooperate to avoid feeling bad.

Testing competing hypotheses is one way to perform theory triangulation. Using theory triangulation may help you understand a research problem from different perspectives or reconcile contradictions in your data.

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

Researchers use triangulation for a more holistic perspective on a specific research question. Triangulation is also helpful for enhancing credibility and validity.

To cross-check evidence

It’s important to gather high-quality data for rigorous research. When you have data from only one source or investigator, it may be difficult to say whether the data are trustworthy.

But if data from multiple sources or investigators line up, you can be more certain of their credibility.

Credibility is about how confident you can be that your findings reflect reality. The more your data converge, or or agree with each other, the more credible your results will be.

For a complete picture

Triangulation helps you get a more complete understanding of your research problem.

When you rely on only one data source, methodology, or investigator, you may risk bias in your research. Observer bias may occur when there’s only one researcher collecting data. Similarly, using just one methodology means you may be disadvantaged by the inherent flaws and limitations of that method.

• Behavioral observations from a lab setting
• Self-report survey data from participants reflecting on their daily lives
• Neural data from an fMRI scanner during a cooperative task

It’s helpful to use triangulation when you want to capture the complexity of real-world phenomena. By varying your data sources, theories, and methodologies, you gain insights into the research problem from multiple perspectives and levels.

To enhance validity

Validity is about how accurately a method measures what it’s supposed to measure.

You can increase the validity of your research through triangulation. Since each method has its own strengths and weaknesses, you can combine complementary methods that account for each other’s limitations.

In contrast, survey data offers you more insights into everyday behaviors outside a lab setting, but since it’s self-reported, it may be biased.

Finally, fMRI data can tell you more about hidden neural mechanisms without any participant interference. But this type of data is only valuable for your research when combined with the others.

Like all research strategies, triangulation has both advantages and disadvantages.

Reduces bias

Triangulating data, methods, investigators, or theories helps you avoid the research bias that comes with using a single perspective in your research. You’ll get a well-rounded look into the research topic when you use triangulation.

Establishes credibility and validity

Combining different methods, data sources, and theories enhances the credibility and validity of your research. You’ll be able to trust that your data reflect real life more closely when you gather them using multiple perspectives and techniques.

Time-consuming

Triangulation can be very time-consuming and labor-intensive. You’ll need to juggle different datasets, sources, and methodologies to answer one research question.

This type of research often involves an interdisciplinary team and a higher cost and workload. You’ll need to weigh your options and strike a balance based on your time frame and research needs.

Inconsistent

Sometimes, the data from different sources, investigators, methods may not line up to give you a clear picture. Your data may be inconsistent or contradict each other.

This doesn’t necessarily mean that your research is incoherent. Rather, you’ll need to dig deeper to make sense of why your data are contradictory. These inconsistencies can be challenging but may also lead to new avenues for further research.

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

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Ecological validity

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Triangulation in research means using multiple datasets, methods, theories and/or investigators to address a research question. It’s a research strategy that can help you enhance the validity and credibility of your findings.

Triangulation is mainly used in qualitative research , but it’s also commonly applied in quantitative research . Mixed methods research always uses triangulation.

There are four main types of triangulation :

• Data triangulation : Using data from different times, spaces, and people
• Investigator triangulation : Involving multiple researchers in collecting or analyzing data
• Theory triangulation : Using varying theoretical perspectives in your research

Triangulation can help:

• Reduce research bias that comes from using a single method, theory, or investigator
• Enhance validity by approaching the same topic with different tools
• Establish credibility by giving you a complete picture of the research problem

But triangulation can also pose problems:

• It’s time-consuming and labor-intensive, often involving an interdisciplinary team.
• Your results may be inconsistent or even contradictory.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

Bhandari, P. (2023, June 22). Triangulation in Research | Guide, Types, Examples. Scribbr. Retrieved September 4, 2024, from https://www.scribbr.com/methodology/triangulation/

Is this article helpful?

Pritha Bhandari

Other students also liked, mixed methods research | definition, guide & examples, qualitative vs. quantitative research | differences, examples & methods, observer bias | definition, examples, prevention, what is your plagiarism score.

The university of tulsa Online Blog

Trending topics in the tu online community

Nursing Research: What It Is and Why It Matters

When people think about medical research, they often think about cutting-edge surgical procedures and revolutionary new medications. As important as those advancements are, another type of research is just as vital: nursing research.

This type of research informs and improves nursing practice. In many cases, it’s focused on improving patient care. Experienced nurses who have advanced nursing degrees and training in research design typically conduct this research.

Nurse research can explore any number of topics, from symptomology to patient diet. However, no matter the focus of a research project, nurse research can improve health care in an impressive number of ways. As experts in their field, nurse researchers can pursue a wide range of unique career advancement opportunities .

Why Nursing Research Matters: Examples of Research in Action

Research drives innovation in every industry. Given that nurses are on the front line of the health care industry, the research they do can be particularly impactful for patient outcomes. 

It Can Improve Patients’ Quality of Life

Patients diagnosed with life-threatening chronic diseases often undergo intense treatments with sometimes debilitating side effects. Nursing research is vital to helping such patients maintain a high quality of life.

For example, a 2018 study led by a nurse scientist explored why cancer patients undergoing chemotherapy frequently experience severe nausea. While the physical toll of chemotherapy contributes to nausea, the study found that patients who have factors such as children to take care of, high psychological stress, and trouble performing day-to-day tasks are often much more likely to experience nausea.

By identifying the root causes of nausea and which patients are more likely to experience it, this research allows health care professionals to develop evidence-based care practices . This can include prescribing anti-nausea medications and connecting patients to mental health professionals.

It’s Central to Making Health Care More Equitabl

A Gallup survey reports that about 38% of Americans put off seeking medical treatment due to costs. Unfortunately, cost is only one factor that prevents people from seeking treatment. Many Americans don’t live close to medical providers that can meet their needs, aren’t educated about health, or encounter discrimination.

As complex as this issue is, the National Institute of Nursing Research (NINR) asserts that the country’s nurse researchers can lead the charge in tackling it. In its strategic plan for 2022 to 2026, the institute highlights the following:

• Nursing has long been one of the most trusted professions in the country.
• Nurses often interact with patients, patients’ families, and communities more frequently than other health care professionals.
• The care that nurses provide must often take environmental and social factors into account.

These traits put nurses in the position to not only research health inequity but also put their research to work in their organizations. To help make that happen, NINR often funds nurse-led research projects focused on equity and social determinants of health. With that kind of backing, the field may become more transformative than ever.

It Can Strengthen the Health Care Workforce

While nursing research can be used to improve patient care, it can also be leveraged to solve issues health care professionals face daily. Research about the state of the health care workforce during the COVID-19 pandemic is a perfect illustration.

In 2022, a team of nurse researchers published a report called Nursing Crisis: Challenges and Opportunities for Our Profession After COVID-19 in the International Journal of Nursing Practice . In it, the authors provided concrete statistics about the following:

• Mental and physical health issues many nurses encountered
• Effects of increased workloads and decreased nurse-to-patient ratios
• How many nurses were planning to leave the profession altogether

As nurses themselves, the authors also offer actionable, evidence-based solutions to these issues, such as streamlining patient documentation systems and implementing employee wellness programs.

However, this type of research isn’t just important to solving workforce issues stemming from specific emergencies, such as the COVID-19 pandemic. By publishing quantifiable data about the challenges they face, nurse researchers empower other nurses and professional nursing organizations to advocate for themselves. This can help employers enact effective policies, support their nursing staff, and draw more talented people into the profession.

Career Opportunities in Nursing Research

Nurse researchers can work in any number of administrative, direct care, and academic roles. However, because nurse research often requires clinical care and data analysis skills, jobs in this field typically require an advanced degree, such as a Master of Science in Nursing (MSN).

While many more nurse research career opportunities exist, here are four career paths nurses with research experience and advanced degrees can explore.

Nurse Researcher

Nurse researchers identify issues related to nursing practice, collect data about them, and conduct research projects designed to inform practice and policy. While they often work in academic medical centers and universities, they can work for any type of health care provider as well as health care advocacy agencies.

In addition to conducting research, these professionals typically provide direct patient care. Many also write papers for peer-reviewed journals and make presentations about their work at conferences.

Clinical Research Nurse

Despite having a similar title to nurse researchers, clinical research nurses have slightly different responsibilities. These professionals are usually in charge of providing care to patients participating in medical research projects, including clinical trials and nursing research initiatives. They also typically collect data about patient progress, coordinate care between different team members, and contribute to academic papers.

Occupational Health Nurse

Also referred to as environmental health nurses, occupational health nurses serve specific communities, such as professionals in a particular industry or people who live in a particular area. They often educate their communities about relevant health risks, advocate for stronger health and safety regulations, and run wellness programs.

To carry out their duties, occupational and environmental health nurses must typically research health trends about the people they serve, including living and working conditions that put them at risk for illness or injury. They can work for private companies and government agencies.

Nurse Educator

Nurse educators prepare new nurses to enter the workforce or train experienced nurses in more advanced techniques. This can include teaching classes and providing on-the-job training. They often work for colleges, universities, and large health care providers.

While their duties don’t always include research, nurse educators must keep up with the health care industry’s needs and new patient care practices. This is so they can provide relevant education themselves and help their organizations design up-to-date curricula.

Make Nursing Research a Part of Your Journey

Conducting and implementing nurse research is a collaborative effort. It takes a team of informed leaders, skilled analysts, and creative educators to create effective, evidence-based policies. Those interested in pursuing nurse research should consider The University of Tulsa’s online MSN program , which can prepare you to fill any one of those roles and more.

All of TU’s MSN students take classes on research and evidence-based practices. However, the program’s specialty tracks allow students to take their studies in multiple research-oriented directions. For instance, if you’re interested in collecting and interpreting clinical data, you can choose the Informatics and Analysis track. If you have a passion for public health policy, the Public Health and Global Vision track includes classes on population health and epidemiology.

Delivered in a flexible online format, this program can be a great option for working nurses and nontraditional students alike. To find out more, read about TU’s admission policies and request more information today.

Recommended Readings

A Nurse Educator’s Role in the Future of Nursing

How Global Health Nursing Supports Population Health

What Can You Do With an MSN?

Gallup, “Record High in U.S. Put Off Medical Care Due to Cost in 2022”

International Journal of Nursing Practice, “Nursing Crisis: Challenges and Opportunities for Our Profession After COVID‐19”

Journal of Pain Symptom Management , “Risk Factors Associated With Chemotherapy-Induced Nausea in the Week Prior to the Next Cycle and Impact of Nausea on Quality of Life Outcomes”

Mayo Clinic, Nursing

National Institute of Nursing Research, Scientific Strategy: NINR’s Research Framework

National Institute of Nursing Research, The National Institute of Nursing Research 2022-2026 Strategic Plan

Recent Articles

How Leaders Drive Quality Improvement in Nursing

University of Tulsa

Aug 23, 2024

Wellness Nurse: Career Definition and More

Types of Nursing Degrees

Aug 21, 2024

Learn more about the benefits of receiving your degree from The University of Tulsa

• Online Program Tuition
• AGACNP Certificate Online
• Online MSN Program
• Accelerated Online BSN
• RN to BSN Program
• RN to MSN Program
• MS in Cyber Security
• Meet the Team
• Nursing Student Practicum Requirements
• Disclosures for Professional Nursing Licensure
• On Campus Programs

When bats were wiped out, more human babies died, a study found. Here's why

Researchers find infant deaths increased after farmers used more pesticides to compensate for rise of pests.

Social Sharing

A deadly pandemic has decimated bats in North America — and that has ultimately had harmful effects on humans, including higher rates of infant mortality, according to a new study.

The research is part of growing evidence that humans rely on the animal and plant species around them, and are harmed when those species decline or go extinct.

White-nose syndrome is a deadly fungal disease that kills an average of 70 per cent of bats it infects, and has been spreading to new areas since it was first reported on the continent in 2006.

The disease wakes bats during their hibernation, often causing them to freeze and starve to death.

What happens when bats aren't there for farmers?

Ecologists know that bats play a crucial role in eating up and controlling insect pests.

Because of that, Eyal Frank, an environmental economist at the University of Chicago, decided to look at what happened when white-nose syndrome spread into new counties in the eastern U.S., decimating bat populations.

He found that farmers responded to the resulting insect outbreaks by increasing their pesticide use 31 per cent. Pesticides are toxic, and often associated with human health impacts such as increases in infant deaths.

Frank found that infant mortality went up eight per cent after the arrival of white-nose syndrome in a county, according to his study published today in the journal Science .

"At first I was surprised," Frank said, noting those increases are "big effects."

But he noted that in regions affected by white-nose syndrome, bat populations don't just decline, but plummet, and are often wiped out altogether.

"This is really turning off the switch on biological pest control in some of these counties," he said.

That forces farmers to compensate with "a lot more insecticides," which he notes are toxic by design.

• World's globetrotting animals at risk due to habitat loss, climate change

Frank also found evidence that not only were the pesticides expensive, but they weren't as good as the bats at controlling insects — farmers' revenue from crop sales fell 29 per cent in areas hit by the bat pandemic.

He estimates that in total, farmers in communities with bat die-offs lost $26.9 billion between 2006 and 2017. Putting a number to damages from infant mortality resulted in a societal cost of $39.6 billion from the loss of bats.

B.C. researchers trying to stave off deadly bat disease

The importance of biodiversity.

The study shows how interactions between species such as bats and insects stabilize the ecosystems that other species rely on, including humans, who can be harmed when those species disappear, Frank said.

"These ecosystems are very complex systems with many interactions between species, and we do not fully understand what to expect or what will happen when we allow one species to fall below some viable population level or to go extinct," said Frank, who had previously linked the deaths of half a million people in India to the collapse of local vulture populations due to accidental poisoning.

• When India's vulture population collapsed, half a million human deaths followed: study

He added that preserving more species and more biodiversity can provide redundancies so that if one species declines, another may be able to fill its role.

Jianping Xu, a McMaster University professor who studies white-nose syndrome in North American bats, said the new study shows that bats are important "not only for ecosystem, but also for agriculture and for human health."

Xu, who did not participate in the research, said the "data looks pretty solid." While the study focused on the eastern U.S., Xu said white-nose syndrome is in all 10 Canadian provinces, and bats here are even more affected, as it's colder and they have a longer hibernation.

He'd like to see similar Canadian data on the link between bat declines,  pesticides and infant mortality.

"I wouldn't be surprised if Canadian data show a similar pattern," he said.

Xu added that increased use of pesticides is also linked to bat declines, creating a "vicious cycle." He believes pesticide applications should be limited to areas without bats.

• Can urban parks protect biodiversity as they welcome more visitors?
• Independent scientist resigns from pesticide regulator over transparency concerns

Bruce Lanphear, a health sciences professor and expert in pesticides at Simon Fraser University, said the study "elegantly" uses the pandemic among bats as a natural experiment to show the impact of pesticides on human health. But he noted the research has limitations in determining which pesticides were implicated in these health impacts.

Lanphear, who has been critical of the federal government's transparency when it comes to pesticides, said the findings should also lead us to "ask questions like, 'Why aren't our governments finding ways to reduce pesticide use?'"

ABOUT THE AUTHOR

Science, Climate, Environment Reporter

Emily Chung covers science, the environment and climate for CBC News. She has previously worked as a digital journalist for CBC Ottawa and as an occasional producer at CBC's Quirks & Quarks. She has a PhD in chemistry from the University of British Columbia. In 2019, she was part of the team that won a Digital Publishing Award for best newsletter for "What on Earth." You can email story ideas to [email protected].

• Subscribe to the What on Earth newsletter

With files from Inayat Singh

Related Stories

• Saving nature: WWF study highlights the best places for ecological restoration in Canada

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Can J Hosp Pharm
• v.68(3); May-Jun 2015

Qualitative Research: Data Collection, Analysis, and Management

Introduction.

In an earlier paper, 1 we presented an introduction to using qualitative research methods in pharmacy practice. In this article, we review some principles of the collection, analysis, and management of qualitative data to help pharmacists interested in doing research in their practice to continue their learning in this area. Qualitative research can help researchers to access the thoughts and feelings of research participants, which can enable development of an understanding of the meaning that people ascribe to their experiences. Whereas quantitative research methods can be used to determine how many people undertake particular behaviours, qualitative methods can help researchers to understand how and why such behaviours take place. Within the context of pharmacy practice research, qualitative approaches have been used to examine a diverse array of topics, including the perceptions of key stakeholders regarding prescribing by pharmacists and the postgraduation employment experiences of young pharmacists (see “Further Reading” section at the end of this article).

In the previous paper, 1 we outlined 3 commonly used methodologies: ethnography 2 , grounded theory 3 , and phenomenology. 4 Briefly, ethnography involves researchers using direct observation to study participants in their “real life” environment, sometimes over extended periods. Grounded theory and its later modified versions (e.g., Strauss and Corbin 5 ) use face-to-face interviews and interactions such as focus groups to explore a particular research phenomenon and may help in clarifying a less-well-understood problem, situation, or context. Phenomenology shares some features with grounded theory (such as an exploration of participants’ behaviour) and uses similar techniques to collect data, but it focuses on understanding how human beings experience their world. It gives researchers the opportunity to put themselves in another person’s shoes and to understand the subjective experiences of participants. 6 Some researchers use qualitative methodologies but adopt a different standpoint, and an example of this appears in the work of Thurston and others, 7 discussed later in this paper.

Qualitative work requires reflection on the part of researchers, both before and during the research process, as a way of providing context and understanding for readers. When being reflexive, researchers should not try to simply ignore or avoid their own biases (as this would likely be impossible); instead, reflexivity requires researchers to reflect upon and clearly articulate their position and subjectivities (world view, perspectives, biases), so that readers can better understand the filters through which questions were asked, data were gathered and analyzed, and findings were reported. From this perspective, bias and subjectivity are not inherently negative but they are unavoidable; as a result, it is best that they be articulated up-front in a manner that is clear and coherent for readers.

THE PARTICIPANT’S VIEWPOINT

What qualitative study seeks to convey is why people have thoughts and feelings that might affect the way they behave. Such study may occur in any number of contexts, but here, we focus on pharmacy practice and the way people behave with regard to medicines use (e.g., to understand patients’ reasons for nonadherence with medication therapy or to explore physicians’ resistance to pharmacists’ clinical suggestions). As we suggested in our earlier article, 1 an important point about qualitative research is that there is no attempt to generalize the findings to a wider population. Qualitative research is used to gain insights into people’s feelings and thoughts, which may provide the basis for a future stand-alone qualitative study or may help researchers to map out survey instruments for use in a quantitative study. It is also possible to use different types of research in the same study, an approach known as “mixed methods” research, and further reading on this topic may be found at the end of this paper.

The role of the researcher in qualitative research is to attempt to access the thoughts and feelings of study participants. This is not an easy task, as it involves asking people to talk about things that may be very personal to them. Sometimes the experiences being explored are fresh in the participant’s mind, whereas on other occasions reliving past experiences may be difficult. However the data are being collected, a primary responsibility of the researcher is to safeguard participants and their data. Mechanisms for such safeguarding must be clearly articulated to participants and must be approved by a relevant research ethics review board before the research begins. Researchers and practitioners new to qualitative research should seek advice from an experienced qualitative researcher before embarking on their project.

DATA COLLECTION

Whatever philosophical standpoint the researcher is taking and whatever the data collection method (e.g., focus group, one-to-one interviews), the process will involve the generation of large amounts of data. In addition to the variety of study methodologies available, there are also different ways of making a record of what is said and done during an interview or focus group, such as taking handwritten notes or video-recording. If the researcher is audio- or video-recording data collection, then the recordings must be transcribed verbatim before data analysis can begin. As a rough guide, it can take an experienced researcher/transcriber 8 hours to transcribe one 45-minute audio-recorded interview, a process than will generate 20–30 pages of written dialogue.

Many researchers will also maintain a folder of “field notes” to complement audio-taped interviews. Field notes allow the researcher to maintain and comment upon impressions, environmental contexts, behaviours, and nonverbal cues that may not be adequately captured through the audio-recording; they are typically handwritten in a small notebook at the same time the interview takes place. Field notes can provide important context to the interpretation of audio-taped data and can help remind the researcher of situational factors that may be important during data analysis. Such notes need not be formal, but they should be maintained and secured in a similar manner to audio tapes and transcripts, as they contain sensitive information and are relevant to the research. For more information about collecting qualitative data, please see the “Further Reading” section at the end of this paper.

DATA ANALYSIS AND MANAGEMENT

If, as suggested earlier, doing qualitative research is about putting oneself in another person’s shoes and seeing the world from that person’s perspective, the most important part of data analysis and management is to be true to the participants. It is their voices that the researcher is trying to hear, so that they can be interpreted and reported on for others to read and learn from. To illustrate this point, consider the anonymized transcript excerpt presented in Appendix 1 , which is taken from a research interview conducted by one of the authors (J.S.). We refer to this excerpt throughout the remainder of this paper to illustrate how data can be managed, analyzed, and presented.

Interpretation of Data

Interpretation of the data will depend on the theoretical standpoint taken by researchers. For example, the title of the research report by Thurston and others, 7 “Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory,” indicates at least 2 theoretical standpoints. The first is the culture of the indigenous population of Canada and the place of this population in society, and the second is the social constructivist theory used in the constructivist grounded theory method. With regard to the first standpoint, it can be surmised that, to have decided to conduct the research, the researchers must have felt that there was anecdotal evidence of differences in access to arthritis care for patients from indigenous and non-indigenous backgrounds. With regard to the second standpoint, it can be surmised that the researchers used social constructivist theory because it assumes that behaviour is socially constructed; in other words, people do things because of the expectations of those in their personal world or in the wider society in which they live. (Please see the “Further Reading” section for resources providing more information about social constructivist theory and reflexivity.) Thus, these 2 standpoints (and there may have been others relevant to the research of Thurston and others 7 ) will have affected the way in which these researchers interpreted the experiences of the indigenous population participants and those providing their care. Another standpoint is feminist standpoint theory which, among other things, focuses on marginalized groups in society. Such theories are helpful to researchers, as they enable us to think about things from a different perspective. Being aware of the standpoints you are taking in your own research is one of the foundations of qualitative work. Without such awareness, it is easy to slip into interpreting other people’s narratives from your own viewpoint, rather than that of the participants.

To analyze the example in Appendix 1 , we will adopt a phenomenological approach because we want to understand how the participant experienced the illness and we want to try to see the experience from that person’s perspective. It is important for the researcher to reflect upon and articulate his or her starting point for such analysis; for example, in the example, the coder could reflect upon her own experience as a female of a majority ethnocultural group who has lived within middle class and upper middle class settings. This personal history therefore forms the filter through which the data will be examined. This filter does not diminish the quality or significance of the analysis, since every researcher has his or her own filters; however, by explicitly stating and acknowledging what these filters are, the researcher makes it easer for readers to contextualize the work.

Transcribing and Checking

For the purposes of this paper it is assumed that interviews or focus groups have been audio-recorded. As mentioned above, transcribing is an arduous process, even for the most experienced transcribers, but it must be done to convert the spoken word to the written word to facilitate analysis. For anyone new to conducting qualitative research, it is beneficial to transcribe at least one interview and one focus group. It is only by doing this that researchers realize how difficult the task is, and this realization affects their expectations when asking others to transcribe. If the research project has sufficient funding, then a professional transcriber can be hired to do the work. If this is the case, then it is a good idea to sit down with the transcriber, if possible, and talk through the research and what the participants were talking about. This background knowledge for the transcriber is especially important in research in which people are using jargon or medical terms (as in pharmacy practice). Involving your transcriber in this way makes the work both easier and more rewarding, as he or she will feel part of the team. Transcription editing software is also available, but it is expensive. For example, ELAN (more formally known as EUDICO Linguistic Annotator, developed at the Technical University of Berlin) 8 is a tool that can help keep data organized by linking media and data files (particularly valuable if, for example, video-taping of interviews is complemented by transcriptions). It can also be helpful in searching complex data sets. Products such as ELAN do not actually automatically transcribe interviews or complete analyses, and they do require some time and effort to learn; nonetheless, for some research applications, it may be a valuable to consider such software tools.

All audio recordings should be transcribed verbatim, regardless of how intelligible the transcript may be when it is read back. Lines of text should be numbered. Once the transcription is complete, the researcher should read it while listening to the recording and do the following: correct any spelling or other errors; anonymize the transcript so that the participant cannot be identified from anything that is said (e.g., names, places, significant events); insert notations for pauses, laughter, looks of discomfort; insert any punctuation, such as commas and full stops (periods) (see Appendix 1 for examples of inserted punctuation), and include any other contextual information that might have affected the participant (e.g., temperature or comfort of the room).

Dealing with the transcription of a focus group is slightly more difficult, as multiple voices are involved. One way of transcribing such data is to “tag” each voice (e.g., Voice A, Voice B). In addition, the focus group will usually have 2 facilitators, whose respective roles will help in making sense of the data. While one facilitator guides participants through the topic, the other can make notes about context and group dynamics. More information about group dynamics and focus groups can be found in resources listed in the “Further Reading” section.

Reading between the Lines

During the process outlined above, the researcher can begin to get a feel for the participant’s experience of the phenomenon in question and can start to think about things that could be pursued in subsequent interviews or focus groups (if appropriate). In this way, one participant’s narrative informs the next, and the researcher can continue to interview until nothing new is being heard or, as it says in the text books, “saturation is reached”. While continuing with the processes of coding and theming (described in the next 2 sections), it is important to consider not just what the person is saying but also what they are not saying. For example, is a lengthy pause an indication that the participant is finding the subject difficult, or is the person simply deciding what to say? The aim of the whole process from data collection to presentation is to tell the participants’ stories using exemplars from their own narratives, thus grounding the research findings in the participants’ lived experiences.

Smith 9 suggested a qualitative research method known as interpretative phenomenological analysis, which has 2 basic tenets: first, that it is rooted in phenomenology, attempting to understand the meaning that individuals ascribe to their lived experiences, and second, that the researcher must attempt to interpret this meaning in the context of the research. That the researcher has some knowledge and expertise in the subject of the research means that he or she can have considerable scope in interpreting the participant’s experiences. Larkin and others 10 discussed the importance of not just providing a description of what participants say. Rather, interpretative phenomenological analysis is about getting underneath what a person is saying to try to truly understand the world from his or her perspective.

Once all of the research interviews have been transcribed and checked, it is time to begin coding. Field notes compiled during an interview can be a useful complementary source of information to facilitate this process, as the gap in time between an interview, transcribing, and coding can result in memory bias regarding nonverbal or environmental context issues that may affect interpretation of data.

Coding refers to the identification of topics, issues, similarities, and differences that are revealed through the participants’ narratives and interpreted by the researcher. This process enables the researcher to begin to understand the world from each participant’s perspective. Coding can be done by hand on a hard copy of the transcript, by making notes in the margin or by highlighting and naming sections of text. More commonly, researchers use qualitative research software (e.g., NVivo, QSR International Pty Ltd; www.qsrinternational.com/products_nvivo.aspx ) to help manage their transcriptions. It is advised that researchers undertake a formal course in the use of such software or seek supervision from a researcher experienced in these tools.

Returning to Appendix 1 and reading from lines 8–11, a code for this section might be “diagnosis of mental health condition”, but this would just be a description of what the participant is talking about at that point. If we read a little more deeply, we can ask ourselves how the participant might have come to feel that the doctor assumed he or she was aware of the diagnosis or indeed that they had only just been told the diagnosis. There are a number of pauses in the narrative that might suggest the participant is finding it difficult to recall that experience. Later in the text, the participant says “nobody asked me any questions about my life” (line 19). This could be coded simply as “health care professionals’ consultation skills”, but that would not reflect how the participant must have felt never to be asked anything about his or her personal life, about the participant as a human being. At the end of this excerpt, the participant just trails off, recalling that no-one showed any interest, which makes for very moving reading. For practitioners in pharmacy, it might also be pertinent to explore the participant’s experience of akathisia and why this was left untreated for 20 years.

One of the questions that arises about qualitative research relates to the reliability of the interpretation and representation of the participants’ narratives. There are no statistical tests that can be used to check reliability and validity as there are in quantitative research. However, work by Lincoln and Guba 11 suggests that there are other ways to “establish confidence in the ‘truth’ of the findings” (p. 218). They call this confidence “trustworthiness” and suggest that there are 4 criteria of trustworthiness: credibility (confidence in the “truth” of the findings), transferability (showing that the findings have applicability in other contexts), dependability (showing that the findings are consistent and could be repeated), and confirmability (the extent to which the findings of a study are shaped by the respondents and not researcher bias, motivation, or interest).

One way of establishing the “credibility” of the coding is to ask another researcher to code the same transcript and then to discuss any similarities and differences in the 2 resulting sets of codes. This simple act can result in revisions to the codes and can help to clarify and confirm the research findings.

Theming refers to the drawing together of codes from one or more transcripts to present the findings of qualitative research in a coherent and meaningful way. For example, there may be examples across participants’ narratives of the way in which they were treated in hospital, such as “not being listened to” or “lack of interest in personal experiences” (see Appendix 1 ). These may be drawn together as a theme running through the narratives that could be named “the patient’s experience of hospital care”. The importance of going through this process is that at its conclusion, it will be possible to present the data from the interviews using quotations from the individual transcripts to illustrate the source of the researchers’ interpretations. Thus, when the findings are organized for presentation, each theme can become the heading of a section in the report or presentation. Underneath each theme will be the codes, examples from the transcripts, and the researcher’s own interpretation of what the themes mean. Implications for real life (e.g., the treatment of people with chronic mental health problems) should also be given.

DATA SYNTHESIS

In this final section of this paper, we describe some ways of drawing together or “synthesizing” research findings to represent, as faithfully as possible, the meaning that participants ascribe to their life experiences. This synthesis is the aim of the final stage of qualitative research. For most readers, the synthesis of data presented by the researcher is of crucial significance—this is usually where “the story” of the participants can be distilled, summarized, and told in a manner that is both respectful to those participants and meaningful to readers. There are a number of ways in which researchers can synthesize and present their findings, but any conclusions drawn by the researchers must be supported by direct quotations from the participants. In this way, it is made clear to the reader that the themes under discussion have emerged from the participants’ interviews and not the mind of the researcher. The work of Latif and others 12 gives an example of how qualitative research findings might be presented.

Planning and Writing the Report

As has been suggested above, if researchers code and theme their material appropriately, they will naturally find the headings for sections of their report. Qualitative researchers tend to report “findings” rather than “results”, as the latter term typically implies that the data have come from a quantitative source. The final presentation of the research will usually be in the form of a report or a paper and so should follow accepted academic guidelines. In particular, the article should begin with an introduction, including a literature review and rationale for the research. There should be a section on the chosen methodology and a brief discussion about why qualitative methodology was most appropriate for the study question and why one particular methodology (e.g., interpretative phenomenological analysis rather than grounded theory) was selected to guide the research. The method itself should then be described, including ethics approval, choice of participants, mode of recruitment, and method of data collection (e.g., semistructured interviews or focus groups), followed by the research findings, which will be the main body of the report or paper. The findings should be written as if a story is being told; as such, it is not necessary to have a lengthy discussion section at the end. This is because much of the discussion will take place around the participants’ quotes, such that all that is needed to close the report or paper is a summary, limitations of the research, and the implications that the research has for practice. As stated earlier, it is not the intention of qualitative research to allow the findings to be generalized, and therefore this is not, in itself, a limitation.

Planning out the way that findings are to be presented is helpful. It is useful to insert the headings of the sections (the themes) and then make a note of the codes that exemplify the thoughts and feelings of your participants. It is generally advisable to put in the quotations that you want to use for each theme, using each quotation only once. After all this is done, the telling of the story can begin as you give your voice to the experiences of the participants, writing around their quotations. Do not be afraid to draw assumptions from the participants’ narratives, as this is necessary to give an in-depth account of the phenomena in question. Discuss these assumptions, drawing on your participants’ words to support you as you move from one code to another and from one theme to the next. Finally, as appropriate, it is possible to include examples from literature or policy documents that add support for your findings. As an exercise, you may wish to code and theme the sample excerpt in Appendix 1 and tell the participant’s story in your own way. Further reading about “doing” qualitative research can be found at the end of this paper.

CONCLUSIONS

Qualitative research can help researchers to access the thoughts and feelings of research participants, which can enable development of an understanding of the meaning that people ascribe to their experiences. It can be used in pharmacy practice research to explore how patients feel about their health and their treatment. Qualitative research has been used by pharmacists to explore a variety of questions and problems (see the “Further Reading” section for examples). An understanding of these issues can help pharmacists and other health care professionals to tailor health care to match the individual needs of patients and to develop a concordant relationship. Doing qualitative research is not easy and may require a complete rethink of how research is conducted, particularly for researchers who are more familiar with quantitative approaches. There are many ways of conducting qualitative research, and this paper has covered some of the practical issues regarding data collection, analysis, and management. Further reading around the subject will be essential to truly understand this method of accessing peoples’ thoughts and feelings to enable researchers to tell participants’ stories.

Appendix 1. Excerpt from a sample transcript

The participant (age late 50s) had suffered from a chronic mental health illness for 30 years. The participant had become a “revolving door patient,” someone who is frequently in and out of hospital. As the participant talked about past experiences, the researcher asked:

• What was treatment like 30 years ago?
• Umm—well it was pretty much they could do what they wanted with you because I was put into the er, the er kind of system er, I was just on
• endless section threes.
• Really…
• But what I didn’t realize until later was that if you haven’t actually posed a threat to someone or yourself they can’t really do that but I didn’t know
• that. So wh-when I first went into hospital they put me on the forensic ward ’cause they said, “We don’t think you’ll stay here we think you’ll just
• run-run away.” So they put me then onto the acute admissions ward and – er – I can remember one of the first things I recall when I got onto that
• ward was sitting down with a er a Dr XXX. He had a book this thick [gestures] and on each page it was like three questions and he went through
• all these questions and I answered all these questions. So we’re there for I don’t maybe two hours doing all that and he asked me he said “well
• when did somebody tell you then that you have schizophrenia” I said “well nobody’s told me that” so he seemed very surprised but nobody had
• actually [pause] whe-when I first went up there under police escort erm the senior kind of consultants people I’d been to where I was staying and
• ermm so er [pause] I . . . the, I can remember the very first night that I was there and given this injection in this muscle here [gestures] and just
• having dreadful side effects the next day I woke up [pause]
• . . . and I suffered that akathesia I swear to you, every minute of every day for about 20 years.
• Oh how awful.
• And that side of it just makes life impossible so the care on the wards [pause] umm I don’t know it’s kind of, it’s kind of hard to put into words
• [pause]. Because I’m not saying they were sort of like not friendly or interested but then nobody ever seemed to want to talk about your life [pause]
• nobody asked me any questions about my life. The only questions that came into was they asked me if I’d be a volunteer for these student exams
• and things and I said “yeah” so all the questions were like “oh what jobs have you done,” er about your relationships and things and er but
• nobody actually sat down and had a talk and showed some interest in you as a person you were just there basically [pause] um labelled and you
• know there was there was [pause] but umm [pause] yeah . . .

This article is the 10th in the CJHP Research Primer Series, an initiative of the CJHP Editorial Board and the CSHP Research Committee. The planned 2-year series is intended to appeal to relatively inexperienced researchers, with the goal of building research capacity among practising pharmacists. The articles, presenting simple but rigorous guidance to encourage and support novice researchers, are being solicited from authors with appropriate expertise.

Previous articles in this series:

Bond CM. The research jigsaw: how to get started. Can J Hosp Pharm . 2014;67(1):28–30.

Tully MP. Research: articulating questions, generating hypotheses, and choosing study designs. Can J Hosp Pharm . 2014;67(1):31–4.

Loewen P. Ethical issues in pharmacy practice research: an introductory guide. Can J Hosp Pharm. 2014;67(2):133–7.

Tsuyuki RT. Designing pharmacy practice research trials. Can J Hosp Pharm . 2014;67(3):226–9.

Bresee LC. An introduction to developing surveys for pharmacy practice research. Can J Hosp Pharm . 2014;67(4):286–91.

Gamble JM. An introduction to the fundamentals of cohort and case–control studies. Can J Hosp Pharm . 2014;67(5):366–72.

Austin Z, Sutton J. Qualitative research: getting started. C an J Hosp Pharm . 2014;67(6):436–40.

Houle S. An introduction to the fundamentals of randomized controlled trials in pharmacy research. Can J Hosp Pharm . 2014; 68(1):28–32.

Charrois TL. Systematic reviews: What do you need to know to get started? Can J Hosp Pharm . 2014;68(2):144–8.

Competing interests: None declared.

Further Reading

Examples of qualitative research in pharmacy practice.

• Farrell B, Pottie K, Woodend K, Yao V, Dolovich L, Kennie N, et al. Shifts in expectations: evaluating physicians’ perceptions as pharmacists integrated into family practice. J Interprof Care. 2010; 24 (1):80–9. [ PubMed ] [ Google Scholar ]
• Gregory P, Austin Z. Postgraduation employment experiences of new pharmacists in Ontario in 2012–2013. Can Pharm J. 2014; 147 (5):290–9. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Marks PZ, Jennnings B, Farrell B, Kennie-Kaulbach N, Jorgenson D, Pearson-Sharpe J, et al. “I gained a skill and a change in attitude”: a case study describing how an online continuing professional education course for pharmacists supported achievement of its transfer to practice outcomes. Can J Univ Contin Educ. 2014; 40 (2):1–18. [ Google Scholar ]
• Nair KM, Dolovich L, Brazil K, Raina P. It’s all about relationships: a qualitative study of health researchers’ perspectives on interdisciplinary research. BMC Health Serv Res. 2008; 8 :110. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pojskic N, MacKeigan L, Boon H, Austin Z. Initial perceptions of key stakeholders in Ontario regarding independent prescriptive authority for pharmacists. Res Soc Adm Pharm. 2014; 10 (2):341–54. [ PubMed ] [ Google Scholar ]

Qualitative Research in General

• Breakwell GM, Hammond S, Fife-Schaw C. Research methods in psychology. Thousand Oaks (CA): Sage Publications; 1995. [ Google Scholar ]
• Given LM. 100 questions (and answers) about qualitative research. Thousand Oaks (CA): Sage Publications; 2015. [ Google Scholar ]
• Miles B, Huberman AM. Qualitative data analysis. Thousand Oaks (CA): Sage Publications; 2009. [ Google Scholar ]
• Patton M. Qualitative research and evaluation methods. Thousand Oaks (CA): Sage Publications; 2002. [ Google Scholar ]
• Willig C. Introducing qualitative research in psychology. Buckingham (UK): Open University Press; 2001. [ Google Scholar ]

Group Dynamics in Focus Groups

• Farnsworth J, Boon B. Analysing group dynamics within the focus group. Qual Res. 2010; 10 (5):605–24. [ Google Scholar ]

Social Constructivism

• Social constructivism. Berkeley (CA): University of California, Berkeley, Berkeley Graduate Division, Graduate Student Instruction Teaching & Resource Center; [cited 2015 June 4]. Available from: http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/social-constructivism/ [ Google Scholar ]

Mixed Methods

• Creswell J. Research design: qualitative, quantitative, and mixed methods approaches. Thousand Oaks (CA): Sage Publications; 2009. [ Google Scholar ]

Collecting Qualitative Data

• Arksey H, Knight P. Interviewing for social scientists: an introductory resource with examples. Thousand Oaks (CA): Sage Publications; 1999. [ Google Scholar ]
• Guest G, Namey EE, Mitchel ML. Collecting qualitative data: a field manual for applied research. Thousand Oaks (CA): Sage Publications; 2013. [ Google Scholar ]

Constructivist Grounded Theory

• Charmaz K. Grounded theory: objectivist and constructivist methods. In: Denzin N, Lincoln Y, editors. Handbook of qualitative research. 2nd ed. Thousand Oaks (CA): Sage Publications; 2000. pp. 509–35. [ Google Scholar ]

Mental Health, Substance Use, and Child Maltreatment

Child maltreatment is a pressing concern in the United States, with more than four million children referred to child protective services in 2022. Reducing child maltreatment is a national health objective given the substantial, negative consequences for children who experience maltreatment, both in the short- and long-term. Parental mental health and substance use disorders are strongly associated with child maltreatment. In this study, we use administrative data over the period 2004 to 2021 to study the relationship between the number of mental health and substance use treatment centers per county and child maltreatment reports. Our findings provide evidence that better access to mental health and substance use treatment reduces child maltreatment reports. In particular, an 8% increase in the supply of treatment would reduce maltreatment reports by 1%. These findings suggest that recent and ongoing efforts by the federal government to expand mental health and substance use treatment availability may lead to reduced child maltreatment.

All authors contributed equally to this study. Authors are listed in alphabetical order. Research reported in this publication was supported by the National Institute on Mental Health of the National Institutes of Health under Award Number 1R01MH132552 (PI: Johanna Catherine Maclean). Dr. Meinhofer acknowledges support from the Foundation for Opioid Response Efforts GR00015582 and the National Institute on Drug Abuse K01DA051777. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the Foundation for Opioid Response Efforts. We thank Douglas Webber and Jiaxin Wei for excellent comments. All errors are our own. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

MARC RIS BibTeΧ

Download Citation Data

More from NBER

In addition to working papers , the NBER disseminates affiliates’ latest findings through a range of free periodicals — the NBER Reporter , the NBER Digest , the Bulletin on Retirement and Disability , the Bulletin on Health , and the Bulletin on Entrepreneurship  — as well as online conference reports , video lectures , and interviews .

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Article Menu

• Subscribe SciFeed
• Recommended Articles
• Google Scholar
• on Google Scholar
• Table of Contents

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

JSmol Viewer

Hydrology and droughts in the nile: a review of key findings and implications.

1. Introduction

2. past trends of rainfall, temperature, evaporation, runoff, and soil moisture, 3. future trends of rainfall, temperature, evaporation, and runoff, 4. droughts in the nile, 5. the roles of large-scale climate phenomena in the nile basin, 6. the roles of water infrastructure in the nile’s hydrology, 7. data and modeling resources to study the nile’s hydrology, 8. discussion, supplementary materials, conflicts of interest, appendix a. selected drought events.

Appendix B.1. Data—Satellite

Appendix B.2. Data—Observed

Appendix B.3. Climate Models

• Merem, E.C.; Twumasi, Y.A.; Wesley, J.; Olagbegi, D.; Crisler, M.; Romorno, C.; Alsarari, M.; Isokpehi, P.; Hines, A.; Ochai, G.S.; et al. Issues in Transboundary Water Use in the River Nile Basin Area of Africa. World Environ. 2020 , 10 , 27–44. [ Google Scholar ] [ CrossRef ]
• United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2024, Online Edition. 2024. Available online: https://population.un.org/wpp/Download/Standard/Population/ (accessed on 14 August 2024).
• NBI. Socio Economic Component of the Basin Countries. Available online: https://nilebasin.org/socioeconomic (accessed on 14 August 2024).
• WBG. World Development Indicators. Available online: https://databank.worldbank.org/source/world-development-indicators (accessed on 14 August 2024).
• Roth, V.; Lemann, T.; Zeleke, G.; Subhatu, A.T.; Nigussie, T.K.; Hurni, H. Effects of Climate Change on Water Resources in the Upper Blue Nile Basin of Ethiopia. Heliyon 2018 , 4 , e00771. [ Google Scholar ] [ CrossRef ]
• Beyene, T.; Lettenmaier, D.P.; Kabat, P. Hydrologic Impacts of Climate Change on the Nile River Basin: Implications of the 2007 IPCC Scenarios. Clim. Change 2010 , 100 , 433–461. [ Google Scholar ] [ CrossRef ]
• Barnes, J. The Future of the Nile: Climate Change, Land Use, Infrastructure Management, and Treaty Negotiations in a Transboundary River Basin. Wiley Interdiscip. Rev. Clim. Change 2017 , 8 , e449. [ Google Scholar ] [ CrossRef ]
• Linke, S.; Lehner, B.; Ouellet Dallaire, C.; Ariwi, J.; Grill, G.; Anand, M.; Beames, P.; Burchard-Levine, V.; Maxwell, S.; Moidu, H.; et al. Global Hydro-Environmental Sub-Basin and River Reach Characteristics at High Spatial Resolution. Sci. Data 2019 , 6 , 283. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Dile, Y.T.; Srinivasan, R. Evaluation of CFSR Climate Data for Hydrologic Prediction in Data-Scarce Watersheds: An Application in the Blue Nile River Basin. J. Am. Water Resour. Assoc. 2014 , 50 , 1226–1241. [ Google Scholar ] [ CrossRef ]
• Butts, M.B.; Buontempo, C.; Lørup, J.K.; Williams, K.; Mathison, C.; Jessen, O.Z.; Riegels, N.D.; Glennie, P.; McSweeney, C.; Wilson, M.; et al. A Regional Approach to Climate Adaptation in the Nile Basin. Proc. Int. Assoc. Hydrol. Sci. 2016 , 374 , 3–7. [ Google Scholar ] [ CrossRef ]
• Ombadi, M.; Nguyen, P.; Sorooshian, S.; Hsu, A.K.L. Retrospective Analysis and Bayesian Model Averaging of CMIP6 Precipitation in the Nile River Basin. J. Hydrometeorol. 2021 , 22 , 217–229. [ Google Scholar ] [ CrossRef ]
• Takele, G.S.; Gebrie, G.S.; Gebremariam, A.G.; Engida, A.N. Future Climate Change and Impacts on Water Resources in the Upper Blue Nile Basin. J. Water Clim. Change 2022 , 13 , 908–925. [ Google Scholar ] [ CrossRef ]
• Senay, G.B.; Velpuri, N.M.; Bohms, S.; Demissie, Y.; Gebremichael, M. Understanding the Hydrologic Sources and Sinks in the Nile Basin Using Multisource Climate and Remote Sensing Data Sets. Water Resour. Res. 2014 , 50 , 8625–8650. [ Google Scholar ] [ CrossRef ]
• Abtew, W.; Melesse, A.M.; Dessalegne, T. El Niño Southern Oscillation Link to the Blue Nile River Basin Hydrology. Hydrol. Process. 2009 , 23 , 3653–3660. [ Google Scholar ] [ CrossRef ]
• Haregeweyn, N.; Tsunekawa, A.; Tsubo, M.; Meshesha, D.; Adgo, E.; Poesen, J.; Schütt, B. Analyzing the Hydrologic Effects of Region-Wide Land and Water Development Interventions: A Case Study of the Upper Blue Nile Basin. Reg. Environ. Change 2016 , 16 , 951–966. [ Google Scholar ] [ CrossRef ]
• Steenhuis, T.S.; Collick, A.S.; Easton, Z.M.; Leggesse, E.S.; Bayabil, H.K.; White, E.D.; Awulachew, S.B.; Adgo, E.; Ahmed, A.A. Predicting Discharge and Sediment for the Abay (Blue Nile) with a Simple Model. Hydrol. Process. 2009 , 23 , 3728–3737. [ Google Scholar ] [ CrossRef ]
• Ghorab, E.; Helal, Y.E.; Mahgoub, S.; Sobeih, M.F.; Shalash, A. Numerical investigations to the effects of the proposed dams on the blue Nile basin discharge. ERJ Eng. Res. J. 2013 , 36 , 69–77. [ Google Scholar ] [ CrossRef ]
• Eldardiry, H.; Hossain, F. Understanding Reservoir Operating Rules in the Transboundary Nile River Basin Using Macroscale Hydrologic Modeling with Satellite Measurements. J. Hydrometeorol. 2019 , 20 , 2253–2269. [ Google Scholar ] [ CrossRef ]
• Mohamed, Y.A.; van den Hurk, B.J.J.M.; Savenije, H.H.G.; Bastiaanssen, W.G.M. Hydroclimatology of the Nile: Results from a Regional Climate Model. Hydrol. Earth Syst. Sci. 2005 , 9 , 263–278. [ Google Scholar ] [ CrossRef ]
• Bayissa, Y.; Maskey, S.; Tadesse, T.; van Andel, S.J.; Moges, S.; van Griensven, A.; Solomatine, D. Comparison of the Performance of Six Drought Indices in Characterizing Historical Drought for the Upper Blue Nile Basin, Ethiopia. Geosciences 2018 , 8 , 81. [ Google Scholar ] [ CrossRef ]
• Taye, M.T.; Willems, P.; Block, P. Implications of Climate Change on Hydrological Extremes in the Blue Nile Basin: A Review. J. Hydrol. Reg. Stud. 2015 , 4 , 280–293. [ Google Scholar ] [ CrossRef ]
• Conway, D. From Headwater Tributaries to International River: Observing and Adapting to Climate Variability and Change in the Nile Basin. Glob. Environ. Change 2005 , 15 , 99–114. [ Google Scholar ] [ CrossRef ]
• Hennekam, R.; Jilbert, T.; Schnetger, B.; De Lange, G.J. Solar Forcing of Nile Discharge and Sapropel S1 Formation in the Early to Middle Holocene Eastern Mediterranean. Paleoceanography 2014 , 29 , 343–356. [ Google Scholar ] [ CrossRef ]
• Macklin, M.G.; Toonen, W.H.J.; Woodward, J.C.; Williams, M.A.J.; Flaux, C.; Marriner, N.; Nicoll, K.; Verstraeten, G.; Spencer, N.; Welsby, D. A New Model of River Dynamics, Hydroclimatic Change and Human Settlement in the Nile Valley Derived from Meta-Analysis of the Holocene Fluvial Archive. Quat. Sci. Rev. 2015 , 130 , 109–123. [ Google Scholar ] [ CrossRef ]
• Williams, M.A.J.; Williams, F.M.; Duller, G.A.T.; Munro, R.N.; El Tom, O.A.M.; Barrows, T.T.; Macklin, M.; Woodward, J.; Talbot, M.R.; Haberlah, D.; et al. Late Quaternary Floods and Droughts in the Nile Valley, Sudan: New Evidence from Optically Stimulated Luminescence and AMS Radiocarbon Dating. Quat. Sci. Rev. 2010 , 29 , 1116–1137. [ Google Scholar ] [ CrossRef ]
• Woodward, J.C.; MackLin, M.G.; Krom, M.D.; Williams, M.A.J. The River Nile: Evolution and Environment. In Large Rivers: Geomorphology and Management , 2nd ed.; Gupta, A., Ed.; Wiley-Blackwell: Hoboken, NJ, USA, 2022; pp. 388–432. [ Google Scholar ] [ CrossRef ]
• Kim, U.; Kaluarachchi, J.J. Climate Change Impacts on Water Resources in the Upper Blue Nile River Basin, Ethiopia. J. Am. Water Resour. Assoc. 2009 , 45 , 1361–1378. [ Google Scholar ] [ CrossRef ]
• Nkwasa, A.; Chawanda, C.J.; Schlemm, A.; Ekolu, J.; Frieler, K.; van Griensven, A. Historical Climate Impact Attribution of Changes in River Flow and Sediment Loads at Selected Gauging Stations in the Nile Basin. Clim. Change 2024 , 177 , 42. [ Google Scholar ] [ CrossRef ]
• Williams, M.A.J. Human Impact on the Nile Basin: Past, Present, Future. In The Nile: Origin, Environments, Limnology and Human Use ; Dumont, H.J., Ed.; Springer: Dordrecht, The Netherlands, 2009; Volume 89, pp. 771–779. [ Google Scholar ] [ CrossRef ]
• Hasan, E.; Tarhule, A.; Kirstetter, P.E.; Clark, R.; Hong, Y. Runoff Sensitivity to Climate Change in the Nile River Basin. J. Hydrol. 2018 , 561 , 312–321. [ Google Scholar ] [ CrossRef ]
• Melesse, A.M.; Loukas, A.G.; Senay, G.; Yitayew, M. Climate Change, Land-Cover Dynamics and Ecohydrology of the Nile River Basin. Hydrol. Process. 2009 , 23 , 3651–3652. [ Google Scholar ] [ CrossRef ]
• Conway, D.; Hulme, M. The Impacts of Climate Variability and Future Climate Change in the Nile Basin on Water Resources in Egypt. Int. J. Water Resour. Dev. 1996 , 12 , 277–296. [ Google Scholar ] [ CrossRef ]
• Teklemariam, D.; Lanckriet, S.; Azadi, H.; Asfaha, T.G.; Haile, M.; Witlox, F.; Nyssen, J. Effects of Land Deals on Peak Discharge and Sediment Transport in the Catchments Around the Grand Ethiopian Renaissance Dam. Land Degrad. Dev. 2017 , 28 , 1852–1861. [ Google Scholar ] [ CrossRef ]
• Hasan, E.; Tarhule, A. GRACE: Gravity Recovery and Climate Experiment Long-Term Trend Investigation over the Nile River Basin: Spatial Variability Drivers. J. Hydrol. 2020 , 586 , 124870. [ Google Scholar ] [ CrossRef ]
• NBI. Nile Basin Water Resources Atlas ; New Vision Printing and Publishing Company Ltd.: Kampala, Uganda, 2016. [ Google Scholar ]
• Nigatu, Z.M.; Fan, D.; You, W.; Melesse, A.M.; Pu, L.; Yang, X.; Wan, X.; Jiang, Z. Crop Production Response to Soil Moisture and Groundwater Depletion in the Nile Basin Based on Multi-Source Data. Sci. Total Environ. 2022 , 825 , 154007. [ Google Scholar ] [ CrossRef ]
• United Nations Environment Programme, & United Nations Environment Programme-DHI. Transboundary Waters Assessment Programme (TWAP) Vol. 3: River Basins—Transboundary River Basins: Status and Trends—Summary for Policy Makers. 2016. Available online: https://stg-wedocs.unep.org/handle/20.500.11822/7639 (accessed on 11 August 2024).
• Ayehu, G.; Tadesse, T.; Gessesse, B. Monitoring Residual Soil Moisture and Its Association to the Long-Term Variability of Rainfall over the Upper Blue Nile Basin in Ethiopia. Remote Sens. 2020 , 12 , 2138. [ Google Scholar ] [ CrossRef ]
• Alaminie, A.; Annys, S.; Nyssen, J.; Jury, M.R.; Jury, M.; Giriraj, A.; Mekonnen, M.; Tilahun, S.A. A Comprehensive Evaluation of Satellite-Based and Reanalysis Soil Moisture Products over the Upper Blue Nile Basin, Ethiopia. Available online: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4827296 (accessed on 15 July 2024).
• Mengistu, D.; Bewket, W.; Lal, R. Recent Spatiotemporal Temperature and Rainfall Variability and Trends over the Upper Blue Nile River Basin, Ethiopia. Int. J. Climatol. 2014 , 34 , 2278–2292. [ Google Scholar ] [ CrossRef ]
• Alemu, H.; Kaptué, A.T.; Senay, G.B.; Wimberly, M.C.; Henebry, G.M. Evapotranspiration in the Nile Basin: Identifying Dynamics and Drivers, 2002–2011. Water 2015 , 7 , 4914–4931. [ Google Scholar ] [ CrossRef ]
• Nooni, I.K.; Wang, G.; Hagan, D.F.T.; Lu, J.; Ullah, W.; Li, S. Evapotranspiration and Its Components in the Nile River Basin Based on Long-Term Satellite Assimilation Product. Water 2019 , 11 , 1400. [ Google Scholar ] [ CrossRef ]
• Nashwan, M.S.; Shahid, S. Spatial Distribution of Unidirectional Trends in Climate and Weather Extremes in Nile River Basin. Theor. Appl. Climatol. 2019 , 137 , 1181–1199. [ Google Scholar ] [ CrossRef ]
• Samy, A.; Ibrahim, M.G.; Mahmod, W.E.; Fujii, M.; Eltawil, A.; Daoud, W. Statistical Assessment of Rainfall Characteristics in Upper Blue Nile Basin over the Period from 1953 to 2014. Water 2019 , 11 , 468. [ Google Scholar ] [ CrossRef ]
• Coffel, E.D.; Keith, B.; Lesk, C.; Horton, R.M.; Bower, E.; Lee, J.; Mankin, J.S. Future Hot and Dry Years Worsen Nile Basin Water Scarcity Despite Projected Precipitation Increases. Earths Future 2019 , 7 , 967–977. [ Google Scholar ] [ CrossRef ]
• Tariku, T.B.; Gan, T.Y. Sensitivity of the Weather Research and Forecasting Model to Parameterization Schemes for Regional Climate of Nile River Basin. Clim. Dyn. 2018 , 50 , 4231–4247. [ Google Scholar ] [ CrossRef ]
• Gamal, G.; Nejedlik, P.; El Kenawy, A.M. Assessing Future Precipitation Patterns, Extremes and Variability in Major Nile Basin Cities: An Ensemble Approach with CORDEX CORE Regional Climate Models. Climate 2024 , 12 , 9. [ Google Scholar ] [ CrossRef ]
• Taye, M.T.; Ntegeka, V.; Ogiramoi, N.P.; Willems, P. Assessment of Climate Change Impact on Hydrological Extremes in Two Source Regions of the Nile River Basin. Hydrol. Earth Syst. Sci. 2011 , 15 , 209–222. [ Google Scholar ] [ CrossRef ]
• Booij, M.J.; Tollenaar, D.; van Beek, E.; Kwadijk, J.C.J. Simulating Impacts of Climate Change on River Discharges in the Nile Basin. Phys. Chem. Earth 2011 , 36 , 696–709. [ Google Scholar ] [ CrossRef ]
• Ezzat Elshamy, M.; Elshamy, M.E.; Sayed, M.A.; Badawy, B. Impacts of Climate Change on the Nile Flows at Dongola Using Statistical Downscaled GCM Scenarios. Nile Basin Water Eng. Sci. Mag. 2009 , 2 , 1–14. [ Google Scholar ]
• Siam, M.S.; Eltahir, E.A.B. Climate Change Enhances Interannual Variability of the Nile River Flow. Nat. Clim. Change 2017 , 7 , 350–354. [ Google Scholar ] [ CrossRef ]
• Gebre, S.L.; Ludwig, F. Hydrological Response to Climate Change of the Upper Blue Nile River Basin: Based on IPCC Fifth Assessment Report (AR5). J. Climatol. Weather Forecast. 2015 , 3 , 1000121. [ Google Scholar ] [ CrossRef ]
• Fenta Mekonnen, D.; Disse, M. Analyzing the Future Climate Change of Upper Blue Nile River Basin Using Statistical Downscaling Techniques. Hydrol. Earth Syst. Sci. 2018 , 22 , 2391–2408. [ Google Scholar ] [ CrossRef ]
• Langman, J.B. Spatial Distribution of Δ2H and Δ18O Values in the Hydrologic Cycle of the Nile Basin. J. Arid Land 2015 , 7 , 133–145. [ Google Scholar ] [ CrossRef ]
• Elkollaly, M.; Khadr, M.; Zeidan, B. Drought Analysis in the Eastern Nile Basin Using the Standardized Precipitation Index. Environ. Sci. Pollut. Res. 2018 , 25 , 30772–30786. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Khadr, M. Forecasting of Meteorological Drought Using Hidden Markov Model (Case Study: The Upper Blue Nile River Basin, Ethiopia). Ain Shams Eng. J. 2016 , 7 , 47–56. [ Google Scholar ] [ CrossRef ]
• Amare, Z.Y.; Ayoade, J.O.; Adelekan, I.O.; Zeleke, M.T. Climatic Variations, Trends and Drought Frequency in Dejen District, Nile Basin of Ethiopia. J. Appl. Sci. Environ. Manag. 2018 , 21 , 1237. [ Google Scholar ] [ CrossRef ]
• Bayissa, Y.; Tadesse, T.; Demisse, G.; Shiferaw, A. Evaluation of Satellite-Based Rainfall Estimates and Application to Monitor Meteorological Drought for the Upper Blue Nile Basin, Ethiopia. Remote Sens. 2017 , 9 , 669. [ Google Scholar ] [ CrossRef ]
• Mabrouk, E.H.; Moursy, F.I.; Mohamed, M.A.; Omar, M.E.D.M. Impact of Meteorological Drought in Upper Blue Nile Basin on the Hydrological Drought of Nile River in Egypt. Int. J. Eng. Adv. Technol. 2020 , 9 , 50–55. [ Google Scholar ] [ CrossRef ]
• Dilnesa, W. Hydro-Metrological Drought Assessments along the Blue Nile River Basin in East Gojjam Zone. Civ. Environ. Res. 2020 , 12 , 24–35. [ Google Scholar ] [ CrossRef ]
• Kebede, A.; Prakash Raju, U.; Nigussie, M.; Kebede, A.; Jaya Prakash Raju, U.; Koricha, D.; Nigussie, M. Characterizing and Monitoring Drought over Upper Blue Nile of Ethiopia with the Aid of Copula Analysis. Int. J. Environ. Clim. Change 2018 , 8 , 17. [ Google Scholar ] [ CrossRef ]
• Kebede, A.; Raju, J.P.; Korecha, D.; Takele, S.; Nigussie, M. Drought Sensitivity Characteristics and Relationships between Drought Indices over Upper Blue Nile Basin. J. Water Land Dev. 2019 , 43 , 64–75. [ Google Scholar ] [ CrossRef ]
• Bayissa, Y.; Moges, S.; Melesse, A.; Tadesse, T.; Abiy, A.Z.; Worqlul, A. Multi-Dimensional Drought Assessment in Abbay/Upper Blue Nile Basin: The Importance of Shared Management and Regional Coordination Efforts for Mitigation. Remote Sens. 2021 , 13 , 1835. [ Google Scholar ] [ CrossRef ]
• Kebede, A.; Raju, U.J.P.; Korecha, D.; Nigussie, M. Developing New Drought Indices with and without Climate Signal Information over the Upper Blue Nile. Model Earth Syst. Environ. 2020 , 6 , 151–161. [ Google Scholar ] [ CrossRef ]
• Ali, M.; Ghaith, M.; Wagdy, A.; Helmi, A.M. Development of a New Multivariate Composite Drought Index for the Blue Nile River Basin. Water 2022 , 14 , 886. [ Google Scholar ] [ CrossRef ]
• Awadallah, A.G. Evolution of the Nile River Drought Risk Based on the Streamflow Record at Aswan Station, Egypt. Civ. Eng. Environ. Syst. 2014 , 31 , 260–269. [ Google Scholar ] [ CrossRef ]
• Nigatu, Z.M.; You, W.; Melesse, A.M. Drought Dynamics in the Nile River Basin: Meteorological, Agricultural, and Groundwater Drought Propagation. Remote Sens. 2024 , 16 , 919. [ Google Scholar ] [ CrossRef ]
• Bayissa, Y.; Tadesse, T.; Demisse, G. Building a High-Resolution Vegetation Outlook Model to Monitor Agricultural Drought for the Upper Blue Nile Basin, Ethiopia. Remote Sens. 2019 , 11 , 371. [ Google Scholar ] [ CrossRef ]
• Mahmoud, S.H.; Gan, T.Y.; Allan, R.P.; Li, J.; Funk, C. Worsening Drought of Nile Basin under Shift in Atmospheric Circulation, Stronger ENSO and Indian Ocean Dipole. Sci. Rep. 2022 , 12 , 8049. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Tenfie, H.W.; Saathoff, F.; Hailu, D.; Gebissa, A. Selection of Representative General Circulation Models for Climate Change Study Using Advanced Envelope-Based and Past Performance Approach on Transboundary River Basin, a Case of Upper Blue Nile Basin, Ethiopia. Sustainability 2022 , 14 , 2140. [ Google Scholar ] [ CrossRef ]
• Sun, Q.; Liu, Y.; Salem, A.; Marks, L.; Welc, F.; Ma, F.; Zhang, W.; Chen, J.; Jiang, J.; Chen, Z. Climate-Induced Discharge Variations of the Nile during the Holocene: Evidence from the Sediment Provenance of Faiyum Basin, North Egypt. Glob. Planet. Change 2019 , 172 , 200–210. [ Google Scholar ] [ CrossRef ]
• Jalali, B.; Sicre, M.A.; Kallel, N.; Azuara, J.; Combourieu-Nebout, N.; Bassetti, M.A.; Klein, V. High-Resolution Holocene Climate and Hydrological Variability from Two Major Mediterranean Deltas (Nile and Rhone). Holocene 2017 , 27 , 1158–1168. [ Google Scholar ] [ CrossRef ]
• Tedla, M.G.; Rasmy, M.; Tamakawa, K.; Selvarajah, H.; Koike, T. Assessment of Climate Change Impacts for Balancing Transboundary Water Resources Development in the Blue Nile Basin. Sustainability 2022 , 14 , 15438. [ Google Scholar ] [ CrossRef ]
• Abtew, W.; Melesse, A.M. The Nile River Basin. In Nile River Basin: Ecohydrological Challenges, Climate Change and Hydropolitics ; Springer: Cham, Switzerland, 2014; pp. 7–21. ISBN 9783319027203. [ Google Scholar ] [ CrossRef ]
• Siam, M.S.; Eltahir, E.A.B. Explaining and Forecasting Interannual Variability in the Flow of the Nile River. Hydrol. Earth Syst. Sci. 2015 , 19 , 1181–1192. [ Google Scholar ] [ CrossRef ]
• Onyutha, C.; Willems, P. Investigation of Flow-Rainfall Co-Variation for Catchments Selected Based on the Two Main Sources of River Nile. Stoch. Environ. Res. Risk Assess. 2018 , 32 , 623–641. [ Google Scholar ] [ CrossRef ]
• Wang, G.; Eltahir, E.A.B. Use of ENSO Information in Medium- and Long-Range Forecasting of the Nile Floods. J. Clim. 1999 , 12 , 1726–1737. [ Google Scholar ] [ CrossRef ]
• Conway, D. Future Nile River Flows. Nat. Clim. Change 2017 , 7 , 319–320. [ Google Scholar ] [ CrossRef ]
• Eltahir, E.A.B. El Niño and the Natural Variability in the Flow of the Nile River. Water Resour. Res. 1996 , 32 , 131–137. [ Google Scholar ] [ CrossRef ]
• Zaroug, M.A.H.; Giorgi, F.; Coppale, E.; Eltahir, E.A.B. Connections of ENSO and the Hydrology of the Blue Nile Simulating the Connections of ENSO and the Hydrology of the Blue Nile Using a Climate Model of the Tropics Connections of ENSO and the Hydrology of the Blue Nile. Hydrol. Earth Syst. Sci. Discuss 2014 , 11 , 2233–2262. [ Google Scholar ] [ CrossRef ]
• Moon, W.; Hannachi, A. River Nile Discharge, the Pacific Ocean and World Climate–a Seasonal Synchronization Perspective. Tellus Ser. A Dyn. Meteorol. Oceanogr. 2021 , 73 , 1947551. [ Google Scholar ] [ CrossRef ]
• Awange, J.L.; Forootan, E.; Kuhn, M.; Kusche, J.; Heck, B. Water Storage Changes and Climate Variability within the Nile Basin between 2002 and 2011. Adv. Water Resour. 2014 , 73 , 1–15. [ Google Scholar ] [ CrossRef ]
• Sene, K.J.; Tate, E.L.; Farquharson, F.A.K. Sensitivity studies of the impacts of climate change on white Nile flows. Clim. Change 2001 , 50 , 177–208. [ Google Scholar ] [ CrossRef ]
• Angelakis, A.N.; Zaccaria, D.; Krasilnikoff, J.; Salgot, M.; Bazza, M.; Roccaro, P.; Jimenez, B.; Kumar, A.; Yinghua, W.; Baba, A.; et al. Irrigation of World Agricultural Lands: Evolution through the Millennia. Water 2020 , 12 , 1285. [ Google Scholar ] [ CrossRef ]
• The First Aswan Dam in Egypt—A Useful Pyramid? Imperialists and Archaeologists, Cotton and Complaints. In From Aswan to Stiegler’s Gorge: Small Stories about Large Dams ; Oestigaard, T.; Beyene, A.; Ögmundardóttir, H. (Eds.) Current African Issues No. 66: 20-39; The Nordic Africa Institute: Uppsala, Sweden, 2019; Available online: https://www.researchgate.net/publication/338005976_The_First_Aswan_Dam_in_Egypt_-_A_useful_pyramid_Imperialists_and_archaeologists_cotton_and_complaints_In_Oestigaard_T_Beyene_A_and_Ogmundardottir_H_eds_From_Aswan_to_Stiegler%27s_Gorge_Small_Stories_abo (accessed on 12 June 2024).
• Basheer, M.; Nechifor, V.; Calzadilla, A.; Gebrechorkos, S.; Pritchard, D.; Forsythe, N.; Gonzalez, J.M.; Sheffield, J.; Fowler, H.J.; Harou, J.J. Negotiating Nile Infrastructure Management Should Consider Climate Change Uncertainties. Nat. Clim. Change 2023 , 13 , 17–19. [ Google Scholar ] [ CrossRef ]
• Tekuya, M.E. The Nile in Legal and Political Perspective: Between Change and Continuity ; BRILL: Leiden, The Netherlands, 2024; ISBN 9789004549869. [ Google Scholar ]
• EEP. The Grand Ethiopian Renaissances Dam Project—Ethiopian Electric Power. Available online: https://www.eep.com.et/?project=the-grand-ethiopian-renaissances-dam-project (accessed on 14 June 2024).
• Kahsay, T.N.; Arjoon, D.; Kuik, O.; Brouwer, R.; Tilmant, A.; van der Zaag, P. A Hybrid Partial and General Equilibrium Modeling Approach to Assess the Hydro-Economic Impacts of Large Dams—The Case of the Grand Ethiopian Renaissance Dam in the Eastern Nile River Basin. Environ. Model. Softw. 2019 , 117 , 76–88. [ Google Scholar ] [ CrossRef ]
• Tekuya, M.E. The Egyptian Hydro Hegemony In The Nile Basin: The Quest For Changing The Status Quo. J. Water Law 2018 , 26 , 10–20. [ Google Scholar ]
• Cascão, A.E.; Nicol, A. GERD: New Norms of Cooperation in the Nile Basin? Water Int. 2016 , 41 , 550–573. [ Google Scholar ] [ CrossRef ]
• Oestigaard, T.; Beyene, A.; Ögmundardóttir, H. From Aswan to Stiegler’s Gorge: Small Stories about Large Dams ; Current African Issues; The Nordic Africa Institute: Uppsala, Sweden, 2019; Volume 66. [ Google Scholar ]
• Ahmed, Y.; Al-Faraj, F.; Scholz, M.; Soliman, A. Assessment of Upstream Human Intervention Coupled with Climate Change Impact for a Transboundary River Flow Regime: Nile River Basin. Water Resour. Manag. 2019 , 33 , 2485–2500. [ Google Scholar ] [ CrossRef ]
• Kansara, P.; Li, W.; El-Askary, H.; Lakshmi, V.; Piechota, T.; Struppa, D.; Sayed, M.A. An Assessment of the Filling Process of the Grand Ethiopian Renaissance Dam and Its Impact on the Downstream Countries. Remote Sens. 2021 , 13 , 711. [ Google Scholar ] [ CrossRef ]
• Guzman, C.D.; Zimale, F.A.; Tebebu, T.Y.; Bayabil, H.K.; Tilahun, S.A.; Yitaferu, B.; Rientjes, T.H.M.; Steenhuis, T.S. Modeling Discharge and Sediment Concentrations after Landscape Interventions in a Humid Monsoon Climate: The Anjeni Watershed in the Highlands of Ethiopia. Hydrol. Process. 2017 , 31 , 1239–1257. [ Google Scholar ] [ CrossRef ]
• Li, P.; He, Z.; Cai, J.; Zhang, J.; Belete, M.; Deng, J.; Wang, S. Identify the Impacts of the Grand Ethiopian Renaissance Dam on Watershed Sediment and Water Yields Dynamics. Sustainability 2022 , 14 , 7590. [ Google Scholar ] [ CrossRef ]
• Aziz, S.A.; Zelenáková, M.; Mésároš, P.; Purcz, P.; Abd-Elhamid, H. Assessing the Potential Impacts of the Grand Ethiopian Renaissance Dam on Water Resources and Soil Salinity in the Nile Delta, Egypt. Sustainability 2019 , 11 , 7050. [ Google Scholar ] [ CrossRef ]
• Hussein, K.B.; El-Sharkawy, H.S. Hydrological Study of Groundwater and Its Appropriateness for Irrigation. J. Eng. Res.-Egypt 2021 , 5 , 56–64. [ Google Scholar ] [ CrossRef ]
• Heggy, E.; Abotalib, A.; Hanert, E. Resolving Mega-Dams Energy-Water Nexus in the Eastern Nile Basin During Prolonged Droughts. 2024. Available online: https://www.researchgate.net/publication/380140232_Resolving_Mega-Dams_Energy-Water_Nexus_in_the_Eastern_Nile_Basin_During_Prolonged_Droughts (accessed on 14 June 2024).
• Basheer, M.; Nechifor, V.; Calzadilla, A.; Siddig, K.; Etichia, M.; Whittington, D.; Hulme, D.; Harou, J.J. Collaborative Management of the Grand Ethiopian Renaissance Dam Increases Economic Benefits and Resilience. Nat. Commun. 2021 , 12 , 5622. [ Google Scholar ] [ CrossRef ]
• Madson, A.; Sheng, Y. Coulomb Stress Analysis for Several Filling and Operational Scenarios at the Grand Ethiopian Renaissance Dam Impoundment. Environ. Earth Sci. 2021 , 80 , 1–17. [ Google Scholar ] [ CrossRef ]
• Wheeler, K.G.; Jeuland, M.; Hall, J.W.; Zagona, E.; Whittington, D. Understanding and Managing New Risks on the Nile with the Grand Ethiopian Renaissance Dam. Nat. Commun. 2020 , 11 , 5222. [ Google Scholar ] [ CrossRef ]
• Lazin, R.; Shen, X.; Moges, S.; Anagnostou, E. The Role of Renaissance Dam in Reducing Hydrological Extremes in the Upper Blue Nile Basin: Current and Future Climate Scenarios. J. Hydrol. 2023 , 616 , 128753. [ Google Scholar ] [ CrossRef ]
• Mulat, A.G.; Moges, S.A.; Mulat, A.G.; Moges, S.A. Assessment of the Impact of the Grand Ethiopian Renaissance Dam on the Performance of the High Aswan Dam. J. Water Resour. Prot. 2014 , 6 , 583–598. [ Google Scholar ] [ CrossRef ]
• NBI. State of the River Nile Basin Water Security in the Nile Basin ; BNI: Entebbe, Uganda, 2021. [ Google Scholar ]
• PJTC. First Annual Report of the Permanent Joint Technical Commission for the Nile Waters ; Government Printing Press: Khartoum, Sudan, 1961.
• Yilmaz, M.T.; Anderson, M.C.; Zaitchik, B.; Hain, C.R.; Crow, W.T.; Ozdogan, M.; Chun, J.A.; Evans, J. Comparison of Prognostic and Diagnostic Surface Flux Modeling Approaches over the Nile River Basin. Water Resour. Res. 2014 , 50 , 386–408. [ Google Scholar ] [ CrossRef ]
• Gebremicael, T.G.; Deitch, M.J.; Gancel, H.N.; Croteau, A.C.; Haile, G.G.; Beyene, A.N.; Kumar, L. Satellite-Based Rainfall Estimates Evaluation Using a Parsimonious Hydrological Model in the Complex Climate and Topography of the Nile River Catchments. Atmos. Res. 2022 , 266 , 105939. [ Google Scholar ] [ CrossRef ]
• Khaki, M.; Awange, J.; Forootan, E.; Kuhn, M. Understanding the Association between Climate Variability and the Nile’s Water Level Fluctuations and Water Storage Changes during 1992–2016. Sci. Total Environ. 2018 , 645 , 1509–1521. [ Google Scholar ] [ CrossRef ] [ PubMed ]
• Gebremichael, M.; Anagnostou, E.N.; Bitew, M.M. Critical Steps for Continuing Advancement of Satellite Rainfall Applications for Surface Hydrology in the Nile River Basin1. JAWRA J. Am. Water Resour. Assoc. 2010 , 46 , 361–366. [ Google Scholar ] [ CrossRef ]
• Bastiaanssen, W.G.M.; Karimi, P.; Rebelo, L.M.; Duan, Z.; Senay, G.; Muthuwatte, L.; Smakhtin, V. Earth Observation Based Assessment of the Water Production and Water Consumption of Nile Basin Agro-Ecosystems. Remote Sens. 2014 , 6 , 10306–10334. [ Google Scholar ] [ CrossRef ]
• Khan, R.S.; Abul, M.; Bhuiyan, E.; Khan, R.S.; Bhuiyan, M.A.E.; García-Ortega, E.; Rigo, T. Artificial Intelligence-Based Techniques for Rainfall Estimation Integrating Multisource Precipitation Datasets. Atmosphere 2021 , 12 , 1239. [ Google Scholar ] [ CrossRef ]
• Stanley, J.D.; Krom, M.D.; Cliff, R.A.; Woodward, J.C. Short Contribution: Nile Flow Failure at the End of the Old Kingdom, Egypt: Strontium Isotopic and Petrologic Evidence. Geoarchaeology 2003 , 18 , 395–402. [ Google Scholar ] [ CrossRef ]
• Cockerton, H.E.; Street-Perrott, F.A.; Leng, M.J.; Barker, P.A.; Horstwood, M.S.A.; Pashley, V. Stable-Isotope (H, O, and Si) Evidence for Seasonal Variations in Hydrology and Si Cycling from Modern Waters in the Nile Basin: Implications for Interpreting the Quaternary Record. Quat. Sci. Rev. 2013 , 66 , 4–21. [ Google Scholar ] [ CrossRef ]
• Blanchet, C.L.; Frank, M.; Schouten, S. Asynchronous Changes in Vegetation, Runoff and Erosion in the Nile River Watershed during the Holocene. PLoS ONE 2014 , 9 , e115958. [ Google Scholar ] [ CrossRef ]
• Castañeda, I.S.; Schouten, S.; Pätzold, J.; Lucassen, F.; Kasemann, S.; Kuhlmann, H.; Schefuß, E. Hydroclimate Variability in the Nile River Basin during the Past 28,000 Years. Earth Planet. Sci. Lett. 2016 , 438 , 47–56. [ Google Scholar ] [ CrossRef ]
• Van Griensven, A.; Ndomba, P.; Yalew, S.; Kilonzo, F. Critical Review of SWAT Applications in the Upper Nile Basin Countries. Hydrol. Earth Syst. Sci. 2012 , 16 , 3371–3381. [ Google Scholar ] [ CrossRef ]
• Betrie, G.D.; Mohamed, Y.A.; Van Griensven, A.; Srinivasan, R. Sediment Management Modelling in the Blue Nile Basin Using SWAT Model. Hydrol. Earth Syst. Sci. 2011 , 15 , 807–818. [ Google Scholar ] [ CrossRef ]
• Basheer, M.; Nechifor, V.; Calzadilla, A.; Gebrechorkos, S.; Pritchard, D.; Forsythe, N.; Gonzalez, J.M.; Sheffield, J.; Fowler, H.J.; Harou, J.J. Cooperative Adaptive Management of the Nile River with Climate and Socio-Economic Uncertainties. Nat. Clim. Change 2023 , 13 , 48–57. [ Google Scholar ] [ CrossRef ]
• Mostafa, H.; Saleh, H.; El Sheikh, M.; Kheireldin, K. Assessing Statistical Downscaling to Quantify the Impact of Climate Changes of Rainfall over the Blue Nile Basin. Life Sci. J. 2015 , 12 , 86–95. [ Google Scholar ] [ CrossRef ]
• Yimere, A.; Assefa, E. Assessment of the Water-Energy Nexus under Future Climate Change in the Nile River Basin. Climate 2021 , 9 , 84. [ Google Scholar ] [ CrossRef ]
• Nawaz, R.; Bellerby, T.; Sayed, M.; Elshamy, M. Blue Nile Runoff Sensitivity to Climate Change. Open Hydrol. J. 2010 , 4 , 137–151. [ Google Scholar ] [ CrossRef ]
• Kahsay, N.; Kuik, O.; Brouwer, R.; Van Der Zaag, P. The economy-wide impacts of climate change and irrigation development in the Nile basin. Clim. Change Econ. 2017 , 8 , 1–30. [ Google Scholar ] [ CrossRef ]
• Digna, R.F.; Mohamed, Y.A.; van der Zaag, P.; Uhlenbrook, S.; Corzo, G.A. Nile River Basin Modelling for Water Resources Management—A Literature Review. Int. J. River Basin Manag. 2017 , 15 , 39–52. [ Google Scholar ] [ CrossRef ]
• Paisley, R.K.; Henshaw, T.W. Transboundary Governance of the Nile River Basin: Past, Present and Future. Environ. Dev. 2013 , 7 , 59–71. [ Google Scholar ] [ CrossRef ]
• Senay, G.B.; Asante, K.; Artan, G. Water Balance Dynamics in the Nile Basin. Hydrol. Process. 2009 , 23 , 3675–3681. [ Google Scholar ] [ CrossRef ]
• Taye, M.; Sahlu, D.; Zaitchik, B.F.; Neka, M. Evaluation of Satellite Rainfall Estimates for Meteorological Drought Analysis over the Upper Blue Nile Basin, Ethiopia. Geosciences 2020 , 10 , 352. [ Google Scholar ] [ CrossRef ]
• Perera, S.; Allali, M.; Linstead, E.; El-Askary, H. Deriving Drought Vulnerability Index Using Geographically Weighted Principal Component Analysis (GWPCA) and K-Means Clustering for Nile Basin. Int. Geosci. Remote Sens. Symp. (IGARSS) 2022 , 2022 , 3187–3190. [ Google Scholar ] [ CrossRef ]
• Kratzert, F.; Klotz, D.; Herrnegger, M.; Sampson, A.K.; Hochreiter, S.; Nearing, G.S. Toward Improved Predictions in Ungauged Basins: Exploiting the Power of Machine Learning. Water Resour. Res. 2019 , 55 , 11344–11354. [ Google Scholar ] [ CrossRef ]
• Deribe, M.M.; Melesse, A.M.; Kidanewold, B.B.; Dinar, S.; Anderson, E.P. Assessing International Transboundary Water Management Practices to Extract Contextual Lessons for the Nile River Basin. Water 2024 , 16 , 1960. [ Google Scholar ] [ CrossRef ]
• Basheer, M.; Wheeler, K.G.; Ribbe, L.; Majdalawi, M.; Abdo, G.; Zagona, E.A. Quantifying and Evaluating the Impacts of Cooperation in Transboundary River Basins on the Water-Energy-Food Nexus: The Blue Nile Basin. Sci. Total Environ. 2018 , 630 , 1309–1323. [ Google Scholar ] [ CrossRef ]
• Khadr, M. Temporal and Spatial Analysis of Meteorological Drought Characteristics in the Upper Blue Nile River Region. Hydrol. Res. 2017 , 48 , 265–276. [ Google Scholar ] [ CrossRef ]
• Bayissa, Y.A.; Moges, S.A.; Xuan, Y.; Van Andel, S.J.; Maskey, S.; Solomatine, D.P.; Van Griensven, A.; Tadesse, T. Spatio-Temporal Assessment of Meteorological Drought under the Influence of Varying Record Length: The Case of Upper Blue Nile Basin, Ethiopia. Hydrol. Sci. J. 2015 , 60 , 1927–1942. [ Google Scholar ] [ CrossRef ]
• Enyew, B.D.; Van Lanen HA, J.; Van Loon, A.F. Assessment of the Impact of Climate Change on Hydrological Drought in Lake Tana Catchment, Blue Nile Basin, Ethiopia. J. Geol. Geosci. 2014 , 3 , 174. [ Google Scholar ] [ CrossRef ]
• Amare, A.; Simane, B. Determinants of Smallholder Farmers’ Decision to Adopt Adaptation Options to Climate Change and Variability in the Muger Sub Basin of the Upper Blue Nile Basin of Ethiopia. Agric. Food Secur. 2017 , 6 , 64. [ Google Scholar ] [ CrossRef ]
• Tariku, T.B.; Gan, T.Y. Regional Climate Change Impact on Extreme Precipitation and Temperature of the Nile River Basin. Clim. Dyn. 2018 , 51 , 3487–3506. [ Google Scholar ] [ CrossRef ]
• Abdelwares, M.; Haggag, M.; Wagdy, A.; Lelieveld, J. Customized Framework of the WRF Model for Regional Climate Simulation over the Eastern Nile Basin. Theor. Appl. Climatol. 2018 , 134 , 1135–1151. [ Google Scholar ] [ CrossRef ]
• Khadim, F.K.; Dokou, Z.; Lazin, R.; Bagtzoglou, A.C.; Anagnostou, E. Groundwater Modeling to Assess Climate Change Impacts and Sustainability in the Tana Basin, Upper Blue Nile, Ethiopia. Sustainability 2023 , 15 , 6284. [ Google Scholar ] [ CrossRef ]
• Mostafa, H.; Saleh, H.; El-Sheikh, M.A.; Kheireldin, K.A. Assessing the Impacts of Climate Changes on the Eastern Nile Flow at Aswan Climate Change and Its Impacts on Water Resources. J. Am. Sci. 2016 , 12 , 1–9. [ Google Scholar ] [ CrossRef ]
• Ali, M.; Wagdy, A.; Helmi, A.; Ghaith, M. Gap Analysis in the Current Knowledge Limitations in Drought Assessment Research in the Eastern Nile River Basin. Int. J. Eng. Res. Technol. 2019 , 12 , 2200–2206. [ Google Scholar ]
• Mobasher, A.; Moussa, A. The Potential Impacts of Low Releases from Nasser Lake Due to Climate Changes on Irrigation Pump Stations Along the Nile River. Nile Water Sci. Eng. J. 2015 , 8 , 51–66. [ Google Scholar ]

Click here to enlarge figure

Share and Cite

Melesse, M.B.; Demissie, Y. Hydrology and Droughts in the Nile: A Review of Key Findings and Implications. Water 2024 , 16 , 2521. https://doi.org/10.3390/w16172521

Melesse MB, Demissie Y. Hydrology and Droughts in the Nile: A Review of Key Findings and Implications. Water . 2024; 16(17):2521. https://doi.org/10.3390/w16172521

Melesse, Meklit Berihun, and Yonas Demissie. 2024. "Hydrology and Droughts in the Nile: A Review of Key Findings and Implications" Water 16, no. 17: 2521. https://doi.org/10.3390/w16172521

Article Metrics

Article access statistics, supplementary material.

ZIP-Document (ZIP, 132 KiB)

Further Information

Mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

• Open access
• Published: 03 September 2024

Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: a health global federated network analysis

• Chung-An Wang 1 ,
• Li-Chun Lin 2 ,
• Jui-Yi Chen 3 , 4 ,
• Wei-Jie Wang 5 , 6 &
• Vin-Cent Wu 7 , 8 , 9  

Cardiovascular Diabetology volume  23 , Article number:  327 ( 2024 ) Cite this article

Metrics details

Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have demonstrated associations with lowering cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the impact of SGLT-2is on individuals at dialysis commencement remains unclear. The aim of this real-world study is to study the association between SGLT-2is and outcomes in patients with T2DM at dialysis commencement.

This is a retrospective cohort study of electronic health records (EHRs) of patients with T2DM from TriNetX Research Network database between January 1, 2012, and January 1, 2024. New-users using intention to treatment design was employed and propensity score matching was utilized to select the cohort. Clinical outcomes included major adverse cardiac events (MACE) and all-cause mortality. Safety outcomes using ICD-10 codes, ketoacidosis, urinary tract infection (UTI) or genital infection, dehydration, bone fracture, below-knee amputation, hypoglycemia, and achieving dialysis-free status at 90 days and 90-day readmission.

Of 49,762 patients with T2DM who initiated dialysis for evaluation, a mere 1.57% of patients utilized SGLT-2is within 3 months after dialysis. 771 SGLT-2i users (age 63.3 ± 12.3 years, male 65.1%) were matched with 771 non-users (age 63.1 ± 12.9 years, male 65.8%). After a median follow-up of 2.0 (IQR 0.3–3.9) years, SGLT-2i users were associated with a lower risk of MACE (adjusted Hazard Ratio [aHR] = 0.52, p value < 0.001), all-cause mortality (aHR = 0.49, p  < 0.001). SGLT-2i users were more likely to become dialysis-free 90 days after the index date (aHR = 0.49, p  < 0.001). No significant differences were observed in the incidence of ketoacidosis, UTI or genital infection, hypoglycemia, dehydration, bone fractures, below-knee amputations, or 90-day readmissions.

Conclusions

Our findings indicated a lower incidence of all-cause mortality and MACE after long-term follow-up, along with a higher likelihood of achieving dialysis-free status at 90 days in SGLT-2i users. Importantly, they underscored the potential cardiovascular protection and safety of SGLT-2is use in T2DM patients at the onset of dialysis.

Introduction

The prevalence of diabetes mellitus (DM) continues to surge on a global scale. Recent projections from the International Diabetes Federation (IDF) indicate that over half a billion individuals worldwide are currently grappling with diabetes, with expectations of a striking 46% escalation by 2045 1 . Notably, the percentage of incident ESRD patients caused by diabetes progressively increased from 22.1% in 2000 to 31.3% in 2015 2 . IDF also states that 30 to 40% of people living with diabetes develop CKD [ 3 ]. According to Kidney Disease Improving Global Outcomes (KDIGO), it has been estimated that 40% or more of people with diabetes will develop CKD, including a significant number who will develop kidney failure requiring dialysis or transplantation [ 4 ]. Given the well-established link between diabetes and the progression of chronic kidney disease (CKD), characterized by glomerular sclerosis, fibrosis, progressive albuminuria, and hypertension [ 5 ]. In addition to the challenges posed by diabetes-related long-term cardiovascular disease (CVD), individuals undergoing renal replacement therapy find themselves confronting an array of CVD [ 6 , 7 ].

The introduction of sodium-glucose cotransporter 2 inhibitors (SGLT-2is), a novel class of oral antidiabetic drugs (OADs), has caused a paradigm shift in the treatment strategies for patients with type 2 diabetes mellitus (T2DM). These drugs have demonstrated the capacity to reduce major adverse cardiovascular events (MACE), heart failure hospitalization, and renal protection in patients with T2DM with established cardiovascular disease or those at risk [ 8 , 9 , 10 ]. Additionally, clinical trials have shown their benefits in patients with heart failure across the ejection fraction spectrum, regardless of the presence or absence of diabetes [ 11 , 12 , 13 ]. Trials specifically targeting patients with CKD have similarly shown cardio-renal protective effects. EMPA-KIDNEY trial and post-hoc analysis shows that SGLT-2is offer kidney benefits in CKD patients, irrespective of diabetes status, and even in those with estimated glomerular filtration rate (eGFR) < 20 mL/min/1.73 m² 14,15 . The update from the Kidney Disease Improving Global Outcomes (KDIGO) guideline now recommends the initiation of SGLT-2is at a lower eGFR threshold, reducing it from 25 to 20 mL/min/1.73 m², and suggests the continuation of these medications until the need for dialysis and the UK Kidney Association Clinical Practice Guideline recommends initiation of SGLT-2is in people with an eGFR below 20 mL/min/1.73 m² to slow progression of kidney disease [ 4 , 16 ]. This significant change in recommendations signifies potential advantages for individuals with diabetes who require dialysis. As of May 2023, the U.S. FDA has revised its guidance on dapagliflozin by eliminating the previous contraindication related to patients undergoing dialysis [ 17 ]. Intriguingly, a similar pattern has emerged in Europe, with the European Medical Agency (EMA) not listing dialysis as a contraindication for dapagliflozin [ 18 ]. An exploratory analysis of DAPA-CKD trial indicated no significant safety concerns in dialysis patients [ 19 ]. To address this notable gap in the literature, our study endeavors to investigate the potential association between SGLT-2is and all-cause mortality and cardiovascular outcomes in patients with T2DM who initiated dialysis, compared to those initializing dialysis but are not receiving SGLT-2is.

Data sources

In this retrospective study, we leveraged the TriNetX Research Network, a global federated health research platform, and the data in the TriNetX Research Network is sourced from healthcare organizations (HCOs) [ 20 ]. The data set encompassed a broad spectrum of information, including patient demographics, diagnoses (aligned with the International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and the International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes), procedures (documented with ICD-9-CM, the International Classification of Diseases, Tenth Revision, Procedure Coding System [ICD-10-PCS], and Current Procedural Terminology [CPT] codes), medications (coded according to the Veterans Affairs National Formulary and RxNorm ingredients), laboratory tests (categorized by LOINC), and healthcare utilization records from multiple HCOs, including hospitals, primary care units, and specialized facilities.

We utilized the TriNetX Research Network database, which includes EHRs of over 100 million patients across 93 healthcare organizations (HCOs) in five countries: Taiwan, Georgia, Colombia, Brazil, and the United States [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Patient-level data were analyzed using the built-in statistical tool on the TriNetX platform, based on Java (version 11.0.16), R (version 4.0.2, with packages Hmisc and Survival), and Python (version 3.7, with libraries lifelines, matplotlib, numpy, pandas, scipy, and statsmodels). The results were presented to investigators in an aggregated format. Further details about the database are available online and in previously published descriptions [ 28 , 29 ].

This study using the TriNetX database obtained ethical approval from the Institutional Review Board of Chi-Mei Hospital, Tainan, Taiwan (No: 11202-002), and the institutional review boards of all participating hospitals. A waiver of informed consent was granted by the Western Institutional Review Board because this study was conducted using only aggregated statistical summaries of de-identified information. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki [ 30 ] and adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for its design.

Study population

In this study, a cohort was established by selecting and organizing participants from the database, covering the period from January 1, 2012, to January 1, 2024, involving 131,791,763 individuals. The study included patients aged 18 to 90 years with T2DM who initiated dialysis during this period. Patients were categorized as SGLT-2i users if they had received a prescription for an SGLT-2is within 3 months following the commencement of dialysis. Patients were categorized as SGLT-2i users if they received a prescription for an SGLT-2is within 3 months of commencing dialysis. T2DM patients who did not use SGLT-2is during the specified period were grouped as controls, in line with our intention-to-treat (ITT) design. Exclusion criteria included any instance of dialysis within 30 days before the current dialysis session, and individuals who used SGLT-2is before initial dialysis for 3 months and passed away within 3 months following their initial dialysis. These criteria aimed to identify patients with T2DM undergoing acute dialysis or newly entering chronic dialysis treatment and a new-users design also implemented to ensure SGLT-2is who did not have a prior history of using SGLT-2is. The index date was set at 90 days after dialysis commencement. To address potential sources of protopathic or ascertainment bias [ 31 ], any occurrences of outcomes that transpired before the index date were meticulously excluded from the analysis. Enrollment algorithm of participants was illustrated in Fig.  1 .

Enrollment algorithm for patients. BMI body mass index, T2DM type 2 diabetes mellitus, PSM propensity score matching, SBP systolic blood pressure, SGLT-2is sodium–glucose cotransporter 2 inhibitors

The primary outcomes centered on two critical aspects of patient health: all-cause mortality and the occurrence of major adverse cardiovascular events (MACEs) during the follow-up period. These MACEs, representing a composite outcome, encompassed non-fatal myocardial infarction, non-fatal ischemic stroke, cardiovascular death/mortality, and hospitalization for unstable angina. Secondary outcomes included 3-Point Major Adverse Cardiovascular Events (3p-MACEs), which comprised non-fatal myocardial infarction, non-fatal ischemic stroke, and cardiovascular death/mortality. Additionally, the analysis extended to other safety outcomes and side effects such as ketoacidosis, UTI or genital infection, dehydration, bone fracture, below-knee amputation, hypoglycemia, dialysis-free status at 90 days, and 90-day readmission. Patients were followed until death, the last recorded entry in their health record, the completion of 5 years of follow-up, which starting after the index date, or until July 23, 2024, whichever occurred first. The detailed diagnostic, visit, and procedural codes used to define the outcomes can be found in the Supplementary Methods. To mitigate the potential impact of protopathic or ascertainment biases, we meticulously excluded any occurrences of secondary outcomes before the index date [ 22 ].

To account for differences in baseline characteristics between the two study groups, we incorporated specific covariate factors and potential confounding factors into our analysis. These factors included demographic variables such as age, gender, ethnicity, and race. Additionally, our analysis encompassed the evaluation of various comorbidities, including ever hospitalization within the past year, hypertensive diseases, peripheral vascular diseases, ischemic heart diseases, cerebrovascular diseases, chronic obstructive pulmonary diseases, asthma, chronic kidney disease (CKD), peritoneal dialysis, dementia, sleep disorders, depression, and neoplasms. We also considered clinical measures including body mass index (BMI), and systolic blood pressure and laboratory results such as, hemoglobin A1c, estimated glomerular filtration rate (eGFR), total cholesterol, alanine aminotransferase (ALT), B-type natriuretic peptide (BNP), potassium levels, and urine protein. Daily behaviors and habits, such as smoking and alcohol consumption and medication history were included, covering insulin, thiazolidinediones, glucagon like peptide-1-receptor (GLP-1) analogues, dipeptidyl peptidase-4 (DPP-4) inhibitors, sulfonylureas, aspirin, clopidogrel, statins, allopurinol, febuxostat, alpha-blockers, beta-blockers, calcium channel blockers (CCB), and the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB).

These variables were integrated into our analysis to adjust for any variations in the baseline characteristics of the study cohorts. To ensure the accuracy of our analysis and minimize multicollinearity, we utilized quantifiable continuous variables such as body mass index (BMI) and estimated glomerular filtration rate (eGFR), categorized appropriately, instead of relying solely on categorical variables like obesity and CKD. The detailed codes used to define the covariates can be found in the Supplementary Methods.

Subgroup and sensitivity analysis

In our study, we were conducting a comprehensive subgroup analysis to explore potential variations across different subgroups. Patients were stratified according to age (≥ 65 or < 65 years), baseline estimated glomerular filtration rate (eGFR) (≥ or < 30 mL/min/1.73 m²), urine protein/creatinine ratio (UPCR) (≥ or < 300 mg/g), body mass index (BMI) (≥ or < 30 kg/m²), and HbA1c levels (≥ or < 7%). We also assessed outcomes based on the use of beta blockers, ACEI/ARB, the enrolled period (before 2018 or after 2018), the presence of cardiovascular disease (CVD), smoking history, the various types of SGLT-2is and advanced CKD (≥ or < 15 mL/min/1.73 m²).

Positive and negative controls

To assess the reliability of our analytical approach and avoid systemic bias, we conducted negative outcome controls, including the incidence of skin cancer, herniated disc, hemorrhoids, COPD, URIs, and GERD, which based on prior knowledge or expectations [ 32 , 33 ]. We selected Angiotensin II Receptor Blockers (ARB) as our positive exposure control, based on literature suggesting that ARB usage is linked to a reduced risk of all-cause mortality and MACE [ 34 , 35 , 36 ]. For our negative exposure control, we chose Histamine Type 2 Receptor Antagonists (H2 blockers) and antidepressants (Selective Serotonin Reuptake Inhibitors, SSRI) [ 37 , 38 ].

Landmark analysis for selection period and followed-up period

To address the impact of immortal or ascertainment bias, our series of landmark analyses involved initiating the follow-up period on the 14th, 30th, or 60th days post-acute dialysis. We also performed analyses across follow-up periods of 1, 2, 3, 4, and 5 years and compared these results to the overall study period. To ensure the robustness, we evaluated various exclusion criteria, including patients who died after dialysis initiation, and applied Cox regression model with different covariates. Additionally, we assessed the impact of SGLT-2is discontinuation timing by comparing continued use versus discontinuation within 3 months after the index date.

Statistical analysis

Baseline characteristics of the SGLT-2i users and non-users groups were presented numerically as mean [SD] for continuous variables and as count and percentage for categorical variables. Categorical variables were compared using chi-squared tests, and continuous variables were compared using independent 2-sample t-tests. One-to-one PSM was performed using logistic regression and greedy nearest neighbor matching based on several factors, with a caliper of 0.1 pooled standard deviations to balance baseline characteristics between the two groups. Variables were considered adequately matched if the between-group difference was below 0.1, indicating a small difference [ 39 ]. Survival probabilities were estimated using the Kaplan-Meier method. Patients were censored on the day they received a kidney transplant or after the last recorded event if that event occurred within the time window of the study. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models, while relative risks (RRs), odds ratios (ORs), and risk differences were also assessed.

Additionally, E values were used to provide insights into the potential impact of unmeasured confounders on the observed associations [ 40 ]. Missing data were addressed by excluding the respective cases to ensure complete datasets and maintain result integrity. Patients lost to follow-up were also excluded to minimize bias and inaccuracies due to incomplete data.

We further conducted a Bayesian analysis to update the probability of mortality based on the treatment. The prior probability of receiving treatment was set at 50%, with subsequent calculations using Bayes’ theorem to determine the posterior probability of mortality associated with SGLT-2is, which indicated a reduced risk of mortality compared to the baseline.

All statistical analyses were conducted using the analytic tool on the TriNetX platform and R, version 4.2.2. Statistical software SAS, version 9.2 (SAS Institute Inc), and Stata/MP software, version 16 (StataCorp LLC), were also used for data analysis. Statistical significance was defined as a two-tailed p-value of less than 0.05.

Study population characteristics

Of 49,762 patients with T2DM who initiated dialysis for evaluation, the study population was divided into two distinct groups: the SGLT-2i users ( n  = 781, 1.57%) and the non-user ( n  = 48,981, 98.43%), based on the utilization of SGLT-2is within the first three months after the dialysis. The median follow-up period for the entire cohort was 2.0 (IQR, 0.3–3.9) years. Before PSM, the major race was Asian in both groups. SGLT-2i users had a lower percentage of White (17.4% vs. 32.5%; SD = 0.347) and Black or African American (11.7% vs. 18.2%; SD = 0.181); however, a higher percentage of Asian (64.7% vs. 33.6%; SD = 0.642) and not Hispanic or Latino (91.9% vs. 72.2%; SD = 0.529) compared to non-users. Additionally, SGLT-2i users had a higher percentage of male patients (65.6% vs. 56.6%; SD = 0.179). SGLT-2i users had lower rates of nicotine dependence and CKD but higher rates of cardiovascular comorbidities and neoplasms. They were more frequently prescribed glucose-lowering, antiplatelet, and antihypertensive drugs. Additionally, obesity, poor sugar control, and better kidney function were observed among SGLT-2i users. After PSM, both groups were well balanced in each covariate, with all standardized differences less than 0.1 (Table  1 ). The number of patients excluded due to the absence of any follow-up after the index date was 10 out of 771 (1.3%) in the SGLT-2i users and 10 out of 771 (1.3%) in the non-users (detailed in Table S1 ). The reasons for initiating dialysis are detailed in Table S2 , with the advanced CKD accounting for 23.9% and 24.3% of cases, respectively. Specifically, AKI primarily stems from heart failure (37.0%) and sepsis (23.2%).

The impact of SGLT-2is on all-cause mortality, MACEs and other outcomes

During follow-up period, 42 (5.4%) patients in the SGLT-2i users and 127 (16.5%) patients in the non-users died, while 39 (8.6%) patients in the SGLT-2i users and 106 (22.5%) patients in the non-users experienced MACE. We found a significantly lower hazard of all-cause mortality (adjusted hazard ratio (aHR) = 0.49; 95% CI = 0.34–0.69, p  < 0.001) and MACE (aHR = 0.52; 95% CI = 0.36–0.75, p  < 0.001) in SGLT-2i users compared with non-users (Figs.  2 and 3 , Figure S1 , and Table S3). The risk difference of mortality was − 11% between SGLT-2i users and non-users (95% CI=-0.14- -0.08, p  < 0.001) (Table S4-5). Analysis of the individual elements of MACE revealed that cardiovascular death/mortality contributed the most to the overall MACE outcome (aHR = 0.47; 95% CI = 0.33–0.68, p  < 0.001) (Table S6). The E -value for all-cause mortality was 3.54, larger than the upper limit of the confidence interval at 2.26. For MACE, the E -value was 3.28, larger than the upper limit of the confidence interval at 2.01 (Table S3). No significant differences were observed in the outcomes of ketoacidosis, UTI or genital infection, hypoglycemia, dehydration, bone fracture, below-knee amputation, and 90-day readmission (Fig.  2 and Table S7). SGLT-2i users had a significantly higher likelihood of being free from dialysis compared to non-users in 90 days after the index date, with 95.1% of SGLT-2i users achieving dialysis-free status compared to 89.5% of non-users (aHR = 0.49; 95% CI = 0.33–0.73, p  < 0.001). Additionally, only a very limited number of patients in the SGLT-2i group (less than 10) underwent kidney transplantation during the study period, while no patients in the non-SGLT-2i group received a kidney transplant (Table S8).

Comparison of the pre-specified outcomes of patients treated with SGLT-2is versus those non-users after prosperity score matching. The forest plots illustrated the adjusted HRs of all-cause mortality, MACE, and other secondary outcomes for SGLT-2i users versus non-users after propensity score matching. The plots present both the adjusted HRs and their 95% confidence intervals (CIs), represented as error bars. The vertical line denotes an aHR of 1.00, with lower limits of the 95% CIs exceeding 1.00 indicating a statistically significant increased risk. aHR adjust hazard ratio, 3p-MACE 3-piont major adverse cardiac event, MACE major adverse cardiac event, PS propensity score, UTI urinary tract infection

Kaplan-Meier curves of the pre-specified long-term outcome. The blue curve represents individuals who are SGLT-2i users, while the purple curve represents those who are SGLT-2i non-users. Shaded areas indicate 95% CIs. (A) All-cause mortality (log-rank P  < 0. 001). (B) MACE (log-rank P  < 0. 001). MACE major adverse cardiac event, SGLT-2is sodium–glucose cotransporter 2 inhibitors

Negative outcome, positive and negative exposure controls

Our study revealed that there were no significant associations between SGLT-2is use and the incidence of skin cancer, herniated disc, hemorrhoids, COPD, upper respiratory infections, and GERD. The results indicated that the use of SGLT-2is was not significantly associated with a heightened risk of any of these outcomes, which aligns with prior knowledge and expectations [ 32 , 33 ] (Figure S2 ).

Based on literature suggesting that use of ARB is linked to a reduced risk of all-cause mortality and MACE. Our findings supported these reports, showing that ARB users had a significantly lower hazard of all-cause mortality and MACE compared to non-users. Results were consistent when H2 blockers and antidepressants (SSRIs) were introduced as negative exposure controls. (Figure S2 )

We conducted subgroup analyses to assess the influence of various factors on study outcomes. These analyses included baseline characteristics (eGFR, UPCR, and HbA1c levels, BMI, CVD, advanced CKD, and current use of beta blockers or ACEI/ARB), demographic factors (smoking status and age) and participants enrolled before or after 2018 (Fig.  4 ). These results showed that SGLT-2is were associated with reduced hazard of mortality and MACE across various subgroups. However, none of the interaction p-values were greater than 0.05, indicating that these associations were consistent across all subgroups without significant variation.

Subgroup analysis. The forest plots illustrated the adjusted HRs of all-cause mortality and MACE for SGLT-2is users versus non-users across various subgroups. The plots present both the adjusted HRs and their 95% confidence intervals (CIs), represented as error bars. The vertical line denotes an aHR of 1.00, with lower limits of the 95% CIs exceeding 1.00 indicating a statistically significant increased risk. Advanced CKD defined as baseline kidney function less than eGFR 15 ml/min/1.73 2 . ACEi angiotensin converting enzyme inhibitors, ARB angiotensin receptor blockers, BMI body mass index, CI confidence interval, CKD chronic kidney disease, CVD cardiovascular diseases, eGFR estimated, glomerular filtration rate, HbA1c Glycated Hemoglobin, aHR adjusted hazard ratio, MACE major adverse cardiac event, SGLT-2i sodium–glucose cotransporter 2 inhibitor

For the sensitivity analysis, we examined the effects of varying follow-up durations, as well as different types of SGLT-2 inhibitors used (Table S9 and Figure S3). Landmark analysis further confirmed that setting the different timeframe of selection period within 14, 30, 60 days produced consistent results (Table S10). We also employed various Cox proportional hazards regression models with different covariates, all of which consistently aligned with our primary approach (Table S11-12). The extended analysis of SGLT-2is discontinuation timing, comparing continued use versus discontinuation within 3 months after the index date, also showed consistent outcomes (Table S13).

Our analysis suggested that among T2DM patients at dialysis initiation, the new users of SGLT-2i could be linked with a reduction in the risk of all-cause mortality, and MACE over a median follow-up period of 2.0 years. Our study did not observe significant differences in the incidence of ketoacidosis, hypoglycemia, below-knee amputations, bone fractures, UTI or genital infection, dehydration, or 90-day readmission when compared to patients not using SGLT-2is. Notably, SGLT-2i users had a higher likelihood of achieving dialysis-free status at 90 days.

Several current studies have shown that SGLT-2is improve cardiovascular outcomes in patients with T2DM [ 8 , 10 , 41 , 42 ]. Clinical trials have established that SGLT-2is reduce the risk of renal disease progression and death from renal causes in patients with T2DM, as well as in those with CKD, regardless of their diabetes status [ 14 , 41 , 43 ]. SGLT-2is improve glucose control primarily by promoting glucosuria, which leads to increased insulin sensitivity and enhanced beta-cell function [ 44 ]. Beyond glycemic control, these inhibitors exert pleiotropic effects that extend to cardiovascular benefits [ 44 , 45 , 46 ]. The combined effect of glucose-induced osmotic diuresis and natriuresis contributes to a decrease in cardiac preload while the reduction in arterial stiffness and systemic blood pressure aids in diminishing afterload [ 47 ]. However, the exact mechanisms underlying the persistent cardiovascular benefits of SGLT-2is in patients on dialysis or with severely impaired kidney function are multifaceted and not fully understood [ 48 ].

Potential mechanisms include the inhibition of the cardiac sodium-hydrogen exchanger, which contributes to the amelioration of cardiac hypertrophy, fibrosis, and injury [ 49 ]. This concept of SGLT-2 transporter-independent cardiac benefits is supported by a bioinformatic study that used in silico modeling of RNA sequence datasets from cardiac tissues of diabetic rats treated with empagliflozin [ 50 ]. Enhancing ketogenic nutrient deprivation signaling through the upregulation of the SIRT1/PGC-1α/FGF21 pathway leads to alleviation of oxidative stress/inflammation, augmentation of autophagic flux, and increased erythropoiesis, which may contribute to improved cardiovascular outcomes and overall cellular health [ 51 ]. SGLT-2is have demonstrated beneficial of preventing adverse cardiac remodeling. In a randomized trial, change in LV mass index was shown in people with T2DM who treated with empagliflozin [ 52 ]. Collectively, these potential mechanisms are independent of proximal tubular SGLT-2 and contribute to the improvement of cardiovascular events in patients with minimal diuresis.

Our study demonstrates that T2DM patients initiating dialysis who were treated with SGLT-2is had a higher likelihood of achieving dialysis-free status at 90 days. In the post-hoc analysis from EMPA-KIDNEY trial, 245 participants were with eGFR less than 20 mL/min/1.73 m², 27% relative risk reduction in the incidence of the progression of kidney disease was consistent with the effect size in the overall population [ 15 ]. These exploratory subgroup data support the hypothesis that SGLT-2is may exert beneficial effects in patients at advanced stages of CKD. The kidney-protective effects of SGLT-2is are believed to operate through multiple mechanisms [ 53 ]. They reduce intraglomerular pressure by restoring tubuloglomerular feedback and may also exert anti-inflammatory effects and enhance mitochondrial function, collectively contributing to reduced fibrosis and oxidative stress in the kidney [ 45 , 54 ].

Safety concerns regarding the use of SGLT-2is in patients with T2DM on dialysis are important. Our study suggested that SGLT-2is were not associated with ketoacidosis, hypoglycemia, below-knee amputations, bone fractures, UTI or genital infection, or dehydration. A retrospective study on seven patients with diabetes undergoing intermittent hemodialysis (iHD) over 12 months found SGLT-2is treatment to be safe, with no reported cases of euglycemic ketoacidosis, bone fractures, or amputations [ 55 ]. Further research by Barreto et al. has provided insights into the pharmacokinetics of dapagliflozin in individuals with kidney failure undergoing hemodialysis or peritoneal dialysis [ 56 ]. The findings suggest that while dapagliflozin is not dialyzable, significant drug accumulation was not observed, and no serious adverse events were reported, though the follow-up duration was short. Specifically, the DAPA-CKD trial offered insights into the use of SGLT-2is in patients with kidney failure [ 43 ]. In an exploratory analysis of 167 participants who progressed to chronic dialysis, the rates of serious adverse events were comparable between those treated with dapagliflozin and those given a placebo. However, this analysis did not specifically address the cardiovascular benefits and kidney protection associated with SGLT-2 inhibitors [ 19 ]. Consequently, further randomized clinical trials are necessary to validate these findings and explore these potential benefits in greater depth.

The consistent results across prespecified subgroups support the strength of our findings. Our study highlights the potential association between new SGLT-2i users and cardiovascular outcomes in patients with T2DM who initiated dialysis, marking an initial step in understanding this relationship. The new-users design employed in our study ensures the data’s relevance to patients starting SGLT-2is, thereby enhancing the validity of our findings. Utilizing real-world data, as demonstrated in our research, provides unique advantages, offering a broad perspective on patient information that is crucial for informing future treatment approaches and research efforts.

Our studies did have some limitations. First, the predominance of Asian participants in our study may limit the generalizability of our findings. Second, the inherent nature of retrospective designs and the potential for misclassification bias and residual confounding cannot be completely eliminated. To evaluate the influence of potential unmeasured confounding, we conducted an E -value analysis, as well as PSM and variable models of multivariate Cox proportional analysis. The findings suggest that it is unlikely for an unmeasured confounder to exert a more significant effect on the primary outcome than the use of SGLT-2is. Third, the limited number of patients initiating dialysis who used SGLT-2is within our study cohort could affect the robustness of our results. The small sample size of our cohort inherently limits the statistical power to detect heterogeneity, increasing the risk of type 2 error. Additionally, the process of selecting an appropriate control group from a large cohort may lead to challenges in finding suitable matches. This can result in increased sample imbalance and potential bias. Fourth, the shorter follow-up period limits our ability to assess long-term outcomes and sustained effects of SGLT-2is, reflecting real-world practices where these drugs are selectively prescribed. Hazard ratios alone may not fully capture clinical significance [ 57 ], so we also present absolute risks and risk differences to provide a clearer view of the potential clinical relevance. Fifth, limitations related to the dataset include its aggregated nature, which restricts the ability to trace reasons for discontinuation of prescriptions and limits the application of advanced statistical methods. Due to the constraints of the TriNetX platform, we were unable to perform either multiple rounds of PSM or competing risk analysis to enhance model precision and minimize bias. Additionally, the dataset does not provide the precise dates of dialysis initiation and/or discontinuation, or renal transplant, thereby precluding the use of time-varying models. Sixth, our study did not specifically consider the dosage of SGLT-2is. While the effects of SGLT-2is are generally not considered dose-dependent, future research may further explore this aspect to confirm consistency across different dosages. Finally, it is important to note that our study was centered on patients with T2DM at the new onset of dialysis. Our landmark analysis ensured consistent results, mitigating the possibility of guarantee-time bias or immortal time bias [ 58 ]. As a result, our findings may not extend to patients on long-term dialysis. In light of these limitations, cautious interpretation of our findings is warranted, and further research is needed to validate and expand upon our observations.

Our real-world study suggested that new SGLT-2i users in T2DM patients at the onset of dialysis were associated with a reduced long-term risk of all-cause mortality and MACE over a median follow-up of 2.0 years. Additionally, they would have a higher likelihood of achieving dialysis-free status at 90 days without an increased risk of serious adverse events such as ketoacidosis, hypoglycemia, or infections. Further randomized clinical trials are essential to fully validate these findings and explore the cardiovascular and kidney protective effects in this population.

Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119 .

Article   PubMed   Google Scholar  

Cheng HT, Xu X, Lim PS, Hung KY. Worldwide epidemiology of diabetes-related end-stage renal disease, 2000–2015. Diabetes Care. 2021;44(1):89–97. https://doi.org/10.2337/dc20-1913 .

Federation ID. Diabetes and kidney disease: the latest data from the IDF diabetes atlas and the iCaReMe registry. 2024. Accessed 4 Aug 2024. https://diabetesatlas.org/atlas/diabetes-and-kidney-disease/

KDIGO. Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4s):S117-314. https://doi.org/10.1016/j.kint.2023.10.018 .

Article   Google Scholar  

Yu SM, Bonventre JV. Acute kidney injury and progression of diabetic kidney disease. Adv Chronic Kidney Dis. 2018;25(2):166–80. https://doi.org/10.1053/j.ackd.2017.12.005 .

Article   PubMed   PubMed Central   Google Scholar  

Stein G, Fünfstück R, Schiel R. Diabetes mellitus and dialysis. Minerva Urol Nefrol. 2004;56(3):289–303.

CAS   PubMed   Google Scholar  

Sowers JR, Lester MA. Diabetes and cardiovascular disease. Diabetes Care. 1999;22(Suppl 3):C14-20.

PubMed   Google Scholar  

Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;26(22):2117–28. https://doi.org/10.1056/NEJMoa1504720 .

Article   CAS   Google Scholar  

Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;17(7):644–57. https://doi.org/10.1056/NEJMoa1611925 .

Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;24(4):347–57. https://doi.org/10.1056/NEJMoa1812389 .

McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;21(21):1995–2008. https://doi.org/10.1056/NEJMoa1911303 .

Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;8(15):1413–24. https://doi.org/10.1056/NEJMoa2022190 .

Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart failure with a preserved ejection fraction. N Engl J Med. 2021;14(16):1451–61. https://doi.org/10.1056/NEJMoa2107038 .

Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in patients with chronic kidney disease. N Engl J Med. 2023;12(2):117–27. https://doi.org/10.1056/NEJMoa2204233 .

Roddick AJ, Wonnacott A, Webb D, et al. UK kidney association clinical practice guideline: sodium-glucose co-transporter-2 (SGLT-2) inhibition in adults with kidney disease 2023 update. BMC Nephrol. 2023;25(1):310. https://doi.org/10.1186/s12882-023-03339-3 .

UK Kidney Association. UK kidney association clinical practice guideline: sodium-glucose co-transporter-2 (SGLT-2) inhibition in adults with kidney disease. UK Kidney Association. Accessed 17 Oct 2023. https://guidelines.ukkidney.org/

U.S. Food and Drug Administration. FARXIGA ® (dapagliflozin) tablets, for oral use. U.S. Food and Drug Administration. Updated May 2023. Accessed 17 Oct 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/202293s026lbl.pdf

European Medicines Agency. Dapagliflozin Viatris: EPAR - Product Information. European Medicines Agency. Updated April 2023. Accessed 17 Oct 2023. https://www.ema.europa.eu/en/documents/product-information/dapagliflozin-viatris-epar-product-information_en.pdf

Heerspink HL, Wheeler DC, Jong N, #3382, Reasons for dialysis initiation and safety of dapagliflozin among dialysis participants, et al. new insights from DAPA-CKD. Nephrol Dialysis Transplantation. 2023;38(Supplement1). https://doi.org/10.1093/ndt/gfad063a_3382 .

Wang W, Wang CY, Wang SI, Wei JC. Long-term cardiovascular outcomes in COVID-19 survivors among non-vaccinated population: a retrospective cohort study from the TriNetX US collaborative networks. EClinicalMedicine. 2022;53:101619. https://doi.org/10.1016/j.eclinm.2022.101619 .

Pan H-C, Chen J-Y, Chen H-Y, et al. Sodium-glucose cotransport protein 2 inhibitors in patients with type 2 diabetes and acute kidney disease. JAMA Netw Open. 2024;7(1):e2350050–2350050. https://doi.org/10.1001/jamanetworkopen.2023.50050 .

Wu VC, Chen JY, Lin YH, Wang CY, Lai CC. Assessing the cardiovascular events and clinical outcomes of COVID-19 on patients with primary aldosteronism. J Microbiol Immunol Infect. 2023;56(6):1158–68. https://doi.org/10.1016/j.jmii.2023.09.005 .

Pan HC, Chen JY, Chen HY, et al. GLP-1 receptor agonists’ impact on cardio-renal outcomes and mortality in T2D with acute kidney disease. Nat Commun. 2024;13(1):5912. https://doi.org/10.1038/s41467-024-50199-y .

Lai HW, See CY, Chen JY, Wu VC. Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists. Cardiovasc Diabetol. 2024;29(1):277. https://doi.org/10.1186/s12933-024-02364-2 .

Chuang MH, Chen JY, Wang HY, Jiang ZH, Wu VC. Clinical outcomes of Tirzepatide or GLP-1 receptor agonists in individuals with type 2 diabetes. JAMA Netw Open. 2024;1(8):e2427258. https://doi.org/10.1001/jamanetworkopen.2024.27258 .

Wu VC, Chen JY, Lin YH, Wang CY, Lai CC. Assessing the cardiovascular events and clinical outcomes of COVID-19 on patients with primary aldosteronism. J Microbiol Immunol Infect. 2023. https://doi.org/10.1016/j.jmii.2023.09.005 .

Topaloglu U, Palchuk MB. Using a federated network of real-world data to optimize clinical trials operations. JCO Clin Cancer Inf. 2018;2:1–10. https://doi.org/10.1200/cci.17.00067 .

Palchuk MB, London JW, Perez-Rey D, et al. A global federated real-world data and analytics platform for research. JAMIA Open Jul. 2023;6(2):ooad035. https://doi.org/10.1093/jamiaopen/ooad035 .

Pan H-C, Chen J-Y, Chen H-Y, et al. GLP-1 receptor agonists’ impact on cardio-renal outcomes and mortality in T2D with acute kidney disease. Nat Commun. 2024;15(1):5912. https://doi.org/10.1038/s41467-024-50199-y .

Article   CAS   PubMed   PubMed Central   Google Scholar  

World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama. 2013;27(20):2191–4. https://doi.org/10.1001/jama.2013.281053 .

Pan HC, Chen JY, Chen HY, et al. Sodium-glucose cotransport protein 2 inhibitors in patients with type 2 diabetes and acute kidney disease. JAMA Netw Open. 2024;2(1):e2350050. https://doi.org/10.1001/jamanetworkopen.2023.50050 .

Tang H, Yang K, Song Y, Han J. Meta-analysis of the association between sodium-glucose co-transporter-2 inhibitors and risk of skin cancer among patients with type 2 diabetes. Diabetes Obes Metab. 2018;20(12):2919–24. https://doi.org/10.1111/dom.13474 .

Article   CAS   PubMed   Google Scholar  

Wang YW, Lin JH, Yang CS. Meta-analysis of the association between new hypoglycemic agents and digestive diseases. Med (Baltimore). 2022;26(34):e30072. https://doi.org/10.1097/md.0000000000030072 .

Qiao Y, Shin JI, Chen TK, et al. Association between renin-angiotensin system blockade discontinuation and all-cause mortality among persons with low estimated glomerular filtration rate. JAMA Intern. 2020;1(5):718–26. https://doi.org/10.1001/jamainternmed.2020.0193 .

Yang CW, Tzeng NS, Yin YJ, et al. Angiotensin receptor blockers decrease the risk of major adverse cardiovascular events in patients with end-stage renal disease on maintenance dialysis: a nationwide matched-cohort study. PLoS ONE. 2015;10(10):e0140633. https://doi.org/10.1371/journal.pone.0140633 .

Liu Y, Ma X, Zheng J, Jia J, Yan T. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. BMC Nephrol. 2017;30(1):206. https://doi.org/10.1186/s12882-017-0605-7 .

Hughes DG, Dowling EA, DeMeersman RE, Garnett WR, Karnes HT. Cardiovascular effects of H2-receptor antagonists. J Clin Pharmacol. 1989;29(5):472–7. https://doi.org/10.1002/j.1552-4604.1989.tb03365.x .

Almuwaqqat Z, Jokhadar M, Norby FL, et al. Association of antidepressant medication type with the incidence of cardiovascular disease in the ARIC study. J Am Heart Assoc. 2019;4(11):e012503. https://doi.org/10.1161/jaha.119.012503 .

Andrade C, Mean Difference. Standardized Mean difference (SMD), and their use in Meta-Analysis: as simple as it gets. J Clin Psychiatry Sep. 2020;22(5). https://doi.org/10.4088/JCP.20f13681 .

VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;15(4):268–74. https://doi.org/10.7326/m16-2607 .

Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;13(24):2295–306. https://doi.org/10.1056/NEJMoa1811744 .

Bhatt DL, Szarek M, Pitt B, et al. Sotagliflozin in patients with diabetes and chronic kidney disease. N Engl J Med. 2021;14(2):129–39. https://doi.org/10.1056/NEJMoa2030186 .

Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;8(15):1436–46. https://doi.org/10.1056/NEJMoa2024816 .

Fonseca-Correa JI, Correa-Rotter R, Sodium-Glucose. Cotransporter 2 inhibitors mechanisms of action: a review. Front Med (Lausanne). 2021;8:777861. https://doi.org/10.3389/fmed.2021.777861 .

Ferrannini E, Muscelli E, Frascerra S, et al. Metabolic response to sodium-glucose cotransporter 2 inhibition in type 2 diabetic patients. J Clin Invest. 2014;124(2):499–508. https://doi.org/10.1172/jci72227 .

Merovci A, Mari A, Solis-Herrera C, et al. Dapagliflozin lowers plasma glucose concentration and improves β-cell function. J Clin Endocrinol Metab. 2015;100(5):1927–32. https://doi.org/10.1210/jc.2014-3472 .

Lytvyn Y, Bjornstad P, Udell JA, Lovshin JA, Cherney DZI. Sodium glucose cotransporter-2 inhibition in Heart failure: potential mechanisms, clinical applications, and summary of clinical trials. Circulation. 2017;24(17):1643–58. https://doi.org/10.1161/circulationaha.117.030012 .

Heerspink HJL, Berger S, Gansevoort RT. Will SGLT2 inhibitors be effective and safe in patients with severe CKD, dialysis, or kidney transplantation. Clin J Am Soc Nephrol. 2023;1(11):1500–2. https://doi.org/10.2215/cjn.0000000000000221 .

Lopaschuk GD, Verma S. Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors: a state-of-the-art review. JACC Basic Transl Sci. 2020;5(6):632–44. https://doi.org/10.1016/j.jacbts.2020.02.004 .

Iborra-Egea O, Santiago-Vacas E, Yurista SR, et al. Unraveling the molecular mechanism of action of empagliflozin in heart failure with reduced ejection fraction with or without diabetes. JACC Basic Transl Sci. 2019;4(7):831–40. https://doi.org/10.1016/j.jacbts.2019.07.010 .

Packer M. Cardioprotective effects of Sirtuin-1 and its downstream effectors: potential role in mediating the heart failure benefits of SGLT2 (sodium-Glucose cotransporter 2) inhibitors. Circ Heart Fail. 2020;13(9):e007197. https://doi.org/10.1161/circheartfailure.120.007197 .

Verma S, Mazer CD, Yan AT, et al. Effect of empagliflozin on left ventricular mass in patients with type 2 diabetes mellitus and coronary artery disease: the EMPA-HEART CardioLink-6 randomized clinical trial. Circulation. 2019;19(21):1693–702. https://doi.org/10.1161/circulationaha.119.042375 .

Chen JY, Pan HC, Shiao CC, et al. Impact of SGLT2 inhibitors on patient outcomes: a network meta-analysis. Cardiovasc Diabetol. 2023;27(1):290. https://doi.org/10.1186/s12933-023-02035-8 .

Bailey CJ, Day C, Bellary S. Renal protection with SGLT2 inhibitors: effects in acute and chronic kidney disease. Curr Diab Rep. 2022;22(1):39–52. https://doi.org/10.1007/s11892-021-01442-z .

De La Flor JC, Villa D, Cruzado L, et al. Efficacy and safety of the use of SGLT2 inhibitors in patients on incremental hemodialysis: maximizing residual renal function, is there a role for SGLT2 inhibitors? Biomedicines. 2023. https://doi.org/10.3390/biomedicines11071908 .

Barreto J, Borges C, Rodrigues TB, et al. Pharmacokinetic properties of dapagliflozin in hemodialysis and peritoneal dialysis patients. Clin J Am Soc Nephrol. 2023;1(8):1051–8. https://doi.org/10.2215/cjn.0000000000000196 .

Hernán MA. The hazards of hazard ratios. Epidemiology. 2010;21(1):13–5. https://doi.org/10.1097/EDE.0b013e3181c1ea43 .

Buyse M, Piedbois P. On the relationship between response to treatment and survival time. Stat Med. 1996;30(24):2797–812. https://doi.org/10.1002/(SICI)1097-0258(19961230)15:24%3c2797::AID-SIM290>3.0.CO;2-V .

Download references

The research did not receive any specific grant from funding agencies in public, commercial, or not-for-profit sectors.

Author information

Authors and affiliations.

College of Medicine, Taipei Medical University, Taipei, Taiwan

Chung-An Wang

Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan

Li-Chun Lin

Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan

Jui-Yi Chen

Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Healthy and Welfare, Taoyuan, Taiwan

Wei-Jie Wang

Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, Taiwan

Primary Aldosteronism Center of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Vin-Cent Wu

National Taiwan University Hospital Study Group of Acute Renal Failure (NSARF), Consortium for Acute Kidney Injury and Renal Diseases, Taipei, Taiwan

Department of Internal Medicine, National Taiwan University Hospital, Room 1555, B4, Clinical Research Building, 7 Chung-Shan South Road, Taipei, 100, Taiwan

You can also search for this author in PubMed   Google Scholar

Contributions

All author had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data analysis. The research study and methodology were conceptualized by V.C.W. and C.A.W. V.C.W., L.C.L., and C.A.W. conducted the data analysis and literature search. V.C.W. and L.C.L. were responsible for visualizing and interpreting the data. C.A.W. undertook the writing of the original draft and drafting of the manuscript. V.C.W., W.J.W., and L.C.L. supervised the work and reviewed the edited manuscript. Statistical analysis was performed by V.C.W. and C.A.W. V.C.W. and J.Y.C. provided administrative, technical, or material support. All authors contributed to the discussion and interpretation of the results, critically reviewed and approved the final manuscript.

Corresponding author

Correspondence to Vin-Cent Wu .

Ethics declarations

Ethical approval and consent to participate.

Not applicable.

Consent for publication

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Electronic supplementary material

Supplementary material 1, supplementary material 2, rights and permissions.

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

Reprints and permissions

About this article

Cite this article.

Wang, CA., Lin, LC., Chen, JY. et al. Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: a health global federated network analysis. Cardiovasc Diabetol 23 , 327 (2024). https://doi.org/10.1186/s12933-024-02424-7

Download citation

Received : 24 June 2024

Accepted : 27 August 2024

Published : 03 September 2024

DOI : https://doi.org/10.1186/s12933-024-02424-7

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Type 2 diabetes mellitus
• Dialysis initiation
• Major adverse cardiovascular events
• Propensity score matching
• Sodium-glucose cotransporter 2 inhibitors

Cardiovascular Diabetology

ISSN: 1475-2840

• Submission enquiries: [email protected]