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Empirical Research: Defining, Identifying, & Finding

Defining empirical research, what is empirical research, quantitative or qualitative.

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Calfee & Chambliss (2005)  (UofM login required) describe empirical research as a "systematic approach for answering certain types of questions."  Those questions are answered "[t]hrough the collection of evidence under carefully defined and replicable conditions" (p. 43). 

The evidence collected during empirical research is often referred to as "data." 

Characteristics of Empirical Research

Emerald Publishing's guide to conducting empirical research identifies a number of common elements to empirical research: 

• A  research question , which will determine research objectives.
• A particular and planned  design  for the research, which will depend on the question and which will find ways of answering it with appropriate use of resources.
• The gathering of  primary data , which is then analysed.
• A particular  methodology  for collecting and analysing the data, such as an experiment or survey.
• The limitation of the data to a particular group, area or time scale, known as a sample [emphasis added]: for example, a specific number of employees of a particular company type, or all users of a library over a given time scale. The sample should be somehow representative of a wider population.
• The ability to  recreate  the study and test the results. This is known as  reliability .
• The ability to  generalize  from the findings to a larger sample and to other situations.

If you see these elements in a research article, you can feel confident that you have found empirical research. Emerald's guide goes into more detail on each element. 

Empirical research methodologies can be described as quantitative, qualitative, or a mix of both (usually called mixed-methods).

Ruane (2016)  (UofM login required) gets at the basic differences in approach between quantitative and qualitative research:

• Quantitative research  -- an approach to documenting reality that relies heavily on numbers both for the measurement of variables and for data analysis (p. 33).
• Qualitative research  -- an approach to documenting reality that relies on words and images as the primary data source (p. 33).

Both quantitative and qualitative methods are empirical . If you can recognize that a research study is quantitative or qualitative study, then you have also recognized that it is empirical study. 

Below are information on the characteristics of quantitative and qualitative research. This video from Scribbr also offers a good overall introduction to the two approaches to research methodology: 

Characteristics of Quantitative Research 

Researchers test hypotheses, or theories, based in assumptions about causality, i.e. we expect variable X to cause variable Y. Variables have to be controlled as much as possible to ensure validity. The results explain the relationship between the variables. Measures are based in pre-defined instruments.

Examples: experimental or quasi-experimental design, pretest & post-test, survey or questionnaire with closed-ended questions. Studies that identify factors that influence an outcomes, the utility of an intervention, or understanding predictors of outcomes. 

Characteristics of Qualitative Research

Researchers explore “meaning individuals or groups ascribe to social or human problems (Creswell & Creswell, 2018, p3).” Questions and procedures emerge rather than being prescribed. Complexity, nuance, and individual meaning are valued. Research is both inductive and deductive. Data sources are multiple and varied, i.e. interviews, observations, documents, photographs, etc. The researcher is a key instrument and must be reflective of their background, culture, and experiences as influential of the research.

Examples: open question interviews and surveys, focus groups, case studies, grounded theory, ethnography, discourse analysis, narrative, phenomenology, participatory action research.

Calfee, R. C. & Chambliss, M. (2005). The design of empirical research. In J. Flood, D. Lapp, J. R. Squire, & J. Jensen (Eds.),  Methods of research on teaching the English language arts: The methodology chapters from the handbook of research on teaching the English language arts (pp. 43-78). Routledge.  http://ezproxy.memphis.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=125955&site=eds-live&scope=site .

Creswell, J. W., & Creswell, J. D. (2018).  Research design: Qualitative, quantitative, and mixed methods approaches  (5th ed.). Thousand Oaks: Sage.

How to... conduct empirical research . (n.d.). Emerald Publishing.  https://www.emeraldgrouppublishing.com/how-to/research-methods/conduct-empirical-research .

Scribbr. (2019). Quantitative vs. qualitative: The differences explained  [video]. YouTube.  https://www.youtube.com/watch?v=a-XtVF7Bofg .

Ruane, J. M. (2016).  Introducing social research methods : Essentials for getting the edge . Wiley-Blackwell.  http://ezproxy.memphis.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=1107215&site=eds-live&scope=site .  

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• Choosing a Topic
• Developing a Research Question
• Determine Keywords

Exploring Different Types of Articles

Features of a peer-reviewed article (loyd sealy library), finding empirical articles.

• Find Articles
• Database Search Strategies
• Using Google Scholar
• Open Educational Resources (OERs)
• Evaluate Sources
• Cite Sources This link opens in a new window
• Annotated Bibliography
• Zotero This link opens in a new window
• Literature Review
• Statistics & Assessment
• CMH Websites
• CMH Organizations

Scholarly Articles

Scholarly articles are a great resource for finding  in-depth, current information on a topic . Scholarly articles have a more narrow focus than books, so you can try searching for more specific topics. 

• This type of article may also be called  peer-reviewed articles , or  refereed articles . 
• Scholarly articles are one of the most common types of sources your professors will require you to include in your research. 
• Scholarly articles are found in journals, which you can search for in a  database.   T he McQuade Library subscribes to over 220 databases that range from  general  to  subject-specific.  

What makes a book scholarly?

How can you tell if a book is scholarly?

The fastest way is to check the publisher- if it's published by a university press (e.g. Chicago, Harvard, etc.) or other academic presses (e.g., Blackwell, Routledge, Palgrave, Ashgate) it is scholarly. Another way to decide is to look at the book's intended audience and purpose.

How are scholarly books different from regular books?

Scholarly books are published with the goal of contributing to research and knowledge of a subject, and support future research by scholars and students, not necessarily making money.

Who decides whether or not a scholarly book gets published?

All scholarly books go through an extensive process in which experts in the field read the manuscripts and decide if the book is worthy to be published.  In other words, scholarly books are peer reviewed sources.

Remember, scholarly books are just one of many kinds of books available through the library. If you are unsure if the book you have found is scholarly ask a librarian or your professor.

• EMPIRICAL ARTICLES
• LITERATURE REVIEW ARTICLES
• THEORETICAL ARTICLES
• NEWS, BOOK REVIEWS, OPINION, ETC.

Empirical articles are those in which authors report on their own study. The authors will have collected data to answer a research question.  Empirical research contains observed and measured examples that inform or answer the research question. The data can be collected in a variety of ways such as interviews, surveys, questionnaires, observations, and various other quantitative and qualitative research methods. 

Identifying empirical research

 Various phrases or keywords can identify articles that use empirical or qualitative research.  These include:

PURPOSE OF A LIT REVIEW

A literature summarizes & analyzes published work on a topic in order to

• evaluate the state of research on the topic.
• provide an overview of previous research on a topic that critically evaluates, classifies, and compares what has already been published on a particular topic.
• suggest future research and/or gaps in knowledge.
• synthesize and place into context original research and scholarly literature relevant to the topic (as in the literature review prior within an empirical research article.

WHAT DOES A LIT REVIEW LOOK LIKE?

The format  is usually a bibliographic essay; sources are briefly cited within the body of the essay, with full bibliographic citations at the end.

The introduction should define the topic and set the context for the literature review. It will include the author's perspective or point of view on the topic, how they have defined the scope of the topic (including what's not included), and how the review will be organized. It can point out overall trends, conflicts in methodology or conclusions, and gaps in the research.

The body of the review should organize the research into major topics and subtopics. These groupings may be by subject, (e.g., globalization of clothing manufacturing), type of research (e.g., case studies), methodology (e.g., qualitative), genre, chronology, or other common characteristics. Within these groups the author can then discuss the merits of each article and provide analysis and comparison of the importance of each article to similar ones.

The conclusion will summarize the main findings, make clear how this review of the literature supports (or not) the research to follow, and may point the direction for further research.

The list of references will include full citations for all of the items mentioned in the lit review.

A theoretical article contains or refers to new or established abstract principles related to a specific field of knowledge. These article are peer reviewed but do not normally contain research or present experimental data.

How do I know I found a theoretical article?

Look for terms like concepts, conceptual, framework, model, theoretical foundation, and perspectives.

Scholarly journals will publish some types of articles that are not peer reviewed or based on research.  

Remember that not every article in peer-reviewed journals is a peer-reviewed research article .

Editorials:  Often times the editor of a journal will write an article with his or opinion or summary of the article. This can lead you to good sources but are not appropriate for most research papers.

Also consider...

• Is the journal in which you found the article published or sponsored by a professional scholarly society, professional association, or university academic department? Does it describe itself as a peer-reviewed publication? (To know that, check the journal's website). 
• Did you find a citation for it in one of the databases that includes scholarly publications? Read the database description to see if it includes scholarly publications.
• In the database, did you limit your search to  peer-reviewed  publications?
• Is the topic of the article  narrowly focused and explored in depth ?
• Is the article based on either  original research  or  authorities in the field  (as opposed to personal opinion)?
• Is the article written for readers with some prior knowledge of the subject?
• If your field is social or natural science, is the article divided into sections with headings such as those listed below?

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Research: Overview & Approaches

• Getting Started with Undergraduate Research
• Planning & Getting Started
• Building Your Knowledge Base
• Locating Sources
• Reading Scholarly Articles
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• Productivity & Organizing Research
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Introduction to Empirical Research

Databases for finding empirical research, guided search, google scholar, examples of empirical research, sources and further reading.

• Interpretive Research
• Action-Based Research
• Creative & Experimental Approaches

Your Librarian

• Introductory Video This video covers what empirical research is, what kinds of questions and methods empirical researchers use, and some tips for finding empirical research articles in your discipline.

• Guided Search: Finding Empirical Research Articles This is a hands-on tutorial that will allow you to use your own search terms to find resources.

• Study on radiation transfer in human skin for cosmetics
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• Review of design considerations and technological challenges for successful development and deployment of plug-in hybrid electric vehicles
• Endocrine disrupters and human health: could oestrogenic chemicals in body care cosmetics adversely affect breast cancer incidence in women?

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Public Health: Searching for Empirical Articles

• Searching for Empirical Articles
• Grey Literature
• APA 7th Edition
• Annotated Bibliography vs. Literature Review

What is Empirical Research?

Empirical research  is conducted based on observed and measured phenomena and derives knowledge from actual experience, rather than from theory or belief.  Empirical research articles are examples of primary research.

How do you know if a study is empirical?

Read the subheadings within the article, book, or report and look for a description of the research methodology.  Ask yourself: Could I recreate this study and test these results?

Key characteristics to look for:

• Specific research questions  to be answered
• Definition of the  population, behavior, or   phenomena  being studied
• Description of the  process  used to study this population or phenomena, including selection criteria, controls, and testing instruments (such as surveys)
• The article abstract  mentions a study, observation, analysis, # of participants/subjects .
• The article includes  charts ,  graphs , or  statistical analysis .
• The article is substantial in size, likely to be  more than 5 pages  long.
• The article contains the following sections (the exact terms may vary): abstract, introduction, methodology , results , discussion, references.
• Empirical research is often (but not always) published in peer-reviewed academic journals.

Finding Empirical Research in the Databases

Most databases will not have a simple way to only look at empirical research. In the window below are some suggestions for specific databases, but here are some good rules of thumb to follow:

Search subject-specific databases - Multipurpose databases can definitely contain empirical research, but it's almost always easier to use the databases devoted to your topic, which should have more topical results and will respond better to your keywords.

Select "Peer-reviewed Journals" - Not all empirical research is published in academic journals. Grey literature is a great place to search, particularly in the health sciences. However, grey literature can be difficult to identify, so it is recommended to search the databases until you are more comfortable identifying empirical literature.

Check the abstract / methods - Most articles will not have the phrase "empirical research" in their title, or even in the whole article. A better place to get an idea of what the article contains is by looking at the abstract and the methods section. In the abstract, there will usually be a description of what was done in the article. If there isn't, look in the methods. Ideally, you can get an idea of whether original research is being conducted or if it's reviewing it from other sources.

Consider your keywords - Think about what types of methods are used in empirical research and incorporate those into your keywords. or example, searching for "sleep loss" will certainly bring back many articles about that subject, but "sleep loss and study" might yield some results describing studies being conducted on sleep loss.

The box to the right features some typical methods of conducting empirical research that you might consider including in your search terms.

Empirical research search terms

• observation
• questionnaire
• participants

Specific database examples

• CINAHL Plus
• APA PsychINFO
• Science Direct
• Linguistics and Language Behavior Abstracts
• CINAHL Complete This link opens in a new window CINAHL, the Cumulative Index to Nursing & Allied Health Literature, is a comprehensive research tool for nursing, allied health, public health, biomedicine, and related fields. It provides indexing for articles from 5,400 journals in the fields of nursing and allied health. This database provides full text access to more than 1,300 journals dating back to 1937.
• Use the "Advanced Search"
• Type your keywords into the search boxes
• Below the search windows, check off "Evidence-Based Practice" in the "Special Interests" menu
• Choose other limits, such as published date, if needed
• Click on the "Search" button
• Empirical Research
• Experimental Studies
• Nonexperimental Studies
• Qualitative Studies
• Quantitative Studies
• PubMed This link opens in a new window A comprehensive index to biomedical and life sciences journals with citations to over 18 million articles back to 1948. Note: To limit to full-text articles, search PUBMED CENTRAL.

There are 2 ways to find empirical articles in PubMed:

One technique is to limit your search results after you perform a search:

• Type in your keywords and click on the "Search" button
• To the left of your results, under "Article Types," click on "Customize"
• Choose the types of studies that interest you, and click on the "Show" button

Another alternative is to construct a more sophisticated search:

• From PubMed's main screen, click on "Advanced" link underneath the search box
• On the Advance Search Builder screen type your keywords into the search boxes
• Change one of the empty boxes from "All Fields" to "Publication Type"
• To the right of Publication Type, click on "Show Index List" and choose a methodology that interests you. You can choose more than one by holding down the "Ctrl" or "⌘" on your keyboard as you click on each methodology
• APA PsycINFO This link opens in a new window Available via EBSCO. The American Psychological Associations (APA) notable database for locating abstracts of scholarly journal articles, book chapters, books, and dissertations. This resource is the largest of its kind dedicated to peer-reviewed literature in behavioral science and mental health, and it also includes information about the psychological aspects of related fields such as medicine, psychiatry, nursing, sociology, education, pharmacology, technology, linguistics, anthropology, business, and law. Material is drawn from over 2,000 periodicals in more than 20 languages.

To find empirical articles in PsycINFO:

• Scroll down the page to "Methodology," and choose "Empirical Study." There are more specific methodologies below.
• Choose other limits, such as publication date, if needed

To find empirical articles in ScienceDirect:

• Click on "Advanced Search" to the right of the search windows
• On next page, click on "Show all fields"
• Under "Article Types," select "Research Articles," or any other type of article which might be helpful.
• Slick Search
• Case Studies
• Qualitative Analysis
• Quantitative Analysis
• Statistical Analysis
• ERIC This link opens in a new window Abstracts (and in some cases, full-text) articles, reports, book reviews and government documents covering all aspects of education from 1966 to the present
• Action Research
• Ethnography
• Evaluation Methods
• Evaluation Research
• Experiments
• Focus Groups
• Field Studies
• Mail Surveys
• Mixed Methods Research
• Naturalistic Observation
• Online Surveys
• Participant Observation
• Participatory Research
• Qualitative Research
• Questionnaires
• Statistical Studies
• Telephone Surveys

Empirical Articles - Sample Research Tips -- CAS & PSYC 101 / PSYC 341 IN-PERSON & ONLINE -- ACCESSIBLE VERSION

This  guide  helps to identify the major parts of an empirical article and covers sample strategies for locating them through databases such as  APA PsycInfo  and  ERIC . There are also general tips applicable to other databases.

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• Published: 31 August 2024

Knowledge mapping and evolution of research on older adults’ technology acceptance: a bibliometric study from 2013 to 2023

• Xianru Shang   ORCID: orcid.org/0009-0000-8906-3216 1 ,
• Zijian Liu 1 ,
• Chen Gong 1 ,
• Zhigang Hu 1 ,
• Yuexuan Wu 1 &
• Chengliang Wang   ORCID: orcid.org/0000-0003-2208-3508 2  

Humanities and Social Sciences Communications volume  11 , Article number:  1115 ( 2024 ) Cite this article

Metrics details

• Science, technology and society

The rapid expansion of information technology and the intensification of population aging are two prominent features of contemporary societal development. Investigating older adults’ acceptance and use of technology is key to facilitating their integration into an information-driven society. Given this context, the technology acceptance of older adults has emerged as a prioritized research topic, attracting widespread attention in the academic community. However, existing research remains fragmented and lacks a systematic framework. To address this gap, we employed bibliometric methods, utilizing the Web of Science Core Collection to conduct a comprehensive review of literature on older adults’ technology acceptance from 2013 to 2023. Utilizing VOSviewer and CiteSpace for data assessment and visualization, we created knowledge mappings of research on older adults’ technology acceptance. Our study employed multidimensional methods such as co-occurrence analysis, clustering, and burst analysis to: (1) reveal research dynamics, key journals, and domains in this field; (2) identify leading countries, their collaborative networks, and core research institutions and authors; (3) recognize the foundational knowledge system centered on theoretical model deepening, emerging technology applications, and research methods and evaluation, uncovering seminal literature and observing a shift from early theoretical and influential factor analyses to empirical studies focusing on individual factors and emerging technologies; (4) moreover, current research hotspots are primarily in the areas of factors influencing technology adoption, human-robot interaction experiences, mobile health management, and aging-in-place technology, highlighting the evolutionary context and quality distribution of research themes. Finally, we recommend that future research should deeply explore improvements in theoretical models, long-term usage, and user experience evaluation. Overall, this study presents a clear framework of existing research in the field of older adults’ technology acceptance, providing an important reference for future theoretical exploration and innovative applications.

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Introduction.

In contemporary society, the rapid development of information technology has been intricately intertwined with the intensifying trend of population aging. According to the latest United Nations forecast, by 2050, the global population aged 65 and above is expected to reach 1.6 billion, representing about 16% of the total global population (UN 2023 ). Given the significant challenges of global aging, there is increasing evidence that emerging technologies have significant potential to maintain health and independence for older adults in their home and healthcare environments (Barnard et al. 2013 ; Soar 2010 ; Vancea and Solé-Casals 2016 ). This includes, but is not limited to, enhancing residential safety with smart home technologies (Touqeer et al. 2021 ; Wang et al. 2022 ), improving living independence through wearable technologies (Perez et al. 2023 ), and increasing medical accessibility via telehealth services (Kruse et al. 2020 ). Technological innovations are redefining the lifestyles of older adults, encouraging a shift from passive to active participation (González et al. 2012 ; Mostaghel 2016 ). Nevertheless, the effective application and dissemination of technology still depends on user acceptance and usage intentions (Naseri et al. 2023 ; Wang et al. 2023a ; Xia et al. 2024 ; Yu et al. 2023 ). Particularly, older adults face numerous challenges in accepting and using new technologies. These challenges include not only physical and cognitive limitations but also a lack of technological experience, along with the influences of social and economic factors (Valk et al. 2018 ; Wilson et al. 2021 ).

User acceptance of technology is a significant focus within information systems (IS) research (Dai et al. 2024 ), with several models developed to explain and predict user behavior towards technology usage, including the Technology Acceptance Model (TAM) (Davis 1989 ), TAM2, TAM3, and the Unified Theory of Acceptance and Use of Technology (UTAUT) (Venkatesh et al. 2003 ). Older adults, as a group with unique needs, exhibit different behavioral patterns during technology acceptance than other user groups, and these uniquenesses include changes in cognitive abilities, as well as motivations, attitudes, and perceptions of the use of new technologies (Chen and Chan 2011 ). The continual expansion of technology introduces considerable challenges for older adults, rendering the understanding of their technology acceptance a research priority. Thus, conducting in-depth research into older adults’ acceptance of technology is critically important for enhancing their integration into the information society and improving their quality of life through technological advancements.

Reviewing relevant literature to identify research gaps helps further solidify the theoretical foundation of the research topic. However, many existing literature reviews primarily focus on the factors influencing older adults’ acceptance or intentions to use technology. For instance, Ma et al. ( 2021 ) conducted a comprehensive analysis of the determinants of older adults’ behavioral intentions to use technology; Liu et al. ( 2022 ) categorized key variables in studies of older adults’ technology acceptance, noting a shift in focus towards social and emotional factors; Yap et al. ( 2022 ) identified seven categories of antecedents affecting older adults’ use of technology from an analysis of 26 articles, including technological, psychological, social, personal, cost, behavioral, and environmental factors; Schroeder et al. ( 2023 ) extracted 119 influencing factors from 59 articles and further categorized these into six themes covering demographics, health status, and emotional awareness. Additionally, some studies focus on the application of specific technologies, such as Ferguson et al. ( 2021 ), who explored barriers and facilitators to older adults using wearable devices for heart monitoring, and He et al. ( 2022 ) and Baer et al. ( 2022 ), who each conducted in-depth investigations into the acceptance of social assistive robots and mobile nutrition and fitness apps, respectively. In summary, current literature reviews on older adults’ technology acceptance exhibit certain limitations. Due to the interdisciplinary nature and complex knowledge structure of this field, traditional literature reviews often rely on qualitative analysis, based on literature analysis and periodic summaries, which lack sufficient objectivity and comprehensiveness. Additionally, systematic research is relatively limited, lacking a macroscopic description of the research trajectory from a holistic perspective. Over the past decade, research on older adults’ technology acceptance has experienced rapid growth, with a significant increase in literature, necessitating the adoption of new methods to review and examine the developmental trends in this field (Chen 2006 ; Van Eck and Waltman 2010 ). Bibliometric analysis, as an effective quantitative research method, analyzes published literature through visualization, offering a viable approach to extracting patterns and insights from a large volume of papers, and has been widely applied in numerous scientific research fields (Achuthan et al. 2023 ; Liu and Duffy 2023 ). Therefore, this study will employ bibliometric methods to systematically analyze research articles related to older adults’ technology acceptance published in the Web of Science Core Collection from 2013 to 2023, aiming to understand the core issues and evolutionary trends in the field, and to provide valuable references for future related research. Specifically, this study aims to explore and answer the following questions:

RQ1: What are the research dynamics in the field of older adults’ technology acceptance over the past decade? What are the main academic journals and fields that publish studies related to older adults’ technology acceptance?

RQ2: How is the productivity in older adults’ technology acceptance research distributed among countries, institutions, and authors?

RQ3: What are the knowledge base and seminal literature in older adults’ technology acceptance research? How has the research theme progressed?

RQ4: What are the current hot topics and their evolutionary trajectories in older adults’ technology acceptance research? How is the quality of research distributed?

Methodology and materials

Research method.

In recent years, bibliometrics has become one of the crucial methods for analyzing literature reviews and is widely used in disciplinary and industrial intelligence analysis (Jing et al. 2023 ; Lin and Yu 2024a ; Wang et al. 2024a ; Xu et al. 2021 ). Bibliometric software facilitates the visualization analysis of extensive literature data, intuitively displaying the network relationships and evolutionary processes between knowledge units, and revealing the underlying knowledge structure and potential information (Chen et al. 2024 ; López-Robles et al. 2018 ; Wang et al. 2024c ). This method provides new insights into the current status and trends of specific research areas, along with quantitative evidence, thereby enhancing the objectivity and scientific validity of the research conclusions (Chen et al. 2023 ; Geng et al. 2024 ). VOSviewer and CiteSpace are two widely used bibliometric software tools in academia (Pan et al. 2018 ), recognized for their robust functionalities based on the JAVA platform. Although each has its unique features, combining these two software tools effectively constructs mapping relationships between literature knowledge units and clearly displays the macrostructure of the knowledge domains. Particularly, VOSviewer, with its excellent graphical representation capabilities, serves as an ideal tool for handling large datasets and precisely identifying the focal points and hotspots of research topics. Therefore, this study utilizes VOSviewer (version 1.6.19) and CiteSpace (version 6.1.R6), combined with in-depth literature analysis, to comprehensively examine and interpret the research theme of older adults’ technology acceptance through an integrated application of quantitative and qualitative methods.

Data source

Web of Science is a comprehensively recognized database in academia, featuring literature that has undergone rigorous peer review and editorial scrutiny (Lin and Yu 2024b ; Mongeon and Paul-Hus 2016 ; Pranckutė 2021 ). This study utilizes the Web of Science Core Collection as its data source, specifically including three major citation indices: Science Citation Index Expanded (SCIE), Social Sciences Citation Index (SSCI), and Arts & Humanities Citation Index (A&HCI). These indices encompass high-quality research literature in the fields of science, social sciences, and arts and humanities, ensuring the comprehensiveness and reliability of the data. We combined “older adults” with “technology acceptance” through thematic search, with the specific search strategy being: TS = (elder OR elderly OR aging OR ageing OR senile OR senior OR old people OR “older adult*”) AND TS = (“technology acceptance” OR “user acceptance” OR “consumer acceptance”). The time span of literature search is from 2013 to 2023, with the types limited to “Article” and “Review” and the language to “English”. Additionally, the search was completed by October 27, 2023, to avoid data discrepancies caused by database updates. The initial search yielded 764 journal articles. Given that searches often retrieve articles that are superficially relevant but actually non-compliant, manual screening post-search was essential to ensure the relevance of the literature (Chen et al. 2024 ). Through manual screening, articles significantly deviating from the research theme were eliminated and rigorously reviewed. Ultimately, this study obtained 500 valid sample articles from the Web of Science Core Collection. The complete PRISMA screening process is illustrated in Fig. 1 .

Presentation of the data culling process in detail.

Data standardization

Raw data exported from databases often contain multiple expressions of the same terminology (Nguyen and Hallinger 2020 ). To ensure the accuracy and consistency of data, it is necessary to standardize the raw data (Strotmann and Zhao 2012 ). This study follows the data standardization process proposed by Taskin and Al ( 2019 ), mainly executing the following operations:

(1) Standardization of author and institution names is conducted to address different name expressions for the same author. For instance, “Chan, Alan Hoi Shou” and “Chan, Alan H. S.” are considered the same author, and distinct authors with the same name are differentiated by adding identifiers. Diverse forms of institutional names are unified to address variations caused by name changes or abbreviations, such as standardizing “FRANKFURT UNIV APPL SCI” and “Frankfurt University of Applied Sciences,” as well as “Chinese University of Hong Kong” and “University of Hong Kong” to consistent names.

(2) Different expressions of journal names are unified. For example, “International Journal of Human-Computer Interaction” and “Int J Hum Comput Interact” are standardized to a single name. This ensures consistency in journal names and prevents misclassification of literature due to differing journal names. Additionally, it involves checking if the journals have undergone name changes in the past decade to prevent any impact on the analysis due to such changes.

(3) Keywords data are cleansed by removing words that do not directly pertain to specific research content (e.g., people, review), merging synonyms (e.g., “UX” and “User Experience,” “aging-in-place” and “aging in place”), and standardizing plural forms of keywords (e.g., “assistive technologies” and “assistive technology,” “social robots” and “social robot”). This reduces redundant information in knowledge mapping.

Bibliometric results and analysis

Distribution power (rq1), literature descriptive statistical analysis.

Table 1 presents a detailed descriptive statistical overview of the literature in the field of older adults’ technology acceptance. After deduplication using the CiteSpace software, this study confirmed a valid sample size of 500 articles. Authored by 1839 researchers, the documents encompass 792 research institutions across 54 countries and are published in 217 different academic journals. As of the search cutoff date, these articles have accumulated 13,829 citations, with an annual average of 1156 citations, and an average of 27.66 citations per article. The h-index, a composite metric of quantity and quality of scientific output (Kamrani et al. 2021 ), reached 60 in this study.

Trends in publications and disciplinary distribution

The number of publications and citations are significant indicators of the research field’s development, reflecting its continuity, attention, and impact (Ale Ebrahim et al. 2014 ). The ranking of annual publications and citations in the field of older adults’ technology acceptance studies is presented chronologically in Fig. 2A . The figure shows a clear upward trend in the amount of literature in this field. Between 2013 and 2017, the number of publications increased slowly and decreased in 2018. However, in 2019, the number of publications increased rapidly to 52 and reached a peak of 108 in 2022, which is 6.75 times higher than in 2013. In 2022, the frequency of document citations reached its highest point with 3466 citations, reflecting the widespread recognition and citation of research in this field. Moreover, the curve of the annual number of publications fits a quadratic function, with a goodness-of-fit R 2 of 0.9661, indicating that the number of future publications is expected to increase even more rapidly.

A Trends in trends in annual publications and citations (2013–2023). B Overlay analysis of the distribution of discipline fields.

Figure 2B shows that research on older adults’ technology acceptance involves the integration of multidisciplinary knowledge. According to Web of Science Categories, these 500 articles are distributed across 85 different disciplines. We have tabulated the top ten disciplines by publication volume (Table 2 ), which include Medical Informatics (75 articles, 15.00%), Health Care Sciences & Services (71 articles, 14.20%), Gerontology (61 articles, 12.20%), Public Environmental & Occupational Health (57 articles, 11.40%), and Geriatrics & Gerontology (52 articles, 10.40%), among others. The high output in these disciplines reflects the concentrated global academic interest in this comprehensive research topic. Additionally, interdisciplinary research approaches provide diverse perspectives and a solid theoretical foundation for studies on older adults’ technology acceptance, also paving the way for new research directions.

Knowledge flow analysis

A dual-map overlay is a CiteSpace map superimposed on top of a base map, which shows the interrelationships between journals in different domains, representing the publication and citation activities in each domain (Chen and Leydesdorff 2014 ). The overlay map reveals the link between the citing domain (on the left side) and the cited domain (on the right side), reflecting the knowledge flow of the discipline at the journal level (Leydesdorff and Rafols 2012 ). We utilize the in-built Z-score algorithm of the software to cluster the graph, as shown in Fig. 3 .

The left side shows the citing journal, and the right side shows the cited journal.

Figure 3 shows the distribution of citing journals clusters for older adults’ technology acceptance on the left side, while the right side refers to the main cited journals clusters. Two knowledge flow citation trajectories were obtained; they are presented by the color of the cited regions, and the thickness of these trajectories is proportional to the Z-score scaled frequency of citations (Chen et al. 2014 ). Within the cited regions, the most popular fields with the most records covered are “HEALTH, NURSING, MEDICINE” and “PSYCHOLOGY, EDUCATION, SOCIAL”, and the elliptical aspect ratio of these two fields stands out. Fields have prominent elliptical aspect ratios, highlighting their significant influence on older adults’ technology acceptance research. Additionally, the major citation trajectories originate in these two areas and progress to the frontier research area of “PSYCHOLOGY, EDUCATION, HEALTH”. It is worth noting that the citation trajectory from “PSYCHOLOGY, EDUCATION, SOCIAL” has a significant Z-value (z = 6.81), emphasizing the significance and impact of this development path. In the future, “MATHEMATICS, SYSTEMS, MATHEMATICAL”, “MOLECULAR, BIOLOGY, IMMUNOLOGY”, and “NEUROLOGY, SPORTS, OPHTHALMOLOGY” may become emerging fields. The fields of “MEDICINE, MEDICAL, CLINICAL” may be emerging areas of cutting-edge research.

Main research journals analysis

Table 3 provides statistics for the top ten journals by publication volume in the field of older adults’ technology acceptance. Together, these journals have published 137 articles, accounting for 27.40% of the total publications, indicating that there is no highly concentrated core group of journals in this field, with publications being relatively dispersed. Notably, Computers in Human Behavior , Journal of Medical Internet Research , and International Journal of Human-Computer Interaction each lead with 15 publications. In terms of citation metrics, International Journal of Medical Informatics and Computers in Human Behavior stand out significantly, with the former accumulating a total of 1,904 citations, averaging 211.56 citations per article, and the latter totaling 1,449 citations, with an average of 96.60 citations per article. These figures emphasize the academic authority and widespread impact of these journals within the research field.

Research power (RQ2)

Countries and collaborations analysis.

The analysis revealed the global research pattern for country distribution and collaboration (Chen et al. 2019 ). Figure 4A shows the network of national collaborations on older adults’ technology acceptance research. The size of the bubbles represents the amount of publications in each country, while the thickness of the connecting lines expresses the closeness of the collaboration among countries. Generally, this research subject has received extensive international attention, with China and the USA publishing far more than any other countries. China has established notable research collaborations with the USA, UK and Malaysia in this field, while other countries have collaborations, but the closeness is relatively low and scattered. Figure 4B shows the annual publication volume dynamics of the top ten countries in terms of total publications. Since 2017, China has consistently increased its annual publications, while the USA has remained relatively stable. In 2019, the volume of publications in each country increased significantly, this was largely due to the global outbreak of the COVID-19 pandemic, which has led to increased reliance on information technology among the elderly for medical consultations, online socialization, and health management (Sinha et al. 2021 ). This phenomenon has led to research advances in technology acceptance among older adults in various countries. Table 4 shows that the top ten countries account for 93.20% of the total cumulative number of publications, with each country having published more than 20 papers. Among these ten countries, all of them except China are developed countries, indicating that the research field of older adults’ technology acceptance has received general attention from developed countries. Currently, China and the USA were the leading countries in terms of publications with 111 and 104 respectively, accounting for 22.20% and 20.80%. The UK, Germany, Italy, and the Netherlands also made significant contributions. The USA and China ranked first and second in terms of the number of citations, while the Netherlands had the highest average citations, indicating the high impact and quality of its research. The UK has shown outstanding performance in international cooperation, while the USA highlights its significant academic influence in this field with the highest h-index value.

A National collaboration network. B Annual volume of publications in the top 10 countries.

Institutions and authors analysis

Analyzing the number of publications and citations can reveal an institution’s or author’s research strength and influence in a particular research area (Kwiek 2021 ). Tables 5 and 6 show the statistics of the institutions and authors whose publication counts are in the top ten, respectively. As shown in Table 5 , higher education institutions hold the main position in this research field. Among the top ten institutions, City University of Hong Kong and The University of Hong Kong from China lead with 14 and 9 publications, respectively. City University of Hong Kong has the highest h-index, highlighting its significant influence in the field. It is worth noting that Tilburg University in the Netherlands is not among the top five in terms of publications, but the high average citation count (130.14) of its literature demonstrates the high quality of its research.

After analyzing the authors’ output using Price’s Law (Redner 1998 ), the highest number of publications among the authors counted ( n  = 10) defines a publication threshold of 3 for core authors in this research area. As a result of quantitative screening, a total of 63 core authors were identified. Table 6 shows that Chen from Zhejiang University, China, Ziefle from RWTH Aachen University, Germany, and Rogers from Macquarie University, Australia, were the top three authors in terms of the number of publications, with 10, 9, and 8 articles, respectively. In terms of average citation rate, Peek and Wouters, both scholars from the Netherlands, have significantly higher rates than other scholars, with 183.2 and 152.67 respectively. This suggests that their research is of high quality and widely recognized. Additionally, Chen and Rogers have high h-indices in this field.

Knowledge base and theme progress (RQ3)

Research knowledge base.

Co-citation relationships occur when two documents are cited together (Zhang and Zhu 2022 ). Co-citation mapping uses references as nodes to represent the knowledge base of a subject area (Min et al. 2021). Figure 5A illustrates co-occurrence mapping in older adults’ technology acceptance research, where larger nodes signify higher co-citation frequencies. Co-citation cluster analysis can be used to explore knowledge structure and research boundaries (Hota et al. 2020 ; Shiau et al. 2023 ). The co-citation clustering mapping of older adults’ technology acceptance research literature (Fig. 5B ) shows that the Q value of the clustering result is 0.8129 (>0.3), and the average value of the weight S is 0.9391 (>0.7), indicating that the clusters are uniformly distributed with a significant and credible structure. This further proves that the boundaries of the research field are clear and there is significant differentiation in the field. The figure features 18 cluster labels, each associated with thematic color blocks corresponding to different time slices. Highlighted emerging research themes include #2 Smart Home Technology, #7 Social Live, and #10 Customer Service. Furthermore, the clustering labels extracted are primarily classified into three categories: theoretical model deepening, emerging technology applications, research methods and evaluation, as detailed in Table 7 .

A Co-citation analysis of references. B Clustering network analysis of references.

Seminal literature analysis

The top ten nodes in terms of co-citation frequency were selected for further analysis. Table 8 displays the corresponding node information. Studies were categorized into four main groups based on content analysis. (1) Research focusing on specific technology usage by older adults includes studies by Peek et al. ( 2014 ), Ma et al. ( 2016 ), Hoque and Sorwar ( 2017 ), and Li et al. ( 2019 ), who investigated the factors influencing the use of e-technology, smartphones, mHealth, and smart wearables, respectively. (2) Concerning the development of theoretical models of technology acceptance, Chen and Chan ( 2014 ) introduced the Senior Technology Acceptance Model (STAM), and Macedo ( 2017 ) analyzed the predictive power of UTAUT2 in explaining older adults’ intentional behaviors and information technology usage. (3) In exploring older adults’ information technology adoption and behavior, Lee and Coughlin ( 2015 ) emphasized that the adoption of technology by older adults is a multifactorial process that includes performance, price, value, usability, affordability, accessibility, technical support, social support, emotion, independence, experience, and confidence. Yusif et al. ( 2016 ) conducted a literature review examining the key barriers affecting older adults’ adoption of assistive technology, including factors such as privacy, trust, functionality/added value, cost, and stigma. (4) From the perspective of research into older adults’ technology acceptance, Mitzner et al. ( 2019 ) assessed the long-term usage of computer systems designed for the elderly, whereas Guner and Acarturk ( 2020 ) compared information technology usage and acceptance between older and younger adults. The breadth and prevalence of this literature make it a vital reference for researchers in the field, also providing new perspectives and inspiration for future research directions.

Research thematic progress

Burst citation is a node of literature that guides the sudden change in dosage, which usually represents a prominent development or major change in a particular field, with innovative and forward-looking qualities. By analyzing the emergent literature, it is often easy to understand the dynamics of the subject area, mapping the emerging thematic change (Chen et al. 2022 ). Figure 6 shows the burst citation mapping in the field of older adults’ technology acceptance research, with burst citations represented by red nodes (Fig. 6A ). For the ten papers with the highest burst intensity (Fig. 6B ), this study will conduct further analysis in conjunction with literature review.

A Burst detection of co-citation. B The top 10 references with the strongest citation bursts.

As shown in Fig. 6 , Mitzner et al. ( 2010 ) broke the stereotype that older adults are fearful of technology, found that they actually have positive attitudes toward technology, and emphasized the centrality of ease of use and usefulness in the process of technology acceptance. This finding provides an important foundation for subsequent research. During the same period, Wagner et al. ( 2010 ) conducted theory-deepening and applied research on technology acceptance among older adults. The research focused on older adults’ interactions with computers from the perspective of Social Cognitive Theory (SCT). This expanded the understanding of technology acceptance, particularly regarding the relationship between behavior, environment, and other SCT elements. In addition, Pan and Jordan-Marsh ( 2010 ) extended the TAM to examine the interactions among predictors of perceived usefulness, perceived ease of use, subjective norm, and convenience conditions when older adults use the Internet, taking into account the moderating roles of gender and age. Heerink et al. ( 2010 ) adapted and extended the UTAUT, constructed a technology acceptance model specifically designed for older users’ acceptance of assistive social agents, and validated it using controlled experiments and longitudinal data, explaining intention to use by combining functional assessment and social interaction variables.

Then the research theme shifted to an in-depth analysis of the factors influencing technology acceptance among older adults. Two papers with high burst strengths emerged during this period: Peek et al. ( 2014 ) (Strength = 12.04), Chen and Chan ( 2014 ) (Strength = 9.81). Through a systematic literature review and empirical study, Peek STM and Chen K, among others, identified multidimensional factors that influence older adults’ technology acceptance. Peek et al. ( 2014 ) analyzed literature on the acceptance of in-home care technology among older adults and identified six factors that influence their acceptance: concerns about technology, expected benefits, technology needs, technology alternatives, social influences, and older adult characteristics, with a focus on differences between pre- and post-implementation factors. Chen and Chan ( 2014 ) constructed the STAM by administering a questionnaire to 1012 older adults and adding eight important factors, including technology anxiety, self-efficacy, cognitive ability, and physical function, based on the TAM. This enriches the theoretical foundation of the field. In addition, Braun ( 2013 ) highlighted the role of perceived usefulness, trust in social networks, and frequency of Internet use in older adults’ use of social networks, while ease of use and social pressure were not significant influences. These findings contribute to the study of older adults’ technology acceptance within specific technology application domains.

Recent research has focused on empirical studies of personal factors and emerging technologies. Ma et al. ( 2016 ) identified key personal factors affecting smartphone acceptance among older adults through structured questionnaires and face-to-face interviews with 120 participants. The study found that cost, self-satisfaction, and convenience were important factors influencing perceived usefulness and ease of use. This study offers empirical evidence to comprehend the main factors that drive smartphone acceptance among Chinese older adults. Additionally, Yusif et al. ( 2016 ) presented an overview of the obstacles that hinder older adults’ acceptance of assistive technologies, focusing on privacy, trust, and functionality.

In summary, research on older adults’ technology acceptance has shifted from early theoretical deepening and analysis of influencing factors to empirical studies in the areas of personal factors and emerging technologies, which have greatly enriched the theoretical basis of older adults’ technology acceptance and provided practical guidance for the design of emerging technology products.

Research hotspots, evolutionary trends, and quality distribution (RQ4)

Core keywords analysis.

Keywords concise the main idea and core of the literature, and are a refined summary of the research content (Huang et al. 2021 ). In CiteSpace, nodes with a centrality value greater than 0.1 are considered to be critical nodes. Analyzing keywords with high frequency and centrality helps to visualize the hot topics in the research field (Park et al. 2018 ). The merged keywords were imported into CiteSpace, and the top 10 keywords were counted and sorted by frequency and centrality respectively, as shown in Table 9 . The results show that the keyword “TAM” has the highest frequency (92), followed by “UTAUT” (24), which reflects that the in-depth study of the existing technology acceptance model and its theoretical expansion occupy a central position in research related to older adults’ technology acceptance. Furthermore, the terms ‘assistive technology’ and ‘virtual reality’ are both high-frequency and high-centrality terms (frequency = 17, centrality = 0.10), indicating that the research on assistive technology and virtual reality for older adults is the focus of current academic attention.

Research hotspots analysis

Using VOSviewer for keyword co-occurrence analysis organizes keywords into groups or clusters based on their intrinsic connections and frequencies, clearly highlighting the research field’s hot topics. The connectivity among keywords reveals correlations between different topics. To ensure accuracy, the analysis only considered the authors’ keywords. Subsequently, the keywords were filtered by setting the keyword frequency to 5 to obtain the keyword clustering map of the research on older adults’ technology acceptance research keyword clustering mapping (Fig. 7 ), combined with the keyword co-occurrence clustering network (Fig. 7A ) and the corresponding density situation (Fig. 7B ) to make a detailed analysis of the following four groups of clustered themes.

A Co-occurrence clustering network. B Keyword density.

Cluster #1—Research on the factors influencing technology adoption among older adults is a prominent topic, covering age, gender, self-efficacy, attitude, and and intention to use (Berkowsky et al. 2017 ; Wang et al. 2017 ). It also examined older adults’ attitudes towards and acceptance of digital health technologies (Ahmad and Mozelius, 2022 ). Moreover, the COVID-19 pandemic, significantly impacting older adults’ technology attitudes and usage, has underscored the study’s importance and urgency. Therefore, it is crucial to conduct in-depth studies on how older adults accept, adopt, and effectively use new technologies, to address their needs and help them overcome the digital divide within digital inclusion. This will improve their quality of life and healthcare experiences.

Cluster #2—Research focuses on how older adults interact with assistive technologies, especially assistive robots and health monitoring devices, emphasizing trust, usability, and user experience as crucial factors (Halim et al. 2022 ). Moreover, health monitoring technologies effectively track and manage health issues common in older adults, like dementia and mild cognitive impairment (Lussier et al. 2018 ; Piau et al. 2019 ). Interactive exercise games and virtual reality have been deployed to encourage more physical and cognitive engagement among older adults (Campo-Prieto et al. 2021 ). Personalized and innovative technology significantly enhances older adults’ participation, improving their health and well-being.

Cluster #3—Optimizing health management for older adults using mobile technology. With the development of mobile health (mHealth) and health information technology, mobile applications, smartphones, and smart wearable devices have become effective tools to help older users better manage chronic conditions, conduct real-time health monitoring, and even receive telehealth services (Dupuis and Tsotsos 2018 ; Olmedo-Aguirre et al. 2022 ; Kim et al. 2014 ). Additionally, these technologies can mitigate the problem of healthcare resource inequality, especially in developing countries. Older adults’ acceptance and use of these technologies are significantly influenced by their behavioral intentions, motivational factors, and self-management skills. These internal motivational factors, along with external factors, jointly affect older adults’ performance in health management and quality of life.

Cluster #4—Research on technology-assisted home care for older adults is gaining popularity. Environmentally assisted living enhances older adults’ independence and comfort at home, offering essential support and security. This has a crucial impact on promoting healthy aging (Friesen et al. 2016 ; Wahlroos et al. 2023 ). The smart home is a core application in this field, providing a range of solutions that facilitate independent living for the elderly in a highly integrated and user-friendly manner. This fulfills different dimensions of living and health needs (Majumder et al. 2017 ). Moreover, eHealth offers accurate and personalized health management and healthcare services for older adults (Delmastro et al. 2018 ), ensuring their needs are met at home. Research in this field often employs qualitative methods and structural equation modeling to fully understand older adults’ needs and experiences at home and analyze factors influencing technology adoption.

Evolutionary trends analysis

To gain a deeper understanding of the evolutionary trends in research hotspots within the field of older adults’ technology acceptance, we conducted a statistical analysis of the average appearance times of keywords, using CiteSpace to generate the time-zone evolution mapping (Fig. 8 ) and burst keywords. The time-zone mapping visually displays the evolution of keywords over time, intuitively reflecting the frequency and initial appearance of keywords in research, commonly used to identify trends in research topics (Jing et al. 2024a ; Kumar et al. 2021 ). Table 10 lists the top 15 keywords by burst strength, with the red sections indicating high-frequency citations and their burst strength in specific years. These burst keywords reveal the focus and trends of research themes over different periods (Kleinberg 2002 ). Combining insights from the time-zone mapping and burst keywords provides more objective and accurate research insights (Wang et al. 2023b ).

Reflecting the frequency and time of first appearance of keywords in the study.

An integrated analysis of Fig. 8 and Table 10 shows that early research on older adults’ technology acceptance primarily focused on factors such as perceived usefulness, ease of use, and attitudes towards information technology, including their use of computers and the internet (Pan and Jordan-Marsh 2010 ), as well as differences in technology use between older adults and other age groups (Guner and Acarturk 2020 ). Subsequently, the research focus expanded to improving the quality of life for older adults, exploring how technology can optimize health management and enhance the possibility of independent living, emphasizing the significant role of technology in improving the quality of life for the elderly. With ongoing technological advancements, recent research has shifted towards areas such as “virtual reality,” “telehealth,” and “human-robot interaction,” with a focus on the user experience of older adults (Halim et al. 2022 ). The appearance of keywords such as “physical activity” and “exercise” highlights the value of technology in promoting physical activity and health among older adults. This phase of research tends to make cutting-edge technology genuinely serve the practical needs of older adults, achieving its widespread application in daily life. Additionally, research has focused on expanding and quantifying theoretical models of older adults’ technology acceptance, involving keywords such as “perceived risk”, “validation” and “UTAUT”.

In summary, from 2013 to 2023, the field of older adults’ technology acceptance has evolved from initial explorations of influencing factors, to comprehensive enhancements in quality of life and health management, and further to the application and deepening of theoretical models and cutting-edge technologies. This research not only reflects the diversity and complexity of the field but also demonstrates a comprehensive and in-depth understanding of older adults’ interactions with technology across various life scenarios and needs.

Research quality distribution

To reveal the distribution of research quality in the field of older adults’ technology acceptance, a strategic diagram analysis is employed to calculate and illustrate the internal development and interrelationships among various research themes (Xie et al. 2020 ). The strategic diagram uses Centrality as the X-axis and Density as the Y-axis to divide into four quadrants, where the X-axis represents the strength of the connection between thematic clusters and other themes, with higher values indicating a central position in the research field; the Y-axis indicates the level of development within the thematic clusters, with higher values denoting a more mature and widely recognized field (Li and Zhou 2020 ).

Through cluster analysis and manual verification, this study categorized 61 core keywords (Frequency ≥5) into 11 thematic clusters. Subsequently, based on the keywords covered by each thematic cluster, the research themes and their directions for each cluster were summarized (Table 11 ), and the centrality and density coordinates for each cluster were precisely calculated (Table 12 ). Finally, a strategic diagram of the older adults’ technology acceptance research field was constructed (Fig. 9 ). Based on the distribution of thematic clusters across the quadrants in the strategic diagram, the structure and developmental trends of the field were interpreted.

Classification and visualization of theme clusters based on density and centrality.

As illustrated in Fig. 9 , (1) the theme clusters of #3 Usage Experience and #4 Assisted Living Technology are in the first quadrant, characterized by high centrality and density. Their internal cohesion and close links with other themes indicate their mature development, systematic research content or directions have been formed, and they have a significant influence on other themes. These themes play a central role in the field of older adults’ technology acceptance and have promising prospects. (2) The theme clusters of #6 Smart Devices, #9 Theoretical Models, and #10 Mobile Health Applications are in the second quadrant, with higher density but lower centrality. These themes have strong internal connections but weaker external links, indicating that these three themes have received widespread attention from researchers and have been the subject of related research, but more as self-contained systems and exhibit independence. Therefore, future research should further explore in-depth cooperation and cross-application with other themes. (3) The theme clusters of #7 Human-Robot Interaction, #8 Characteristics of the Elderly, and #11 Research Methods are in the third quadrant, with lower centrality and density. These themes are loosely connected internally and have weak links with others, indicating their developmental immaturity. Compared to other topics, they belong to the lower attention edge and niche themes, and there is a need for further investigation. (4) The theme clusters of #1 Digital Healthcare Technology, #2 Psychological Factors, and #5 Socio-Cultural Factors are located in the fourth quadrant, with high centrality but low density. Although closely associated with other research themes, the internal cohesion within these clusters is relatively weak. This suggests that while these themes are closely linked to other research areas, their own development remains underdeveloped, indicating a core immaturity. Nevertheless, these themes are crucial within the research domain of elderly technology acceptance and possess significant potential for future exploration.

Discussion on distribution power (RQ1)

Over the past decade, academic interest and influence in the area of older adults’ technology acceptance have significantly increased. This trend is evidenced by a quantitative analysis of publication and citation volumes, particularly noticeable in 2019 and 2022, where there was a substantial rise in both metrics. The rise is closely linked to the widespread adoption of emerging technologies such as smart homes, wearable devices, and telemedicine among older adults. While these technologies have enhanced their quality of life, they also pose numerous challenges, sparking extensive research into their acceptance, usage behaviors, and influencing factors among the older adults (Pirzada et al. 2022 ; Garcia Reyes et al. 2023 ). Furthermore, the COVID-19 pandemic led to a surge in technology demand among older adults, especially in areas like medical consultation, online socialization, and health management, further highlighting the importance and challenges of technology. Health risks and social isolation have compelled older adults to rely on technology for daily activities, accelerating its adoption and application within this demographic. This phenomenon has made technology acceptance a critical issue, driving societal and academic focus on the study of technology acceptance among older adults.

The flow of knowledge at the level of high-output disciplines and journals, along with the primary publishing outlets, indicates the highly interdisciplinary nature of research into older adults’ technology acceptance. This reflects the complexity and breadth of issues related to older adults’ technology acceptance, necessitating the integration of multidisciplinary knowledge and approaches. Currently, research is primarily focused on medical health and human-computer interaction, demonstrating academic interest in improving health and quality of life for older adults and addressing the urgent needs related to their interactions with technology. In the field of medical health, research aims to provide advanced and innovative healthcare technologies and services to meet the challenges of an aging population while improving the quality of life for older adults (Abdi et al. 2020 ; Wilson et al. 2021 ). In the field of human-computer interaction, research is focused on developing smarter and more user-friendly interaction models to meet the needs of older adults in the digital age, enabling them to actively participate in social activities and enjoy a higher quality of life (Sayago, 2019 ). These studies are crucial for addressing the challenges faced by aging societies, providing increased support and opportunities for the health, welfare, and social participation of older adults.

Discussion on research power (RQ2)

This study analyzes leading countries and collaboration networks, core institutions and authors, revealing the global research landscape and distribution of research strength in the field of older adults’ technology acceptance, and presents quantitative data on global research trends. From the analysis of country distribution and collaborations, China and the USA hold dominant positions in this field, with developed countries like the UK, Germany, Italy, and the Netherlands also excelling in international cooperation and research influence. The significant investment in technological research and the focus on the technological needs of older adults by many developed countries reflect their rapidly aging societies, policy support, and resource allocation.

China is the only developing country that has become a major contributor in this field, indicating its growing research capabilities and high priority given to aging societies and technological innovation. Additionally, China has close collaborations with countries such as USA, the UK, and Malaysia, driven not only by technological research needs but also by shared challenges and complementarities in aging issues among these nations. For instance, the UK has extensive experience in social welfare and aging research, providing valuable theoretical guidance and practical experience. International collaborations, aimed at addressing the challenges of aging, integrate the strengths of various countries, advancing in-depth and widespread development in the research of technology acceptance among older adults.

At the institutional and author level, City University of Hong Kong leads in publication volume, with research teams led by Chan and Chen demonstrating significant academic activity and contributions. Their research primarily focuses on older adults’ acceptance and usage behaviors of various technologies, including smartphones, smart wearables, and social robots (Chen et al. 2015 ; Li et al. 2019 ; Ma et al. 2016 ). These studies, targeting specific needs and product characteristics of older adults, have developed new models of technology acceptance based on existing frameworks, enhancing the integration of these technologies into their daily lives and laying a foundation for further advancements in the field. Although Tilburg University has a smaller publication output, it holds significant influence in the field of older adults’ technology acceptance. Particularly, the high citation rate of Peek’s studies highlights their excellence in research. Peek extensively explored older adults’ acceptance and usage of home care technologies, revealing the complexity and dynamics of their technology use behaviors. His research spans from identifying systemic influencing factors (Peek et al. 2014 ; Peek et al. 2016 ), emphasizing familial impacts (Luijkx et al. 2015 ), to constructing comprehensive models (Peek et al. 2017 ), and examining the dynamics of long-term usage (Peek et al. 2019 ), fully reflecting the evolving technology landscape and the changing needs of older adults. Additionally, the ongoing contributions of researchers like Ziefle, Rogers, and Wouters in the field of older adults’ technology acceptance demonstrate their research influence and leadership. These researchers have significantly enriched the knowledge base in this area with their diverse perspectives. For instance, Ziefle has uncovered the complex attitudes of older adults towards technology usage, especially the trade-offs between privacy and security, and how different types of activities affect their privacy needs (Maidhof et al. 2023 ; Mujirishvili et al. 2023 ; Schomakers and Ziefle 2023 ; Wilkowska et al. 2022 ), reflecting a deep exploration and ongoing innovation in the field of older adults’ technology acceptance.

Discussion on knowledge base and thematic progress (RQ3)

Through co-citation analysis and systematic review of seminal literature, this study reveals the knowledge foundation and thematic progress in the field of older adults’ technology acceptance. Co-citation networks and cluster analyses illustrate the structural themes of the research, delineating the differentiation and boundaries within this field. Additionally, burst detection analysis offers a valuable perspective for understanding the thematic evolution in the field of technology acceptance among older adults. The development and innovation of theoretical models are foundational to this research. Researchers enhance the explanatory power of constructed models by deepening and expanding existing technology acceptance theories to address theoretical limitations. For instance, Heerink et al. ( 2010 ) modified and expanded the UTAUT model by integrating functional assessment and social interaction variables to create the almere model. This model significantly enhances the ability to explain the intentions of older users in utilizing assistive social agents and improves the explanation of actual usage behaviors. Additionally, Chen and Chan ( 2014 ) extended the TAM to include age-related health and capability features of older adults, creating the STAM, which substantially improves predictions of older adults’ technology usage behaviors. Personal attributes, health and capability features, and facilitating conditions have a direct impact on technology acceptance. These factors more effectively predict older adults’ technology usage behaviors than traditional attitudinal factors.

With the advancement of technology and the application of emerging technologies, new research topics have emerged, increasingly focusing on older adults’ acceptance and use of these technologies. Prior to this, the study by Mitzner et al. ( 2010 ) challenged the stereotype of older adults’ conservative attitudes towards technology, highlighting the central roles of usability and usefulness in the technology acceptance process. This discovery laid an important foundation for subsequent research. Research fields such as “smart home technology,” “social life,” and “customer service” are emerging, indicating a shift in focus towards the practical and social applications of technology in older adults’ lives. Research not only focuses on the technology itself but also on how these technologies integrate into older adults’ daily lives and how they can improve the quality of life through technology. For instance, studies such as those by Ma et al. ( 2016 ), Hoque and Sorwar ( 2017 ), and Li et al. ( 2019 ) have explored factors influencing older adults’ use of smartphones, mHealth, and smart wearable devices.

Furthermore, the diversification of research methodologies and innovation in evaluation techniques, such as the use of mixed methods, structural equation modeling (SEM), and neural network (NN) approaches, have enhanced the rigor and reliability of the findings, enabling more precise identification of the factors and mechanisms influencing technology acceptance. Talukder et al. ( 2020 ) employed an effective multimethodological strategy by integrating SEM and NN to leverage the complementary strengths of both approaches, thus overcoming their individual limitations and more accurately analyzing and predicting older adults’ acceptance of wearable health technologies (WHT). SEM is utilized to assess the determinants’ impact on the adoption of WHT, while neural network models validate SEM outcomes and predict the significance of key determinants. This combined approach not only boosts the models’ reliability and explanatory power but also provides a nuanced understanding of the motivations and barriers behind older adults’ acceptance of WHT, offering deep research insights.

Overall, co-citation analysis of the literature in the field of older adults’ technology acceptance has uncovered deeper theoretical modeling and empirical studies on emerging technologies, while emphasizing the importance of research methodological and evaluation innovations in understanding complex social science issues. These findings are crucial for guiding the design and marketing strategies of future technology products, especially in the rapidly growing market of older adults.

Discussion on research hotspots and evolutionary trends (RQ4)

By analyzing core keywords, we can gain deep insights into the hot topics, evolutionary trends, and quality distribution of research in the field of older adults’ technology acceptance. The frequent occurrence of the keywords “TAM” and “UTAUT” indicates that the applicability and theoretical extension of existing technology acceptance models among older adults remain a focal point in academia. This phenomenon underscores the enduring influence of the studies by Davis ( 1989 ) and Venkatesh et al. ( 2003 ), whose models provide a robust theoretical framework for explaining and predicting older adults’ acceptance and usage of emerging technologies. With the widespread application of artificial intelligence (AI) and big data technologies, these theoretical models have incorporated new variables such as perceived risk, trust, and privacy issues (Amin et al. 2024 ; Chen et al. 2024 ; Jing et al. 2024b ; Seibert et al. 2021 ; Wang et al. 2024b ), advancing the theoretical depth and empirical research in this field.

Keyword co-occurrence cluster analysis has revealed multiple research hotspots in the field, including factors influencing technology adoption, interactive experiences between older adults and assistive technologies, the application of mobile health technology in health management, and technology-assisted home care. These studies primarily focus on enhancing the quality of life and health management of older adults through emerging technologies, particularly in the areas of ambient assisted living, smart health monitoring, and intelligent medical care. In these domains, the role of AI technology is increasingly significant (Qian et al. 2021 ; Ho 2020 ). With the evolution of next-generation information technologies, AI is increasingly integrated into elder care systems, offering intelligent, efficient, and personalized service solutions by analyzing the lifestyles and health conditions of older adults. This integration aims to enhance older adults’ quality of life in aspects such as health monitoring and alerts, rehabilitation assistance, daily health management, and emotional support (Lee et al. 2023 ). A survey indicates that 83% of older adults prefer AI-driven solutions when selecting smart products, demonstrating the increasing acceptance of AI in elder care (Zhao and Li 2024 ). Integrating AI into elder care presents both opportunities and challenges, particularly in terms of user acceptance, trust, and long-term usage effects, which warrant further exploration (Mhlanga 2023 ). These studies will help better understand the profound impact of AI technology on the lifestyles of older adults and provide critical references for optimizing AI-driven elder care services.

The Time-zone evolution mapping and burst keyword analysis further reveal the evolutionary trends of research hotspots. Early studies focused on basic technology acceptance models and user perceptions, later expanding to include quality of life and health management. In recent years, research has increasingly focused on cutting-edge technologies such as virtual reality, telehealth, and human-robot interaction, with a concurrent emphasis on the user experience of older adults. This evolutionary process demonstrates a deepening shift from theoretical models to practical applications, underscoring the significant role of technology in enhancing the quality of life for older adults. Furthermore, the strategic coordinate mapping analysis clearly demonstrates the development and mutual influence of different research themes. High centrality and density in the themes of Usage Experience and Assisted Living Technology indicate their mature research status and significant impact on other themes. The themes of Smart Devices, Theoretical Models, and Mobile Health Applications demonstrate self-contained research trends. The themes of Human-Robot Interaction, Characteristics of the Elderly, and Research Methods are not yet mature, but they hold potential for development. Themes of Digital Healthcare Technology, Psychological Factors, and Socio-Cultural Factors are closely related to other themes, displaying core immaturity but significant potential.

In summary, the research hotspots in the field of older adults’ technology acceptance are diverse and dynamic, demonstrating the academic community’s profound understanding of how older adults interact with technology across various life contexts and needs. Under the influence of AI and big data, research should continue to focus on the application of emerging technologies among older adults, exploring in depth how they adapt to and effectively use these technologies. This not only enhances the quality of life and healthcare experiences for older adults but also drives ongoing innovation and development in this field.

Research agenda

Based on the above research findings, to further understand and promote technology acceptance and usage among older adults, we recommend future studies focus on refining theoretical models, exploring long-term usage, and assessing user experience in the following detailed aspects:

Refinement and validation of specific technology acceptance models for older adults: Future research should focus on developing and validating technology acceptance models based on individual characteristics, particularly considering variations in technology acceptance among older adults across different educational levels and cultural backgrounds. This includes factors such as age, gender, educational background, and cultural differences. Additionally, research should examine how well specific technologies, such as wearable devices and mobile health applications, meet the needs of older adults. Building on existing theoretical models, this research should integrate insights from multiple disciplines such as psychology, sociology, design, and engineering through interdisciplinary collaboration to create more accurate and comprehensive models, which should then be validated in relevant contexts.

Deepening the exploration of the relationship between long-term technology use and quality of life among older adults: The acceptance and use of technology by users is a complex and dynamic process (Seuwou et al. 2016 ). Existing research predominantly focuses on older adults’ initial acceptance or short-term use of new technologies; however, the impact of long-term use on their quality of life and health is more significant. Future research should focus on the evolution of older adults’ experiences and needs during long-term technology usage, and the enduring effects of technology on their social interactions, mental health, and life satisfaction. Through longitudinal studies and qualitative analysis, this research reveals the specific needs and challenges of older adults in long-term technology use, providing a basis for developing technologies and strategies that better meet their requirements. This understanding aids in comprehensively assessing the impact of technology on older adults’ quality of life and guiding the optimization and improvement of technological products.

Evaluating the Importance of User Experience in Research on Older Adults’ Technology Acceptance: Understanding the mechanisms of information technology acceptance and use is central to human-computer interaction research. Although technology acceptance models and user experience models differ in objectives, they share many potential intersections. Technology acceptance research focuses on structured prediction and assessment, while user experience research concentrates on interpreting design impacts and new frameworks. Integrating user experience to assess older adults’ acceptance of technology products and systems is crucial (Codfrey et al. 2022 ; Wang et al. 2019 ), particularly for older users, where specific product designs should emphasize practicality and usability (Fisk et al. 2020 ). Researchers need to explore innovative age-appropriate design methods to enhance older adults’ usage experience. This includes studying older users’ actual usage preferences and behaviors, optimizing user interfaces, and interaction designs. Integrating feedback from older adults to tailor products to their needs can further promote their acceptance and continued use of technology products.

Conclusions

This study conducted a systematic review of the literature on older adults’ technology acceptance over the past decade through bibliometric analysis, focusing on the distribution power, research power, knowledge base and theme progress, research hotspots, evolutionary trends, and quality distribution. Using a combination of quantitative and qualitative methods, this study has reached the following conclusions:

Technology acceptance among older adults has become a hot topic in the international academic community, involving the integration of knowledge across multiple disciplines, including Medical Informatics, Health Care Sciences Services, and Ergonomics. In terms of journals, “PSYCHOLOGY, EDUCATION, HEALTH” represents a leading field, with key publications including Computers in Human Behavior , Journal of Medical Internet Research , and International Journal of Human-Computer Interaction . These journals possess significant academic authority and extensive influence in the field.

Research on technology acceptance among older adults is particularly active in developed countries, with China and USA publishing significantly more than other nations. The Netherlands leads in high average citation rates, indicating the depth and impact of its research. Meanwhile, the UK stands out in terms of international collaboration. At the institutional level, City University of Hong Kong and The University of Hong Kong in China are in leading positions. Tilburg University in the Netherlands demonstrates exceptional research quality through its high average citation count. At the author level, Chen from China has the highest number of publications, while Peek from the Netherlands has the highest average citation count.

Co-citation analysis of references indicates that the knowledge base in this field is divided into three main categories: theoretical model deepening, emerging technology applications, and research methods and evaluation. Seminal literature focuses on four areas: specific technology use by older adults, expansion of theoretical models of technology acceptance, information technology adoption behavior, and research perspectives. Research themes have evolved from initial theoretical deepening and analysis of influencing factors to empirical studies on individual factors and emerging technologies.

Keyword analysis indicates that TAM and UTAUT are the most frequently occurring terms, while “assistive technology” and “virtual reality” are focal points with high frequency and centrality. Keyword clustering analysis reveals that research hotspots are concentrated on the influencing factors of technology adoption, human-robot interaction experiences, mobile health management, and technology for aging in place. Time-zone evolution mapping and burst keyword analysis have revealed the research evolution from preliminary exploration of influencing factors, to enhancements in quality of life and health management, and onto advanced technology applications and deepening of theoretical models. Furthermore, analysis of research quality distribution indicates that Usage Experience and Assisted Living Technology have become core topics, while Smart Devices, Theoretical Models, and Mobile Health Applications point towards future research directions.

Through this study, we have systematically reviewed the dynamics, core issues, and evolutionary trends in the field of older adults’ technology acceptance, constructing a comprehensive Knowledge Mapping of the domain and presenting a clear framework of existing research. This not only lays the foundation for subsequent theoretical discussions and innovative applications in the field but also provides an important reference for relevant scholars.

Limitations

To our knowledge, this is the first bibliometric analysis concerning technology acceptance among older adults, and we adhered strictly to bibliometric standards throughout our research. However, this study relies on the Web of Science Core Collection, and while its authority and breadth are widely recognized, this choice may have missed relevant literature published in other significant databases such as PubMed, Scopus, and Google Scholar, potentially overlooking some critical academic contributions. Moreover, given that our analysis was confined to literature in English, it may not reflect studies published in other languages, somewhat limiting the global representativeness of our data sample.

It is noteworthy that with the rapid development of AI technology, its increasingly widespread application in elderly care services is significantly transforming traditional care models. AI is profoundly altering the lifestyles of the elderly, from health monitoring and smart diagnostics to intelligent home systems and personalized care, significantly enhancing their quality of life and health care standards. The potential for AI technology within the elderly population is immense, and research in this area is rapidly expanding. However, due to the restrictive nature of the search terms used in this study, it did not fully cover research in this critical area, particularly in addressing key issues such as trust, privacy, and ethics.

Consequently, future research should not only expand data sources, incorporating multilingual and multidatabase literature, but also particularly focus on exploring older adults’ acceptance of AI technology and its applications, in order to construct a more comprehensive academic landscape of older adults’ technology acceptance, thereby enriching and extending the knowledge system and academic trends in this field.

Data availability

The datasets analyzed during the current study are available in the Dataverse repository: https://doi.org/10.7910/DVN/6K0GJH .

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This research was supported by the Social Science Foundation of Shaanxi Province in China (Grant No. 2023J014).

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Xianru Shang, Zijian Liu, Chen Gong, Zhigang Hu & Yuexuan Wu

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Shang, X., Liu, Z., Gong, C. et al. Knowledge mapping and evolution of research on older adults’ technology acceptance: a bibliometric study from 2013 to 2023. Humanit Soc Sci Commun 11 , 1115 (2024). https://doi.org/10.1057/s41599-024-03658-2

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DOI : https://doi.org/10.1057/s41599-024-03658-2

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Altruism and Health: Perspectives from Empirical Research

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Does a kindly, charitable interest in others have health benefits for the agent, particularly when coupled with helping behaviours? Although the answer remains unclear, researchers have established that there is an association between generous emotions, helping behaviour, and longevity. Increasingly, emotional states and their related behaviours are being studied by mainstream scientists in relation to health promotion and disease prevention. If helping affect or behaviour can be linked with health and longevity, there are significant implications for how we think about human nature and prosperity. Although studies show that those who are physically or psychologically overwhelmed by the needs of others do experience a stressful burden that can have significant negative health consequences, little attention has been given to whether there are health benefits from helping behaviour that is fulfilling, not overwhelming. This book's chapters address this question in objective terms. The book provides heuristic models, from evolution and neuroscience, to explain the association between altruism and health, and examines potential public health and practical implications of the existing data.

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• Published: 17 May 2016

Which health research gets used and why? An empirical analysis of 30 cases

• Maarten Olivier Kok 1 , 2 ,
• John Owusu Gyapong 3 ,
• Ivan Wolffers 4 ,
• David Ofori-Adjei 5 &
• Joost Ruitenberg 2  

Health Research Policy and Systems volume  14 , Article number:  36 ( 2016 ) Cite this article

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While health research is considered essential for improving health worldwide, it remains unclear how it is best organized to contribute to health. This study examined research that was part of a Ghanaian-Dutch research program that aimed to increase the likelihood that results would be used by funding research that focused on national research priorities and was led by local researchers. The aim of this study was to map the contribution of this research to action and examine which features of research and translation processes were associated with the use of the results.

Using Contribution Mapping, we systematically examined how 30 studies evolved and how results were used to contribute to action. We combined interviews with 113 purposively selected key informants, document analysis and triangulation to map how research and translation processes evolved and contributions to action were realized. After each case was analysed separately, a cross-case analysis was conducted to identify patterns in the association between features of research processes and the use of research.

The results of 20 of the 30 studies were used to contribute to action within 12 months. The priority setting and proposal selection process led to the funding of studies which were from the outset closely aligned with health sector priorities. Research was most likely to be used when it was initiated and conducted by people who were in a position to use their results in their own work. The results of 17 out of 18 of these user-initiated studies were translated into action. Other features of research that appeared to contribute to its use were involving potential key users in formulating proposals and developing recommendations.

Conclusions

Our study underlines the importance of supporting research that meets locally-expressed needs and that is led by people embedded in the contexts in which results can be used. Supporting the involvement of health sector professionals in the design, conduct and interpretation of research appears to be an especially worthwhile investment.

Peer Review reports

One of the most common laments heard in research policy circles is that the results of even the best studies are rarely translated into action [ 1 – 3 ]. This is especially distressing in the context of health-related research in lower-income countries, where new knowledge, well used, has the potential to save lives and improve welfare [ 4 ].

The traditional response to this apparent under-use of research is to encourage researchers to communicate their results more effectively. While it may help, better communication tends to be insufficient for improving the use of research. Communication is not ad-hoc, but requires ongoing interaction and trust, as well as relevant infrastructure [ 5 , 6 ]. In addition, local capacities are required for translating generic knowledge claims to the specific local situation in which they could be useful [ 7 – 9 ]. An additional challenge that has long hampered research uptake in low-income countries is its limited local utility. As early as 1990, the prominent Commission on Health Research for Development reported that conventional health research contributed little to health and development in poorer countries because it was dominated by foreign scholars instead of locally embedded researchers, and met international rather than local information needs [ 10 ].

To align research more closely with national needs, local policymakers, health professionals and community representatives were encouraged to join in with NGOs, academics and others to set national health research agendas [ 11 ]. The idea was that this would lead to research driven by the demands of local stakeholders, which was more likely to be used than research driven by supply from foreign academics.

It is, however, difficult to ascertain how these various efforts influence the likelihood that research results will be used. Studies of the use of research tend to start with finalized results or evidence-based recommendations, and trace their use in action [ 12 – 16 ]. Most of these studies indicate that the use of research increases as potential users consider research pertinent, as research coincides with the users’ needs, as the users’ attitude is to give credibility to research and as results reach users at the right time [ 17 – 20 ].

In line with these observations, research funders and others have tried to foster interaction between the producers and users of research. Initially, this interaction was focused on the joint interpretation of research results and the development of recommendations. More recently, interesting methods have been designed that encourage researchers and others to think how results might be used, and engage potential users from the time research is planned and throughout research processes [ 21 – 24 ].

While approaches such as priority setting and involving potential users are increasingly promoted, there are few systematic studies that examine how they influence the eventual use of research [ 25 – 27 ]. Such studies need to examine what happens throughout research processes and relate that to the use of results [ 28 ].

Our work aimed to fill this gap, using a newly-developed method known as Contribution Mapping, to systematically assess 30 studies conducted in Ghana between 2001 and 2008 [ 29 ]. These studies were part of a program jointly developed by the governments of the Netherlands and Ghana that aimed to increase the use of research by ensuring that it was locally relevant and locally led [ 30 ]. Beginning with a national research agenda-setting process, the Ghanaian Dutch Health Research for Development Program supported research-use efforts at various points in the research process. Ghanaian professionals from three groups identified as representing the health research constituency were invited to submit research proposals that would fit the research priority agenda. These three groups comprised academia, policymakers at all levels and end-users of health research: the health workers and the communities that were to benefit from efforts to improve their health. NGOs were asked to represent the communities, and especially the more marginalized groups that were poorly reached by the regular health system. The Ghanaians leading the studies could invite Dutch researchers to collaborate with them. At the end of each study, the researchers had to submit a detailed report which contained a policy brief and specific recommendations, which were disseminated to potential key users. The research program started in 2001 and funded 79 research projects through five annual rounds of priority setting, proposal selection, funding and support.

Our study aims to map the contribution of these research projects to action and examine which features of research and translation processes were associated with the use of the results. To our knowledge, this is the first study to try to systematically analyse the relation between features of research processes and the eventual use of research across the spectrum of health research processes in a low-income country, using a substantial number of case studies.

We used Contribution Mapping to assess how 30 research projects evolved and the results were translated into action. Contribution Mapping, which is described more fully elsewhere [ 29 ], is ground in social studies of science. Contribution Mapping recognizes that determining and attributing the ultimate ‘impact’ of research is often unrealistic and practically impossible. A true ‘impact’ perspective neglects the active role of users, who combine research outcomes with existing knowledge and use it for their own purposes in an evolving world full of ongoing processes. To take into account the active role of users and contexts, the translation of knowledge into action is better viewed as a collective process in which the agency is distributed.

A key feature of Contribution Mapping is that it contains a specific perspective on how research outcomes are integrated with existing knowledge and translated into action. This 'actor-scenario' perspective begins with the idea that those who try to translate knowledge into action put forward a more or less explicit story about a future in which they assign roles and responsibilities to a variety of ‘actors’ such as people, organizations, technologies, budgets, microbes and artefacts (e.g. these findings mean that this organization should do this, those professionals should do that, these medicine should do this, and that funder is responsible for that, etc.). Knowledge can be brought into such an ‘actor-scenario’ to confirm, support or strengthen it or introduce new elements. Knowledge can also be used to undermine the actor-scenarios of others (e.g. these findings show that they should stop funding because that policy will not work). When users bring research outcomes into such a scenario, they combine these outcomes with existing knowledge and formulate what that knowledge means for a specific aim in a specific situation. The actor-scenario perspective thus recognizes that research outcomes do not have a fixed meaning that is somehow imposed upon a passive user. While research outcomes can play a role, the perspective recognizes that such outcomes can be assigned different meanings by different actors in different situations. Regardless of the role that knowledge plays, its use can always be analyzed in terms of evolving and interacting actor-scenarios, and attempts to realize them.

Instead of trying to attribute ultimate ‘impacts’, Contribution Mapping focusses on how research and translation processes evolve and contributions to action come about, by tracing the actions of actors that are involved in, or interact with, a research project and the most likely influential users amongst them, which are referred to as potential key-users. The method follows a structured, iterative approach in which key informant interviews and document analysis are combined to develop a narrative of how processes evolved and contributions to action were realized.

Determining whether a study was used

The outcome measure of our study was whether the results of research were used to contribute to action. A contribution to action can be described as a process in which knowledge plays a meaningful role in action for health. For the purpose of this study, we made a somewhat crude distinction between studies that were used and studies that were not. We considered a study as ‘used’ when at least one person described that produced knowledge had played a meaningful role in action for health, this was corroborated by someone else and/or documentary evidence, and the translation process seemed plausible to the external analyst. We focused on the contributions to action that could be identified between 6 and 12 months after a study was finalized. We chose this relatively fixed timeframe to allow us to compare cases.

Case selection

For this multiple case study, we selected the first 30 research projects of the Ghanaian Dutch Health Research for Development Program that were finalized. These 30 research projects were funded between 2002 and 2004 and are described in Table  1 . These research projects were all led by a Ghanaian principal investigator (PI) and included one or more co-investigators. Most research projects were completed less than 2 years after funding was provided. The research projects had budgets varying from US$ 10,000 to 20,000, excluding the salaries of the involved investigators. Until at least 6 months after a study was finalized, those involved in research and translation processes were not made aware that the use of the results would be assessed.

The research program aimed to fund research that was oriented towards the national research agenda in Ghana. The research agenda was set in four steps: (1) reviewing existing research information, (2) consulting the health sector, policymakers and NGOs about research needs, (3) interviewing community members and (4) holding a workshop to prioritize issues based upon the existence of a problem, relevance, urgency, or whether research was needed to solve the problem. The research agenda was widely disseminated and public and private research institutes, NGOs and other interested groups were invited to submit a letter of intent that fell within the research priorities. The best letters of intent were selected and research teams invited to submit a full proposal. Each proposal had to contain a section about the societal relevance/utility of the proposed research. An external, Ghanaian-Dutch scientific review committee reviewed the full proposals for scientific merit, societal relevance/utility of the research, feasibility within time, budgetary and methodological framework, and ethical considerations. Final selection of proposals was done by the Joint Program Committee based on the comments of the reviewers.

Organization of data collection

Data collection started in March 2005 with the creation of an overview of the background and development of the research program. The assessment of each case started with reading available documentation, such as research proposals, mid-term reviews and final reports, and making a timeline-based process map. The timeline was divided into three phases: (1) formulation phase, (2) knowledge production phase and (3) the knowledge extension phase (e.g. dissemination and utilization). For each phase, the main actors, activities and interactions were mapped.

The first interview was held between 12 and 18 months after the investigators had established their results and were ready to disseminate them. The mapping process started with interviewing the principal investigators of a research project, developing a first version of the three-phase process map and identifying potential key-users and translation processes. Next, potential key-users and other informants were interviewed to trace, explore and triangulate possible contributions. In the third stage, process summaries were shared with key informants for feedback and validation. After inconsistencies were clarified, the process maps and description of contributions were finalized.

Interviewing

One hundred and thirteen purposively selected participants were interviewed face-to-face in four rounds of data collection (2005–2008) by four different researchers; 18 participants were interviewed about several research projects and 36 participants were involved in the studies as PI or co-investigator. The others were selected as potential key-user or interviewed to further explore, triangulate or elaborate descriptions of translation processes and contributions to action. Most potential key-users had a leading role at the Ministry of Health, the Ghana Health Service or other health-related organizations.

Following the steps of Contribution Mapping, interviewees were asked to describe how the process of formulating a study proposal and conducting research had evolved, and how produced knowledge claims were disseminated and translated into action. Interviewees were encouraged to be specific about processes and interactions, to provide detailed examples and share documents that supported their claims and to provide further insight into how research and translation processes evolved. Examples of such documents are texts related to specific meetings, policy briefs, reports and presentation sheets. Emerging descriptions of translations and contributions to action were triangulated with subsequent interviewees, who could also put forward new stories of contributions and other documents that supported their claims. Interviews were audio recorded, except in five cases in which equipment failed or interviewees did not want to be recorded, and a detailed summary was made directly afterwards.

Data management and analysis

Directly after each interview, a detailed summary was prepared. By listening to the interviews, all relevant parts were identified and transcribed verbatim. Data analysis was done in two steps: (1) a detailed qualitative within-case analysis and (2) cross-case analysis. Data analysis for each case started after the first interview and continued during the whole data collection time [ 28 ]. Interview summaries, documents and transcripts were used to iteratively develop the three-phase process maps, and the contributions to action.

To identify which features of research and translation processes were associated with the use of research, we first analyzed the individual process maps and developed a set of open codes. Examples of codes are ‘involving potential key-users in the formulation of research’ and ‘targeted dissemination of written results’. Using a constant comparative method of analysis and a manual coding system, two researchers and a research assistant then developed a more specific set of codes for those process features that seemed to matter the most [ 31 ].

We then conducted a second systematic cross-case analysis, in which, for each case, we analysed the presence and role of the selected process features and described them in a table. For each of the process features, a specific summary was developed. Our analysis was recursive, constantly moving from the specific cases, to the more general, with the aim of identifying commonalities and patterns across the variety of cases.

This study did not require ethics approval in Ghana. Under Dutch law, ethics approval in the Netherlands was also not required. Even though formal approval was not required, we followed regular ethically responsible qualitative research practice to ensure that substantive ethical issues would be dealt with in an appropriate way. Informed consent to participate in the study, record the interviews, use quotations and publish the results was obtained from all study participants. A report with the preliminary results was shared with participants in 2008. Based upon comments, two small adaptations were made in how the data was presented. The preliminary results were presented and discussed at a meeting with participants in Ghana in 2008 and at a meeting in the Netherlands in 2009. Those involved in the discussions confirmed the presented results.

We start this section with an overview of some of the studies and how they contributed to changes in health policy and practice. Next, we describe which features of research and translation processes were related to the contribution of research to action. In the last part, we further examine how translation processes evolved. In Table  1 , the 30 research projects and the most prominent translation process and contributions to action are described.

The identified contributions to action

In 20 of the 30 studies, we identified a contribution to action between 6 and 12 months after the studies were finalized. We refer to these 20 studies as the ‘used’ studies.

The produced knowledge was used in many different ways. Several studies provided new knowledge about the nature and scope of health problems. This new knowledge was often used by investigators with a formal position in the health system. An example is case 1, a study into factors associated with treatment default among tuberculosis patients [ 32 ]. The PI of the study was in charge of the regional tuberculosis program and said that he initiated the study with the aim of improving tuberculosis treatment. “ For a long time I was concerned about treatment default, we talked about what to do. […] This study created an opportunity to do something about it, to better understand the problems and improve treatment success. ” The PI translated his results in several actions: “ This study showed that financial constraint was the main reason for patients for defaulting. Distance was one of the main issues, because they had to board vehicles to the hospital every day. When we noticed that, one of the things I have done is I have opened five new treatment locations to bring access to TB treatment. Previously there was only one treatment center in the whole district. We have also arranged for transportation money to the treatment and a daily meal during the intensive phase .”

Another study revealed unexpected problems with the functioning and implementation of the immunization program, such as illegal charges and the sale of food supplements by health workers alongside the vaccination (case 10). Poor mothers who could not afford these extra charges and food supplements felt stigmatized and were less likely to have their children vaccinated. One of the co-investigators of the study was a district director for the Ghana Health Service, who aligned the research proposal with his concerns about the immunization program in his district and his aim to improve it. Towards the end of his study, he was promoted to the position of regional director in the Ghana Health Service. In this new function, he used the results in designing and implementing a new communication policy, a policy on abolishing illegal charges and the sale of food supplements at vaccination sites, and a new way for supervising the immunization process. “ When I started I was at district level, so I saw the need to do something to EPI [immunization program] . Being at regional level was a great opportunity. I met all the districts of the region and showed them the issues of immunization in Techiman, what I thought was not so different from other areas […] actually showing what went wrong was important for making those changes. ”

In many cases, the produced knowledge was first used in the research context and subsequently elsewhere. The co-investigator of the previous case said that he continued to use his results after he was transferred to a new region. In his new region, he informed the staff of the health districts about his study findings, encouraged them to look out for similar problems and implement the proposed policies. A district director confirmed this translation process: “ He has informed us in one of the EPI meetings […]. He studied the performance of the district and how to increase the performance. So he showed us the figures before the study, the difficulties they were having and after the study, the input they put in and the figures they were having. Since he came, we put everything in place. ”

In several studies, new practices, protocols and methods were developed and tested, which were first implemented locally and subsequently used elsewhere. An example is case 12, in which quality indicators were developed and teams were trained to improve the quality of care in a district. After the research project, the use of the developed indicators and quality teams was continued: “ The quality assurance has been institutionalized. Some of the district wide quality parameters that were proposed are being used already. Some others are still being reviewed for use ” (district director Ghana Health Service). A different interviewee linked to the study in case 12 described a second translation process: “ there were constraints between regular and enrolled nurses. This had been ongoing for years and came out again during the focus groups. Before the report was even finished they have changed the rule. Now they are wearing the same uniform to lower this rivalry. ” Two more examples are cases 13 and 19, in which results were used to develop a training program and support package for implementing the Community-based Health Planning and Services Initiative. The program and support package was used by different people involved in implementing this initiative throughout the country.

Interviewees also described a range of unanticipated ways in which the conduct of the research itself contributed to changes in health service practices. Case 9 provides two examples. According to one investigator: “ When we conducted the study we noticed very sharp shortages [in consumables for preventing maternal mortality] and linked up with the medical stores. When we found out that the stores were not there at all, we immediately reported to the regional director and made sure the situation was addressed. So indirectly that will enhance service delivery. And also the filing system: we had difficulties retrieving data. Some patients went out and with their cards. So the records were not complete. When we discovered that, we had to correct the system. So it facilitated the documentation system. ”

In several cases, results were used by different actors in different translation processes. An illustrative example is case 17, a study into the prevalence of infectious diseases among prisoners and guards in Ghana. For years, there had been anecdotes and occasional media reports about the poor health status of prisoners. After being contacted by a concerned prison officer, a university-based researcher initiated a disease surveillance study showing a significant outbreak of HIV and hepatitis C among prisoners and guards and a lot of risk behaviour among prisoners such as illegal drugs use, unprotected sex and tattooing with shared needles [ 33 ]. Counselling and treatment were provided and a peer education program was set up following the research in the prisons in which the studies were conducted. The prison service used the results to encourage the Ministry of Health to provide better health services to prisoners. Interviewees described how, after several discussions, the results played a role in the decision to include prisoners in the National Health Insurance Scheme. Other interviewees described how the results played a role in the lobby, and eventual decision to close Usher Fort prison, which was housed in an 17th century Dutch colonial fortress. Interviewees also described how the results inspired USAID to provide anti-retroviral treatment at a clinic next to Nsawam prison.

Another example in which results were translated in diverse actions is case 3: a study into resistance to anti-microbial drugs in Ghana. The study, which was initiated by a microbiology professor from a medical school, showed an alarming resistance to commonly used antimicrobials, such as tetracycline (82%), ampicillin (76%) and chloramphenicol (75%), and widespread multi-drug resistance [ 34 ]. The researchers provided several recommendations, such as training laboratory technicians, re-evaluating criteria for the use of antibiotics, enforcing laws on the sale of antibiotics and educating the public about their use. While participants described several plans that were inspired by the findings, most were shelved due to a lack of resources. The head of the Reference Laboratory described a plan to train laboratory technicians, but soon after this he retired. His successor was aware of the results, but did not mention any training plans and pointed to the lack of funding for such initiatives. The head of the Quality Assurance Unit described ideas to encourage laboratory testing before prescribing antibiotics, but had not taken any action. After additional interviews, two translation processes were identified. In response to feedback from the study, hospitals had taken the initiative to start a training for laboratory technicians. A policymaker pointed out that the results also played a role in discussions and decision-making about the list of essential medicines at the Ghana Health Service. This claim was confirmed by second interviewee who attended the same meeting.

Participants reported that the results of seven studies (cases 4, 5, 7, 23, 25, 27, 29) contributed, in diverse ways, to the design and implementation of the National Health Insurance Scheme. The development of the health insurance law was a lengthy, complex and sometimes highly contested process in which numerous actors were involved who negotiated about different proposals and plans, which slowly converged into the law that was eventually passed by Parliament in 2003 [ 35 ]. During this process, countless ideas, recommendations and plans were put forward in which all kinds of knowledge claims, experiences and interests played a role. Participants described how results of two studies were used in this process to support new proposals and challenge existing plans that were being developed. Case 5 showed that citizens wanted to be able to opt out of the insurance and districts needed additional funding to start-up the health insurance, which were both taken into account in the eventual policy. Participants described how the results of case 5, together with those of case 4, supported the choice for a district wide organization of the health insurance and provided insights in how these could be implemented. Case 4 also provided a method for identifying the poorest of the poor, which was adapted and then used in practice.

Other studies were used in the implementation of the National Health Insurance Scheme. The results of case 27 were used to successfully advocate for a flat fee system for reimbursing hospitals. Unit-cost data that were developed during this study were used by the Ghana Health Service to fund hospitals. The results of cases 7, 23 and 25 were used to improve the implementation of the insurance at district level. Case 7 showed local policymakers which groups were less likely to enroll in the insurance, after which a targeted enrolment campaign was organized. The results of both cases 7 and 25 helped to identify existing structures and networks through which the insurance could better reach target groups and collect premiums.

Process features that were associated with the use of research

Below, we describe which features of research and translation processes were associated with the use of the produced knowledge. We start with the ones directly linked to the research program.

Fit with the national research agenda

The national health research priority strategy, which was a key component of the research program, helped to attune the research projects to the health sector priorities. The priority setting process, which interviewees described as useful, resulted in a research agenda with four priority themes (Box 1). These four themes matched with the health policy priorities that were described in the 2001–2006 Ghanaian Health Sector Programme of Work. The research agenda clearly influenced the formulation of research proposals. Some researchers said that they took the priorities as starting point for formulating a proposal. Others adapted their existing ideas and proposals to make them fit with the research agenda. Of the 30 assessed studies, 28 were clearly in line with the research agenda. This is unsurprising, since alignment with national needs was an important consideration in the selection of studies for funding.

Initiation by potential key users

Eighteen studies were initiated by people who were primary decision-makers or held influential positions in the health system (Table  2 ). These people defined research questions that arose from the programs they ran or advised and were thus themselves a potential key user. As one PI described: “ The proposal grew out of observations as a district director that there is a problem with the functioning of this level in the health system. From years of problems. All kinds of problems. Then you realize that, because when you talk with your other colleague district directors, and they all say yes, we also have this problem. So then it is like, instead of investigating this felt need in my little district, why don’t I look at it beyond. So it was a national scale study. ”

Examples of these ‘user-investigators’ include the head of the regional tuberculosis program who initiated a study into therapy adherence, the district director who aimed to better implement the vaccination program, and a member of a health financing committee who studied ways to fund hospitals. “ It very much influenced how the proposal was structured, because I realized there was a gap that needed some kind of investigation, some kind of evidence, to be able to present, if I should say, a paper for policy decision to be taken. ”

User-investigators were a striking feature of studies that were utilized: 17 of the 18 studies with a user-investigator were translated into action.

Involving potential key users during the formulation of a research proposal

In addition to the potential key users who were part of the study team (as user-investigators), studies could also involve external potential key users during the formulation of the research proposal (Table  3 ). Participants described different reasons for consulting these external key users. Some were consulted to inform them about the proposal, ask for input, or increase the likelihood of use. Others mentioned that these potential key users had to be consulted in order to access to study populations, clinics or hospital administrations.

These consultations often led to adaptations of research proposals. The proposal of the study into maternal mortality was adapted after discussing it with the regional director: “ It was his idea that I should refocus on the service delivery factors, because that is what we have immediate control over. I had to remodel the framework a bit. I was going for a broader investigation” . In the prison health study, the director of the Prison Service asked the researchers to include not only inmates, but also prison officers in the disease surveillance study.

User-initiators also discussed their proposals with other potential key users. One of them said: “ What changed the proposal? For example, comments like, well, because it is possible, we are going to look at this to inform policy in the whole health sector. The Ghana Health Service, which has over two hundred hospitals and over a thousand clinics. Can you expend the sample size? I think to about two of each type, across the country, about eight or so. Try to cover all types, locations? So that influenced the design and also the sample size. ”

External potential key users were involved in the formulation of eight of the 18 user-initiated studies and in four of the other 12 studies, of which two were used. In a further four studies, none of them were user-initiated; external key users were informed about research proposals, but were not involved in shaping them.

Introducing new practices as part of research

Activities that were part of the implementation of the research itself could also contribute directly to action, and make it easier to use the results. In several cases, investigators and others provided examples of direct contributions that resulted from research activities, such as training health workers to follow a protocol, reorganizing administrative or logistical procedures, or teaching community members about HIV or the right to exemptions during interviews. While these direct contributions were of limited scope, interviewees said that they often remained after a study ended, and facilitated the use of the results. Case 12 provides a clear example. For the purpose of the study, new quality indicators were developed and teams were trained to use them to monitor quality of services in local clinics. After the study showed that this quality improvement strategy was beneficial, the use of these indicators was institutionalized in the involved clinics.

Involving potential key-users in developing recommendations

In almost all used studies, potential key users were engaged in interpreting the meaning of the results and developing recommendations for action (Table  4 ). In 15 of the 18 user-initiated studies and five of the 12 other studies, external potential key users were involved in developing recommendations. A user-investigator said: “ First we sat down together in the region and pooled the study findings. We came out with an operational document. What is the job description of a sub district head? What support must be given to them? How should they relate? We then send it out, everybody has commented on it. We then said ok, let’s start working with this. ”

Targeted distribution of printed results

The results of almost all studies were distributed in printed form beyond the scientific domain. In three cases, this dissemination was organized by the secretariat of the research program. In the other cases, the researchers had themselves taken the initiative to disseminate their results. Investigators who tried to mobilize others to use their results more often said that they adapted texts and prints to their target audience and sent it specifically to them: “ I send it to the Director of Human Resources and the Director General. What I did, I send not a research report, sometimes when people are busy, they don’t want a research report, but rather a memo. ”

Another investigator, who seemed very keen on the use of their results, described: “ When we did the final report. The Health Summit, you know the annual health summit. It was going on. We couldn’t get a slot to present the report, but were allowed to give people copies. So we carried copies of the report there and gave everybody a copy. We budgeted to print the report so that it looked attractive. ”

While the distribution of printed results may have supported translation processes, it was never described as playing an influential role in the use of research.

The translation of results into action: examining the process

As the preceding paragraphs show, many researchers made concerted efforts to involve potential users in interpreting study results, and to make sure users were aware of those results. On further examination, we found that the translation of results into action involved a complex interplay between different actors with different ideas about the meaning of the results, actual change efforts in which results were used and evolving dynamics and structures in the context. Here, we describe some of these processes in more detail.

Envisioning what should be done and who should do what

Researchers were themselves the first to shape the meaning of their study results. In four of the cases we studied, the investigators said that their results had no immediate implications for action. These investigators argued that their results confirmed existing knowledge or that further research was required. One of them explained: “ My findings and recommendations are not new things to the people in policy. They are things they already know. If there is anything at all, the presentation would only be to reinforce, to tell them that what they are doing is in the right direction. ” Not surprisingly, the results of these studies were not used to contribute to changes in policy or practice.

In the other 26 cases, the investigators said that their results should be translated into action, and they had ideas about how that should happen, and who should be involved. To achieve the changes they envisioned, actors put forward more or less explicit stories about a desired future, in which they assigned roles and responsibilities to a variety of actors and described what they should be doing. Depending on the forces at play and the situation in which these ‘actor-scenarios’ were put forward, research knowledge was assigned a role in them.

A technical advisor who aimed to use the results of the antimicrobial resistance study provides an example of a scenario of the future in which roles and responsibilities were assigned to several actors: “ The results show the Ministry of Health that what is happening in Accra is going on all over the country. From now on, the Regions must apply the law. The Ministry must take the results and use them to educate the pharmacists. They need to better explain how to take the medication. They must also educate the general population and thirdly, the herbalist who mix antimicrobial agents with their herbs. They have to stop that. ”

The stories about what results meant for action were not automatically accepted. Some people became inspired and put forward similar or somewhat modified actor-scenarios. Others started to resist the envisioned futures and roles they were assigned, and put forward alternative views in which the results had different implications for what should be done and who should do what. This could lead to further actions and interactions, after which a relatively stable set of ideas emerged about what results meant for action.

We analyzed who, according to the investigators, should play a role in the scenario’s which they described as leading to change (Table  5 ). In 14 cases, the investigators said that they should themselves play a key role in achieving change. In the other 12 cases, the investigators envisaged others playing the main role.Investigators gave different reasons why others had to play a key role in applying their results. Eight of them said they were constrained because they did not work in the health sector. For some, this was reason enough not to foresee a role for themselves in acting on the study results. “ I am an economist and I work here at the university. We presented to them [involved hospitals] and gave them the report […] How far they took it? It is up to them to use the result or not. ”

Not all investigators shared this idea. Three of the eight, also university-based researchers, saw a role for themselves even though they did not imagine that they would be the prime movers in achieving change. They described a strong motivation to encourage others to use their results for change. One of them explained: “ We did the study so it is logical for us to want to move the findings forward. I am not sure if anyone else would try to move the findings forward .”

Others said that they would not be able to take forward their results because they lacked the required seniority, influence or responsibility. One investigator said that, in Ghanaian culture, he would be considered too young to advise policymakers. Another investigator who was a district director and keen on the use of his findings, nonetheless felt that the results should be used in national policy processes, to which he had limited access and which were going in a different direction than the recommendation of his study.

Who mobilized results to achieve change?

Once the implications of results for action became accepted, people drew upon this accepted knowledge, and were influenced by it, to make real changes in policies and programs (Table  6 ). In 14 of the 20 used studies, one of the user-investigators played a key role in using this knowledge for achieving change. In the other six studies that were used, others, with whom the results had been personally discussed, played a key role in making change happen. In only one case we identified a translation process that happened without any interaction with the investigators, but this occurred more than 2 years after a study ended.

In all our cases, translations required efforts or support from people with a specific formal position, such as a regional health director, a program manager or a working group at the Ministry of Health. These formal positions were described as essential for acquiring support, mobilizing resources and making new knowledge part of concrete policies and practices.

Several investigators described how their position in policy processes became more influential because they were conducting a study. One of them said: “ When you do the study, then they know, it gives you a kind of authority in that area, they listen because you are involved, you have the data .”

In addition, some investigators said that they could scale up the use of their results when they themselves shifted positions, usually through promotions. An example is the district director in the immunization case, who was promoted to regional director during his study, and then transferred to lead a new region: “ When I came to this region, […] I found out that most of the things I saw over there, I am seeing here. I am carrying my luggage with me. Wherever I am going, the data goes with me .”

Interviewees pointed out that formal positions also had their limitations. Their influence was limited to specific subject areas, locations and directions. They also emphasized that trust, reputation, advocacy skills and sheer persistence could be just as important for gaining access to policy arenas, gathering support and mobilizing resources so that results could be turned into action.

The role of structures and dynamics in the context

Translations were not only shaped by actors and the coalitions they build, but also by the evolving world in which processes were embedded. Ideas, budgets, local practices, equipment and infrastructures that played a role in the envisioned change and in concrete actions could not be mobilized at will, but were entangled in a larger world full of existing structures and ongoing dynamics. Ideas were linked to value systems, budgets were part of financing schemes, practices were embedded in a social order, equipment depended on trained health workers and physical infrastructures were shaped by the local landscape. As a result of these entanglements, the structures and dynamics in the larger world enabled some translations and constrained others.

While we focused our analyses on the actions of individuals, in some cases, these structures and dynamics seemed just as important for how translations worked out. An example of a larger dynamic that influenced several translation processes was the design and implementation of the National Health Insurance Scheme. Cases 5 and 6 illustrate how this interacted with research and translation efforts. Case 5 examined the functioning of district level health insurance schemes, while the study in case 6 focused on community based health insurance. The study in case 5 was formulated and executed in relative isolation, with no involvement of potential key-users. Study 6 was led by a district health director, who interacted with potential key-users and was keen on making a contribution. When the national task force, which designed the blueprint for the National Health Insurance Scheme, was considering the role of the districts, some members became very interested in the recommendations from case 5. “ We had just finished the project when the government wanted to adapt the health insurance program. Most of our recommendations were incorporated in what was eventually adopted as national policy .” Despite the intentions and position of the district director, the results from case 6 were neglected by the national task force: “ It has not contributed to national policy because it didn’t fit the current agenda. It should have, and I think it is a prophecy document .”

The aim of our study was to map the contribution of health research to action and examine which features of research and translation processes were associated with the use of the results. All 30 cases in our sample were part of a program of health research which aimed particularly to foster locally led, demand-driven studies in Ghana.

Overall, we found that, in 20 of the 30 assessed research projects, a contribution to action for health could be identified between 6 and 12 months after studies were finalized. It is difficult to compare this use rate with other research programs, since data are sparse. The few studies that have been published tend to focus on a small number of cases, use self-reporting without triangulation, and/or interview a limited number of informants [ 13 , 36 , 37 ]. Perhaps the most similar study to ours was recently conducted in Australia, and used a questionnaire, one interview per case and a panel to assess the “ real world policy and practice impacts ” of 50 intervention studies within 5 years after finalization. In this study, 38% of the cases seemed to have ‘impact’, though this could not always be corroborated [ 15 ]. In our study of 30 cases, for which we interviewed several informants per case, the results of 67% of the studies were used to contribute to action for health within a year.

Our analysis suggests that this relatively high proportion is related to the strategy of the research program, which was designed specifically to enable studies that would be likely to contribute to action. Two aspects in particular seem to have made a difference. The first was the process of priority setting and study selection, which led to the funding of studies that were, from the onset, closely aligned with local health sector priorities, and that therefore posed questions that met the immediate information needs of those who shaped policy in health.

The second, and perhaps most important aspect of the program strategy in terms of the eventual use of research results, was that research had to be initiated and led by Ghanaians and that health sector professionals as well as academics were eligible to initiate studies.

Looking more closely at which features of research were most strongly associated with eventual use of study results, we found that one stood out above all. That was the presence of a single person who initiated the study, remained involved in the process, and was in a position to use the results in their own work. Critically, these user-investigators were likely to formulate ‘need-to-know’ research questions that filled urgently-felt information gaps and took initiatives to use their result. The results of 17 out of 18 of the studies involving user-investigators were translated into action.

The use of the results by the user-investigator was not the only reason why 17 of these 18 studies were used. Studies initiated by potential end-users were also more likely to involve other potential users in the formulation of research as well as in interpreting results and developing recommendations. In three cases, the user-investigators themselves did not have a major role in using study results. It was their ongoing interaction with other ‘external’ potential users that seemed to enable the use of the results.

If none of a study’s investigators was themselves a potential key user, interaction with external potential users seemed critical to the use of results. In one case, involving research in prisons, potential key-users contributed to both the study design and the interpretation of results. In three other cases, potential key-users were not involved until the field work was completed. It was their engagement in the interpretation of study results that appeared to contribute to the translation of research into action.

Our findings are in line with an analysis of research impact in the United Kingdom by Greenhalgh and Fahy [ 38 ] in which the use of research was characterized by an ethical commitment by researchers, strong institutional support and a proactive interdisciplinary approach to impact activities. Our findings contradict attempts to explain the use of research in terms of the characteristics of the results, such as their salience, applicability or validity [ 39 – 41 ]. While results could certainly play a role, we found that the use of research was strongly influenced by those who put forward what the results meant for action. The involvement of potential key users in this process seemed to contribute to developing recommendations and concrete plans that were broadly feasible, taking into account the validity of results, the specifics of the local situations and the aims of those who shaped policies for health.

Our analysis of how translation processes evolved suggests that there were two overall dynamics in the translation of knowledge into action: a first, in which investigators and others put forward stories about what results meant for action, which, after interaction and stabilization, could become part of the repertoire of locally accepted knowledge; and a second dynamic, in which actors drew upon this accepted knowledge, and were influenced by it, to actually effect change. These processes were not linear or isolated, but recursive, and embedded in, and interacting with, ongoing action and dynamics and structures in the context [ 42 ].

This perspective on knowledge translation may be useful to those who study how context influences the use of research, evidence briefs or other knowledge products [ 43 , 44 ]. The actor-scenario perspective suggests that context cannot easily be studied as a set of fixed factors that somehow have effect on the use of research, as different users may put forward very different actor-scenarios, in which the same results play a very different role and very different elements of ‘context’ are mobilized.

While several studies in other countries find that interaction with users enhances the likelihood that research is used, this is the first study to our knowledge in which the relation between what happens throughout research processes, and the use of the results, is systematically analyzed in a substantial number of demand-driven, locally led studies in a lower-income country.

Our findings support those of Walley et al. [ 45 ], who, based upon experiences in China and Pakistan, argued for an approach of “ getting practice into research: to get research into practice ”, especially for operational research in developing countries. An advantage of such an approach is that a problematic gap between researchers who ‘discover’ and policymakers and practitioners who ‘apply’ may not emerge [ 46 ]. Such an approach is perhaps not appropriate for research into new and untried treatments were the efficacy has not been established, but our study shows that it has great application for applied research.

A possible limitation of the focus on potential key users is that the use of results could be constrained by their authority or influence. In our study, we found this not generally to be the case. In part because they were promoted and transferred, and in part because the use of results created a concrete example to others, which helped to spread changes more widely. A potential risk of involving influential users in research processes is that their aims and interests may bias research. While this requires attention, it is important to recognize that researchers themselves have their own aims, interests and perspectives, which may also need to be reflected upon [ 23 ].

Researchers tend to focus on the written texts that they produce and disseminate and which they hope are picked up by others and then translated into action. We observed that results were mostly spread by people who were moving about, personal interaction and through the spread of successful innovations in which results were used. In none of our cases was the dissemination of written texts described as important for the use of results. This can be explained perhaps by the important role of user-investigators and personal interaction, which may have replaced the role of written texts, our selection of interviewees, and our 1-year follow-up, which seems short compared to other studies. Another explanation is that the use of written texts by unknown individuals, at unknown times and places is rather difficult to map, which may lead to an overestimation of the role of interaction [ 7 ].

This study shows both the potential and importance of locally led, demand-driven health research in lower-income countries. The approach of the research program was inspired by the critique in the early nineties that health research contributed little to health and development in poorer countries because it was dominated by foreign scholars instead of locally embedded researchers, and met international rather than local needs. The research program tried to turn this around by fostering research that was driven by local demands and led by local researchers. Our analysis shows the success of this approach in terms of contributing with research to action for health. This finding corresponds with analyses of research programs by others in several other countries [ 47 , 48 ]. Our analysis also shows the importance of local research for improving local action for health. While the studies did not produce major scientific breakthroughs, they often played a key role in improving local action for health, which is remarkable given their small budgets.

Considerations for research policy

The results allow us to formulate some suggestions for those who attempt to support research that more effectively contributes to health in low-income countries and elsewhere.

A first suggestion is to continue promoting national research priority setting, which is becoming increasingly common around the world [ 49 , 50 ]. While priority setting is only a first step, a demand-driven priority agenda can assist researchers in formulating proposals towards local needs and can help funders to select studies that are more likely to be used. A careful and inclusive priority setting process not only helps to orient research to needs, but also provides a platform for interaction, building trust and networking, which are important for the eventual use of research [ 50 – 52 ].

A second suggestion is to stimulate research that is initiated and conducted by those who can play a role in the use of the results. A challenge is that the number of professionals with an influential role in health policy, sufficient research skills and the necessary time for research is likely to be small [ 53 , 54 ]. It may be worth exploring how these user-investigators can best be incentivized and supported in their work, for example, by junior researchers [ 55 ].

The third suggestion is to engage potential key users in research processes from the start, especially in designing research proposals, interpreting results and formulating recommendations. To select potential key users, researchers can try to envision how results may be used and who will play a role in that process (an actor-scenario), and then try to involve those who seem most interested and influential.

While this study shows the advantages of demand-driven research, several cases show that more independent and critical research is also essential for improving global health [ 56 – 59 ]. A risk of a unilateral focus on demand-driven research is that it may take prevailing ideas, power relations and dominant elites as a starting point, and may lead to ignoring questions about what dominant views are based upon, the effects of power relations, and the needs of more marginalized groups [ 25 ].

Limitations

The detailed interviews showed that each case was unique, context-specific and far more nuanced that we have been able to describe in this paper. In order to assess what played a role in whether research was used or not, we have been obliged to reduce a precarious, ongoing and complex process into a snapshot of a limited period and number of actors and actions. The ‘use’ and ‘non-use’ of results, for example, actually covers a wide and dynamic spectrum which is not fully reflected in a binary categorization. Similarly, the roles of individuals in the inherently collaborative process of research did not always fit as neatly into binary categories of ‘user-initiated’ or ‘not user-initiated.’ Our iterative and inclusive research design aimed to minimize the subjectivity of these simplifications. The large number of interviews, openness of participants and the relatively small number of key actors involved in both the research and policy community helped us to examine how processes evolved and to triangulate claims. While some investigators had the initial tendency to under or overestimate the use of their research, the shared exploration of how processes evolved often helped to describe the role that research knowledge had played.

In examining the contribution of health research to action we identified a number of features which have implications for organizations that support research, especially but not exclusively, in low- and middle-income countries. Our study underlines the importance of supporting research that meets locally-expressed needs and that is led by people embedded in the contexts in which results can be used. Supporting the involvement of health sector professionals in the design, conduct and interpretation of research appears to be an especially worthwhile investment.

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Acknowledgements

The team is grateful to Esther Vordzorgbe, Amanua Chinbuah and Mercy Abbey, the HRU team in Accra, and Rene van Veenhuizen. We would also like to thank Clement Amofah, Mandy Thijm, Jitske Both and Isabel Siemelink for their assistance in the data collection processes. We also gratefully acknowledge Jantine Schuit, Roland Bal and Arie Rip for their constructive suggestions to earlier versions of this manuscript, Elizabeth Pisani for her help with editing the final draft, and MvM for her invaluable support. We would like to reserve our final acknowledgement to all those professionals, from research, policy and practice for health, who somehow participated in this study. This work was supported by the SOR programme of the Netherlands National Institute for Public Health and the Environment and the Research Excellence and Innovation grant from Erasmus University.

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JOG was executive director of the HRDP and received a part time salary for this work. JR was co-chair of the Joint Programme Committee of the HRDP. DOA was co-chair of the Joint Programme Committee of the HRDP. IW was a member of the Joint Programme Committee of the HRDP. The remaining authors have no conflicts of interest to declare.

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The idea of conducting this study and writing this paper emerged collectively from the group of authors. MK developed the methods, conducted the empirical analyses together with three assistants and wrote the first draft of the manuscript, on which all authors commented. All authors read and approved the final manuscript.

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Kok, M.O., Gyapong, J.O., Wolffers, I. et al. Which health research gets used and why? An empirical analysis of 30 cases. Health Res Policy Sys 14 , 36 (2016). https://doi.org/10.1186/s12961-016-0107-2

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DOI : https://doi.org/10.1186/s12961-016-0107-2

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Effects of Mindfulness on Psychological Health: A Review of Empirical Studies

Shian-ling keng.

a Department of Psychology and Neuroscience, Duke University, Durham, NC 27708

Moria J. Smoski

b Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710

Clive J. Robins

Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.

Mindfulness is the miracle by which we master and restore ourselves. Consider, for example: a magician who cuts his body into many parts and places each part in a different region—hands in the south, arms in the east, legs in the north, and then by some miraculous power lets forth a cry which reassembles whole every part of his body. Mindfulness is like that—it is the miracle which can call back in a flash our dispersed mind and restore it to wholeness so that we can live each minute of life. Hanh (1976 , p. 14)

Mindfulness has been theoretically and empirically associated with psychological well-being. The elements of mindfulness, namely awareness and nonjudgmental acceptance of one's moment-to-moment experience, are regarded as potentially effective antidotes against common forms of psychological distress—rumination, anxiety, worry, fear, anger, and so on—many of which involve the maladaptive tendencies to avoid, suppress, or over-engage with one's distressing thoughts and emotions ( Hayes & Feldman, 2004 ; Kabat-Zinn, 1990 ). Though promoted for centuries as a part of Buddhist and other spiritual traditions, the application of mindfulness to psychological health in Western medical and mental health contexts is a more recent phenomenon, largely beginning in the 1970s (e.g., Kabat-Zinn, 1982 ). Along with this development, there has been much theoretical and empirical work illustrating the impact of mindfulness on psychological health. The goal of this paper is to offer a comprehensive narrative review of the effects of mindfulness on psychological health. We begin with an overview of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology. We then review evidence from three areas of research that shed light on the relationship between mindfulness and psychological health: 1. correlational, cross-sectional research that examines the relations between individual differences in trait or dispositional mindfulness and other mental-health related traits, 2. intervention research that examines the effects of mindfulness-oriented interventions on psychological functioning, and 3. laboratory-based research that examines, experimentally, the effects of brief mindfulness inductions on emotional and behavioral processes indicative of psychological health. We conclude with an examination of mechanisms of effects of mindfulness interventions and suggestions for future research directions.

The word mindfulness may be used to describe a psychological trait, a practice of cultivating mindfulness (e.g., mindfulness meditation), a mode or state of awareness, or a psychological process ( Germer, Siegel, & Fulton, 2005 ). To minimize possible confusion, we clarify which meaning is intended in each context we describe ( Chambers, Gullone, & Allen, 2009 ). One of the most commonly cited definitions of mindfulness is the awareness that arises through “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” ( Kabat-Zinn, 1994 , p. 4). Descriptions of mindfulness provided by most other researchers are similar. Baer (2003) , for example, defines mindfulness as “the nonjudgmental observation of the ongoing stream of internal and external stimuli as they arise” (p. 125). Though some researchers focus almost exclusively on the attentional aspects of mindfulness (e.g., Brown & Ryan, 2003 ), most follow the model of Bishop et al. (2004) , which proposed that mindfulness encompasses two components: self-regulation of attention, and adoption of a particular orientation towards one's experiences. Self-regulation of attention refers to non-elaborative observation and awareness of sensations, thoughts, or feelings from moment to moment. It requires both the ability to anchor one's attention on what is occurring, and the ability to intentionally switch attention from one aspect of the experience to another. Orientation to experience concerns the kind of attitude that one holds towards one's experience, specifically an attitude of curiosity, openness, and acceptance. It is worth noting that “acceptance” in the context of mindfulness should not be equated with passivity or resignation ( Cardaciotto, Herbert, Forman, Moitra, & Farrow, 2008 ). Rather, acceptance in this context refers to the ability to experience events fully, without resorting to either extreme of excessive preoccupation with, or suppression of, the experience. To sum up, current conceptualizations of mindfulness in clinical psychology point to two primary, essential elements of mindfulness: awareness of one's moment-to-moment experience nonjudgmentally and with acceptance .

As alluded to earlier, mindfulness finds its roots in ancient spiritual traditions, and is most systematically articulated and emphasized in Buddhism, a spiritual tradition that is at least 2550 years old. As the idea and practice of mindfulness has been introduced into Western psychology and medicine, it is not surprising that differences emerge with regard to how mindfulness is conceptualized within Buddhist and Western perspectives. Several researchers (e.g., Chambers, Gullone, & Allen, 2009 ; Rosch, 2007 ) have argued that in order to more fully appreciate the potential contribution of mindfulness in psychological health it is important to gain an understanding of these differences, and specifically, from a Western perspective, how mindfulness is conceptualized in Buddhism. Given the diversity of traditions and teachings within Buddhism, an in-depth exploration of this topic is beyond the scope of this review (for a more extensive discussion of this topic, see Rosch, 2007 ). We offer a preliminary overview of differences in conceptualization of mindfulness in Western usage versus early Buddhist teachings, specifically, those of Theravada Buddhism.

Arguably, Buddhist and Western conceptualizations of mindfulness differ in at least three levels: contextual, process, and content. At the contextual level, mindfulness in the Buddhist tradition is viewed as one factor of an interconnected system of practices that are necessary for attaining liberation from suffering, the ultimate state or end goal prescribed to spiritual practitioners in the tradition. Thus, it needs to be cultivated alongside with other spiritual practices, such as following an ethical lifestyle, in order for one to move toward the goal of liberation. Western conceptualization of mindfulness, on the other hand, is generally independent of any specific circumscribed philosophy, ethical code, or system of practices. At the process level, mindfulness, in the context of Buddhism, is to be practiced against the psychological backdrop of reflecting on and contemplating key aspects of the Buddha's teachings, such as impermanence, non-self, and suffering. As an example, in the Satipatthana Sutta (The Foundation of Mindfulness Discourse), one of the key Buddhist discourses on mindfulness, the Buddha recommended that one maintains mindfulness of one's bodily functions, sensations and feelings, consciousness, and content of consciousness while observing clearly the impermanent nature of these objects. Western practice generally places less emphasis on non-self and impermanence than traditional Buddhist teachings. Finally, at the content level and in relation to the above point, in early Buddhist teachings, mindfulness refers rather specifically to an introspective awareness with regard to one's physical and psychological processes and experiences. This is contrast to certain Western conceptualizations of mindfulness, which view mindfulness as a form of awareness that encompasses all forms of objects in one's internal and external experience, including features of external sensory objects like sights and smells. This is not to say that external sensory objects do not ultimately form part of one's internal experience; rather, in Buddhist teachings, mindfulness more fundamentally has to do with observing one's perception of and reactions toward sensory objects than focusing on features of the sensory objects themselves.

The integration of mindfulness into Western medicine and psychology can be traced back to the growth of Zen Buddhism in America in the 1950s and 1960s, partly through early writings such as Zen in the Art of Archery ( Herrigel, 1953 ) , The World of Zen: An East-West Anthology ( Ross, 1960 ), and The Method of Zen ( Herrigel, Hull, & Tausend, 1960 ). Beginning the 1960s, interest in the use of meditative techniques in psychotherapy began to grow among clinicians, especially psychoanalysts (e.g., see Boss, 1965 ; Fingarette, 1963 ; Suzuki, Fromm, & De Martino, 1960 ; Watts, 1961 ). Through the 1960s and the 1970s, there was growing interest within experimental psychology in examining various means of heightening awareness and broadening the boundaries of consciousness, including meditation. Early electroencephalogram (EEG) studies on meditation found that individuals who meditated showed persistent alpha activity with restful reductions in metabolic rate ( Anand, Chhina, & Singh, 1961 ; Bagchi & Wenger, 1957 ; Wallace, 1970 ), as well as increases in theta waves, which reflect lower states of arousal associated with sleep ( Kasamatsu & Hirai, 1966 ). Beginning in the early 1970s, there was a surge of interest in and research on transcendental meditation, a form of concentrative meditation technique popularized by Maharishi Mahesh Yogi ( Wallace, 1970 ). The practice of transcendental meditation was found to be associated with reductions in indicators of physiological arousal such as oxygen consumption, carbon dioxide elimination, and respiratory rate ( Benson, Rosner, Marzetta, & Klemchuk, 1974 ; Wallace, 1970 ; Wallace, Benson, & Wilson, 1971 ).

Despite the fact that research on mindfulness meditation had already begun in the 1960s, it was not until the late 1970s that mindfulness meditation began to be studied as an intervention to enhance psychological well-being. Application of mindfulness meditation as a form of behavioral intervention for clinical problems began with the work of Jon Kabat-Zinn, which explored the use of mindfulness meditation in treating patients with chronic pain ( Kabat-Zinn, 1982 ), now known popularly as Mindfulness-Based Stress Reduction. Since the establishment of MBSR, several other interventions have also been developed using mindfulness-related principles and practices, including Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002 ), Dialectical Behavior Therapy (DBT; Linehan, 1993a ) and Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999 ). In this review, both meditation-oriented interventions (i.e., MBSR and MBCT), as well as interventions that teach mindfulness using less meditation-oriented techniques (i.e., DBT and ACT), are considered as a family of “mindfulness-oriented interventions”, and thus are of empirical interest.

Correlational Research on Mindfulness and Psychological Health

Relationship between trait mindfulness and psychological health.

Many studies of mindfulness to date have reported on correlations between self-reported mindfulness and psychological health. Such correlations have been reported for samples of undergraduate students (e.g., Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006 ; Brown & Ryan, 2003 ), community adults (e.g., Brown & Ryan, 2003 ; Chadwick et al., 2008 ) and clinical populations (e.g., Baer, Smith, & Allen, 2004 ; Chadwick et al., 2008 ; Walach, Buchheld, Buttenmuller, Kleinknecht, & Schmidt, 2006 ). Before going over these findings, it may be helpful to review questionnaires that have been developed to measure mindfulness. Questionnaires that assess mindfulness as a general, trait-like tendency to be mindful in daily life include: Freiburg Mindfulness Inventory ( Buchheld, Grossman, & Walach, 2001 ), Kentucky Inventory of Mindfulness Skills (KIMS; Baer et al., 2004 ), Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003 ), Five-Facet Mindfulness Questionnaire ( Baer et al., 2006 ), Cognitive Affective Mindfulness Scale-Revised ( Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007 ), Toronto Mindfulness Scale-Trait Version ( Davis, Lau, & Cairns, 2009 ), Philadelphia Mindfulness Scale ( Cardaciotto et al., 2008 ), and Southampton Mindfulness Questionnaire ( Chadwick et al., 2008 ). Some of these questionnaires measure mindfulness as a single-factor construct. For example, the MAAS ( Brown & Ryan, 2003 ) assesses mindfulness as the general tendency to be attentive to and aware of experiences in daily life, and has a single factor structure of open/ receptive awareness and attention. Other questionnaires measure mindfulness as a multi-faceted construct. For example, the KIMS ( Baer et al., 2004 ) contains subscales that correspond to four mindfulness skills conceptualized in DBT's framework: observing one's moment-to-moment experience, describing one's experiences with words, acting or participating with awareness, and nonjudgmental acceptance of one's experiences. In addition to trait measures of mindfulness, state measures of mindfulness have been developed to measure momentary mindful states. These measures include the Toronto Mindfulness Scale ( Lau et al., 2006 ) and Brown and Ryan (2003) 's state version of the MAAS.

Trait mindfulness has been associated with higher levels of life satisfaction ( Brown & Ryan, 2003 ), agreeableness ( Thompson & Waltz, 2007 ), conscientiousness ( Giluk, 2009 ; Thompson & Waltz, 2007 ), vitality ( Brown & Ryan, 2003 ), self esteem ( Brown & Ryan, 2003 ; Rasmussen & Pidgeon, 2010 ), empathy ( Dekeyser, Raes, Leijssen, Leysen, & Dewulf, 2008 ), sense of autonomy ( Brown & Ryan, 2003 ), competence ( Brown & Ryan, 2003 ), optimism ( Brown & Ryan, 2003 ), and pleasant affect ( Brown & Ryan, 2003 ). Studies have also demonstrated significant negative correlations between mindfulness and depression ( Brown & Ryan, 2003 ; Cash & Whittingham, 2010 ), neuroticism ( Dekeyser et al., 2008 ; Giluk, 2009 ), absent-mindedness ( Herndon, 2008 ), dissociation ( Baer et al., 2006 ; Walach et al., 2006 ), rumination ( Raes & Williams, 2010 ), cognitive reactivity ( Raes, Dewulf, Van Heeringen, & Williams, 2009 ), social anxiety ( Brown & Ryan, 2003 ; Dekeyser et al., 2008 ; Rasmussen & Pidgeon, 2010 ), difficulties in emotion regulation ( Baer et al., 2006 ), experiential avoidance ( Baer et al., 2004 ), alexithymia ( Baer et al., 2004 ), intensity of delusional experience in the context of psychosis ( Chadwick et al., 2008 ), and general psychological symptoms ( Baer et al., 2006 ). Research also has begun to explore the association between mindfulness and cognitive processes that may have important implications for psychological health. For example, Frewen, Evans, Maraj, Dozois, and Partridge (2008) found that, among undergraduate students, mindfulness was related both to a lower frequency of negative automatic thoughts and to an enhanced ability to let go of those thoughts. Two other studies have also demonstrated an association between mindfulness and enhanced performance on tasks assessing sustained attention ( Schmertz, Anderson, & Robins, 2009 ) and persistence ( Evans, Baer, & Segerstrom, 2009 ).

Mindfulness has been shown to be related not only to self-report measures of psychological health, but also to differences in brain activity observed using functional neuroimaging methods. Creswell, Way, Eisenberger, and Lieberman (2007) found that trait mindfulness was associated with reduced bilateral amygdala activation and greater widespread prefrontal cortical activation during an affect labeling task. There was also a strong inverse association between prefrontal cortex and right amygdala responses among those who scored high on mindfulness, but not among those who scored low on mindfulness, which suggests that individuals who are mindful may be better able to regulate emotional responses via prefrontal cortical inhibition of the amygdala. Trait mindfulness also was negatively correlated with resting activity in the amygdala and in medial prefrontal and parietal brain areas that are associated with self-referential processing, whereas levels of depressive symptoms were positively correlated with resting activity in these areas ( Way, Creswell, Eisenberger, & Lieberman, 2010 ). These findings are consistent with the association of mindfulness with greater self-reported ability to let go of negative thoughts about the self (e.g., Frewen et al., 2008 ).

Relationship between Mindfulness Meditation and Psychological Health

Research also has examined the relationship between mindfulness meditation practices and psychological well-being. Lykins and Baer (2009) compared meditators and non-meditators on several indices of psychological well-being. Meditators reported significantly higher levels of mindfulness, self-compassion and overall sense of well-being, and significantly lower levels of psychological symptoms, rumination, thought suppression, fear of emotion, and difficulties with emotion regulation, compared to non-meditators, and changes in these variables were linearly associated with extent of meditation practice. In addition, the data were consistent with a model in which trait mindfulness mediates the relationship between extent of meditation practice and several outcome variables, including fear of emotion, rumination, and behavioral self-regulation. In two other studies, facets of trait mindfulness were found to mediate the relationship between meditation experience and psychological well-being in combined samples of meditators and non-meditators ( Baer et al., 2008 ; Josefsson, Larsman, Broberg, & Lundh, 2011 ). In addition to correlations with self-report measures, research has examined behavioral and neurobiological correlates of mindfulness meditation. Ortner, Kilner and Zelazo (2007) used an emotional interference task in which participants categorized tones presented 1 or 4 seconds following the onset of affective or neutral pictures. Levels of emotional interference were indexed by differences in reaction times to tones for affective pictures versus neutral pictures. A participant's mindfulness meditation experience was significantly associated with reduced interference both from unpleasant pictures (for 1 and 4 second delays) as well as pleasant pictures (for 4 second delay only), as well as higher levels of self-reported mindfulness and psychological well-being. These findings suggest that mindfulness meditation practice may enhance psychological well-being by increasing mindfulness and attenuating reactivity to emotional stimuli by facilitating disengagement of attention from stimuli. There is also emerging evidence from studies comparing meditators and non-meditators on a variety of performance-based measures that suggest that regular meditation practice is associated with enhanced cognitive flexibility and attentional functioning ( Hodgins & Adair, 2010 ; Moore & Malinowski, 2009 ), outcomes that may have important implications for psychological well-being. Research has also identified potential neurobiological correlates of mindfulness meditation by comparing brain structure and activity in adept mindfulness meditation practitioners to those of non-practitioners. These studies found that extensive mindfulness meditation experience is associated with increased thickness in brain regions implicated in attention, interoception, and sensory processing, including the prefrontal cortex and right anterior insula ( Lazar et al., 2005 ); increased activation in brain areas involved in processing of distracting events and emotions, which include the rostral anterior cingulate cortex and dorsomedial prefrontal cortex, respectively ( Hölzel et al., 2007 ); and greater gray matter concentration in brain areas that have been found to be active during meditation, including the right anterior insula, left inferior temporal gyrus, and right hippocampus ( Hölzel et al., 2008 ). These findings are consistent with the premise that systematic training in mindfulness meditation induces changes in attention, awareness, and emotion, which can be assessed and identified at subjective, behavioral, and neurobiological levels (cf. Treadway & Lazar, 2009 ).

Overall, evidence from correlational research suggests that mindfulness is positively associated with a variety of indicators of psychological health, such as higher levels of positive affect, life satisfaction, vitality, and adaptive emotion regulation, and lower levels of negative affect and psychopathological symptoms. There is also burgeoning evidence from neurobiological and laboratory behavioral research that indicates the potential roles of trait mindfulness and mindfulness meditation practices in reducing reactivity to emotional stimuli and enhancing psychological well-being. Given the correlational nature of these data, experimental studies are needed to clarify the directional links between mindfulness and psychological well-being. Does training in mindfulness practices result in improvements in psychological well-being? Does psychological well-being facilitate greater mindfulness and/or inclination towards engagement in mindfulness practice? The next section reviews empirical evidence from studies of the effects of mindfulness-oriented interventions on psychological health.

Controlled Studies of Mindfulness-Oriented Interventions

Several mindfulness-oriented interventions have been developed and received much research attention within the past two decades, including MBSR, MBCT, DBT and ACT. Some research on these interventions has been uncontrolled and some has focused primarily on physical health outcomes. In this section, we limit our review to published, peer-reviewed randomized controlled trials (RCTs) that assessed psychological health outcomes in adult populations. Some other promising interventions have also incorporated mindfulness techniques, including mindfulness-based relapse prevention ( Witkiewitz, Marlatt, & Walker, 2005 ) and exposure-based cognitive therapy for depression ( Hayes, Beevers, Feldman, Laurenceau, & Perlman, 2005 ), but no RCTs of those interventions have yet been published.

Mindfulness-Based Stress Reduction (MBSR): Description of Intervention and Review of Controlled Studies

MBSR is a group-based intervention program originally designed as an adjunct treatment for patients with chronic pain ( Kabat-Zinn, 1982 ; 1990 ). The program offers intensive training in mindfulness meditation to help individuals relate to their physical and psychological conditions in more accepting and nonjudgmental ways. The program consists of an eight-to-ten week course, in which a group of up to thirty participants meet for two to two and a half hours per week for mindfulness meditation instruction and training ( Kabat-Zinn, 1990 ). In addition to in-class mindfulness exercises, participants are encouraged to engage in home mindfulness practices and attend an all-day intensive mindfulness meditation retreat. The premise of MBSR is that with repeated training in mindfulness meditation, individuals will eventually learn to be less reactive and judgmental toward their experiences, and more able to recognize, and break free from, habitual and maladaptive patterns of thinking and behavior.

A number of RCTs of MBSR have been conducted among clinical and non-clinical populations, mostly using a waiting-list control design. Early studies were reviewed by Baer (2003) and Grossman, Niemann, Schmidt, and Walach (2004) , but several important studies have since been published. Table 1 summarizes RCTs that have examined the impact of MBSR on psychological functioning. Overall, these studies found that MBSR reduces self-reported levels of anxiety ( Shapiro, Schwartz, & Bonner, 1998 ; Anderson, Lau, Segal, & Bishop, 2007 ), depression ( Anderson et al., 2007 ; Grossman et al., 2010 ; Koszycki, Benger, Shlik, & Bradwejn, 2007 ; Sephton et al., 2007 ; Shapiro et al., 1998 ; Speca, Carlson, Goodey, & Angen, 2000 ), anger ( Anderson et al., 2007 ), rumination ( Anderson et al. 2007 ; Jain et al., 2007 ), general psychological distress, including perceived stress ( Astin, 1997 ; Bränström, Kvillemo, Brandberg, & Moskowitz, 2010 ; Nyklíček, & Kuipers, 2008; Oman, Shapiro, Thoresen, Plante, & Flinders, 2008 ; Shapiro, Astin, Bishop, & Cordova, 2005 ; Speca et al., 2000 ; Williams, Kolar, Reger, & Pearson, 2001 ), cognitive disorganization ( Speca et al., 2000 ), post-traumatic avoidance symptoms ( Bränström et al., 2010 ), and medical symptoms ( Williams et al., 2001 ). It has been found to improve positive affect ( Anderson et al., 2007 ; Bränström et al., 2010 ), Nyklíček, & Kuijpers, 2008), sense of spirituality ( Astin, 1997 ; Shapiro et al., 1998 ), empathy ( Shapiro et al., 1998 ), sense of cohesion ( Weissbecker et al., 2002 ), mindfulness ( Anderson et al., 2007 ; Shapiro, Oman, Thoresen, Plante, & Flinders, 2008 ; Nyklíček, & Kuijpers, 2008), forgiveness ( Oman et al., 2008 ), self compassion ( Shapiro et al., 2005 ), satisfaction with life, and quality of life ( Grossman et al., 2010 ; Koszycki et al., 2007 ; Nyklíček, & Kuijpers,2008; Shapiro et al., 2005 ) among both clinical and non-clinical populations.

NR = Not Reported; NI = No Intervention; WL = Wait-list; SR = Somatic Relaxation; CBGT = Cognitive-Behavioral Group Therapy; mPFC = medial prefrontal cortex; lPFC = lateral prefrontal cortex; UC = Usual Care.

Participation in MBSR has also been associated with brain changes reflective of positive emotional states and adaptive self representation and emotion regulatory processes, such as increases in left frontal activation, which is indicative of dispositional and state positive affect ( Davidson et al., 2003 ), increased activation in brain regions implicated in experiential, present-focused mode of self reference ( Farb et al., 2007 ), and reduced activation in brain regions implicated in conceptual processing, cognitive elaboration, and reappraisal ( Farb et al., 2010 ; Ochsner & Gross, 2008 ).

Mindfulness-Based Cognitive Therapy (MBCT): Description of Intervention and Review of Controlled Studies

MBCT is an eight-week, manualized group intervention program adapted from the MBSR model ( Segal et al., 2002 ). Developed as an approach to prevent relapse in remitted depression, MBCT combines mindfulness training and elements of cognitive therapy (CT) with the goal of targeting vulnerability processes that have been implicated in the maintenance of depressive episodes. Like CT, MBCT aims to help participants view thoughts as mental events rather than as facts, recognize the role of negative automatic thoughts in maintaining depressive symptoms, and disengage the occurrence of negative thoughts from their negative psychological effects ( Barnhofer, Crane, & Didonna, 2009 ). However, unlike the traditional CT approach that places considerable emphasis on evaluating and changing the validity of the content of thoughts and developing alternative thoughts, MBCT aims primarily to change one's awareness of and relationship to thoughts and emotions ( Teasdale et al., 2000 ). The theoretical rationale on which MBCT is based ( Teasdale, Segal, & Williams, 1995 ) is that the negative thoughts that accompany depression become associated with the depressed state, and that, as the number of depressive episodes increases, negative automatic thoughts become more easily reactivated by feelings of dysphoria, even when these do not occur in the context of a full-blown depressive episode. The negative thoughts, in turn, increase depressed mood and other symptoms of depression, leading to an increased risk for relapse to a major depressive episode. MBCT specifically targets loosening the association between negative automatic thinking and dysphoria. Because these associations are theorized to be stronger among those with a greater number of previous episodes, they may be expected to show the greatest benefit of the intervention.

Several RCTs, summarized in Table 2 , have evaluated the effects of MBCT on relapse prevention and other depression-related outcomes (for recent reviews, see Chiesa & Serreti, 2010 ; Coelho, Canter, & Ernst, 2007 ). Consistent with the theoretical model, initial studies found that MBCT reduced relapse rates among patients with three or more episodes of depression, but not among those with two or fewer past episodes ( Ma & Teasdale, 2004 ; Teasdale et al., 2000 ). Subsequent studies of MBCT and depression relapse selected only patients with three or more episodes and have replicated the effect of MBCT on reduced relapse rates ( Goldfrin & Heeringen, 2010 ; Kuyken et al., 2008 ) or prolonged time to relapse ( Bondolfi et al., 2010 ). Furthermore, MBCT also has been found to improve a range of symptomatic and psychosocial outcomes among remitted depressed patients, such as residual depressive symptoms and quality of life ( Goldfrin & Heeringen, 2010 ; Kuyken et al., 2008 ). There is also preliminary evidence that MBCT is more effective than treatment as usual (TAU) in reducing depressive symptoms among currently depressed patients ( Barnhofer et al., 2009 ; Hepburn et al., 2009 ). Lastly, MBCT has been adapted for treatment of bipolar disorder ( Williams et al., 2008 ), social phobia ( Piet, Hougaard, Hecksher, & Rosenberg, 2010 ), and depressive symptoms among individuals with epilepsy ( Thompson et al., 2010 ). The results of these studies are promising and in need of further replication.

NR = Not Reported; NI = No Intervention; WL = Wait-list; TAU = Treatment As Usual; m-ADM = Maintenance Anti-depressant Medication; GCBT = Group Cognitive-Behavioral Therapy.

Dialectical Behavior Therapy (DBT): Description of Intervention and Review of Controlled Studies

DBT ( Linehan, 1993a ) was first developed as a treatment for chronic suicidal and other self-injurious behaviors, which are often present in patients with severe borderline personality disorder (BPD). It conceptualizes the dysfunctional behaviors of individuals with BPD as a consequence of an underlying dysfunction of the emotion regulation system, which involves intense emotional reactivity and an inability to modulate emotions. DBT integrates elements of traditional CBT with Zen philosophy and practice, and has a simultaneous focus on acceptance and behavior change strategies to help patients improve their emotion regulation abilities ( Linehan, 1993a ; Robins, 2002 ). There are four modes of treatment in DBT: individual therapy, group skills training, telephone consultation between therapist and patient, and consultation team meetings for therapists. Mindfulness skills are taught in the context of the skills-training group as a way of helping patients increase self acceptance, and as an exposure strategy aiming to reduce avoidance of difficult emotion and fear responses ( Linehan, 1993b ). These skills consist of a set of mindfulness “what” skills (observe, describe, and participate) and a set of mindfulness “how” skills (nonjudgmentally, one-mindfully, and effectively). Specific exercises that are used to foster mindfulness include visualizing thoughts, feelings, and sensations as if they are clouds passing by in the sky, observing breath by counting or coordinating with footsteps, and bringing mindful awareness into daily activities. Mindfulness skills are also integrated within the other three skills modules, which focus on distress tolerance, emotion regulation, and interpersonal effectiveness.

To date, 11 randomized trials of DBT, or adaptations of it, have been conducted ( Lynch, Trost, Salsman, & Linehan, 2007 ; Robins & Chapman, 2004 ). These studies are summarized in Table 3 . Standard outpatient DBT has been found to be more effective than TAU or another active treatment in reducing frequency and severity of parasuicidal and self harm behavior among individuals with BPD, especially those with a history of parasuicidal behavior; reducing number of inpatient psychiatric days, emergency visits, and hospitalizations ( Koons et al., 2001 ; Linehan, Amstrong, Suarez, Allmon, & Heard, 1991 ; Linehan et al., 2006 ; Verheul et al., 2003 ); and in reducing substance use among individuals with co-morbid BDP and substance use disorders ( Linehan et al., 1999 ; Linehan et al., 2002 ). Among studies that included follow-up assessments, the effects of DBT were found to last for up to one year on the following outcome measures: number of parasuicidal behaviors, global functioning, social adjustment, and use of crisis services ( Linehan et al., 1991 ; Linehan et al., 2006 ; Linehan et al., 1999 ; Linehan, Heard, & Armstrong, 1993 ; Linehan, Tutek, Heard, & Armstrong, 1994 ). Finally, modifications of DBT have been found to be effective in binge eating disorder ( Telch, Agras, and Linehan, 2001 ), bulimia ( Safer, Telch, & Agras, 2001 ), and chronic depression in the elderly ( Lynch, Morse, Mendelson & Robins, 2003 ).

NR = Not Reported; BPD = Borderline Personality Disorder; TAU = Treatment As Usual; BED = Binge Eating Disorder; WL = Waiting List; CVT+12S = Comprehensive Validation Therapy with 12-Step; MED = Antidepressant Medication; CTBE = Community Treatment by Experts.

Acceptance and Commitment Therapy (ACT): Description of Intervention and Review of Controlled Studies

ACT ( Hayes et al., 1999 ) was developed based on the premise that psychological distress is often associated with attempts to control or avoid negative thoughts and emotions, which often paradoxically increase the frequency, intensity, or salience of these internal events, and result in further distress and inability to engage in behaviors that would lead to valued long-term goals. Thus, the central aim of ACT is to create greater psychological flexibility by teaching skills that increase an individual's willingness to come into fuller contact with their experiences, recognize their values, and commit to behaviors that are consistent with those values. There are six core treatment processes that are highlighted in ACT: acceptance, defusion, contact with the present moment, self as context, values, and committed action ( Hayes, Luoma, Bond, Masuda, & Lillis, 2006 ). Mindfulness is taught in the context of the first four processes, where a variety of exercises are used to enhance awareness of an observing self and foster the deliteralization of thoughts and beliefs. Although ACT does not incorporate mindfulness meditation exercises, its focus on helping patients cultivate present-centered awareness and acceptance is consistent with that of other mindfulness-based approaches ( Baer, 2003 ). ACT has been delivered in both individual and group settings, with durations varying from one day (e.g., Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007 ) to 16 weeks (e.g., Hayes et al., 2004 ).

A number of studies, summarized in Table 4 , have been conducted to evaluate the efficacy of ACT in treating a range of mental health outcomes, including those associated with depression, anxiety, impulse control disorders, schizophrenia, substance abuse and addiction, and workplace stress ( Hayes et al., 2006 ; Powers, Zum Vorde Sive Vording, & Emmelkamp, 2009 ). Specifically, ACT has been found to be more effective than TAU in improving affective symptoms, social functioning, and symptom reporting, and lowering rehospitalization rates and symptom believability among psychiatric inpatients with psychotic symptoms ( Bach & Hayes, 2002 ; Gaudiano & Herbert, 2006 ). Among populations with depressive and anxiety symptoms, ACT was generally found to be superior to no intervention, and as effective as another established treatment in reducing levels of depression, anxiety, and poor mental health outcomes ( Bond & Bunce, 2000 ; Forman, Herbert, Moitra, Yeomans, & Geller, 2007 ; Lappalainen et al., 2007 ; Zettle, 2003 ; Zettle & Hayes, 1986 ; Zettle & Rains, 1989 ). In addition, ACT has been shown to be effective at reducing substance use and dependence among nicotine-dependent ( Gifford et al., 2004 ) and polysubstance-abusing individuals ( Hayes et al., 2004 ). Finally, there is preliminary evidence indicating the effectiveness of ACT in treating trichotillomania ( Woods, Wetterneck, & Flessner, 2006 ).

Notes . NR = Not Reported; CT = Cognitive Therapy; CCT = Complete Cognitive Therapy; PCT = Partial Cognitive Therapy; WL = Waitlist; TAU = Treatment As Usual; SD = Systematic Desensitization; NRT = Nicotine Replacement Therapy; MM = Methodone Alone; ITSF = Intensive Twelve Step Facilitation Therapy Plus Methodone Maintenance; ETAU = Enhanced Treatment As Usual.

A growing research body supports the efficacy of all four major forms of mindfulness-oriented interventions, but several important research questions need to be addressed in future studies. Because these interventions all involve multiple components, future research should examine how individual treatment components, especially the mindfulness training component, contribute to overall treatment effects. Also, these interventions differ in how they teach mindful awareness, and future research could compare the efficacy of different mindfulness teaching approaches in fostering greater mindful awareness in daily life. For example, both MBSR and MBCT place considerable emphasis on engaging participants in formal meditative practices. DBT and ACT, on the other hand, incorporate a range of informal mindfulness exercises in their treatment approach. Research attention should also be devoted to possible moderators of treatment effects, such as pre-existing differences in coping style and types of cognitive processes maintaining a particular psychological problem. Finally, research needs to examine whether there is a dose-response relationship between amount of intervention exposure and amount of psychological benefits. Although MBSR in its standard form involves eight weekly 2-2.5 hour classes and an all-day retreat, it has been delivered in abbreviated forms to fit the needs of specific populations. Carmody and Baer (2009) examined class contact hours and effect sizes of psychological outcomes reported in published trials of MBSR, and did not find a systematic relationship between the two variables. Another review ( Vettese, Toneatto, Stea, Nguyen, & Wang, 2009 ) found no consistent relationship between amount of home mindfulness meditation practice and treatment outcomes. Taken together, these reviews do not support a dose-response relationship between level of treatment exposure and reported psychological benefits. Other factors, such as level of expertise of an instructor, may account for the psychological improvements observed following MBSR or other mindfulness-based interventions, and should be systematically measured in future studies.

Laboratory Research on Immediate Effects of Mindfulness Interventions

In addition to correlational and clinical intervention research on mindfulness, a third line of empirical research has examined the immediate effects of brief mindfulness interventions in controlled laboratory settings on a variety of emotion-related processes, including recovery from dysphoric mood, emotional reactivity to aversive or emotionally provocative stimuli, and willingness to return to or persist on an unpleasant task. Such laboratory studies have the advantage of more easily isolating mindfulness practice from other elements typically present in clinical intervention packages, thus allowing greater control over independent variables and stronger conclusions about causal effects.

Several studies have examined the immediate effects of mindfulness interventions on coping with dysphoric mood. Instructions to practice mindfulness of thoughts and feelings following negative mood induction were found to be more effective than rumination or no instruction in alleviating negative mood states in healthy university students ( Broderick, 2005 ), previously depressed individuals ( Singer & Dobson, 2007 ), and currently depressed individuals ( Huffziger & Kuehner, 2009 ), but not in one study of university students ( Kuehner, Huffziger, & Liebsch, 2009 ). As the latter authors noted, these differential findings may result in part from differences in methods used to induce mindfulness across studies (use of mindful self-focus statements on cards in Kuehner et al., 2009 versus audiotaped guided meditation instructions in Broderick, 2005 ), and/or differences in clinical status of study samples (e.g., beneficial effects of mindfulness may be more noticeable among clinical populations than among healthy subjects). It is unsurprising that mindfulness instructions would be more helpful in recovery from sad mood than rumination, which has been shown to be maladaptive ( Nolen-Hoeksema & Morrow, 1991 ). Mindfulness also has been compared with other potentially adaptive mood-regulation strategies. Evidence is mixed with regard to the relative effects of mindfulness and distraction. Whereas two studies ( Huffziger & Kuehner, 2009 ; Singer & Dobson, 2007 ) found that mindfulness and distraction had equivalent effects on recovery from dysphoric mood, one study ( Broderick, 2005 ) found that mindfulness was more effective than distraction and another study ( Kuehner et al., 2009 ) found that distraction was more effective than mindfulness. Further studies are needed to clarify the relative effects of mindfulness and distraction on mood regulation, and whether those effects may be moderated by situational or personality factors. No published studies to date have compared the effects on recovery from dysphoric mood of mindfulness and cognitive reappraisal of distressing stimuli or situations.

Studies have also examined effects of mindfulness instructions on emotional responses to aversive or emotionally provocative stimuli. In a study by Arch and Craske (2006) , university students viewed a series of affectively-valenced pictures and rated their emotional responses to them, both before and after one of three sets of recorded instructions to which they were randomly assigned: focused breathing, unfocused attention, or worry. Whereas the other two groups showed a decrease in positive emotional response to neutral slides from pre-induction to post-induction, those assigned to the focused breathing condition maintained consistently positive responses to neutral slides. They also reported lower negative affect than the worry group in response to post-induction negative-valence slides and greater willingness to view negative slides than those in the unfocused attention condition, as indicated by viewing a greater number of additional optional negative slides. Findings of this study were extended by a recent study by Erisman and Roemer (2010) , which found that a brief mindfulness intervention, relative to a control condition, resulted in reduced emotion regulation difficulties and negative affect in response to an affectively-mixed film clip. Campbell-Sills, Barlow, Brown, and Hofmann (2006) randomly assigned patients with mood and anxiety disorders to instructions to either accept or suppress their emotions while viewing an emotionally provocative film. The two groups reported similar levels of subjective distress while watching the film but, relative to those in the suppression condition, the acceptance group displayed lower heart rate while viewing the film and reported less negative emotion during the post-film recovery period. The findings of these studies suggest that training in two key elements of mindfulness practice (focused awareness and acceptance) may reduce emotional reactivity to negative stimuli and increase willingness to remain in contact with them. There is preliminary work investigating the effects of brief mindfulness instructions on substance-related urges and substance use behavior. Bowen and Marlatt (2009) presented college smokers either brief mindfulness instructions or no instructions before and after exposure to a cue designed to elicit urges to smoke. Although there was no immediate effect on urge to smoke, mindfulness instructions resulted in significant decreases in smoking behavior during the next 7 days. As the authors noted, mindfulness training may alter responses to urges, rather than reducing urges. These findings were extended in another study that compared the effectiveness of using suppression versus a mindfulness-based strategy in coping with cigarette craving among a community sample of smokers ( Rogojanski, Vettese, & Antony, 2011 ). The study found that whereas both strategies reduced self-reported amount of smoking and increased self-efficacy associated with coping with cigarette craving, only those in the mindfulness condition reported significant decreases in negative affect and depressive symptoms and marginal decreases in nicotine dependence.

Research has also examined the efficacy of mindfulness as an emotion regulation strategy in response to a biological challenge, specifically to inhalations of carbon dioxide-enriched air (CO 2 challenge), a procedure that has frequently been used to create a laboratory analog of panic attacks ( Sanderson, Rapee, & Barlow, 1988 ). In a study by Feldner, Zvolensky, Eifert, and Spira (2003) , individuals who scored either high or low on a measure of emotional avoidance were instructed either to mindfully observe and accept or to try to suppress feelings during CO 2 challenge. High emotional avoidance participants reported higher anxiety than low emotional avoidance participants in the suppression condition, but not in the observation condition. Levitt, Brown, Orsillo, and Barlow (2004) randomized patients with panic disorder to one of three experimental conditions: a 10-minute audiotape describing a rationale for either suppressing or accepting one's emotions, or a neutral narrative, and then exposed them to CO 2 challenge. The acceptance group reported significantly lower levels of anxiety during the biological challenge than the other two groups and greater willingness to participate in a second challenge. One coping strategy commonly taught to patients with anxiety disorders, particularly panic disorder, is breathing retraining, in which patients are taught to take deeper, slower breaths. Eifert and Heffner (2003) compared the effects of brief acceptance training, breathing retraining, and no training on responses to CO 2 challenge in undergraduates who scored high on a measure of anxiety sensitivity. Acceptance instructions led to less intense fear, fewer catastrophic thoughts, and lower behavioral avoidance (indicated both by latency between trials and reported willingness to return for another experimental session) than breathing retraining instructions or no instructions. Collectively, these studies suggest that mindful observation and acceptance of emotional responses may be an effective strategy for reducing subjective anxiety and behavioral avoidance in the face of physiological arousal, among highly anxiety sensitive or emotionally avoidant individuals and patients with panic disorder.

Laboratory studies of mindfulness have helped provide further insight into the functions of mindfulness and the potential processes through which mindfulness lead to positive psychological effects. The majority of the findings suggest that brief mindfulness training, whether in the form of a short, guided meditation practice or in the form of instructions to adopt an accepting attitude toward internal experiences, can have an immediate positive effect on recovery from dysphoric mood and level of emotional reactivity to aversive stimuli, consistent with the positive psychological effects reported in research on mindfulness-oriented intervention programs. The laboratory studies also suggest that it does not take extensive prior training in mindfulness to experience some immediate benefits of mindfulness training.

From a methodological standpoint, it is important that future studies more closely examine the extent to which a state of mindfulness is actually manipulated by the study instructions. Whereas most studies did include post-experimental manipulation checks on adherence to the training instructions, they did not explicitly assess the extent to which participants were able to be mindfully aware of their emotions or thoughts during or after exposure to a mood induction or a laboratory stressor. Research also could examine which training approaches or instructions (e.g. mindful breathing or mindfulness of emotions) are most effective at helping individuals regulate emotions in response to a stressor; whether there are key moderator variables such as pre-existing differences in dispositional mindfulness or coping styles; and whether effects differ by type of stressors or across different emotions. Research is also needed to compare the effects and mechanisms of mindfulness instructions with those of other documented emotion regulation strategies, such as cognitive reappraisal and distraction.

Mechanisms of Effects of Mindfulness Interventions

The studies reviewed so far indicate that measures of mindful awareness are related to various indices of psychological health and that mindfulness interventions have a positive impact on psychological health. The next natural question, then, is how this impact comes about. Several psychological processes, some of which may overlap, have been proposed as potential mediators of the beneficial effects of mindfulness interventions, including increases in mindful awareness, reperceiving (also known as decentering, metacognitive awareness, or defusion), exposure, acceptance, attentional control, memory, values clarification, and behavioral self-regulation.

Mindfulness training would be expected to increase scores on measures of mindfulness, and changes in mindfulness would be expected, in turn, to predict clinical outcomes. Research has found that mindfulness training leads to increases in self-reported trait mindfulness, assessed by the MAAS ( Anderson et al., 2007 ; Brown & Ryan, 2003 ; Carmody, Reed, Kristeller and Merriam, 2008 ; Michalak, Heidenreich, Meibert, & Schulte, 2008 ; Shapiro, Brown & Biegel, 2007 ), the CAMS-R ( Greeson et al., in press ) and the FFMQ ( Carmody & Baer, 2008 ; Robins, Keng, Ekblad, & Brantley, 2010 ; Shapiro et al., 2008 ), as well as TMS-assessed state mindfulness ( Carmody et al., 2008 ; Lau et al., 2006 ). Intervention-associated increases in trait mindfulness, assessed by the MAAS, the KIMS, the CAMS-R, and/or the FFMQ, have been shown to predict increases in sense of spirituality ( Carmody et al., 2008 ; Greeson et al., in press ), self-compassion ( Shapiro et al., 2007 ), and positive states of mind ( Bränström et al., 2010 ), and decreases in rumination ( Shapiro et al., 2007 ), trait anxiety ( Shapiro et al., 2007 ), risk of depressive relapse ( Michalak et al., 2008 ), posttraumatic avoidance symptoms ( Bränström et al., 2010 ), perceived stress ( Bränström et al., 2010 ; Shapiro et al., 2007 ), and overall psychological distress ( Carmody et al., 2008 ). A number of studies have also demonstrated that increases in trait mindfulness (again, assessed by the MAAS, the KIMS, and/or the FFMQ) statistically mediated the effects of mindfulness interventions on perceived stress (Nyklíček, & Kuipers, 2008; Shapiro et al., 2008 ), rumination ( Shapiro et al., 2008 ), cognitive reactivity ( Raes et al., 2009 ), quality of life (Nyklíček, & Kuipers, 2008), depressive symptoms ( Kuyken et al., 2010 ; Shahar, Britton, Sbarra, Figueredo, & Bootzin, 2010 ), and behavioral regulation ( Keng, Smoski, Robins, Ekblad, & Brantley, 2010 ). Lastly, one study ( Carmody & Baer, 2008 ) demonstrated that changes in FFMQ-assessed mindfulness at least partially mediated the relationships between amount of formal mindfulness practice and changes in psychological well being, perceived stress, and psychological symptoms.

Mindfulness training also is thought to increase metacognitive awareness, which is the ability to reperceive or decenter from one's thoughts and emotions, and view them as passing mental events rather than to identify with them or believe thoughts to be accurate representations of reality ( Hayes et al., 1999 ; Segal et al., 2002 ; Shapiro, Carlson, Astin, & Freeman, 2006 ). Increased metacognitive awareness has been hypothesized to lead to reductions in rumination ( Teasdale, 1999 ), a process of repetitive negative thinking that has been considered a risk factor for a number of psychological disorders ( Ehring & Watkins, 2008 ). Preliminary evidence suggests that mindfulness training leads to increases in metacognitive awareness ( Hargus et al., 2010 ; Teasdale et al., 2002 ) and reductions in rumination ( Jain et al., 2007 ; Ramel, Goldin, Carmona, & McQuaid, 2004 ), and that increased metacognitive awareness, or decentering, may in turn predict better clinical outcomes such as lower rates of depressive relapses ( Fresco, Segal, Buis, & Kennedy, 2007 ).

Exposure is another process that several authors have suggested may occur during mindfulness practice ( Baer, 2003 ; Kabat-Zinn, 1982 ; Linehan, 1993a ). By intentionally attending to experiences in a nonjudgmental and open manner, an individual may undergo a process of desensitization through which distressing sensations, thoughts and emotions that otherwise would be avoided become less distressing. One study has shown that participation in MBSR is associated with significant pre- to post-intervention increases in exposure ( Carmody, Baer, Lykins, & Olendzki, 2009 ). A closely-related process of change that has been highlighted in the literature is acceptance ( Hayes, 1994 ). Several studies reported that increases in experiential acceptance mediated the effects of ACT on a range of psychological outcomes, including workplace stress ( Bond & Bunce, 2000 ), smoking cessation ( Gifford et al., 2004 ), and functioning difficulties ( Forman et al., 2007 ).

Because mindfulness practices involve sustaining attention on the present-moment experience, as well as switching attention back to the present-moment experience whenever it wanders ( Bishop et al., 2004 ), mindfulness training may improve the ability to control attention, which may, in turn, influence other beneficial psychological outcomes. Several aspects of attention, each related to different neurobiological substrates, may be distinguished ( Posner & Petersen, 1990 ): orienting (the ability to direct attention towards a set of stimuli and sustain attention on it), alerting (the ability to remain vigilant or receptive towards a wide range of potential stimuli), and conflict monitoring (the ability to prioritize attention among competing cognitive demands/tasks). Using a variety of neuropsychological tasks, experimental studies have shown that mindfulness training is associated with improvements in orienting ( Jha, Krompinger, & Baime, 2007 ) and conflict monitoring ( Tang et al., 2007 ). Among experienced meditators, participation in an intensive mindfulness retreat has also been associated with improved alerting ( Jha et al., 2007 ). In addition, mindfulness training has been associated with improvements in sustained attention among both novice meditators ( Chambers, Lo, & Allen, 2008 ) and experienced meditators ( Valentine & Sweet, 1999 ), with one study demonstrating an association between intervention-related improvements in sustained attention and reductions in depressive symptoms ( Chambers et al., 2008 ). Overall, evidence suggests that mindfulness training may affect various subcomponents of attention, and that the specific subsystems affected may depend on the extent of previous meditation experience.

Another mechanism through which mindfulness training may influence psychological well-being is change in memory functioning. Two studies ( Hargus et al., 2010 ; Williams et al., 2000 ) have shown that mindfulness training reduces overgeneral autobiographical memory, a construct that has been associated with increased severity of depression and suicidality ( Kuyken & Brewin, 1995 ). Participation in mindfulness training has also been shown to buffer against decreases in working memory capacity (WMC) during high stress periods, with changes in WMC mediating the relationship between amount of mindfulness practice and reductions in negative affect ( Jha, Stanley, Kiyonaga, Wong, & Gelfand, 2010 ). In addition, brief mindfulness training has been shown to reduce memory for negative stimuli ( Alberts & Thewissen, in press ), a mechanism that may partly underlie the beneficial effects of mindfulness-based interventions on emotion functioning.

Finally, values clarification and improved behavioral self-regulation may be two additional avenues through which mindfulness training improves psychological well-being ( Gratz & Roemer, 2004 ; Shapiro et al., 2006 ). Staying present with thoughts and emotions in an objective, open and nonjudgmental manner may facilitate a greater sense of clarity with regard to one's values, and behaviors that are more consistent with those values. Higher levels of self-reported mindfulness are associated with self-reports of greater engagement in valued behaviors and interests ( Brown & Ryan, 2003 ) and of ability to engage in goal-directed behavior when emotionally upset ( Baer et al., 2006 ). In addition, mindfulness training has been found to lead to self-reported improved behavioral regulation in a nonclinical sample ( Robins et al., 2010 ) and reduced self-discrepancy, which is associated with adaptive self-regulation, among recovered depressed patients with a history of depression and suicidality ( Crane et al., 2008 ). In another study, values clarification was found to mediate partially the relationship between increased mindfulness/ reperceiving and decreased psychological distress in a sample of participants who underwent MBSR ( Carmody et al., 2009 ).

Areas in Need of Further Research

Understanding and quantification of mindfulness.

Because mindfulness is a construct that originates in Buddhism, and has only a brief history in Western psychological science, it is unsurprising that there is considerable challenge in defining, operationalizing, and quantifying it ( Grossman, 2008 ). Although a number of self-report inventories have been developed to assess mindfulness, they vary greatly in content and factor structure, reflecting a lack of agreement on the meaning and nature of mindfulness ( Brown, Ryan, & Creswell, 2007 ). Whereas some researchers consider mindfulness to be a one-dimensional construct referring specifically to paying attention to the present-moment experience (e.g., Brown & Ryan, 2003 ; Carmody, 2009 ), others argue that qualities such as curiosity, acceptance, and compassion are inherent to mindfulness ( Baer & Sauer, 2009 ; Feldman et al., 2007 ; Lau et al., 2006 ). Further collaborative inquiry is needed so that researchers can reach a general agreement on the nature and meaning of mindfulness, or at least clarify and specify which aspects of mindfulness are being addressed in a particular study.

Several issues pertaining to the assessment of mindfulness are also worth highlighting here. First, individual responses to questionnaire items may vary as a function of differential understanding of the questionnaire items ( Grossman, 2008 ), which may depend on the extent of an individual's exposure to the idea or practice of mindfulness. One study demonstrated that the factor structure of the Freiburg Mindfulness Inventory changed within the same group of respondents from just before to just after attending meditation retreats of 3 to 10 days ( Buchheld, Grossman, & Wallach, 2001 ). Further research is clearly needed to improve the construct validity of self-report mindfulness questionnaires, in part via reducing potential variability in item functioning across meditators and non-meditators. A second issue concerns limitations in the use of self-report measures of mindfulness, which rely on the assumption that mindfulness is assessable by declarative knowledge ( Brown et al., 2007 ). It is not known how well self-reports of mindfulness correspond with actual experiences in daily life. To make the matter more complicated, there is an inherent paradox in using frequency of attention lapses as an index of mindfulness because the ability to detect such lapses is contingent upon one's overall level of mindfulness ( Van Dam, Earlywine, & Borders, 2010 ; Van Dam, Earleywine, & Danoff-Burg, 2009 ). One way in which the validity of self-report questionnaires can be improved is by developing performance-based measures of mindfulness against which they can be calibrated, or which can be used in multi-method assessment of the construct ( Garland & Gaylord, 2009 ).

Specificity of Effects of Mindfulness Interventions

Little is yet known regarding for whom and under what conditions mindfulness training is most effective, but there is some preliminary evidence to suggest that its effectiveness may vary as a function of individual differences. Cordon, Brown, and Gibson (2009) found that participation in MBSR resulted in greater reduction in perceived stress for individuals with an insecure attachment style than for securely attached individuals. Another recent study ( Shapiro, Brown, Thoresen, & Plante, 2011 ) showed that trait mindfulness moderated the effects of MBSR. Specifically, compared to controls, participants with higher levels of baseline trait mindfulness demonstrated greater improvements in mindfulness, subjective well-being, empathy, and hope, and larger decreases in perceived stress up to one year post-intervention. MBCT is effective for reducing depressive relapses among remitted depressed patients with a history of three or more depressive episodes, but not among patients with two previous episodes (e.g., Teasdale et al., 2000 ; Ma & Teasdale, 2004 ). In light of these considerations, several researchers have cautioned against the indiscriminate application of mindfulness as a general-purpose, “cure-all” therapeutic technique, and instead advocated for a problem formulation approach in the use of mindfulness techniques for treating psychological conditions ( Kocovski, Segal, Battista, & Didonna, 2009 ; Teasdale, Segal, & Williams, 2003 ). In order to maximize the effectiveness and clinical utility of mindfulness interventions, sufficient attention needs to go into tailoring them to fit the needs of specific populations and psychological conditions. For example, treatment of disorders that primarily involve a deficit in attentional abilities, like attention deficit hyperactivity disorder (ADHD), may require that greater focus be placed on the attentional aspect of mindfulness training. On the other hand, treatment of disorders that tend to involve excessive shame and guilt, such as eating disorders, may benefit from greater treatment emphasis on the acceptance and self compassion aspects of mindfulness. Finally, given that mindfulness training has been increasingly integrated with a variety of psychotherapeutic techniques (e.g., Linehan, 1993a ), it is important that future research examine how mindfulness works alongside these psychotherapeutic techniques.

Other Potential Applications of Mindfulness Interventions

Mindfulness-oriented interventions have been shown to improve psychological health in nonclinical populations and effectively treat a range of psychological and psychosomatic conditions. There may be additional therapeutic applications of mindfulness training. Researchers have reported promising results in pilot trials of mindfulness interventions for attention deficit hyperactivity disorder ( Zylowska et al., 2008 ), bipolar disorder ( Miklowitz et al., 2009 ; Weber et al., 2010 ; Williams et al., 2008 ), panic disorder ( Kim et al., 2010 ), generalized anxiety disorder ( Evans et al., 2008 ; Craigie, Rees, Marsh, & Nathan, 2008 ; Roemer, Orsillo, & Salters-Pedneault, 2008 ), eating disorders ( Baer, Fischer, & Huss, 2005 ; Kristeller & Hallett, 1999 ), psychosis ( Chadwick, Taylor, & Abba, 2005 ), and alcohol and substance use problems ( Bowen et al., 2006 ; Witkiewitz et al., 2005 ). While the data is overall preliminary and requires further validation, the results are promising. Researchers have also begun to investigate the application of mindfulness techniques within specific populations and settings, such as children ( Bogels, Hoogstad, van Dun, de Schutter, & Restifo, 2008 ; Lee, Semple, Rosa, & Miller, 2008 ; Napoli, Krech, & Holley, 2005 ), adolescent psychiatric outpatients ( Biegel, Brown, Shapiro, & Schubert, 2009 ), parents ( Altmaier & Maloney, 2007 ; Bögels et al., 2008 ; Singh et al., 2006 ), school teachers ( Napoli, 2004 ), elderly and their caregivers ( Epstein-Lubow, McBee, Darling, Armey, & Miller, in press ; McBee, 2008 ; Smith, 2004 ), prison inmates ( Bowen et al., 2006 ; Samuelson, Carmody, Kabat-Zinn, & Bratt, 2007 ), and socio-economically disadvantaged individuals ( Hick & Furlotte, 2010 ).

With regard to applications of mindfulness training that have received empirical support, research now needs to examine practical issues surrounding their implementation, delivery, and dissemination. Little is known about their cost effectiveness, nor about the amount and type(s) of training that is required for an individual to be a competent provider of mindfulness training ( Allen, Blashki, & Gullone, 2006 ). Future research should examine these issues as they are critical to the successful implementation and dissemination of mindfulness-oriented interventions.

Based on an examination of empirical literature across multiple methodologies, this review concludes that mindfulness and its cultivation facilitates adaptive psychological functioning. Despite existing methodological limitations within each body of literature, there is a clear convergence of findings from correlational studies, clinical intervention studies, and laboratory-based, experimental studies of mindfulness—all of which suggest that mindfulness is positively associated with psychological health, and that training in mindfulness may bring about positive psychological effects. These effects ranged from increased subjective well-being, reduced psychological symptoms and emotional reactivity, to improved regulation of behavior. There is also an increasingly substantial research body pointing to a number of psychological processes that may serve as key mechanisms of effects of mindfulness interventions. As research on mindfulness is in its early stages of development, further collaborative research is needed to develop a more solid understanding concerning the nature of mindfulness, how mindfulness can best be measured, fostered, and cultivated, and the mechanisms and specificity of effects of mindfulness-oriented interventions. Future research should also continue to explore other potential applications of mindfulness, and examine practical issues concerning the delivery, implementation, and dissemination of mindfulness-oriented interventions. Given the advances that have been made thus far, it is likely that new paradigms for the understanding and application of mindfulness will continue to appear, which would move us further toward the goals of alleviating human psychological suffering and helping others live a life that is happier and more fulfilling.

Acknowledgments

We gratefully acknowledge M. Zachary Rosenthal, Mark Leary, Jeffrey Brantley, and Kathleen Sikkema for their helpful comments on an earlier version of this manuscript.

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Empirical Research: Definition, Methods, Types and Examples

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Empirical research: Definition

Empirical research: origin, quantitative research methods, qualitative research methods, steps for conducting empirical research, empirical research methodology cycle, advantages of empirical research, disadvantages of empirical research, why is there a need for empirical research.

Empirical research is defined as any research where conclusions of the study is strictly drawn from concretely empirical evidence, and therefore “verifiable” evidence.

This empirical evidence can be gathered using quantitative market research and  qualitative market research  methods.

For example: A research is being conducted to find out if listening to happy music in the workplace while working may promote creativity? An experiment is conducted by using a music website survey on a set of audience who are exposed to happy music and another set who are not listening to music at all, and the subjects are then observed. The results derived from such a research will give empirical evidence if it does promote creativity or not.

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You must have heard the quote” I will not believe it unless I see it”. This came from the ancient empiricists, a fundamental understanding that powered the emergence of medieval science during the renaissance period and laid the foundation of modern science, as we know it today. The word itself has its roots in greek. It is derived from the greek word empeirikos which means “experienced”.

In today’s world, the word empirical refers to collection of data using evidence that is collected through observation or experience or by using calibrated scientific instruments. All of the above origins have one thing in common which is dependence of observation and experiments to collect data and test them to come up with conclusions.

LEARN ABOUT: Causal Research

Types and methodologies of empirical research

Empirical research can be conducted and analysed using qualitative or quantitative methods.

• Quantitative research : Quantitative research methods are used to gather information through numerical data. It is used to quantify opinions, behaviors or other defined variables . These are predetermined and are in a more structured format. Some of the commonly used methods are survey, longitudinal studies, polls, etc
• Qualitative research:   Qualitative research methods are used to gather non numerical data.  It is used to find meanings, opinions, or the underlying reasons from its subjects. These methods are unstructured or semi structured. The sample size for such a research is usually small and it is a conversational type of method to provide more insight or in-depth information about the problem Some of the most popular forms of methods are focus groups, experiments, interviews, etc.

Data collected from these will need to be analysed. Empirical evidence can also be analysed either quantitatively and qualitatively. Using this, the researcher can answer empirical questions which have to be clearly defined and answerable with the findings he has got. The type of research design used will vary depending on the field in which it is going to be used. Many of them might choose to do a collective research involving quantitative and qualitative method to better answer questions which cannot be studied in a laboratory setting.

LEARN ABOUT: Qualitative Research Questions and Questionnaires

Quantitative research methods aid in analyzing the empirical evidence gathered. By using these a researcher can find out if his hypothesis is supported or not.

• Survey research: Survey research generally involves a large audience to collect a large amount of data. This is a quantitative method having a predetermined set of closed questions which are pretty easy to answer. Because of the simplicity of such a method, high responses are achieved. It is one of the most commonly used methods for all kinds of research in today’s world.

Previously, surveys were taken face to face only with maybe a recorder. However, with advancement in technology and for ease, new mediums such as emails , or social media have emerged.

For example: Depletion of energy resources is a growing concern and hence there is a need for awareness about renewable energy. According to recent studies, fossil fuels still account for around 80% of energy consumption in the United States. Even though there is a rise in the use of green energy every year, there are certain parameters because of which the general population is still not opting for green energy. In order to understand why, a survey can be conducted to gather opinions of the general population about green energy and the factors that influence their choice of switching to renewable energy. Such a survey can help institutions or governing bodies to promote appropriate awareness and incentive schemes to push the use of greener energy.

Learn more: Renewable Energy Survey Template Descriptive Research vs Correlational Research

• Experimental research: In experimental research , an experiment is set up and a hypothesis is tested by creating a situation in which one of the variable is manipulated. This is also used to check cause and effect. It is tested to see what happens to the independent variable if the other one is removed or altered. The process for such a method is usually proposing a hypothesis, experimenting on it, analyzing the findings and reporting the findings to understand if it supports the theory or not.

For example: A particular product company is trying to find what is the reason for them to not be able to capture the market. So the organisation makes changes in each one of the processes like manufacturing, marketing, sales and operations. Through the experiment they understand that sales training directly impacts the market coverage for their product. If the person is trained well, then the product will have better coverage.

• Correlational research: Correlational research is used to find relation between two set of variables . Regression analysis is generally used to predict outcomes of such a method. It can be positive, negative or neutral correlation.

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For example: Higher educated individuals will get higher paying jobs. This means higher education enables the individual to high paying job and less education will lead to lower paying jobs.

• Longitudinal study: Longitudinal study is used to understand the traits or behavior of a subject under observation after repeatedly testing the subject over a period of time. Data collected from such a method can be qualitative or quantitative in nature.

For example: A research to find out benefits of exercise. The target is asked to exercise everyday for a particular period of time and the results show higher endurance, stamina, and muscle growth. This supports the fact that exercise benefits an individual body.

• Cross sectional: Cross sectional study is an observational type of method, in which a set of audience is observed at a given point in time. In this type, the set of people are chosen in a fashion which depicts similarity in all the variables except the one which is being researched. This type does not enable the researcher to establish a cause and effect relationship as it is not observed for a continuous time period. It is majorly used by healthcare sector or the retail industry.

For example: A medical study to find the prevalence of under-nutrition disorders in kids of a given population. This will involve looking at a wide range of parameters like age, ethnicity, location, incomes  and social backgrounds. If a significant number of kids coming from poor families show under-nutrition disorders, the researcher can further investigate into it. Usually a cross sectional study is followed by a longitudinal study to find out the exact reason.

• Causal-Comparative research : This method is based on comparison. It is mainly used to find out cause-effect relationship between two variables or even multiple variables.

For example: A researcher measured the productivity of employees in a company which gave breaks to the employees during work and compared that to the employees of the company which did not give breaks at all.

LEARN ABOUT: Action Research

Some research questions need to be analysed qualitatively, as quantitative methods are not applicable there. In many cases, in-depth information is needed or a researcher may need to observe a target audience behavior, hence the results needed are in a descriptive analysis form. Qualitative research results will be descriptive rather than predictive. It enables the researcher to build or support theories for future potential quantitative research. In such a situation qualitative research methods are used to derive a conclusion to support the theory or hypothesis being studied.

LEARN ABOUT: Qualitative Interview

• Case study: Case study method is used to find more information through carefully analyzing existing cases. It is very often used for business research or to gather empirical evidence for investigation purpose. It is a method to investigate a problem within its real life context through existing cases. The researcher has to carefully analyse making sure the parameter and variables in the existing case are the same as to the case that is being investigated. Using the findings from the case study, conclusions can be drawn regarding the topic that is being studied.

For example: A report mentioning the solution provided by a company to its client. The challenges they faced during initiation and deployment, the findings of the case and solutions they offered for the problems. Such case studies are used by most companies as it forms an empirical evidence for the company to promote in order to get more business.

• Observational method:   Observational method is a process to observe and gather data from its target. Since it is a qualitative method it is time consuming and very personal. It can be said that observational research method is a part of ethnographic research which is also used to gather empirical evidence. This is usually a qualitative form of research, however in some cases it can be quantitative as well depending on what is being studied.

For example: setting up a research to observe a particular animal in the rain-forests of amazon. Such a research usually take a lot of time as observation has to be done for a set amount of time to study patterns or behavior of the subject. Another example used widely nowadays is to observe people shopping in a mall to figure out buying behavior of consumers.

• One-on-one interview: Such a method is purely qualitative and one of the most widely used. The reason being it enables a researcher get precise meaningful data if the right questions are asked. It is a conversational method where in-depth data can be gathered depending on where the conversation leads.

For example: A one-on-one interview with the finance minister to gather data on financial policies of the country and its implications on the public.

• Focus groups: Focus groups are used when a researcher wants to find answers to why, what and how questions. A small group is generally chosen for such a method and it is not necessary to interact with the group in person. A moderator is generally needed in case the group is being addressed in person. This is widely used by product companies to collect data about their brands and the product.

For example: A mobile phone manufacturer wanting to have a feedback on the dimensions of one of their models which is yet to be launched. Such studies help the company meet the demand of the customer and position their model appropriately in the market.

• Text analysis: Text analysis method is a little new compared to the other types. Such a method is used to analyse social life by going through images or words used by the individual. In today’s world, with social media playing a major part of everyone’s life, such a method enables the research to follow the pattern that relates to his study.

For example: A lot of companies ask for feedback from the customer in detail mentioning how satisfied are they with their customer support team. Such data enables the researcher to take appropriate decisions to make their support team better.

Sometimes a combination of the methods is also needed for some questions that cannot be answered using only one type of method especially when a researcher needs to gain a complete understanding of complex subject matter.

We recently published a blog that talks about examples of qualitative data in education ; why don’t you check it out for more ideas?

Learn More: Data Collection Methods: Types & Examples

Since empirical research is based on observation and capturing experiences, it is important to plan the steps to conduct the experiment and how to analyse it. This will enable the researcher to resolve problems or obstacles which can occur during the experiment.

Step #1: Define the purpose of the research

This is the step where the researcher has to answer questions like what exactly do I want to find out? What is the problem statement? Are there any issues in terms of the availability of knowledge, data, time or resources. Will this research be more beneficial than what it will cost.

Before going ahead, a researcher has to clearly define his purpose for the research and set up a plan to carry out further tasks.

Step #2 : Supporting theories and relevant literature

The researcher needs to find out if there are theories which can be linked to his research problem . He has to figure out if any theory can help him support his findings. All kind of relevant literature will help the researcher to find if there are others who have researched this before, or what are the problems faced during this research. The researcher will also have to set up assumptions and also find out if there is any history regarding his research problem

Step #3: Creation of Hypothesis and measurement

Before beginning the actual research he needs to provide himself a working hypothesis or guess what will be the probable result. Researcher has to set up variables, decide the environment for the research and find out how can he relate between the variables.

Researcher will also need to define the units of measurements, tolerable degree for errors, and find out if the measurement chosen will be acceptable by others.

Step #4: Methodology, research design and data collection

In this step, the researcher has to define a strategy for conducting his research. He has to set up experiments to collect data which will enable him to propose the hypothesis. The researcher will decide whether he will need experimental or non experimental method for conducting the research. The type of research design will vary depending on the field in which the research is being conducted. Last but not the least, the researcher will have to find out parameters that will affect the validity of the research design. Data collection will need to be done by choosing appropriate samples depending on the research question. To carry out the research, he can use one of the many sampling techniques. Once data collection is complete, researcher will have empirical data which needs to be analysed.

LEARN ABOUT: Best Data Collection Tools

Step #5: Data Analysis and result

Data analysis can be done in two ways, qualitatively and quantitatively. Researcher will need to find out what qualitative method or quantitative method will be needed or will he need a combination of both. Depending on the unit of analysis of his data, he will know if his hypothesis is supported or rejected. Analyzing this data is the most important part to support his hypothesis.

Step #6: Conclusion

A report will need to be made with the findings of the research. The researcher can give the theories and literature that support his research. He can make suggestions or recommendations for further research on his topic.

A.D. de Groot, a famous dutch psychologist and a chess expert conducted some of the most notable experiments using chess in the 1940’s. During his study, he came up with a cycle which is consistent and now widely used to conduct empirical research. It consists of 5 phases with each phase being as important as the next one. The empirical cycle captures the process of coming up with hypothesis about how certain subjects work or behave and then testing these hypothesis against empirical data in a systematic and rigorous approach. It can be said that it characterizes the deductive approach to science. Following is the empirical cycle.

• Observation: At this phase an idea is sparked for proposing a hypothesis. During this phase empirical data is gathered using observation. For example: a particular species of flower bloom in a different color only during a specific season.
• Induction: Inductive reasoning is then carried out to form a general conclusion from the data gathered through observation. For example: As stated above it is observed that the species of flower blooms in a different color during a specific season. A researcher may ask a question “does the temperature in the season cause the color change in the flower?” He can assume that is the case, however it is a mere conjecture and hence an experiment needs to be set up to support this hypothesis. So he tags a few set of flowers kept at a different temperature and observes if they still change the color?
• Deduction: This phase helps the researcher to deduce a conclusion out of his experiment. This has to be based on logic and rationality to come up with specific unbiased results.For example: In the experiment, if the tagged flowers in a different temperature environment do not change the color then it can be concluded that temperature plays a role in changing the color of the bloom.
• Testing: This phase involves the researcher to return to empirical methods to put his hypothesis to the test. The researcher now needs to make sense of his data and hence needs to use statistical analysis plans to determine the temperature and bloom color relationship. If the researcher finds out that most flowers bloom a different color when exposed to the certain temperature and the others do not when the temperature is different, he has found support to his hypothesis. Please note this not proof but just a support to his hypothesis.
• Evaluation: This phase is generally forgotten by most but is an important one to keep gaining knowledge. During this phase the researcher puts forth the data he has collected, the support argument and his conclusion. The researcher also states the limitations for the experiment and his hypothesis and suggests tips for others to pick it up and continue a more in-depth research for others in the future. LEARN MORE: Population vs Sample

LEARN MORE: Population vs Sample

There is a reason why empirical research is one of the most widely used method. There are a few advantages associated with it. Following are a few of them.

• It is used to authenticate traditional research through various experiments and observations.
• This research methodology makes the research being conducted more competent and authentic.
• It enables a researcher understand the dynamic changes that can happen and change his strategy accordingly.
• The level of control in such a research is high so the researcher can control multiple variables.
• It plays a vital role in increasing internal validity .

Even though empirical research makes the research more competent and authentic, it does have a few disadvantages. Following are a few of them.

• Such a research needs patience as it can be very time consuming. The researcher has to collect data from multiple sources and the parameters involved are quite a few, which will lead to a time consuming research.
• Most of the time, a researcher will need to conduct research at different locations or in different environments, this can lead to an expensive affair.
• There are a few rules in which experiments can be performed and hence permissions are needed. Many a times, it is very difficult to get certain permissions to carry out different methods of this research.
• Collection of data can be a problem sometimes, as it has to be collected from a variety of sources through different methods.

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Empirical research is important in today’s world because most people believe in something only that they can see, hear or experience. It is used to validate multiple hypothesis and increase human knowledge and continue doing it to keep advancing in various fields.

For example: Pharmaceutical companies use empirical research to try out a specific drug on controlled groups or random groups to study the effect and cause. This way, they prove certain theories they had proposed for the specific drug. Such research is very important as sometimes it can lead to finding a cure for a disease that has existed for many years. It is useful in science and many other fields like history, social sciences, business, etc.

LEARN ABOUT: 12 Best Tools for Researchers

With the advancement in today’s world, empirical research has become critical and a norm in many fields to support their hypothesis and gain more knowledge. The methods mentioned above are very useful for carrying out such research. However, a number of new methods will keep coming up as the nature of new investigative questions keeps getting unique or changing.

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What is Empirical Research? Definition, Methods, Examples

Appinio Research · 09.02.2024 · 36min read

Ever wondered how we gather the facts, unveil hidden truths, and make informed decisions in a world filled with questions? Empirical research holds the key.

In this guide, we'll delve deep into the art and science of empirical research, unraveling its methods, mysteries, and manifold applications. From defining the core principles to mastering data analysis and reporting findings, we're here to equip you with the knowledge and tools to navigate the empirical landscape.

What is Empirical Research?

Empirical research is the cornerstone of scientific inquiry, providing a systematic and structured approach to investigating the world around us. It is the process of gathering and analyzing empirical or observable data to test hypotheses, answer research questions, or gain insights into various phenomena. This form of research relies on evidence derived from direct observation or experimentation, allowing researchers to draw conclusions based on real-world data rather than purely theoretical or speculative reasoning.

Characteristics of Empirical Research

Empirical research is characterized by several key features:

• Observation and Measurement : It involves the systematic observation or measurement of variables, events, or behaviors.
• Data Collection : Researchers collect data through various methods, such as surveys, experiments, observations, or interviews.
• Testable Hypotheses : Empirical research often starts with testable hypotheses that are evaluated using collected data.
• Quantitative or Qualitative Data : Data can be quantitative (numerical) or qualitative (non-numerical), depending on the research design.
• Statistical Analysis : Quantitative data often undergo statistical analysis to determine patterns , relationships, or significance.
• Objectivity and Replicability : Empirical research strives for objectivity, minimizing researcher bias . It should be replicable, allowing other researchers to conduct the same study to verify results.
• Conclusions and Generalizations : Empirical research generates findings based on data and aims to make generalizations about larger populations or phenomena.

Importance of Empirical Research

Empirical research plays a pivotal role in advancing knowledge across various disciplines. Its importance extends to academia, industry, and society as a whole. Here are several reasons why empirical research is essential:

• Evidence-Based Knowledge : Empirical research provides a solid foundation of evidence-based knowledge. It enables us to test hypotheses, confirm or refute theories, and build a robust understanding of the world.
• Scientific Progress : In the scientific community, empirical research fuels progress by expanding the boundaries of existing knowledge. It contributes to the development of theories and the formulation of new research questions.
• Problem Solving : Empirical research is instrumental in addressing real-world problems and challenges. It offers insights and data-driven solutions to complex issues in fields like healthcare, economics, and environmental science.
• Informed Decision-Making : In policymaking, business, and healthcare, empirical research informs decision-makers by providing data-driven insights. It guides strategies, investments, and policies for optimal outcomes.
• Quality Assurance : Empirical research is essential for quality assurance and validation in various industries, including pharmaceuticals, manufacturing, and technology. It ensures that products and processes meet established standards.
• Continuous Improvement : Businesses and organizations use empirical research to evaluate performance, customer satisfaction , and product effectiveness. This data-driven approach fosters continuous improvement and innovation.
• Human Advancement : Empirical research in fields like medicine and psychology contributes to the betterment of human health and well-being. It leads to medical breakthroughs, improved therapies, and enhanced psychological interventions.
• Critical Thinking and Problem Solving : Engaging in empirical research fosters critical thinking skills, problem-solving abilities, and a deep appreciation for evidence-based decision-making.

Empirical research empowers us to explore, understand, and improve the world around us. It forms the bedrock of scientific inquiry and drives progress in countless domains, shaping our understanding of both the natural and social sciences.

How to Conduct Empirical Research?

So, you've decided to dive into the world of empirical research. Let's begin by exploring the crucial steps involved in getting started with your research project.

1. Select a Research Topic

Selecting the right research topic is the cornerstone of a successful empirical study. It's essential to choose a topic that not only piques your interest but also aligns with your research goals and objectives. Here's how to go about it:

• Identify Your Interests : Start by reflecting on your passions and interests. What topics fascinate you the most? Your enthusiasm will be your driving force throughout the research process.
• Brainstorm Ideas : Engage in brainstorming sessions to generate potential research topics. Consider the questions you've always wanted to answer or the issues that intrigue you.
• Relevance and Significance : Assess the relevance and significance of your chosen topic. Does it contribute to existing knowledge? Is it a pressing issue in your field of study or the broader community?
• Feasibility : Evaluate the feasibility of your research topic. Do you have access to the necessary resources, data, and participants (if applicable)?

2. Formulate Research Questions

Once you've narrowed down your research topic, the next step is to formulate clear and precise research questions . These questions will guide your entire research process and shape your study's direction. To create effective research questions:

• Specificity : Ensure that your research questions are specific and focused. Vague or overly broad questions can lead to inconclusive results.
• Relevance : Your research questions should directly relate to your chosen topic. They should address gaps in knowledge or contribute to solving a particular problem.
• Testability : Ensure that your questions are testable through empirical methods. You should be able to gather data and analyze it to answer these questions.
• Avoid Bias : Craft your questions in a way that avoids leading or biased language. Maintain neutrality to uphold the integrity of your research.

3. Review Existing Literature

Before you embark on your empirical research journey, it's essential to immerse yourself in the existing body of literature related to your chosen topic. This step, often referred to as a literature review, serves several purposes:

• Contextualization : Understand the historical context and current state of research in your field. What have previous studies found, and what questions remain unanswered?
• Identifying Gaps : Identify gaps or areas where existing research falls short. These gaps will help you formulate meaningful research questions and hypotheses.
• Theory Development : If your study is theoretical, consider how existing theories apply to your topic. If it's empirical, understand how previous studies have approached data collection and analysis.
• Methodological Insights : Learn from the methodologies employed in previous research. What methods were successful, and what challenges did researchers face?

4. Define Variables

Variables are fundamental components of empirical research. They are the factors or characteristics that can change or be manipulated during your study. Properly defining and categorizing variables is crucial for the clarity and validity of your research. Here's what you need to know:

• Independent Variables : These are the variables that you, as the researcher, manipulate or control. They are the "cause" in cause-and-effect relationships.
• Dependent Variables : Dependent variables are the outcomes or responses that you measure or observe. They are the "effect" influenced by changes in independent variables.
• Operational Definitions : To ensure consistency and clarity, provide operational definitions for your variables. Specify how you will measure or manipulate each variable.
• Control Variables : In some studies, controlling for other variables that may influence your dependent variable is essential. These are known as control variables.

Understanding these foundational aspects of empirical research will set a solid foundation for the rest of your journey. Now that you've grasped the essentials of getting started, let's delve deeper into the intricacies of research design.

Empirical Research Design

Now that you've selected your research topic, formulated research questions, and defined your variables, it's time to delve into the heart of your empirical research journey – research design . This pivotal step determines how you will collect data and what methods you'll employ to answer your research questions. Let's explore the various facets of research design in detail.

Types of Empirical Research

Empirical research can take on several forms, each with its own unique approach and methodologies. Understanding the different types of empirical research will help you choose the most suitable design for your study. Here are some common types:

• Experimental Research : In this type, researchers manipulate one or more independent variables to observe their impact on dependent variables. It's highly controlled and often conducted in a laboratory setting.
• Observational Research : Observational research involves the systematic observation of subjects or phenomena without intervention. Researchers are passive observers, documenting behaviors, events, or patterns.
• Survey Research : Surveys are used to collect data through structured questionnaires or interviews. This method is efficient for gathering information from a large number of participants.
• Case Study Research : Case studies focus on in-depth exploration of one or a few cases. Researchers gather detailed information through various sources such as interviews, documents, and observations.
• Qualitative Research : Qualitative research aims to understand behaviors, experiences, and opinions in depth. It often involves open-ended questions, interviews, and thematic analysis.
• Quantitative Research : Quantitative research collects numerical data and relies on statistical analysis to draw conclusions. It involves structured questionnaires, experiments, and surveys.

Your choice of research type should align with your research questions and objectives. Experimental research, for example, is ideal for testing cause-and-effect relationships, while qualitative research is more suitable for exploring complex phenomena.

Experimental Design

Experimental research is a systematic approach to studying causal relationships. It's characterized by the manipulation of one or more independent variables while controlling for other factors. Here are some key aspects of experimental design:

• Control and Experimental Groups : Participants are randomly assigned to either a control group or an experimental group. The independent variable is manipulated for the experimental group but not for the control group.
• Randomization : Randomization is crucial to eliminate bias in group assignment. It ensures that each participant has an equal chance of being in either group.
• Hypothesis Testing : Experimental research often involves hypothesis testing. Researchers formulate hypotheses about the expected effects of the independent variable and use statistical analysis to test these hypotheses.

Observational Design

Observational research entails careful and systematic observation of subjects or phenomena. It's advantageous when you want to understand natural behaviors or events. Key aspects of observational design include:

• Participant Observation : Researchers immerse themselves in the environment they are studying. They become part of the group being observed, allowing for a deep understanding of behaviors.
• Non-Participant Observation : In non-participant observation, researchers remain separate from the subjects. They observe and document behaviors without direct involvement.
• Data Collection Methods : Observational research can involve various data collection methods, such as field notes, video recordings, photographs, or coding of observed behaviors.

Survey Design

Surveys are a popular choice for collecting data from a large number of participants. Effective survey design is essential to ensure the validity and reliability of your data. Consider the following:

• Questionnaire Design : Create clear and concise questions that are easy for participants to understand. Avoid leading or biased questions.
• Sampling Methods : Decide on the appropriate sampling method for your study, whether it's random, stratified, or convenience sampling.
• Data Collection Tools : Choose the right tools for data collection, whether it's paper surveys, online questionnaires, or face-to-face interviews.

Case Study Design

Case studies are an in-depth exploration of one or a few cases to gain a deep understanding of a particular phenomenon. Key aspects of case study design include:

• Single Case vs. Multiple Case Studies : Decide whether you'll focus on a single case or multiple cases. Single case studies are intensive and allow for detailed examination, while multiple case studies provide comparative insights.
• Data Collection Methods : Gather data through interviews, observations, document analysis, or a combination of these methods.

Qualitative vs. Quantitative Research

In empirical research, you'll often encounter the distinction between qualitative and quantitative research . Here's a closer look at these two approaches:

• Qualitative Research : Qualitative research seeks an in-depth understanding of human behavior, experiences, and perspectives. It involves open-ended questions, interviews, and the analysis of textual or narrative data. Qualitative research is exploratory and often used when the research question is complex and requires a nuanced understanding.
• Quantitative Research : Quantitative research collects numerical data and employs statistical analysis to draw conclusions. It involves structured questionnaires, experiments, and surveys. Quantitative research is ideal for testing hypotheses and establishing cause-and-effect relationships.

Understanding the various research design options is crucial in determining the most appropriate approach for your study. Your choice should align with your research questions, objectives, and the nature of the phenomenon you're investigating.

Data Collection for Empirical Research

Now that you've established your research design, it's time to roll up your sleeves and collect the data that will fuel your empirical research. Effective data collection is essential for obtaining accurate and reliable results.

Sampling Methods

Sampling methods are critical in empirical research, as they determine the subset of individuals or elements from your target population that you will study. Here are some standard sampling methods:

• Random Sampling : Random sampling ensures that every member of the population has an equal chance of being selected. It minimizes bias and is often used in quantitative research.
• Stratified Sampling : Stratified sampling involves dividing the population into subgroups or strata based on specific characteristics (e.g., age, gender, location). Samples are then randomly selected from each stratum, ensuring representation of all subgroups.
• Convenience Sampling : Convenience sampling involves selecting participants who are readily available or easily accessible. While it's convenient, it may introduce bias and limit the generalizability of results.
• Snowball Sampling : Snowball sampling is instrumental when studying hard-to-reach or hidden populations. One participant leads you to another, creating a "snowball" effect. This method is common in qualitative research.
• Purposive Sampling : In purposive sampling, researchers deliberately select participants who meet specific criteria relevant to their research questions. It's often used in qualitative studies to gather in-depth information.

The choice of sampling method depends on the nature of your research, available resources, and the degree of precision required. It's crucial to carefully consider your sampling strategy to ensure that your sample accurately represents your target population.

Data Collection Instruments

Data collection instruments are the tools you use to gather information from your participants or sources. These instruments should be designed to capture the data you need accurately. Here are some popular data collection instruments:

• Questionnaires : Questionnaires consist of structured questions with predefined response options. When designing questionnaires, consider the clarity of questions, the order of questions, and the response format (e.g., Likert scale , multiple-choice).
• Interviews : Interviews involve direct communication between the researcher and participants. They can be structured (with predetermined questions) or unstructured (open-ended). Effective interviews require active listening and probing for deeper insights.
• Observations : Observations entail systematically and objectively recording behaviors, events, or phenomena. Researchers must establish clear criteria for what to observe, how to record observations, and when to observe.
• Surveys : Surveys are a common data collection instrument for quantitative research. They can be administered through various means, including online surveys, paper surveys, and telephone surveys.
• Documents and Archives : In some cases, data may be collected from existing documents, records, or archives. Ensure that the sources are reliable, relevant, and properly documented.

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Data Collection Procedures

Data collection procedures outline the step-by-step process for gathering data. These procedures should be meticulously planned and executed to maintain the integrity of your research.

• Training : If you have a research team, ensure that they are trained in data collection methods and protocols. Consistency in data collection is crucial.
• Pilot Testing : Before launching your data collection, conduct a pilot test with a small group to identify any potential problems with your instruments or procedures. Make necessary adjustments based on feedback.
• Data Recording : Establish a systematic method for recording data. This may include timestamps, codes, or identifiers for each data point.
• Data Security : Safeguard the confidentiality and security of collected data. Ensure that only authorized individuals have access to the data.
• Data Storage : Properly organize and store your data in a secure location, whether in physical or digital form. Back up data to prevent loss.

Ethical Considerations

Ethical considerations are paramount in empirical research, as they ensure the well-being and rights of participants are protected.

• Informed Consent : Obtain informed consent from participants, providing clear information about the research purpose, procedures, risks, and their right to withdraw at any time.
• Privacy and Confidentiality : Protect the privacy and confidentiality of participants. Ensure that data is anonymized and sensitive information is kept confidential.
• Beneficence : Ensure that your research benefits participants and society while minimizing harm. Consider the potential risks and benefits of your study.
• Honesty and Integrity : Conduct research with honesty and integrity. Report findings accurately and transparently, even if they are not what you expected.
• Respect for Participants : Treat participants with respect, dignity, and sensitivity to cultural differences. Avoid any form of coercion or manipulation.
• Institutional Review Board (IRB) : If required, seek approval from an IRB or ethics committee before conducting your research, particularly when working with human participants.

Adhering to ethical guidelines is not only essential for the ethical conduct of research but also crucial for the credibility and validity of your study. Ethical research practices build trust between researchers and participants and contribute to the advancement of knowledge with integrity.

With a solid understanding of data collection, including sampling methods, instruments, procedures, and ethical considerations, you are now well-equipped to gather the data needed to answer your research questions.

Empirical Research Data Analysis

Now comes the exciting phase of data analysis, where the raw data you've diligently collected starts to yield insights and answers to your research questions. We will explore the various aspects of data analysis, from preparing your data to drawing meaningful conclusions through statistics and visualization.

Data Preparation

Data preparation is the crucial first step in data analysis. It involves cleaning, organizing, and transforming your raw data into a format that is ready for analysis. Effective data preparation ensures the accuracy and reliability of your results.

• Data Cleaning : Identify and rectify errors, missing values, and inconsistencies in your dataset. This may involve correcting typos, removing outliers, and imputing missing data.
• Data Coding : Assign numerical values or codes to categorical variables to make them suitable for statistical analysis. For example, converting "Yes" and "No" to 1 and 0.
• Data Transformation : Transform variables as needed to meet the assumptions of the statistical tests you plan to use. Common transformations include logarithmic or square root transformations.
• Data Integration : If your data comes from multiple sources, integrate it into a unified dataset, ensuring that variables match and align.
• Data Documentation : Maintain clear documentation of all data preparation steps, as well as the rationale behind each decision. This transparency is essential for replicability.

Effective data preparation lays the foundation for accurate and meaningful analysis. It allows you to trust the results that will follow in the subsequent stages.

Descriptive Statistics

Descriptive statistics help you summarize and make sense of your data by providing a clear overview of its key characteristics. These statistics are essential for understanding the central tendencies, variability, and distribution of your variables. Descriptive statistics include:

• Measures of Central Tendency : These include the mean (average), median (middle value), and mode (most frequent value). They help you understand the typical or central value of your data.
• Measures of Dispersion : Measures like the range, variance, and standard deviation provide insights into the spread or variability of your data points.
• Frequency Distributions : Creating frequency distributions or histograms allows you to visualize the distribution of your data across different values or categories.

Descriptive statistics provide the initial insights needed to understand your data's basic characteristics, which can inform further analysis.

Inferential Statistics

Inferential statistics take your analysis to the next level by allowing you to make inferences or predictions about a larger population based on your sample data. These methods help you test hypotheses and draw meaningful conclusions. Key concepts in inferential statistics include:

• Hypothesis Testing : Hypothesis tests (e.g., t-tests , chi-squared tests ) help you determine whether observed differences or associations in your data are statistically significant or occurred by chance.
• Confidence Intervals : Confidence intervals provide a range within which population parameters (e.g., population mean) are likely to fall based on your sample data.
• Regression Analysis : Regression models (linear, logistic, etc.) help you explore relationships between variables and make predictions.
• Analysis of Variance (ANOVA) : ANOVA tests are used to compare means between multiple groups, allowing you to assess whether differences are statistically significant.

Chi-Square Calculator :

t-Test Calculator :

One-way ANOVA Calculator :

Inferential statistics are powerful tools for drawing conclusions from your data and assessing the generalizability of your findings to the broader population.

Qualitative Data Analysis

Qualitative data analysis is employed when working with non-numerical data, such as text, interviews, or open-ended survey responses. It focuses on understanding the underlying themes, patterns, and meanings within qualitative data. Qualitative analysis techniques include:

• Thematic Analysis : Identifying and analyzing recurring themes or patterns within textual data.
• Content Analysis : Categorizing and coding qualitative data to extract meaningful insights.
• Grounded Theory : Developing theories or frameworks based on emergent themes from the data.
• Narrative Analysis : Examining the structure and content of narratives to uncover meaning.

Qualitative data analysis provides a rich and nuanced understanding of complex phenomena and human experiences.

Data Visualization

Data visualization is the art of representing data graphically to make complex information more understandable and accessible. Effective data visualization can reveal patterns, trends, and outliers in your data. Common types of data visualization include:

• Bar Charts and Histograms : Used to display the distribution of categorical data or discrete data .
• Line Charts : Ideal for showing trends and changes in data over time.
• Scatter Plots : Visualize relationships and correlations between two variables.
• Pie Charts : Display the composition of a whole in terms of its parts.
• Heatmaps : Depict patterns and relationships in multidimensional data through color-coding.
• Box Plots : Provide a summary of the data distribution, including outliers.
• Interactive Dashboards : Create dynamic visualizations that allow users to explore data interactively.

Data visualization not only enhances your understanding of the data but also serves as a powerful communication tool to convey your findings to others.

As you embark on the data analysis phase of your empirical research, remember that the specific methods and techniques you choose will depend on your research questions, data type, and objectives. Effective data analysis transforms raw data into valuable insights, bringing you closer to the answers you seek.

How to Report Empirical Research Results?

At this stage, you get to share your empirical research findings with the world. Effective reporting and presentation of your results are crucial for communicating your research's impact and insights.

1. Write the Research Paper

Writing a research paper is the culmination of your empirical research journey. It's where you synthesize your findings, provide context, and contribute to the body of knowledge in your field.

• Title and Abstract : Craft a clear and concise title that reflects your research's essence. The abstract should provide a brief summary of your research objectives, methods, findings, and implications.
• Introduction : In the introduction, introduce your research topic, state your research questions or hypotheses, and explain the significance of your study. Provide context by discussing relevant literature.
• Methods : Describe your research design, data collection methods, and sampling procedures. Be precise and transparent, allowing readers to understand how you conducted your study.
• Results : Present your findings in a clear and organized manner. Use tables, graphs, and statistical analyses to support your results. Avoid interpreting your findings in this section; focus on the presentation of raw data.
• Discussion : Interpret your findings and discuss their implications. Relate your results to your research questions and the existing literature. Address any limitations of your study and suggest avenues for future research.
• Conclusion : Summarize the key points of your research and its significance. Restate your main findings and their implications.
• References : Cite all sources used in your research following a specific citation style (e.g., APA, MLA, Chicago). Ensure accuracy and consistency in your citations.
• Appendices : Include any supplementary material, such as questionnaires, data coding sheets, or additional analyses, in the appendices.

Writing a research paper is a skill that improves with practice. Ensure clarity, coherence, and conciseness in your writing to make your research accessible to a broader audience.

2. Create Visuals and Tables

Visuals and tables are powerful tools for presenting complex data in an accessible and understandable manner.

• Clarity : Ensure that your visuals and tables are clear and easy to interpret. Use descriptive titles and labels.
• Consistency : Maintain consistency in formatting, such as font size and style, across all visuals and tables.
• Appropriateness : Choose the most suitable visual representation for your data. Bar charts, line graphs, and scatter plots work well for different types of data.
• Simplicity : Avoid clutter and unnecessary details. Focus on conveying the main points.
• Accessibility : Make sure your visuals and tables are accessible to a broad audience, including those with visual impairments.
• Captions : Include informative captions that explain the significance of each visual or table.

Compelling visuals and tables enhance the reader's understanding of your research and can be the key to conveying complex information efficiently.

3. Interpret Findings

Interpreting your findings is where you bridge the gap between data and meaning. It's your opportunity to provide context, discuss implications, and offer insights. When interpreting your findings:

• Relate to Research Questions : Discuss how your findings directly address your research questions or hypotheses.
• Compare with Literature : Analyze how your results align with or deviate from previous research in your field. What insights can you draw from these comparisons?
• Discuss Limitations : Be transparent about the limitations of your study. Address any constraints, biases, or potential sources of error.
• Practical Implications : Explore the real-world implications of your findings. How can they be applied or inform decision-making?
• Future Research Directions : Suggest areas for future research based on the gaps or unanswered questions that emerged from your study.

Interpreting findings goes beyond simply presenting data; it's about weaving a narrative that helps readers grasp the significance of your research in the broader context.

With your research paper written, structured, and enriched with visuals, and your findings expertly interpreted, you are now prepared to communicate your research effectively. Sharing your insights and contributing to the body of knowledge in your field is a significant accomplishment in empirical research.

Examples of Empirical Research

To solidify your understanding of empirical research, let's delve into some real-world examples across different fields. These examples will illustrate how empirical research is applied to gather data, analyze findings, and draw conclusions.

Social Sciences

In the realm of social sciences, consider a sociological study exploring the impact of socioeconomic status on educational attainment. Researchers gather data from a diverse group of individuals, including their family backgrounds, income levels, and academic achievements.

Through statistical analysis, they can identify correlations and trends, revealing whether individuals from lower socioeconomic backgrounds are less likely to attain higher levels of education. This empirical research helps shed light on societal inequalities and informs policymakers on potential interventions to address disparities in educational access.

Environmental Science

Environmental scientists often employ empirical research to assess the effects of environmental changes. For instance, researchers studying the impact of climate change on wildlife might collect data on animal populations, weather patterns, and habitat conditions over an extended period.

By analyzing this empirical data, they can identify correlations between climate fluctuations and changes in wildlife behavior, migration patterns, or population sizes. This empirical research is crucial for understanding the ecological consequences of climate change and informing conservation efforts.

Business and Economics

In the business world, empirical research is essential for making data-driven decisions. Consider a market research study conducted by a business seeking to launch a new product. They collect data through surveys , focus groups , and consumer behavior analysis.

By examining this empirical data, the company can gauge consumer preferences, demand, and potential market size. Empirical research in business helps guide product development, pricing strategies, and marketing campaigns, increasing the likelihood of a successful product launch.

Psychological studies frequently rely on empirical research to understand human behavior and cognition. For instance, a psychologist interested in examining the impact of stress on memory might design an experiment. Participants are exposed to stress-inducing situations, and their memory performance is assessed through various tasks.

By analyzing the data collected, the psychologist can determine whether stress has a significant effect on memory recall. This empirical research contributes to our understanding of the complex interplay between psychological factors and cognitive processes.

These examples highlight the versatility and applicability of empirical research across diverse fields. Whether in medicine, social sciences, environmental science, business, or psychology, empirical research serves as a fundamental tool for gaining insights, testing hypotheses, and driving advancements in knowledge and practice.

Conclusion for Empirical Research

Empirical research is a powerful tool for gaining insights, testing hypotheses, and making informed decisions. By following the steps outlined in this guide, you've learned how to select research topics, collect data, analyze findings, and effectively communicate your research to the world. Remember, empirical research is a journey of discovery, and each step you take brings you closer to a deeper understanding of the world around you. Whether you're a scientist, a student, or someone curious about the process, the principles of empirical research empower you to explore, learn, and contribute to the ever-expanding realm of knowledge.

How to Collect Data for Empirical Research?

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What is Convenience Sampling? Definition, Method, Examples

• Open access
• Published: 02 September 2024

Ecological care in nursing practice: a Walker and Avant concept analysis

• Golshan Moghbeli 1 ,
• Amin Soheili 2 ,
• Mansour Ghafourifard 1 , 3 ,
• Shahla Shahbazi 1 &
• Hanieh Aziz Karkan 1  

BMC Nursing volume  23 , Article number:  614 ( 2024 ) Cite this article

Metrics details

Today, the human population faces an increasing array of emerging environmental challenges. Despite its importance, nurses often neglect ecological issues, which can compromise patient health. While the ecological nursing perspective has the potential to lead to innovative care approaches that benefit patients, the nursing profession, and the environment, the concept of ecological care lacks a clear definition and its dimensions remain unclear. This study aimed to analyze and clarify the concept of ‘ecological care’ in the nursing discipline.

Walker and Avant’s analysis method was used to identify descriptions, antecedents, consequences, and empirical referents of the concept of ‘ecological care’ in nursing. We searched the databases (PubMed, Scopus, PsycINFO, CINAHL, ERIC, SID, and IranDoc) using the keywords “ecological,” “nurse,” and “nursing” using Boolean operators “AND” and “OR” in the title and abstract fields both in English and Persian to identify relevant literature on ecological care in nursing.

Ecological care, as a multidimensional concept, encompasses ecological thinking, ecological attitude, ecological awareness, ecological sensitivity, and ecological literacy. This entails the optimal utilization of environmental factors to provide patients with high-quality care and preserve ecological sustainability through environmentally friendly behaviors.

Conclusions

The findings highlight the need to elucidate, endorse, and solidify ecological thinking in all aspects of nursing care including nursing management, education, and research, which can lead to improved care quality, patient safety, and sustainability. Within this framework, nursing educators could play an essential role in integrating ecological care into nursing education. The study emphasizes the need to integrate ecological thinking into all aspects of nursing.

Peer Review reports

Ecology, the study of interactions between living organisms and their environments, encompasses physical and social surroundings that impact all living beings. From a human science perspective, ecology emphasizes these interconnected relationships, fostering a deeper understanding of nursing and caring practices [ 1 ]. Currently, environmental concerns are considered significant threats to public health. However, healthcare professionals often lack sufficient awareness of the importance of ecological issues [ 2 ].

As the largest group of healthcare professionals, nurses play a crucial role in decisions regarding product use, energy consumption, and chemical selection in healthcare settings. However, they face a significant challenge: balancing environmental concerns and ecological principles with their professional duties [ 3 ]. Although nurses can advocate reducing exposure to harmful chemicals and adopting less toxic products, their work environments often require high energy consumption and generate substantial medical waste [ 4 ]. This medical waste encompasses both hazardous (infectious, pathological, chemical, pharmaceutical, cytotoxic, and radioactive) and non-hazardous or general waste, posing potential risks to patients, communities, and broader ecological health [ 5 ]. Multiple studies have highlighted the critical role of ecological considerations within healthcare in the overall health of ecosystems [ 6 , 7 , 8 , 9 ]. Consequently, ecological issues have become a high priority for nurses, demanding attention and action [ 10 ].

The importance of environment, ecosystems, and ecology in nursing practice has been recognized by pioneers like Florence Nightingale as the founder of modern nursing (published in 1992, originally written in 1959) [ 11 ] and subsequently by Fawcett (1984) [ 12 ]. This vision is further reflected in the International Council of Nurses (ICN) Code of Ethics, which states that “nurses contribute to the population’s health and work to achieve the sustainable development goals.” By adopting sustainable practices, nurses can significantly reduce their environmental footprint and contribute to achieving the UN 2030 Agenda for Sustainable Development [ 9 ]. Recognizing this crucial role, nursing organizations such as the American Nurses Association actively promote nurses’ participation in environmental protection initiatives [ 13 ].

The concept of ecological care in nursing, as a multidimensional concept, encompasses several aspects. Lausten (2006) proposed a nursing ecological theory to broaden nurses’ perspectives by incorporating concepts of global ecosystems, communities, and interrelationships from the ecological sciences. This theory recognizes that human interactions with the environment extend beyond the personal sphere and encompass professional activities. Consequently, nurses can integrate ecological principles into their practice, fostering new directions in care that benefit patients, healthcare professionals, and the environment [ 14 ]. Dahlberg et al. (2016) conducted an empirical study to explore how a phenomenological life-world theory could expand the concept of holistic care into “ecological care.” They argued that the traditional approach to holistic care has neglected environmental and ecological dimensions. Their findings suggested that ecological care goes beyond fighting illnesses. It emphasizes understanding patients within the context of their world, a world that they both influence and are influenced by. This approach helps patients reintegrate into their rhythm of existence [ 1 ].

Al-Shamaly (2021) highlights “ecological awareness,” which emphasizes creating a safe and comfortable patient environment through noise, light, color, and temperature control [ 15 ]. Sattler (2013) adds another dimension, suggesting that nurses can act as catalysts for transforming hospitals into environmentally sustainable spaces. This can be achieved through practices such as adopting environmentally friendly purchasing policies (e.g., waste management strategies, reduced chemical use, and proper disposal of hazardous materials such as batteries), promoting healthy food options, and favoring mercury-free products [ 16 ].

Although ecological factors could influence the quality of care, patient safety, individual and community health, resource preservation, and sustainable practices [ 16 , 17 , 18 , 19 ], nurses’ awareness of ecological care and its dimensions remains limited [ 2 ]. Moreover, there is no universally accepted definition of ecological care as a complex concept [ 20 ]. Therefore, this study aimed to analyze and clarify the concept of ‘ecological care’ within the nursing discipline.

Walker and Avant’s concept analysis method was used as a rigorous and systematic approach to identify descriptions, antecedents, consequences, and empirical referents of the concept of ‘ecological care’ in nursing. Ecological care is a widely applicable concept that extends beyond the confines of nursing care. Therefore, the literature review encompasses all the various applications of ecological care, including both implicit and explicit aspects. The stages of the concept analysis method are as follows: (A) selecting a concept, (B) determining the aims or purposes of the analysis, (C) identifying all uses of the concept that you can discover, (D) determining the defining attributes, (E) identifying a model case, (F) identifying borderline, related, contrary, invented, and illegitimate cases, (G) identifying antecedents and consequences, and (H) defining empirical referents [ 21 ].

Literature search

A systematic literature review was conducted using multiple health databases, including PubMed, Scopus, PsycINFO, CINAHL, ERIC, SID, and IranDoc. The concepts “ecological,” “nurse” and “nursing” were searched using Boolean operators “AND” and “OR” in the title and abstract fields of each database. No temporal limits were applied and articles published in either English or Persian until July 2023 were retrieved.

Initially, 1083 records were identified by searching the titles and abstracts of these databases. Subsequently, 16 additional records were manually included, resulting in a total of 1099 records. Duplicate records were removed, leading to an initial selection of 1068 records. The titles and abstracts of these records were screened, and the eligibility criteria were applied to the full text of the selected records. Eventually, 36 records met the criteria and underwent a comprehensive review of concept analysis (Fig.  1 ). A detailed overview of the included studies, including publication year, title, country, and key findings, can be found in Appendix A.

Flow diagram of the study (data search and selection process)

Concept selection

The importance of a specific concept is influenced by a variety of factors both within and outside its field over time. Consequently, concepts lacking clear definitions warrant further analysis [ 21 ]. Considering the interconnectedness of ecosystems and human health, as well as the imperative to maintain environmental sustainability, particularly within healthcare, the concept of ecology has gained prominence in nursing and other health professions. Nightingale’s emphasis on the environment underscores this importance. Given the increasing significance of ecological care in healthcare and the lack of a clear, unified definition, this concept was selected for analysis to elucidate its dimensions and characteristics.

Determining the aims of the analysis

The concept of “ecological care” has been insufficiently analyzed within the healthcare context, resulting in a lack of a clear definition. This study aims to refine the meaning of ecological care in nursing by identifying its descriptions, antecedents, consequences, and empirical referents.

Identifying the use of the concept

To explore the concept of ecological care, it is crucial to understand the distinct meanings of each word from a variety of sources such as dictionaries, thesauruses, websites, and scholarly literature.

According to the Merriam-Webster dictionary, the term ‘ecological’ is an adjective related to the science of ecology. This refers to the environment of living things or the relationships between living things and their environments [ 22 ].

According to the Merriam-Webster dictionary, the term ‘care’ functions both as a noun, representing responsibility for or attention to health, well-being, safety, or solicitude, and as a verb, meaning to feel interest or concern and to provide care [ 23 ].

Ecological care in nursing literature

The concept of ecological care, originating from the theory of biological ecology, aims to offer solutions that effectively minimize the adverse impacts of nursing care on the ecosystem [ 14 ]. Ecological care can be classified into two types: individuals and professionals. The individual approach focuses on raising public awareness, shaping attitudes and behaviors, and promoting responsible actions regarding energy consumption, the production of toxic substances (such as greenhouse gases), chemical usage, and healthy and organic diet adoption. Conversely, the professional approach emphasizes the importance of sensitivity, awareness, attitude, behavior, and responsible actions among individuals when carrying out their professional responsibilities [ 9 , 24 ].

Clinical environments require ecological care, which can be achieved through two distinct approaches: environmental and organizational care. Environmental care involves maintaining equipment and machines, ensuring workplace safety, minimizing risks, managing noise levels, optimizing lighting conditions, regulating temperature, and employing creative designs to create a comfortable and relaxing environment. It also involves facilitating visits from family members and pets and improving patients’ sleep quality. Additionally, the use of digital technology helps ensure a healthy and safe treatment environment for patients in the Intensive Care Units (ICU). On the other hand, organizational care focuses on time and resource management. This includes strategies such as reducing paper and ink consumption by utilizing electronic records, which aids in efficient time management. Organizational care aims to streamline nurses’ tasks and improve overall work efficiency by minimizing their workload and improving access to patient information. Finally, waste management practices play a crucial role in maintaining an environmentally conscious approach in healthcare settings [ 15 ].

Determining the defining attributes

Ecological thinking.

According to Balgopal and Wallace (2009), ecological thinking is a combination of ecological understanding and ecological awareness [ 25 ]. Understanding ecology involves understanding concepts such as biotic, abiotic, and biological interactions. This serves as the initial stage of ecological thinking, which is further developed by comprehending the impact of human activities on the ecosystem [ 26 ]. Ecological understanding can be conceptualized as a continuum, with one end representing the capacity to identify problems and propose ecological decisions, considering their potential consequences. On the other end of the continuum is a lack of understanding, where the ability to explain the impact of human actions on the ecosystem is insufficient [ 25 ].

Ecological thinking causes a transformation in people’s presuppositions and attitudes towards the surrounding world, enabling them to recognize that we are interconnected and evolving alongside nature. Embracing an ecological perspective requires acknowledging ourselves as integral components of nature rather than being superior to it. This encompassing concept embodies various underlying principles such as ecology, wholeness, interdependence, diversity, partnership, energy flows, flexibility, cycles, and sustainability [ 17 , 27 ]. Hes and de Plessis (2014) refer to this set of principles as the ‘ecological worldview.’ Shifting towards an ecological perspective entail altering our perspective on the world and ourselves. The fundamental essence of this transformation involves moving away from egocentric and anthropocentric thinking, which emphasizes separateness, and instead adopting a holistic perception that aims to counterbalance environmental damage. Enhancing ecological thinking can be achieved through the instruction of ecological concepts and behaviors [ 28 ].

Ecological attitude

Ecological attitude is a complex construct that encompasses various key components such as emotions, perceptions, personal norms, values, and relationships with the environment. The emotional dimension of ecological attitude plays a pivotal role in preparing individuals to address environmental issues and cultivate ecological behaviors in all aspects of life [ 29 , 30 , 31 ], as it determines the extent to which individuals will act in environmentally responsible ways [ 32 ].

Predicting a specific behavior entails possessing a specific attitude towards that behavior, as attitudes alone do not guarantee behavior, but predict or influence it [ 2 , 33 ]. Ecological behavior can be defined as the actions taken by a nurse to protect the environment, and it varies depending on the individual’s context and circumstances. Achieving the goal of ecological behavior can be challenging in certain situations, but it is crucial to promote sustainable living and preserve the planet’s natural resources [ 31 ].

Ecological awareness

Ecological awareness refers to knowledge, attitudes, and behaviors related to the environment. Its focus is on increasing responsibility toward achieving ecological sustainability [ 34 ]. One of its important characteristics is the perception of natural objects from a subject’s perspective [ 35 ]. As a theoretical and practical science, ecological awareness includes two stages: awareness of environmental changes, and feelings of concern about environmental problems and trying to solve them. People with ecological awareness try to be actively responsible for their interactions with the environment and exhibit positive behaviors towards the surrounding environment [ 9 , 20 ].

Ecological awareness is also a level of cognitive thinking that enables nurses to focus on protecting the environment while providing nursing care. This concept requires nurses to pay attention to the potential of nature and the surrounding environment that promotes, maintains, and restores human health [ 9 , 14 ]. This raises important questions about whether nurses are aware of the positive effects of recycling medical equipment and materials, or the harmful effects of greenhouse gases (CO2, NO, etc.) caused by fossil fuels and smoke from medical waste incinerators. It also highlights how much nurses are aware of the impact of their care activities on ecosystem damage and public health [ 9 , 19 , 36 ]. The role of nurses with ecological awareness is crucial in raising awareness among colleagues, managers, patients, and students [ 8 , 37 , 38 , 39 ].

Ecological sensitivity

Ecological sensitivity refers to the inclination to actively address environmental threats and the extent to which healthcare providers demonstrate awareness of hazardous and protective circumstances [ 40 ]. Individuals with varying psychological traits, such as extroversion or introversion, exhibit distinct levels of sensitivity to environmental health [ 41 ].

Ecological sensitivity is a multidimensional concept that contributes significantly to sustainable development. This serves as an emotional foundation for cultivating an ecological worldview and establishing personal norms for pro-environmental actions. This dynamic framework takes shape within families during childhood and is strengthened throughout professional life. Therefore, an essential initial step in enhancing ecological sensitivity among healthcare providers is to impart ecological education and raise awareness levels [ 42 , 43 , 44 ]. The development of ecological sensitivity is influenced by various factors, including families, educational institutions, mass media, and non-governmental organizations [ 45 , 46 , 47 ]. In general, nurses who actively engage in staying informed about ecological news and trends, participate in ecological protection activities and events, and demonstrate awareness of ecologically detrimental behaviors, both in themselves and their colleagues exhibit higher levels of ecological sensitivity [ 42 , 43 ].

Ecological literacy

Ecological literacy is a crucial concept that includes three core components: cognitive, emotional, and behavioral. According to UNESCO, there are five key characteristics of ecological literacy: awareness and sensitivity to the environment; comprehension of environmental issues; having values and sentiments towards environmental concerns; possessing skills, desire, and commitment; and actively engaging in identifying and resolving ecological problems. Generally, ecological literacy can be defined as the integration of environmental sensitivity, knowledge, skills, attitudes, values, responsibilities, and active engagement, which enables nurses to make informed and responsible decisions to promote environmental sustainability [ 48 , 49 ].

Model and additional cases

A model case serves as a paradigmatic illustration of the application of a concept encompassing all its defining elements. In addition to the model case, two other types of cases are presented: (A) the borderline case, which shares most of the essential characteristics of the concept but exhibits some differences; and (B) the contrary case, which presents an apparent example that contrasts with the concept, highlighting what it is not [ 21 ].

A 65-year-old woman was admitted to the neurology ward with a diagnosis of transient ischemic attack during the night shift. The attending nurse approached the patient’s bedside and introduced herself and the inpatient department. During the evaluation, the nurse observed the patients’ uneasiness, homesickness, and concerns regarding sleep disturbance due to changes in sleeping arrangements. She addressed the situation by repositioning the patient’s bed next to the window, aiming to provide a more comfortable environment and alleviate feelings of homesickness. Careful attention was paid to ensure that the bed and equipment were securely locked. During medication administration, the nurse utilized a tablet for dosage calculations, opting for a paperless approach to reduce waste. Proper disposal procedures were followed after medication administration, with empty vials discarded in the chemical waste bin, and needles placed in a safety box. During the initiation of infusion, the nurse noticed loose screws on the electronic infusion device and promptly sought assistance from a colleague to rectify the issue. Toward the end of her tasks, the nurse dimmed unnecessary lights in the ward and adjusted the alarm range of the device to an audible level for more comfort. Immediately before leaving the ward, the nurse noticed a leaking water tap and promptly contacted the facility manager to initiate immediate remedial action.

Borderline case

The head nurse of the pediatric ward conducted a clinical round when she heard the cries of a hospitalized 4-year-old child who was upset due to the absence of her cherished doll. Regrettably, the nurses disregarded the situation and continued down the corridor. Several months later, the nurse was invited to join a committee responsible for making decisions regarding hospital equipment procurement. Drawing from the recent knowledge acquired through a TV program highlighting the hazards of mercury to human health, she recommended the acquisition of mercury-free medical equipment.

Contrary case

A nurse, aged 35, with ten years of experience in surgery, approached the patient who had undergone laparotomy to perform a dressing change. The nurse inadvertently wore a pair of sterile gloves instead of non-sterile gloves while removing the contaminated dressing and disposed of it in the general waste bin. Subsequently, sterile gloves were replaced with a fresh pair, the wound was cleansed using six sterile gauzes, and an additional seven gauzes were applied to dress the surgical site, although a smaller quantity would have sufficed. During the hand washing process, the nurse’s mobile phone rang, and without turning off the water tap, he engaged in a conversation until the patient’s family intervened and turned off the tap. Finally, despite the patient expressing mild pain at the surgical site, the nurse chose to administer a painkiller instead of utilizing non-pharmacological methods to alleviate pain.

Identify antecedents and consequences

Walker and Avant (2011) provided a clear definition of antecedents as events or attributes that precede the occurrence of a concept, whereas consequences refer to events that ensue from the concept’s occurrence [ 21 ]. In this study, it was crucial to identify and examine the associated antecedents and consequences (Fig.  2 ). Therefore, the antecedents and consequences investigated are as follows:

Attributes, antecedents, and consequences of ecological caring in nursing practice

Antecedents

The ecological care provided by nurses can be influenced by both personal characteristics and organizational policies. Personal characteristics include creativity, innovation, responsibility, environmental friendliness [ 41 ], kindness, empathy, and strong communication skills [ 9 ]. Meanwhile, organizational policies encompass the establishment of a supportive organizational culture, provision of training courses [ 14 ], and design of a creative and humanitarian environment within hospitals and healthcare facilities. Moreover, ensuring a safe environment equipped with adequate resources, services, technology, and competent human resources is essential for delivering ecological care in therapeutic settings [ 15 ].

Consequences

Ecological care yields numerous benefits to patients, their families, healthcare providers, healthcare systems, and the environment. Among these benefits, one of the most significant is the provision of high-quality holistic care, which leads to increased patient satisfaction. Additionally, ecological care contributes to patient and staff safety by minimizing hospital infections, conserving energy (electricity, gases, and water), optimizing equipment and time utilization, reducing employee workload, managing hospital procurement costs, and eliminating hospital waste. It also plays a vital role in preventing the entry of pathogens, chemical pollutants, and radioactive substances into the water, soil, and air. Furthermore, ecological care promotes ecological sustainability, safeguards the ecosystem, and helps protect food and agricultural resources by preventing food waste in the hospital setting. These considerations highlight the wide-ranging positive consequences of ecological care [ 14 , 41 ].

Empirical referents

According to Walker and Avant (2011), the final step in concept analysis is to identify the empirical referents of attributes. Empirical referents do not directly serve as instruments for measuring a concept, but they provide illustrations of how defining characteristics or attributes can be recognized or measured. By presenting real-world examples, empirical referents assist in measuring the concept and validating its significance [ 21 ]. Although this study did not identify a specific independent instrument for measuring ecological care in nursing, the following examples demonstrate instruments that measure the defining characteristics or attributes of the concept.

The Nurse’s Environmental Awareness Tool (NEAT) was developed by Schenk et al. in 2015 to measure nurses’ awareness of and behaviors associated with the environmental impact of their practices. The NEAT consists of 48 two-part items in six subscales and three paired subsets as follows: nurse awareness scales, nurse professional ecological behaviors scales, and personal ecological behaviors scales [ 9 ].

The Ecological Risk Perception Scale, developed by Slimak and Dietz in 2006, examines not only the attributes of the risk itself but also the characteristics of individuals perceiving the risk. Consisting of 24 ecological risk items, the scale encompasses four subscales: ecological, chemical, global, and biological [ 50 ].

The Environmental Literacy Questionnaire (ELQ) was derived from part of Michigan State University’s project and was originally used by Kaplowitz and Levine (2005) [ 51 ]. Later, Kahyaoğlu (2011) revised the ELQ. The revised version consisted of four components: knowledge (11 items), attitude (12 items), uses (19 items), and concern (9 items) [ 52 ].

Based on the current analysis, ecological care is a multidimensional integration of thinking, attitudes, awareness, sensitivity, and literacy to deliver high-quality holistic care while maintaining environmental sustainability and promoting energy conservation.

Analysis of the concept of ecological care has significant implications for the nursing profession. Given the limited exploration of ecological care within nursing practice, conducting an analysis can empower nurses to utilize ecological factors in delivering high-quality care and embracing environmentally friendly behaviors. The objective of this study was to present a comprehensive and practical definition of ecological care, thereby establishing a shared platform for not only nurses but also other healthcare professionals to promote pro-environmental behaviors.

Backes et al. (2011) conducted a study aiming to comprehend the meaning of ecological care from the perspective of students and teachers in the healthcare field at a Public Institution of Higher Education. The study revealed several categories, including (a) ecological care as a result of relationships, interactions, and communication with the global environment (main category); (b) the development of ecological awareness (causal conditions); (c) the connection of ecological care with different systems (context); (d) the perception of human-environment-health interaction (intervention); (e) the need to foster ecological consciousness through new references (strategy); and (f) a sense of motivation to understand ecological care (result). While this study acknowledged ecological awareness and conscience as integral components of ecological care, other attributes of the concept, such as adopting an ecological perspective; ecological literacy; and the impact of values, beliefs, and organizational culture on providing holistic care, were not extensively explained [ 20 ].

The findings of a study conducted by Dahlberg et al. (2016) revealed how ecological care facilitates patients to rediscover their place in a world characterized by interconnectedness. The role of ecological care extends beyond perceiving patients within a web of relationships; it encompasses assisting patients in re-establishing their sense of self and comprehending the world anew. Ecological care entails not only combating illness but also acknowledging patients as individuals influenced by and influencing the world. Such care endeavors to facilitate rhythmic movement and create space for activity and rest, being cared for and actively participating in one’s recovery, withdrawing from the world, and re-engaging with it. This study also highlights the use of the term ecological perspective to enhance the understanding of optimal care for patients. In this study, the novel attributes of the concept of ecological care are introduced. However, the potential impacts of constructive and destructive human activities on ecosystems remain unexplored [ 1 ]. In contrast, we refer to ecological sustainability and energy conservation as significant consequences of ecological care in nursing.

In a focused ethnographic study, Al-Shamaly (2021) explored the culture of multidimensional “caring-for” practice among ICU nurses. The inclusive nature of this culture encompasses caring for oneself, patients and their families, and colleagues (including nurses and other team members) as well as ecological consciousness within the ICU environment and organization. Ecological consciousness involves caring for equipment and machines, ensuring workplace safety, reducing hazards, transitioning towards a paperless unit, maintaining thorough documentation, and demonstrating commitment and concern for the organization’s budget regarding staff and resources [ 15 ]. While this study comprehensively addresses the practical aspects of the concept, it constrains the concept of ecological care solely to ecological consciousness. However, our study revealed that ecological care is a multidimensional, and complex phenomenon that extends beyond ecological consciousness. In another study, religious values were identified as a crucial factor in promoting an ecological care orientation that can be incorporated into daily life through religious education, considering the religious and cultural context of each country. These values are instilled into individuals from childhood to adulthood through various learning activities. Therefore, religious education plays a pivotal role in shaping individuals’ commitment to ecological care [ 53 ]. According to this study, religious values significantly contribute to the development of ecological thinking and the manifestation of ecological behavior.

Moreover, a previous study by Akkuzu (2016) introduced ecological intelligence as a new type of conscience, defined as a combination of environmental awareness and the sensitivity of human beings towards adverse global alterations in nature. This understanding empowers individuals to recognize the perils faced by their communities and comprehend the underlying causes. Furthermore, it equips them with the knowledge necessary to address these perils collectively and devise effective solutions [ 54 ].

Implications for nursing practice

While our analysis primarily focused on the ecological perspective, we contend that a profound understanding of this concept is imperative for establishing cultural and political frameworks within the healthcare system. This study contributes to the limited body of research on nursing by highlighting the essentiality of ecological and holistic thinking in the domains of caregiving, treatment, management, and education. Consequently, it has the potential to yield substantial impacts in ensuring the safety of patients and healthcare providers, enhancing the quality of care, and improving patient and family satisfaction.

Limitations

The conceptual analysis is subject to several limitations. Firstly, the literature search was confined to studies published in English and Persian, potentially limiting the diversity of perspectives from other countries, cultures, and languages. To mitigate this limitation, future studies should conduct a comprehensive search in multiple languages to ensure a more holistic understanding of ecological care in nursing practice. Secondly, the analysis is susceptible to selection bias, extraction bias, and analysis bias. To address these limitations, the study selection process, data extraction, and analysis were independently conducted by two researchers. Despite these limitations, the studies were described accurately and systematically, contributing valuable insights into the concept of ecological care in nursing practice.

The results of the present analysis provide a definition of ecological care in nursing that may guide the profession to new directions of care, striving for the greater good of the patient, the profession of caring, and the environment. It is clear that more research is needed to discover the neglected importance of the environment in holistic care and to identify phenomena related to this concept in practical nursing. The literature review shows that the educational field, as the most effective factor, plays a significant role in the formation of ecological literacy and worldviews and the creation of the perceptions, attitudes, and behaviors of ecological care. In this regard, nursing professors and instructors, as the most important role models, significantly contribute to the development of the identity and character of ecological care for today’s students and future nurses.

Data availability

The data supporting the findings of this study are available upon request from the corresponding author. The data were not publicly available because of privacy or ethical restrictions.

Abbreviations

Carbon dioxide

Nitric oxide

The United Nations Educational, Scientific and Cultural Organization

Nurse’s Environmental Awareness Tool

Environmental Literacy Questionnaire

Intensive Care Unit

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Acknowledgements

This study was extracted from a research project approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 73361). The authors would like to thank all those who spent valuable time participating in this research. We are also immensely grateful to the “anonymous” reviewers for their valuable insights.

The present study was financially supported by Tabriz University of Medical Sciences, Tehran, Iran.

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Golshan Moghbeli, Mansour Ghafourifard, Shahla Shahbazi & Hanieh Aziz Karkan

Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran

Amin Soheili

Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

Mansour Ghafourifard

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GM, AS: original concept and study design; GM, HA, ShS: data collection; GM, HA, AS, MGh: data analysis and interpretation; GM, HA, AS, MGh, ShS: manuscript preparation and final critique; GM, MGh: study supervision.

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Correspondence to Hanieh Aziz Karkan .

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This study was approved by the ethics committee of Tabriz Tehran University of Medical Sciences (code of ethics: IR.TBZMED.REC.1402.614). All methods were carried out in accordance with relevant guidelines and regulations of Walker and Avant’s concept analysis method and qualitative research.

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Moghbeli, G., Soheili, A., Ghafourifard, M. et al. Ecological care in nursing practice: a Walker and Avant concept analysis. BMC Nurs 23 , 614 (2024). https://doi.org/10.1186/s12912-024-02279-z

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What is the role of empirical research in bioethical reflection and decision-making? An ethical analysis

Affiliation.

• 1 Center for Biomedical Ethics and Law, K.U. Leuven, Kapucijnenvoer 35/3, 3000 Leuven, Belgium. [email protected]
• PMID: 15139254
• DOI: 10.1023/b:mhep.0000021844.57115.9d

The field of bioethics is increasingly coming into contact with empirical research findings. In this article, we ask what role empirical research can play in the process of ethical clarification and decision-making. Ethical reflection almost always proceeds in three steps: the description of the moral question, the assessment of the moral question and the evaluation of the decision-making. Empirical research can contribute to each step of this process. In the description of the moral object, first of all, empirical research has a role to play in the description of morally relevant facts. It plays a role in answering the "reality-revealing questions" (what, why, how, who, where and when), in assessing the consequences and in proposing alternative courses of action. Secondly, empirical research plays a role in assessing the moral question. It must be acknowledged that research possesses "the normative power of the factual," which can also become normative by suppressing other norms. However, inductive normativity should always be balanced out by a deductive form of normativity. Thirdly, empirical research also has a role to play in evaluating the decision-making process. It can rule out certain moral choices by pointing out the occurrence of certain unexpected consequences or effects. It can also be useful, however, as a sociology of bioethics in which the discipline of bioethics itself becomes an object of research.

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Air quality awareness—empirical evidence from a comparative perspective between two european cities.

1. Context and Motivation

Main findings and contributions.

• Informing policy decisions: The collection of social data enables informed decision-making and the development of policies that address citizens’ concerns. For example, our research identifies issues related to cycling infrastructure in Turin. Negative perceptions of infrastructure, urban spaces, or air quality should prompt the city’s administration to implement more rigorous measures that promote and encourage the use of bike-sharing systems or private bicycles.
• Evaluating policy effectiveness: The collected data serve as a foundation for assessing the effectiveness of existing policies. For instance, the positive perception of air quality and the quality of the cycling infrastructure network among Irish citizens indicate that the current policy measures are functioning well and should be continued and reinforced.
• Identifying research priorities: The results suggest areas for further research. This study highlights specific concerns in the two cities that could lead to new investigations into the causes and effects of these perceptions. Future studies could adopt more comprehensive and inclusive methodological approaches, such as online and offline questionnaires and the use of low-cost sensors in various city areas.
• Community involvement: The survey positively impacts community engagement by involving citizens in the decision-making process. When individuals feel heard, they are more likely to support and adhere to the policies implemented.

2. Materials and Methods

• Section 1 : demographic information (gender, age, education, and profession).
• Section 2 : perception of air quality (using the Likert scale model for various aspects and including open questions for further comments).
• Section 3 : suggestions to improve air quality (open questions).
• Section 4 : the use of cycling infrastructure (closed and open questions).

3. Results and Discussion

3.1. citizen’s perception of air pollution, 3.2. means of transport used and commuting, 3.3. attitudes toward governmental policy for the management of urban air quality and citizens’ suggestions, 3.4. citizens’ attitudes toward local government, 4. conclusions and future work.

• Monitoring network credibility: A functional and accessible monitoring network that provides real-time data is crucial for enhancing institutional credibility and reassuring citizens. The monitoring network in Turin should be made more pervasive, accessible, and capable of delivering real-time information to keep the local population consistently informed about air quality.
• Alignment of perceptions and objective data: There is a significant alignment between residents’ perceptions of local air pollution and the objective data from the respective cities. In Turin, air pollution is a well-recognized social issue with notable health impacts on residents [ 59 , 60 , 61 ]. Future research should focus on exploring any discrepancies between perceived and objective data to identify and address critical local issues.
• Health concerns and objective evidence: Citizens’ concerns about health contribute to their perceptions of poor air quality. The literature provides objective data on the correlation between air pollution and respiratory diseases in Turin [ 62 , 63 , 64 , 65 ]. Understanding the relationship between citizens’ health concerns and objective evidence of disease can help shape more effective public health policies.
• Primary sources of air pollution: Survey participants identified transportation and domestic heating as the primary sources of air pollution in both Turin and Dublin. These findings are consistent with objectively measured pollution levels reported in the literature [ 66 ] and by local political authorities. Analyzing public perceptions of pollution sources can highlight areas for improvement in managing and communicating air quality.
• Infrastructure and transport choices: The quality of infrastructure and cycling facilities significantly influences citizens’ choices regarding alternative modes of transport for long distances. The study shows that 42% of respondents in Dublin use bicycles for commuting and long journeys. This underscores the importance of investing in dedicated cycling infrastructure to promote sustainable transport options such as bicycles and electric scooters. Improved cycling infrastructure not only supports healthier and more sustainable lifestyles but also delivers economic, environmental, and social benefits. These findings suggest that increased investment in cycling infrastructure could enhance daily transportation options in Turin.
• Future research should incorporate real-time comparisons between actual pollution data and citizens’ perceptions, potentially through a smartphone application that allows daily feedback on air quality from different city areas.
• The representativeness of the sample is crucial, as achieving a sample that accurately reflects the demographic and socioeconomic diversity of the local community remains challenging.
• Internet access limitations affect participation, as not all citizens have access to the digital technologies needed to complete online questionnaires, thereby excluding some population segments.
• Measures should be taken to balance different groups in data analysis in order to avoid unrepresentative or biased conclusions.

Author Contributions

Data availability statement, acknowledgments, conflicts of interest.

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Salimbene, O.; Baeza-Romero, M.T.; Pilla, F.; Čok, G. Air Quality Awareness—Empirical Evidence from a Comparative Perspective between Two European Cities. Urban Sci. 2024 , 8 , 133. https://doi.org/10.3390/urbansci8030133

Salimbene O, Baeza-Romero MT, Pilla F, Čok G. Air Quality Awareness—Empirical Evidence from a Comparative Perspective between Two European Cities. Urban Science . 2024; 8(3):133. https://doi.org/10.3390/urbansci8030133

Salimbene, Ornella, María Teresa Baeza-Romero, Francesco Pilla, and Gregor Čok. 2024. "Air Quality Awareness—Empirical Evidence from a Comparative Perspective between Two European Cities" Urban Science 8, no. 3: 133. https://doi.org/10.3390/urbansci8030133

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The University of Chicago The Law School

Civil rights & police accountability clinic—significant achievements for 2023-24.

Our Clinic students continue to make a difference in the community, while learning all that it means to be a lawyer.

The Federal Civil Rights Consent Decree Governing the Chicago Police Department

Years of advocacy by Clinic students and our clients resulted in the 2019 federal civil rights Consent Decree that seeks to remedy the Chicago Police Department’s (CPD’s) pattern and practice of excessive and discriminatory violence targeted disproportionately against Black people. Highlights from our Consent Decree work during the 2023-24 academic year include: (1) our success in remedying CPD’s practice of violent, dehumanizing, and discriminatory home raids that have targeted and traumatized Black and Brown children and families in Chicago; (2) the relief that we won in emergency proceedings that we initiated to prevent unlawful mass arrests and First Amendment violations during the Democratic National Convention in Chicago; (3) our progress toward remedying racially discriminatory practices of targeting Black people for unlawful stop-and-frisks and pretextual traffic stops; and (4) advocacy for critical modifications to strengthen and improve the Decree.

Ending Illegal and Discriminatory Home Raids

Clinic students and our community-based clients won a complete overhaul of the policies that govern residential search warrants in Chicago in months-long court supervised multi-party negotiations, briefs, and court proceedings. CPD’s new policies will seek to restrict home raids to circumstances in which they are necessary and forbid raids whenever the potential harms outweigh the expected benefits. CPD will be required to develop a written plan for the execution of every residential warrant to minimize the harm, trauma, and intrusion to families and their homes. Officers will be evaluated for their success in mitigating harm when executing search warrants. The new policies will protect children and vulnerable people from unnecessary harm, including requiring police to schedule raids at times when they are least likely to be home. They ban high-risk nighttime raids and limit no-knock warrants to circumstances in which people’s lives and physical safety are in jeopardy. They prohibit police from leaving families with broken doors and locks vulnerable to crime. And they will require police to thoroughly document and publicly report on each raid to enhance transparency and accountability. In addition, we won measures that will prevent wrong raids, including requiring CPD to independently investigate and corroborate tips, maintain records of any instance in which the informant provided false or inaccurate information, and provide the prosecutor and court with any information that may undermine the credibility of the informant and tip before seeking a warrant. The proposed new policies will soon be subject to public review and comment in anticipation of full implementation. The public and judicial scrutiny that we brought to bear during our enforcement proceedings has already resulted in a tenfold reduction of home raids and prevented the traumatization of thousands of children.

Protecting First Amendment Rights to Protest and the DNC

In spring 2023, we learned that the CPD intended to implement a new policy to facilitate mass arrests during protests and other First Amendment activities in anticipation of the Democratic National Convention. The proposed new policy would have eviscerated relief that we had won in 2021 that fundamentally transformed Chicago police policies governing the policing of First Amendment activities—relief that requires CPD to protect the rights of people to engage in public protest and dissent rather than to stamp out protests. The Clinic filed an emergency enforcement action to enjoin the proposed mass arrest policy. In the proceedings that followed, we succeeded in preventing the parts of the policy that threatened people’s First Amendment rights from taking effect. The First Amendment policy that we had won in 2021 continues to govern during the DNC and all public demonstrations now and in the future. For example, the revised policy on mass arrests will now prohibit police from arresting people engaged in First Amendment conduct for minor offenses unless they pose an immediate threat to the physical safety or property of others. It also explicitly bans retaliation against people for exercising their First Amendment rights.

Strengthening the Consent Decree and Advancing Racial Justice

Having won our community-based clients’ historic power to enforce the Decree, Clinic students continue to fight to strengthen the Decree to make our clients—people who have been most impacted by CPD’s civil rights violations—full and equal partners in the process. As a result of our advocacy, throughout the 2023-24 academic year, the federal court ordered the City to engage with community representatives when developing policies, procedures, and training—including the recent mass arrests policy that the CPD had initially sought to impose without any meaningful community engagement. Clinic students participated in five full-day public hearings in federal court focusing on potential modifications to the Decree and issues of racial justice. Students presented powerful testimony and legal memoranda that advocated for Consent Decree revisions that (a) require de-escalation and reductions in CPD violence; (b) divert people from the criminal legal system through alternatives to arrest and the elimination of unnecessary negative interactions with police; (c) develop non-criminal responses to people experiencing mental health crises (we won implementation of an historic pilot program on this); (d) prohibit police from pointing guns at people unless they present an immediate threat to serious injury or death to another person; (e) require officers to file a written report each time they point a gun at a community member; (f) provide services to survivors of CPD violence and their family members; and (g) address barriers to police accountability that were erected in the new collective bargaining agreements with the unions representing Chicago police officers. We also succeeded in subjecting CPD’s racially discriminatory stop-and-frisk practices to federal court supervision.

The court is currently deciding whether to also subject CPD traffic stops to federal court oversight under the Consent Decree, as traffic stops have become a flashpoint for unnecessary police violence in Chicago as they have skyrocketed in Black and Brown communities. Eighty-five percent of the instances in which Chicago police used force in traffic stops have been directed at Black people. We presented testimony and briefs that seek to outlaw CPD’s practice of using pretextual stops to harass Black and Brown people, disband police tactical units that have been responsible for unnecessary and disproportionate violence directed toward Black and Brown people, and limit CPD traffic stops to violations that pose genuine threats to public safety.

Ending Incommunicado Detention—A Second Consent Decree

The Clinic continues to advance its historic work in making real the fifty-eight-year-old promise of Miranda v. Arizona in Chicago. Tyler Lawson, ’24 , and Katherine Stanton, ’25, led a team of Clinic students that did outstanding advocacy work with our community-based clients and the Office of the Cook County Public Defender after having won a second consent decree that went into effect in February 2023 in Cook County Circuit Court—a decree that is designed to end the decades-long practice of incommunicado detention in CPD stations that has facilitated torture, coerced confessions, and wrongful convictions. Clinic students produced an empirical report with Professor Kyle Rozema that analyzed data from every arrest in Chicago that took place during the first year of the Decree. The Report found ninety-nine percent of people in CPD custody did not access an attorney and more than half of the people most vulnerable to interrogation did not get prompt access to a phone. Inspections by Clinic students inside Chicago police stations revealed that legible signs required by the Consent Decree that inform people in custody of their rights under the Decree and the Public Defender’s free 24-hour hotline number for legal assistance were routinely missing in the places where CPD detains people who may be subject to interrogation. Clinic students also documented that contrary to the Decree, many of the visiting rooms that CPD is required to maintain in every police station did not allow for private and confidential meetings between people in custody and their attorneys. The Clinic presented the Report and our findings to the court. In response, the Honorable Judge Neil H. Cohen directed CPD to work with the Clinic to ensure the installation of appropriate signs and remedy the documented deficiencies with respect to privacy. We are administering a survey to people at their first court appearance to provide the court with additional information about the reasons why people in CPD custody have not promptly accessed phones and counsel. Our preliminary findings indicate that CPD has failed to offer phones or provided the Public Defender’s 24-hour number to people subject to police interrogation. A quarter of the people surveyed report that CPD interrogated them without access to counsel. In addition, Clinic students have engaged in targeted outreach to people at risk of arrest and criminal defense attorneys in Chicago, created fantastic flyers, social media, and written material to educate people about their rights under the Decree, and developed a long-form interview tool to gain additional insight about barriers to access to counsel and phones.

Individual Cases

While we fight for systemic change, the Clinic has continued its tradition of excellence in serving individuals and families in need.

Clinic students won a stage three post-conviction hearing with our client Christopher Ellis before the Honorable Carol Howard in Cook County Circuit Court that can result in vacating Mr. Ellis’s conviction. Two Chicago police officers pulled Mr. Ellis out of his car, beat and tased him, and then falsely accused Mr. Ellis of aggravated battery against the police officers to cover up their abuse. Mr. Ellis was convicted and sentenced to six years in prison. Based on a phenomenal set of briefs written by Clinic students Hannah V.L. George, ’24, and Becky Marvin, ’24, and Professor Herschella Conyers ’ students Amara Shaikh, ’24 , and Liam Grah, ’25, in the Criminal and Juvenile Justice Clinic and Becky Marvin ’s outstanding oral argument, Judge Howard found that the Clinic has made a substantial showing of Mr. Ellis’s innocence and the ineffective assistance of his trial counsel. Judge Howard offered the highest praise to the students’ work. We expect Mr. Ellis’s case to go to trial in the fall.

 Erin Yonchak,’24, presented Clifton Young’s case before the Illinois Torture and Inquiry Relief Commission. Erin’s presentation and supporting written memorandum were nothing short of superb. As a result of Erin’s scrupulous investigation, factual and legal determinations, and recommendations, the Torture Commission found credible evidence that Mr. Young was tortured by Chicago police and ordered a full evidentiary hearing in Cook County Circuit Court that may result in his freedom after having served more than twenty years in prison.

Amrita Krishnan, ’25, is investigating a novel claim of police torture before the Illinois Torture Commission that is based on Chicago police detectives’ exploitation of a person’s withdrawal symptoms from heroin and denial of medical treatment to obtain a confession. This is the first of a series of claims of torture before the Commission based on deliberate indifference to a person in custody’s severe physical and psychological pain associated with drug withdrawal to leverage an incriminating statement. Amrita’s legal and medical research into whether and under what circumstances drug withdrawal can form a basis for a torture claim is precedential. It has the power to establish the governing legal standards in Illinois for assessing torture claims involving withdrawal.

Gabbie Zook, ’24 , Hannah V.L. George, ’24 , and Becky Marvin, ’24, led an investigation with a client who was repeatedly sexually assaulted by a Chicago police officer in public housing when she was a mere teenager. The Clinic helped to connect our client with the Chicago Torture Justice Center to provide her with critical support as she continues to work through her trauma from the repeated assaults. We face a myriad of legal challenges because of the years that have passed since the assaults and Illinois law that protects municipalities from liability when police officers abuse their state power to sexually assault people, but we remain committed to supporting our client in her fight for a measure of justice and healing. Our students’ work has shined a light on a path forward.

Policy Projects

Chicago police transparency.

Natalie Cohn-Aronoff, ’24 , and Amber Hunter, ’25, have led a critical project to prevent the return to a state of police impunity in Chicago. The Clinic is responding to the Fraternal Order of Police’s (FOP’s) efforts to shroud in secrecy the adjudication of cases in which Chicago police officers have been found to have committed the most serious forms of misconduct to warrant firing or suspension of more than a year. After the FOP won an arbitration award that sought to end a sixty-year history of public hearings before a neutral body to be replaced by secret hearings behind closed doors by a handful of handpicked arbitrators who have a long track record of protecting Chicago police officers from accountability, the Clinic began work with a coalition of community, civil rights, and good government groups organized to stop the FOP from turning back the clock on our progress. We drafted press releases and an op-ed that lifted the threat of Chicago police impunity to visibility. We drafted policy and legal material for City Council to provide the basis for challenging the arbitrator’s award. We provided testimony in public hearings that was widely cited in the media. Our work supporting the organization of community members persuaded the Mayor and City Council to reject the Arbitrator’s award by a 3/5 vote in City Council and challenge the award in court. The Cook County Circuit Court then ruled that the Arbitrator’s award violated fundamental state policy in Chicago police transparency and accountability and ordered that the Chicago police disciplinary cases must remain open to the public. The FOP has filed a notice of appeal. A team of Clinic students led by Ben Postone, ’24, is drafting an amicus brief before the Illinois Court of Appeals on behalf of the broad community-based coalition that will explain the nature and strength of the public interest at stake.

At the same time, Clinic students have conducted extensive research and consulted experts in labor law to draft proposed state legislation that requires the public adjudication of Chicago police misconduct cases. The Clinic is collaborating with stakeholders to devise a path to establish law that will guarantee public transparency on CPD misconduct now and in the future. The Clinic has also drafted potential municipal legislation that would enhance Chicago’s Civilian Office of Police Accountability’s (COPA’s) efforts to promote greater transparency and accountability by enabling COPA to promptly publicly release summaries of completed misconduct investigations, prosecute disciplinary proceedings that result from COPA investigations, and restrict the Police Department’s power to overturn misconduct findings only for clear error and disciplinary recommendations only for abuse of discretion.

Sam Hallam, ’25, and Katherine Stanton, ’25, are leading efforts to remedy other aspects of FOP’s new collective bargaining contract that thwart police accountability and transparency in Chicago, including a provision that prohibits the videotaping of conversations between officers and supervisors after a police officer shoots a community member. The recording and use of such conversations are critical tools to remedy the longstanding code of silence in the CPD—a code that has encouraged officers to manufacture a common narrative when an officer shoots or kills a person or is otherwise accused of misconduct.

Medical-Legal Partnership with University of Chicago Trauma Center

Rosie Gruen, ’25 , and Sam Hallam, ’25, have led a medical-legal project that we launched last year with the Trauma Center at the University of Chicago Medical Center (UCMC) and pro bono attorneys from the Akerman law firm to prevent police from to violating patient civil rights and medical privacy and interfering with critical medical care. We formed this partnership to address reports from the doctors and staff at the Medical Center of police abuse of patients who have suffered gunshot injuries; coercive interrogations of people who are being treated for serious injuries; interference with medical care and patient autonomy over medical decisions; searches and seizures of patients’ personal property; invasions of patient privacy and personal health information; shackling and physical abuse of patients; and forcing medical personal to perform invasive tests on patients. The Clinic team has been conducting and working to publish empirical research on interactions between police and professionals and staff at the Medical Center and patients and their family members. In addition to the conducting approximately fifty long-form interviews, the Clinic has researched the intersection of property law, criminal law and procedure, privacy law, constitutional law, and administrative regulations and practices in medical settings around the United States. Students have also consulted with national medical and legal experts. Based upon our research, the Clinic developed a first draft of recommended UCMC policies for internal feedback to prevent ongoing civil rights violations and interference with patient care. Our research has also taught us that despite similar civil rights violations in hospital settings and interference by law enforcement with medical treatment, there is a lack of model policies or established best practices on the subject. We are hopeful that the publication of our research and the policies that we develop at UCMC will serve as a model for hospitals throughout the country and prevent civil and human rights violations and improve health outcomes in the Trauma Center and beyond.

Partnership with the Cook County Public Defender and Zealous

We also built on our partnership with the Cook County Public Defender’s Office and Zealous, a national non-profit dedicated to supporting public defender offices, to identify and address systemic issues in the criminal legal system that deprive clients of the Public Defender and Clinic access to justice. Darius Diamond, ’24 , Gabbie Zook, ’24 , and Katherine Stanton, ’25, have led our efforts on this project. This year, our focus has been to support the Public Defender’s work to create two holistic community defender offices in Chicago—the first is scheduled to open this fall in the Roseland community on Chicago’s South Side. The second will be in the Austin community on the West Side. Clinic students have been on the ground floor in designing the offices and services with community members, public defenders, and people in jail. We are developing plans for Clinic students to maintain a regular presence in the Community Defender Offices to work with public defenders and their clients in addressing police accountability and other systemic barriers to justice.

In addition, students are working with public defenders in Cook County to achieve greater independence from county prosecutors and judges when advocating with their clients to change and enjoin laws, policies and practices that impair the ability of public defenders to represent their clients and to improve the criminal legal system. For example, Clinic students are currently working with the Public Defender to explore ways to change the law to give the Public Defender the power to retain counsel to bring affirmative civil rights litigation.