significance of the study in qualitative research

How To Write Significance of the Study (With Examples) 

Whether you’re writing a research paper or thesis, a portion called Significance of the Study ensures your readers understand the impact of your work. Learn how to effectively write this vital part of your research paper or thesis through our detailed steps, guidelines, and examples.

Related: How to Write a Concept Paper for Academic Research

Table of Contents

What is the significance of the study.

The Significance of the Study presents the importance of your research. It allows you to prove the study’s impact on your field of research, the new knowledge it contributes, and the people who will benefit from it.

Related: How To Write Scope and Delimitation of a Research Paper (With Examples)

Where Should I Put the Significance of the Study?

The Significance of the Study is part of the first chapter or the Introduction. It comes after the research’s rationale, problem statement, and hypothesis.

Related: How to Make Conceptual Framework (with Examples and Templates)

Why Should I Include the Significance of the Study?

The purpose of the Significance of the Study is to give you space to explain to your readers how exactly your research will be contributing to the literature of the field you are studying 1 . It’s where you explain why your research is worth conducting and its significance to the community, the people, and various institutions.

How To Write Significance of the Study: 5 Steps

Below are the steps and guidelines for writing your research’s Significance of the Study.

1. Use Your Research Problem as a Starting Point

Your problem statement can provide clues to your research study’s outcome and who will benefit from it 2 .

Ask yourself, “How will the answers to my research problem be beneficial?”. In this manner, you will know how valuable it is to conduct your study. 

Let’s say your research problem is “What is the level of effectiveness of the lemongrass (Cymbopogon citratus) in lowering the blood glucose level of Swiss mice (Mus musculus)?”

Discovering a positive correlation between the use of lemongrass and lower blood glucose level may lead to the following results:

• Increased public understanding of the plant’s medical properties;
• Higher appreciation of the importance of lemongrass  by the community;
• Adoption of lemongrass tea as a cheap, readily available, and natural remedy to lower their blood glucose level.

Once you’ve zeroed in on the general benefits of your study, it’s time to break it down into specific beneficiaries.

2. State How Your Research Will Contribute to the Existing Literature in the Field

Think of the things that were not explored by previous studies. Then, write how your research tackles those unexplored areas. Through this, you can convince your readers that you are studying something new and adding value to the field.

3. Explain How Your Research Will Benefit Society

In this part, tell how your research will impact society. Think of how the results of your study will change something in your community. 

For example, in the study about using lemongrass tea to lower blood glucose levels, you may indicate that through your research, the community will realize the significance of lemongrass and other herbal plants. As a result, the community will be encouraged to promote the cultivation and use of medicinal plants.

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

Using the same example above, you may indicate that this research’s results will benefit those seeking an alternative supplement to prevent high blood glucose levels.

5. Indicate How Your Study May Help Future Studies in the Field

You must also specifically indicate how your research will be part of the literature of your field and how it will benefit future researchers. In our example above, you may indicate that through the data and analysis your research will provide, future researchers may explore other capabilities of herbal plants in preventing different diseases.

Tips and Warnings

• Think ahead . By visualizing your study in its complete form, it will be easier for you to connect the dots and identify the beneficiaries of your research.
• Write concisely. Make it straightforward, clear, and easy to understand so that the readers will appreciate the benefits of your research. Avoid making it too long and wordy.
• Go from general to specific . Like an inverted pyramid, you start from above by discussing the general contribution of your study and become more specific as you go along. For instance, if your research is about the effect of remote learning setup on the mental health of college students of a specific university , you may start by discussing the benefits of the research to society, to the educational institution, to the learning facilitators, and finally, to the students.
• Seek help . For example, you may ask your research adviser for insights on how your research may contribute to the existing literature. If you ask the right questions, your research adviser can point you in the right direction.
• Revise, revise, revise. Be ready to apply necessary changes to your research on the fly. Unexpected things require adaptability, whether it’s the respondents or variables involved in your study. There’s always room for improvement, so never assume your work is done until you have reached the finish line.

Significance of the Study Examples

This section presents examples of the Significance of the Study using the steps and guidelines presented above.

Example 1: STEM-Related Research

Research Topic: Level of Effectiveness of the Lemongrass ( Cymbopogon citratus ) Tea in Lowering the Blood Glucose Level of Swiss Mice ( Mus musculus ).

Significance of the Study .

This research will provide new insights into the medicinal benefit of lemongrass ( Cymbopogon citratus ), specifically on its hypoglycemic ability.

Through this research, the community will further realize promoting medicinal plants, especially lemongrass, as a preventive measure against various diseases. People and medical institutions may also consider lemongrass tea as an alternative supplement against hyperglycemia. 

Moreover, the analysis presented in this study will convey valuable information for future research exploring the medicinal benefits of lemongrass and other medicinal plants.  

Example 2: Business and Management-Related Research

Research Topic: A Comparative Analysis of Traditional and Social Media Marketing of Small Clothing Enterprises.

Significance of the Study:

By comparing the two marketing strategies presented by this research, there will be an expansion on the current understanding of the firms on these marketing strategies in terms of cost, acceptability, and sustainability. This study presents these marketing strategies for small clothing enterprises, giving them insights into which method is more appropriate and valuable for them. 

Specifically, this research will benefit start-up clothing enterprises in deciding which marketing strategy they should employ. Long-time clothing enterprises may also consider the result of this research to review their current marketing strategy.

Furthermore, a detailed presentation on the comparison of the marketing strategies involved in this research may serve as a tool for further studies to innovate the current method employed in the clothing Industry.

Example 3: Social Science -Related Research.

Research Topic:  Divide Et Impera : An Overview of How the Divide-and-Conquer Strategy Prevailed on Philippine Political History.

Significance of the Study :

Through the comprehensive exploration of this study on Philippine political history, the influence of the Divide et Impera, or political decentralization, on the political discernment across the history of the Philippines will be unraveled, emphasized, and scrutinized. Moreover, this research will elucidate how this principle prevailed until the current political theatre of the Philippines.

In this regard, this study will give awareness to society on how this principle might affect the current political context. Moreover, through the analysis made by this study, political entities and institutions will have a new approach to how to deal with this principle by learning about its influence in the past.

In addition, the overview presented in this research will push for new paradigms, which will be helpful for future discussion of the Divide et Impera principle and may lead to a more in-depth analysis.

Example 4: Humanities-Related Research

Research Topic: Effectiveness of Meditation on Reducing the Anxiety Levels of College Students.

Significance of the Study: 

This research will provide new perspectives in approaching anxiety issues of college students through meditation. 

Specifically, this research will benefit the following:

 Community – this study spreads awareness on recognizing anxiety as a mental health concern and how meditation can be a valuable approach to alleviating it.

Academic Institutions and Administrators – through this research, educational institutions and administrators may promote programs and advocacies regarding meditation to help students deal with their anxiety issues.

Mental health advocates – the result of this research will provide valuable information for the advocates to further their campaign on spreading awareness on dealing with various mental health issues, including anxiety, and how to stop stigmatizing those with mental health disorders.

Parents – this research may convince parents to consider programs involving meditation that may help the students deal with their anxiety issues.

Students will benefit directly from this research as its findings may encourage them to consider meditation to lower anxiety levels.

Future researchers – this study covers information involving meditation as an approach to reducing anxiety levels. Thus, the result of this study can be used for future discussions on the capabilities of meditation in alleviating other mental health concerns.

Frequently Asked Questions

1. what is the difference between the significance of the study and the rationale of the study.

Both aim to justify the conduct of the research. However, the Significance of the Study focuses on the specific benefits of your research in the field, society, and various people and institutions. On the other hand, the Rationale of the Study gives context on why the researcher initiated the conduct of the study.

Let’s take the research about the Effectiveness of Meditation in Reducing Anxiety Levels of College Students as an example. Suppose you are writing about the Significance of the Study. In that case, you must explain how your research will help society, the academic institution, and students deal with anxiety issues through meditation. Meanwhile, for the Rationale of the Study, you may state that due to the prevalence of anxiety attacks among college students, you’ve decided to make it the focal point of your research work.

2. What is the difference between Justification and the Significance of the Study?

In Justification, you express the logical reasoning behind the conduct of the study. On the other hand, the Significance of the Study aims to present to your readers the specific benefits your research will contribute to the field you are studying, community, people, and institutions.

Suppose again that your research is about the Effectiveness of Meditation in Reducing the Anxiety Levels of College Students. Suppose you are writing the Significance of the Study. In that case, you may state that your research will provide new insights and evidence regarding meditation’s ability to reduce college students’ anxiety levels. Meanwhile, you may note in the Justification that studies are saying how people used meditation in dealing with their mental health concerns. You may also indicate how meditation is a feasible approach to managing anxiety using the analysis presented by previous literature.

3. How should I start my research’s Significance of the Study section?

– This research will contribute… – The findings of this research… – This study aims to… – This study will provide… – Through the analysis presented in this study… – This study will benefit…

Moreover, you may start the Significance of the Study by elaborating on the contribution of your research in the field you are studying.

4. What is the difference between the Purpose of the Study and the Significance of the Study?

The Purpose of the Study focuses on why your research was conducted, while the Significance of the Study tells how the results of your research will benefit anyone.

Suppose your research is about the Effectiveness of Lemongrass Tea in Lowering the Blood Glucose Level of Swiss Mice . You may include in your Significance of the Study that the research results will provide new information and analysis on the medical ability of lemongrass to solve hyperglycemia. Meanwhile, you may include in your Purpose of the Study that your research wants to provide a cheaper and natural way to lower blood glucose levels since commercial supplements are expensive.

5. What is the Significance of the Study in Tagalog?

In Filipino research, the Significance of the Study is referred to as Kahalagahan ng Pag-aaral.

• Draft your Significance of the Study. Retrieved 18 April 2021, from http://dissertationedd.usc.edu/draft-your-significance-of-the-study.html
• Regoniel, P. (2015). Two Tips on How to Write the Significance of the Study. Retrieved 18 April 2021, from https://simplyeducate.me/2015/02/09/significance-of-the-study/

Written by Jewel Kyle Fabula

in Career and Education , Juander How

Jewel Kyle Fabula

Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.

Browse all articles written by Jewel Kyle Fabula

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• > Journals
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• > The Psychiatrist
• > Volume 37 Issue 6
• > Qualitative research: its value and applicability

Article contents

What questions are best answered using qualitative research, countering some misconceptions, in conclusion, qualitative research: its value and applicability.

Published online by Cambridge University Press:  02 January 2018

Qualitative research has a rich tradition in the study of human social behaviour and cultures. Its general aim is to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of individuals, and the meanings attached to them. The effective application of qualitative methods to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. Qualitative approaches have particular potential in psychiatry research, singularly and in combination with quantitative methods. This article outlines the nature and potential application of qualitative research as well as attempting to counter a number of misconceptions.

Qualitative research has a rich tradition in the social sciences. Since the late 19th century, researchers interested in studying the social behaviour and cultures of humankind have perceived limitations in trying to explain the phenomena they encounter in purely quantifiable, measurable terms. Anthropology, in its social and cultural forms, was one of the foremost disciplines in developing what would later be termed a qualitative approach, founded as it was on ethnographic studies which sought an understanding of the culture of people from other societies, often hitherto unknown and far removed in geography. Reference Bernard 1 Early researchers would spend extended periods of time living in societies, observing, noting and photographing the minutia of daily life, with the most committed often learning the language of peoples they observed, in the hope of gaining greater acceptance by them and a more detailed understanding of the cultural norms at play. All academic disciplines concerned with human and social behaviour, including anthropology, sociology and psychology, now make extensive use of qualitative research methods whose systematic application was first developed by these colonial-era social scientists.

Their methods, involving observation, participation and discussion of the individuals and groups being studied, as well as reading related textual and visual media and artefacts, form the bedrock of all qualitative social scientific inquiry. The general aim of qualitative research is thus to develop concepts which help us to understand social phenomena in, wherever possible, natural rather than experimental settings, to gain an understanding of the experiences, perceptions and/or behaviours of those studied, and the meanings attached to them. Reference Bryman 2 Researchers interested in finding out why people behave the way they do; how people are affected by events, how attitudes and opinions are formed; how and why cultures and practices have developed in the way they have, might well consider qualitative methods to answer their questions.

It is fair to say that clinical and health-related research is still dominated by quantitative methods, of which the randomised controlled trial, focused on hypothesis-testing through experiment controlled by randomisation, is perhaps the quintessential method. Qualitative approaches may seem obscure to the uninitiated when directly compared with the experimental, quantitative methods used in clinical research. There is increasing recognition among researchers in these fields, however, that qualitative methods such as observation, in-depth interviews, focus groups, consensus methods, case studies and the interpretation of texts can be more effective than quantitative approaches in exploring complex phenomena and as such are valuable additions to the methodological armoury available to them. Reference Denzin and Lincoln 3

In considering what kind of research questions are best answered using a qualitative approach, it is important to remember that, first and foremost, unlike quantitative research, inquiry conducted in the qualitative tradition seeks to answer the question ‘What?’ as opposed to ‘How often?’. Qualitative methods are designed to reveal what is going on by describing and interpreting phenomena; they do not attempt to measure how often an event or association occurs. Research conducted using qualitative methods is normally done with an intent to preserve the inherent complexities of human behaviour as opposed to assuming a reductive view of the subject in order to count and measure the occurrence of phenomena. Qualitative research normally takes an inductive approach, moving from observation to hypothesis rather than hypothesis-testing or deduction, although the latter is perfectly possible.

When conducting research in this tradition, the researcher should, if possible, avoid separating the stages of study design, data collection and analysis, but instead weave backwards and forwards between the raw data and the process of conceptualisation, thereby making sense of the data throughout the period of data collection. Although there are inevitable tensions among methodologists concerned with qualitative practice, there is broad consensus that a priori categories and concepts reflecting a researcher's own preconceptions should not be imposed on the process of data collection and analysis. The emphasis should be on capturing and interpreting research participants' true perceptions and/or behaviours.

Using combined approaches

The polarity between qualitative and quantitative research has been largely assuaged, to the benefit of all disciplines which now recognise the value, and compatibility, of both approaches. Indeed, there can be particular value in using quantitative methods in combination with qualitative methods. Reference Barbour 4 In the exploratory stages of a research project, qualitative methodology can be used to clarify or refine the research question, to aid conceptualisation and to generate a hypothesis. It can also help to identify the correct variables to be measured, as researchers have been known to measure before they fully understand the underlying issues pertaining to a study and, as a consequence, may not always target the most appropriate factors. Qualitative work can be valuable in the interpretation, qualification or illumination of quantitative research findings. This is particularly helpful when focusing on anomalous results, as they test the main hypothesis formulated. Qualitative methods can also be used in combination with quantitative methods to triangulate findings and support the validation process, for example, where three or more methods are used and the results compared for similarity (e.g. a survey, interviews and a period of observation in situ ).

‘There is little value in qualitative research findings because we cannot generalise from them’

Generalisability refers to the extent that the account can be applied to other people, times and settings other than those actually studied. A common criticism of qualitative research is that the results of a study are rarely, if ever, generalisable to a larger population because the sample groups are small and the participants are not chosen randomly. Such criticism fails to recognise the distinctiveness of qualitative research where sampling is concerned. In quantitative research, the intent is to secure a large random sample that is representative of the general population, with the purpose of eliminating individual variations, focusing on generalisations and thereby allowing for statistical inference of results that are applicable across an entire population. In qualitative research, generalisability is based on the assumption that it is valuable to begin to understand similar situations or people, rather than being representative of the target population. Qualitative research is rarely based on the use of random samples, so the kinds of reference to wider populations made on the basis of surveys cannot be used in qualitative analysis.

Qualitative researchers utilise purposive sampling, whereby research participants are selected deliberately to test a particular theoretical premise. The purpose of sampling here is not to identify a random subgroup of the general population from which statistically significant results can be extrapolated, but rather to identify, in a systematic way, individuals that possess relevant characteristics for the question being considered. Reference Strauss and Corbin 5 The researchers must instead ensure that any reference to people and settings beyond those in the study are justified, which is normally achieved by defining, in detail, the type of settings and people to whom the explanation or theory applies based on the identification of similar settings and people in the study. The intent is to permit a detailed examination of the phenomenon, resulting in a text-rich interpretation that can deepen our understanding and produce a plausible explanation of the phenomenon under study. The results are not intended to be statistically generalisable, although any theory they generate might well be.

‘Qualitative research cannot really claim reliability or validity’

In quantitative research, reliability is the extent to which different observers, or the same observers on different occasions, make the same observations or collect the same data about the same object of study. The changing nature of social phenomena scrutinised by qualitative researchers inevitably makes the possibility of the same kind of reliability problematic in their work. A number of alternative concepts to reliability have been developed by qualitative methodologists, however, known collectively as forms of trustworthiness. Reference Guba 6

One way to demonstrate trustworthiness is to present detailed evidence in the form of quotations from interviews and field notes, along with thick textual descriptions of episodes, events and settings. To be trustworthy, qualitative analysis should also be auditable, making it possible to retrace the steps leading to a certain interpretation or theory to check that no alternatives were left unexamined and that no researcher biases had any avoidable influence on the results. Usually, this involves the recording of information about who did what with the data and in what order so that the origin of interpretations can be retraced.

In general, within the research traditions of the natural sciences, findings are validated by their repeated replication, and if a second investigator cannot replicate the findings when they repeat the experiment then the original results are questioned. If no one else can replicate the original results then they are rejected as fatally flawed and therefore invalid. Natural scientists have developed a broad spectrum of procedures and study designs to ensure that experiments are dependable and that replication is possible. In the social sciences, particularly when using qualitative research methods, replication is rarely possible given that, when observed or questioned again, respondents will almost never say or do precisely the same things. Whether results have been successfully replicated is always a matter of interpretation. There are, however, procedures that, if followed, can significantly reduce the possibility of producing analyses that are partial or biased. Reference Altheide, Johnson, Denzin and Lincoln 7

Triangulation is one way of doing this. It essentially means combining multiple views, approaches or methods in an investigation to obtain a more accurate interpretation of the phenomena, thereby creating an analysis of greater depth and richness. As the process of analysing qualitative data normally involves some form of coding, whereby data are broken down into units of analysis, constant comparison can also be used. Constant comparison involves checking the consistency and accuracy of interpretations and especially the application of codes by constantly comparing one interpretation or code with others both of a similar sort and in other cases and settings. This in effect is a form of interrater reliability, involving multiple researchers or teams in the coding process so that it is possible to compare how they have coded the same passages and where there are areas of agreement and disagreement so that consensus can be reached about a code's definition, improving consistency and rigour. It is also good practice in qualitative analysis to look constantly for outliers – results that are out of line with your main findings or any which directly contradict what your explanations might predict, re-examining the data to try to find a way of explaining the atypical finding to produce a modified and more complex theory and explanation.

Qualitative research has been established for many decades in the social sciences and encompasses a valuable set of methodological tools for data collection, analysis and interpretation. Their effective application to other disciplines, including clinical, health service and education research, has a rapidly expanding and robust evidence base. The use of qualitative approaches to research in psychiatry has particular potential, singularly and in combination with quantitative methods. Reference Crabb and Chur-Hansen 8 When devising research questions in the specialty, careful thought should always be given to the most appropriate methodology, and consideration given to the great depth and richness of empirical evidence which a robust qualitative approach is able to provide.

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• Volume 37, Issue 6
• Steven J. Agius (a1)
• DOI: https://doi.org/10.1192/pb.bp.113.042770

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Experiences of a London PhD student and beyond

What is the Significance of a Study? Examples and Guide

If you’re reading this post you’re probably wondering: what is the significance of a study?

No matter where you’re at with a piece of research, it is a good idea to think about the potential significance of your work. And sometimes you’ll have to explicitly write a statement of significance in your papers, it addition to it forming part of your thesis.

In this post I’ll cover what the significance of a study is, how to measure it, how to describe it with examples and add in some of my own experiences having now worked in research for over nine years.

If you’re reading this because you’re writing up your first paper, welcome! You may also like my how-to guide for all aspects of writing your first research paper .

Looking for guidance on writing the statement of significance for a paper or thesis? Click here to skip straight to that section.

What is the Significance of a Study?

For research papers, theses or dissertations it’s common to explicitly write a section describing the significance of the study. We’ll come onto what to include in that section in just a moment.

However the significance of a study can actually refer to several different things.

Working our way from the most technical to the broadest, depending on the context, the significance of a study may refer to:

• Within your study: Statistical significance. Can we trust the findings?
• Wider research field: Research significance. How does your study progress the field?
• Commercial / economic significance: Could there be business opportunities for your findings?
• Societal significance: What impact could your study have on the wider society.
• And probably other domain-specific significance!

We’ll shortly cover each of them in turn, including how they’re measured and some examples for each type of study significance.

But first, let’s touch on why you should consider the significance of your research at an early stage.

Why Care About the Significance of a Study?

No matter what is motivating you to carry out your research, it is sensible to think about the potential significance of your work. In the broadest sense this asks, how does the study contribute to the world?

After all, for many people research is only worth doing if it will result in some expected significance. For the vast majority of us our studies won’t be significant enough to reach the evening news, but most studies will help to enhance knowledge in a particular field and when research has at least some significance it makes for a far more fulfilling longterm pursuit.

Furthermore, a lot of us are carrying out research funded by the public. It therefore makes sense to keep an eye on what benefits the work could bring to the wider community.

Often in research you’ll come to a crossroads where you must decide which path of research to pursue. Thinking about the potential benefits of a strand of research can be useful for deciding how to spend your time, money and resources.

It’s worth noting though, that not all research activities have to work towards obvious significance. This is especially true while you’re a PhD student, where you’re figuring out what you enjoy and may simply be looking for an opportunity to learn a new skill.

However, if you’re trying to decide between two potential projects, it can be useful to weigh up the potential significance of each.

Let’s now dive into the different types of significance, starting with research significance.

Research Significance

What is the research significance of a study.

Unless someone specifies which type of significance they’re referring to, it is fair to assume that they want to know about the research significance of your study.

Research significance describes how your work has contributed to the field, how it could inform future studies and progress research.

Where should I write about my study’s significance in my thesis?

Typically you should write about your study’s significance in the Introduction and Conclusions sections of your thesis.

It’s important to mention it in the Introduction so that the relevance of your work and the potential impact and benefits it could have on the field are immediately apparent. Explaining why your work matters will help to engage readers (and examiners!) early on.

It’s also a good idea to detail the study’s significance in your Conclusions section. This adds weight to your findings and helps explain what your study contributes to the field.

On occasion you may also choose to include a brief description in your Abstract.

What is expected when submitting an article to a journal

It is common for journals to request a statement of significance, although this can sometimes be called other things such as:

• Impact statement
• Significance statement
• Advances in knowledge section

Here is one such example of what is expected:

Impact Statement:  An Impact Statement is required for all submissions.  Your impact statement will be evaluated by the Editor-in-Chief, Global Editors, and appropriate Associate Editor. For your manuscript to receive full review, the editors must be convinced that it is an important advance in for the field. The Impact Statement is not a restating of the abstract. It should address the following: Why is the work submitted important to the field? How does the work submitted advance the field? What new information does this work impart to the field? How does this new information impact the field? Experimental Biology and Medicine journal, author guidelines

Typically the impact statement will be shorter than the Abstract, around 150 words.

Defining the study’s significance is helpful not just for the impact statement (if the journal asks for one) but also for building a more compelling argument throughout your submission. For instance, usually you’ll start the Discussion section of a paper by highlighting the research significance of your work. You’ll also include a short description in your Abstract too.

How to describe the research significance of a study, with examples

Whether you’re writing a thesis or a journal article, the approach to writing about the significance of a study are broadly the same.

I’d therefore suggest using the questions above as a starting point to base your statements on.

• Why is the work submitted important to the field?
• How does the work submitted advance the field?
• What new information does this work impart to the field?
• How does this new information impact the field?

Answer those questions and you’ll have a much clearer idea of the research significance of your work.

When describing it, try to clearly state what is novel about your study’s contribution to the literature. Then go on to discuss what impact it could have on progressing the field along with recommendations for future work.

Potential sentence starters

If you’re not sure where to start, why not set a 10 minute timer and have a go at trying to finish a few of the following sentences. Not sure on what to put? Have a chat to your supervisor or lab mates and they may be able to suggest some ideas.

• This study is important to the field because…
• These findings advance the field by…
• Our results highlight the importance of…
• Our discoveries impact the field by…

Now you’ve had a go let’s have a look at some real life examples.

Statement of significance examples

A statement of significance / impact:

Impact Statement This review highlights the historical development of the concept of “ideal protein” that began in the 1950s and 1980s for poultry and swine diets, respectively, and the major conceptual deficiencies of the long-standing concept of “ideal protein” in animal nutrition based on recent advances in amino acid (AA) metabolism and functions. Nutritionists should move beyond the “ideal protein” concept to consider optimum ratios and amounts of all proteinogenic AAs in animal foods and, in the case of carnivores, also taurine. This will help formulate effective low-protein diets for livestock, poultry, and fish, while sustaining global animal production. Because they are not only species of agricultural importance, but also useful models to study the biology and diseases of humans as well as companion (e.g. dogs and cats), zoo, and extinct animals in the world, our work applies to a more general readership than the nutritionists and producers of farm animals. Wu G, Li P. The “ideal protein” concept is not ideal in animal nutrition.  Experimental Biology and Medicine . 2022;247(13):1191-1201. doi: 10.1177/15353702221082658

And the same type of section but this time called “Advances in knowledge”:

Advances in knowledge: According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders. Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change. Size changes of at least 6 mm or more in  T 1  weighted or  T 2  weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change. Wennmann M, Grözinger M, Weru V, et al. Test-retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma [published online ahead of print, 2023 Apr 12].  Br J Radiol . 2023;20220745. doi: 10.1259/bjr.20220745

Other examples of research significance

Moving beyond the formal statement of significance, here is how you can describe research significance more broadly within your paper.

Describing research impact in an Abstract of a paper:

Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration. Conclusions section of the abstract in my first paper .

In the Discussion section of a paper:

We report for the utility of a standard laboratory micro-CT scanner to visualise and quantify features of the chondrocyte population within intact articular cartilage in 3D. This study represents a complimentary addition to the growing body of evidence supporting the non-destructive imaging of the constituents of articular cartilage. This offers researchers the opportunity to image chondrocyte distributions in 3D without specialised synchrotron equipment, enabling investigations such as chondrocyte morphology across grades of cartilage damage, 3D strain mapping techniques such as digital volume correlation to evaluate mechanical properties  in situ , and models for 3D finite element analysis  in silico  simulations. This enables an objective quantification of chondrocyte distribution and morphology in three dimensions allowing greater insight for investigations into studies of cartilage development, degeneration and repair. One such application of our method, is as a means to provide a 3D pattern in the cartilage which, when combined with digital volume correlation, could determine 3D strain gradient measurements enabling potential treatment and repair of cartilage degeneration. Moreover, the method proposed here will allow evaluation of cartilage implanted with tissue engineered scaffolds designed to promote chondral repair, providing valuable insight into the induced regenerative process. The Discussion section of the paper is laced with references to research significance.

How is longer term research significance measured?

Looking beyond writing impact statements within papers, sometimes you’ll want to quantify the long term research significance of your work. For instance when applying for jobs.

The most obvious measure of a study’s long term research significance is the number of citations it receives from future publications. The thinking is that a study which receives more citations will have had more research impact, and therefore significance , than a study which received less citations. Citations can give a broad indication of how useful the work is to other researchers but citations aren’t really a good measure of significance.

Bear in mind that us researchers can be lazy folks and sometimes are simply looking to cite the first paper which backs up one of our claims. You can find studies which receive a lot of citations simply for packaging up the obvious in a form which can be easily found and referenced, for instance by having a catchy or optimised title.

Likewise, research activity varies wildly between fields. Therefore a certain study may have had a big impact on a particular field but receive a modest number of citations, simply because not many other researchers are working in the field.

Nevertheless, citations are a standard measure of significance and for better or worse it remains impressive for someone to be the first author of a publication receiving lots of citations.

Other measures for the research significance of a study include:

• Accolades: best paper awards at conferences, thesis awards, “most downloaded” titles for articles, press coverage.
• How much follow-on research the study creates. For instance, part of my PhD involved a novel material initially developed by another PhD student in the lab. That PhD student’s research had unlocked lots of potential new studies and now lots of people in the group were using the same material and developing it for different applications. The initial study may not receive a high number of citations yet long term it generated a lot of research activity.

That covers research significance, but you’ll often want to consider other types of significance for your study and we’ll cover those next.

Statistical Significance

What is the statistical significance of a study.

Often as part of a study you’ll carry out statistical tests and then state the statistical significance of your findings: think p-values eg <0.05. It is useful to describe the outcome of these tests within your report or paper, to give a measure of statistical significance.

Effectively you are trying to show whether the performance of your innovation is actually better than a control or baseline and not just chance. Statistical significance deserves a whole other post so I won’t go into a huge amount of depth here.

Things that make publication in  The BMJ  impossible or unlikely Internal validity/robustness of the study • It had insufficient statistical power, making interpretation difficult; • Lack of statistical power; The British Medical Journal’s guide for authors

Calculating statistical significance isn’t always necessary (or valid) for a study, such as if you have a very small number of samples, but it is a very common requirement for scientific articles.

Writing a journal article? Check the journal’s guide for authors to see what they expect. Generally if you have approximately five or more samples or replicates it makes sense to start thinking about statistical tests. Speak to your supervisor and lab mates for advice, and look at other published articles in your field.

How is statistical significance measured?

Statistical significance is quantified using p-values . Depending on your study design you’ll choose different statistical tests to compute the p-value.

A p-value of 0.05 is a common threshold value. The 0.05 means that there is a 1/20 chance that the difference in performance you’re reporting is just down to random chance.

• p-values above 0.05 mean that the result isn’t statistically significant enough to be trusted: it is too likely that the effect you’re showing is just luck.
• p-values less than or equal to 0.05 mean that the result is statistically significant. In other words: unlikely to just be chance, which is usually considered a good outcome.

Low p-values (eg p = 0.001) mean that it is highly unlikely to be random chance (1/1000 in the case of p = 0.001), therefore more statistically significant.

It is important to clarify that, although low p-values mean that your findings are statistically significant, it doesn’t automatically mean that the result is scientifically important. More on that in the next section on research significance.

How to describe the statistical significance of your study, with examples

In the first paper from my PhD I ran some statistical tests to see if different staining techniques (basically dyes) increased how well you could see cells in cow tissue using micro-CT scanning (a 3D imaging technique).

In your methods section you should mention the statistical tests you conducted and then in the results you will have statements such as:

Between mediums for the two scan protocols C/N [contrast to noise ratio] was greater for EtOH than the PBS in both scanning methods (both  p  < 0.0001) with mean differences of 1.243 (95% CI [confidence interval] 0.709 to 1.778) for absorption contrast and 6.231 (95% CI 5.772 to 6.690) for propagation contrast. … Two repeat propagation scans were taken of samples from the PTA-stained groups. No difference in mean C/N was found with either medium: PBS had a mean difference of 0.058 ( p  = 0.852, 95% CI -0.560 to 0.676), EtOH had a mean difference of 1.183 ( p  = 0.112, 95% CI 0.281 to 2.648). From the Results section of my first paper, available here . Square brackets added for this post to aid clarity.

From this text the reader can infer from the first paragraph that there was a statistically significant difference in using EtOH compared to PBS (really small p-value of <0.0001). However, from the second paragraph, the difference between two repeat scans was statistically insignificant for both PBS (p = 0.852) and EtOH (p = 0.112).

By conducting these statistical tests you have then earned your right to make bold statements, such as these from the discussion section:

Propagation phase-contrast increases the contrast of individual chondrocytes [cartilage cells] compared to using absorption contrast. From the Discussion section from the same paper.

Without statistical tests you have no evidence that your results are not just down to random chance.

Beyond describing the statistical significance of a study in the main body text of your work, you can also show it in your figures.

In figures such as bar charts you’ll often see asterisks to represent statistical significance, and “n.s.” to show differences between groups which are not statistically significant. Here is one such figure, with some subplots, from the same paper:

In this example an asterisk (*) between two bars represents p < 0.05. Two asterisks (**) represents p < 0.001 and three asterisks (***) represents p < 0.0001. This should always be stated in the caption of your figure since the values that each asterisk refers to can vary.

Now that we know if a study is showing statistically and research significance, let’s zoom out a little and consider the potential for commercial significance.

Commercial and Industrial Significance

What are commercial and industrial significance.

Moving beyond significance in relation to academia, your research may also have commercial or economic significance.

Simply put:

• Commercial significance: could the research be commercialised as a product or service? Perhaps the underlying technology described in your study could be licensed to a company or you could even start your own business using it.
• Industrial significance: more widely than just providing a product which could be sold, does your research provide insights which may affect a whole industry? Such as: revealing insights or issues with current practices, performance gains you don’t want to commercialise (e.g. solar power efficiency), providing suggested frameworks or improvements which could be employed industry-wide.

I’ve grouped these two together because there can certainly be overlap. For instance, perhaps your new technology could be commercialised whilst providing wider improvements for the whole industry.

Commercial and industrial significance are not relevant to most studies, so only write about it if you and your supervisor can think of reasonable routes to your work having an impact in these ways.

How are commercial and industrial significance measured?

Unlike statistical and research significances, the measures of commercial and industrial significance can be much more broad.

Here are some potential measures of significance:

Commercial significance:

• How much value does your technology bring to potential customers or users?
• How big is the potential market and how much revenue could the product potentially generate?
• Is the intellectual property protectable? i.e. patentable, or if not could the novelty be protected with trade secrets: if so publish your method with caution!
• If commercialised, could the product bring employment to a geographical area?

Industrial significance:

What impact could it have on the industry? For instance if you’re revealing an issue with something, such as unintended negative consequences of a drug , what does that mean for the industry and the public? This could be:

• Reduced overhead costs
• Better safety
• Faster production methods
• Improved scaleability

How to describe the commercial and industrial significance of a study, with examples

Commercial significance.

If your technology could be commercially viable, and you’ve got an interest in commercialising it yourself, it is likely that you and your university may not want to immediately publish the study in a journal.

You’ll probably want to consider routes to exploiting the technology and your university may have a “technology transfer” team to help researchers navigate the various options.

However, if instead of publishing a paper you’re submitting a thesis or dissertation then it can be useful to highlight the commercial significance of your work. In this instance you could include statements of commercial significance such as:

The measurement technology described in this study provides state of the art performance and could enable the development of low cost devices for aerospace applications. An example of commercial significance I invented for this post

Industrial significance

First, think about the industrial sectors who could benefit from the developments described in your study.

For example if you’re working to improve battery efficiency it is easy to think of how it could lead to performance gains for certain industries, like personal electronics or electric vehicles. In these instances you can describe the industrial significance relatively easily, based off your findings.

For example:

By utilising abundant materials in the described battery fabrication process we provide a framework for battery manufacturers to reduce dependence on rare earth components. Again, an invented example

For other technologies there may well be industrial applications but they are less immediately obvious and applicable. In these scenarios the best you can do is to simply reframe your research significance statement in terms of potential commercial applications in a broad way.

As a reminder: not all studies should address industrial significance, so don’t try to invent applications just for the sake of it!

Societal Significance

What is the societal significance of a study.

The most broad category of significance is the societal impact which could stem from it.

If you’re working in an applied field it may be quite easy to see a route for your research to impact society. For others, the route to societal significance may be less immediate or clear.

Studies can help with big issues facing society such as:

• Medical applications : vaccines, surgical implants, drugs, improving patient safety. For instance this medical device and drug combination I worked on which has a very direct route to societal significance.
• Political significance : Your research may provide insights which could contribute towards potential changes in policy or better understanding of issues facing society.
• Public health : for instance COVID-19 transmission and related decisions.
• Climate change : mitigation such as more efficient solar panels and lower cost battery solutions, and studying required adaptation efforts and technologies. Also, better understanding around related societal issues, for instance this study on the effects of temperature on hate speech.

How is societal significance measured?

Societal significance at a high level can be quantified by the size of its potential societal effect. Just like a lab risk assessment, you can think of it in terms of probability (or how many people it could help) and impact magnitude.

Societal impact = How many people it could help x the magnitude of the impact

Think about how widely applicable the findings are: for instance does it affect only certain people? Then think about the potential size of the impact: what kind of difference could it make to those people?

Between these two metrics you can get a pretty good overview of the potential societal significance of your research study.

How to describe the societal significance of a study, with examples

Quite often the broad societal significance of your study is what you’re setting the scene for in your Introduction. In addition to describing the existing literature, it is common to for the study’s motivation to touch on its wider impact for society.

For those of us working in healthcare research it is usually pretty easy to see a path towards societal significance.

Our CLOUT model has state-of-the-art performance in mortality prediction, surpassing other competitive NN models and a logistic regression model … Our results show that the risk factors identified by the CLOUT model agree with physicians’ assessment, suggesting that CLOUT could be used in real-world clinicalsettings. Our results strongly support that CLOUT may be a useful tool to generate clinical prediction models, especially among hospitalized and critically ill patient populations. Learning Latent Space Representations to Predict Patient Outcomes: Model Development and Validation

In other domains the societal significance may either take longer or be more indirect, meaning that it can be more difficult to describe the societal impact.

Even so, here are some examples I’ve found from studies in non-healthcare domains:

We examined food waste as an initial investigation and test of this methodology, and there is clear potential for the examination of not only other policy texts related to food waste (e.g., liability protection, tax incentives, etc.; Broad Leib et al., 2020) but related to sustainable fishing (Worm et al., 2006) and energy use (Hawken, 2017). These other areas are of obvious relevance to climate change… AI-Based Text Analysis for Evaluating Food Waste Policies

The continued development of state-of-the art NLP tools tailored to climate policy will allow climate researchers and policy makers to extract meaningful information from this growing body of text, to monitor trends over time and administrative units, and to identify potential policy improvements. BERT Classification of Paris Agreement Climate Action Plans

Top Tips For Identifying & Writing About the Significance of Your Study

• Writing a thesis? Describe the significance of your study in the Introduction and the Conclusion .
• Submitting a paper? Read the journal’s guidelines. If you’re writing a statement of significance for a journal, make sure you read any guidance they give for what they’re expecting.
• Take a step back from your research and consider your study’s main contributions.
• Read previously published studies in your field . Use this for inspiration and ideas on how to describe the significance of your own study
• Discuss the study with your supervisor and potential co-authors or collaborators and brainstorm potential types of significance for it.

Now you’ve finished reading up on the significance of a study you may also like my how-to guide for all aspects of writing your first research paper .

Writing an academic journal paper

I hope that you’ve learned something useful from this article about the significance of a study. If you have any more research-related questions let me know, I’m here to help.

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How To Write a Significance Statement for Your Research

A significance statement is an essential part of a research paper. It explains the importance and relevance of the study to the academic community and the world at large. To write a compelling significance statement, identify the research problem, explain why it is significant, provide evidence of its importance, and highlight its potential impact on future research, policy, or practice. A well-crafted significance statement should effectively communicate the value of the research to readers and help them understand why it matters.

Updated on May 4, 2023

A significance statement is a clearly stated, non-technical paragraph that explains why your research matters. It’s central in making the public aware of and gaining support for your research.

Write it in jargon-free language that a reader from any field can understand. Well-crafted, easily readable significance statements can improve your chances for citation and impact and make it easier for readers outside your field to find and understand your work.

Read on for more details on what a significance statement is, how it can enhance the impact of your research, and, of course, how to write one.

What is a significance statement in research?

A significance statement answers the question: How will your research advance scientific knowledge and impact society at large (as well as specific populations)? 

You might also see it called a “Significance of the study” statement. Some professional organizations in the STEM sciences and social sciences now recommended that journals in their disciplines make such statements a standard feature of each published article. Funding agencies also consider “significance” a key criterion for their awards.

Read some examples of significance statements from the Proceedings of the National Academy of Sciences (PNAS) here .

Depending upon the specific journal or funding agency’s requirements, your statement may be around 100 words and answer these questions:

1. What’s the purpose of this research?

2. What are its key findings?

3. Why do they matter?

4. Who benefits from the research results?

Readers will want to know: “What is interesting or important about this research?” Keep asking yourself that question.

Where to place the significance statement in your manuscript

Most journals ask you to place the significance statement before or after the abstract, so check with each journal’s guide. 

This article is focused on the formal significance statement, even though you’ll naturally highlight your project’s significance elsewhere in your manuscript. (In the introduction, you’ll set out your research aims, and in the conclusion, you’ll explain the potential applications of your research and recommend areas for future research. You’re building an overall case for the value of your work.)

Developing the significance statement

The main steps in planning and developing your statement are to assess the gaps to which your study contributes, and then define your work’s implications and impact.

Identify what gaps your study fills and what it contributes

Your literature review was a big part of how you planned your study. To develop your research aims and objectives, you identified gaps or unanswered questions in the preceding research and designed your study to address them.

Go back to that lit review and look at those gaps again. Review your research proposal to refresh your memory. Ask:

• How have my research findings advanced knowledge or provided notable new insights?
• How has my research helped to prove (or disprove) a hypothesis or answer a research question?
• Why are those results important?

Consider your study’s potential impact at two levels: 

• What contribution does my research make to my field?
• How does it specifically contribute to knowledge; that is, who will benefit the most from it?

Define the implications and potential impact

As you make notes, keep the reasons in mind for why you are writing this statement. Whom will it impact, and why?

The first audience for your significance statement will be journal reviewers when you submit your article for publishing. Many journals require one for manuscript submissions. Study the author’s guide of your desired journal to see its criteria ( here’s an example ). Peer reviewers who can clearly understand the value of your research will be more likely to recommend publication. 

Second, when you apply for funding, your significance statement will help justify why your research deserves a grant from a funding agency . The U.S. National Institutes of Health (NIH), for example, wants to see that a project will “exert a sustained, powerful influence on the research field(s) involved.” Clear, simple language is always valuable because not all reviewers will be specialists in your field.

Third, this concise statement about your study’s importance can affect how potential readers engage with your work. Science journalists and interested readers can promote and spread your work, enhancing your reputation and influence. Help them understand your work.

You’re now ready to express the importance of your research clearly and concisely. Time to start writing.

How to write a significance statement: Key elements 

When drafting your statement, focus on both the content and writing style.

• In terms of content, emphasize the importance, timeliness, and relevance of your research results. 
• Write the statement in plain, clear language rather than scientific or technical jargon. Your audience will include not just your fellow scientists but also non-specialists like journalists, funding reviewers, and members of the public. 

Follow the process we outline below to build a solid, well-crafted, and informative statement. 

Get started

Some suggested opening lines to help you get started might be:

• The implications of this study are… 
• Building upon previous contributions, our study moves the field forward because…
• Our study furthers previous understanding about…

Alternatively, you may start with a statement about the phenomenon you’re studying, leading to the problem statement.

Include these components

Next, draft some sentences that include the following elements. A good example, which we’ll use here, is a significance statement by Rogers et al. (2022) published in the Journal of Climate .

1. Briefly situate your research study in its larger context . Start by introducing the topic, leading to a problem statement. Here’s an example:

‘Heatwaves pose a major threat to human health, ecosystems, and human systems.”

2. State the research problem.

“Simultaneous heatwaves affecting multiple regions can exacerbate such threats. For example, multiple food-producing regions simultaneously undergoing heat-related crop damage could drive global food shortages.”

3. Tell what your study does to address it.

“We assess recent changes in the occurrence of simultaneous large heatwaves.”

4. Provide brief but powerful evidence to support the claims your statement is making , Use quantifiable terms rather than vague ones (e.g., instead of “This phenomenon is happening now more than ever,” see below how Rogers et al. (2022) explained it). This evidence intensifies and illustrates the problem more vividly:

“Such simultaneous heatwaves are 7 times more likely now than 40 years ago. They are also hotter and affect a larger area. Their increasing occurrence is mainly driven by warming baseline temperatures due to global heating, but changes in weather patterns contribute to disproportionate increases over parts of Europe, the eastern United States, and Asia.

5. Relate your study’s impact to the broader context , starting with its general significance to society—then, when possible, move to the particular as you name specific applications of your research findings. (Our example lacks this second level of application.) 

“Better understanding the drivers of weather pattern changes is therefore important for understanding future concurrent heatwave characteristics and their impacts.”

Refine your English

Don’t understate or overstate your findings – just make clear what your study contributes. When you have all the elements in place, review your draft to simplify and polish your language. Even better, get an expert AJE edit . Be sure to use “plain” language rather than academic jargon.

• Avoid acronyms, scientific jargon, and technical terms 
• Use active verbs in your sentence structure rather than passive voice (e.g., instead of “It was found that...”, use “We found...”)
• Make sentence structures short, easy to understand – readable
• Try to address only one idea in each sentence and keep sentences within 25 words (15 words is even better)
• Eliminate nonessential words and phrases (“fluff” and wordiness)

Enhance your significance statement’s impact

Always take time to review your draft multiple times. Make sure that you:

• Keep your language focused
• Provide evidence to support your claims
• Relate the significance to the broader research context in your field

After revising your significance statement, request feedback from a reading mentor about how to make it even clearer. If you’re not a native English speaker, seek help from a native-English-speaking colleague or use an editing service like AJE to make sure your work is at a native level.

Understanding the significance of your study

Your readers may have much less interest than you do in the specific details of your research methods and measures. Many readers will scan your article to learn how your findings might apply to them and their own research. 

Different types of significance

Your findings may have different types of significance, relevant to different populations or fields of study for different reasons. You can emphasize your work’s statistical, clinical, or practical significance. Editors or reviewers in the social sciences might also evaluate your work’s social or political significance.

Statistical significance means that the results are unlikely to have occurred randomly. Instead, it implies a true cause-and-effect relationship.

Clinical significance means that your findings are applicable for treating patients and improving quality of life.

Practical significance is when your research outcomes are meaningful to society at large, in the “real world.” Practical significance is usually measured by the study’s  effect size . Similarly, evaluators may attribute social or political significance to research that addresses “real and immediate” social problems.

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What is the Significance of the Study?

• By DiscoverPhDs
• August 25, 2020

• what the significance of the study means,
• why it’s important to include in your research work,
• where you would include it in your paper, thesis or dissertation,
• how you write one
• and finally an example of a well written section about the significance of the study.

What does Significance of the Study mean?

The significance of the study is a written statement that explains why your research was needed. It’s a justification of the importance of your work and impact it has on your research field, it’s contribution to new knowledge and how others will benefit from it.

Why is the Significance of the Study important?

The significance of the study, also known as the rationale of the study, is important to convey to the reader why the research work was important. This may be an academic reviewer assessing your manuscript under peer-review, an examiner reading your PhD thesis, a funder reading your grant application or another research group reading your published journal paper. Your academic writing should make clear to the reader what the significance of the research that you performed was, the contribution you made and the benefits of it.

How do you write the Significance of the Study?

When writing this section, first think about where the gaps in knowledge are in your research field. What are the areas that are poorly understood with little or no previously published literature? Or what topics have others previously published on that still require further work. This is often referred to as the problem statement.

The introduction section within the significance of the study should include you writing the problem statement and explaining to the reader where the gap in literature is.

Then think about the significance of your research and thesis study from two perspectives: (1) what is the general contribution of your research on your field and (2) what specific contribution have you made to the knowledge and who does this benefit the most.

For example, the gap in knowledge may be that the benefits of dumbbell exercises for patients recovering from a broken arm are not fully understood. You may have performed a study investigating the impact of dumbbell training in patients with fractures versus those that did not perform dumbbell exercises and shown there to be a benefit in their use. The broad significance of the study would be the improvement in the understanding of effective physiotherapy methods. Your specific contribution has been to show a significant improvement in the rate of recovery in patients with broken arms when performing certain dumbbell exercise routines.

This statement should be no more than 500 words in length when written for a thesis. Within a research paper, the statement should be shorter and around 200 words at most.

Significance of the Study: An example

Building on the above hypothetical academic study, the following is an example of a full statement of the significance of the study for you to consider when writing your own. Keep in mind though that there’s no single way of writing the perfect significance statement and it may well depend on the subject area and the study content.

Here’s another example to help demonstrate how a significance of the study can also be applied to non-technical fields:

The significance of this research lies in its potential to inform clinical practices and patient counseling. By understanding the psychological outcomes associated with non-surgical facial aesthetics, practitioners can better guide their patients in making informed decisions about their treatment plans. Additionally, this study contributes to the body of academic knowledge by providing empirical evidence on the effects of these cosmetic procedures, which have been largely anecdotal up to this point.

The statement of the significance of the study is used by students and researchers in academic writing to convey the importance of the research performed; this section is written at the end of the introduction and should describe the specific contribution made and who it benefits.

Find out the different dissertation and thesis binding options, which is best, advantages and disadvantages, typical costs, popular services and more.

Need to write a list of abbreviations for a thesis or dissertation? Read our post to find out where they go, what to include and how to format them.

In the UK, a dissertation, usually around 20,000 words is written by undergraduate and Master’s students, whilst a thesis, around 80,000 words, is written as part of a PhD.

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Home » Background of The Study – Examples and Writing Guide

Background of The Study – Examples and Writing Guide

Table of Contents

Background of The Study

Definition:

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

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

How to Write Background of The Study

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

Identify the Research Problem

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

Provide Context

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

Review Literature

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

Identify Research Gap

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

State Objectives

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

Discuss Significance

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

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

How to Write Background of The Study in Proposal

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

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

How to Write Background of The Study In Thesis

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

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

How to Write Background of The Study in Research Paper

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

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

Examples of Background of The Study

Here are some examples of the background of the study:

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

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

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

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

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

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

Edxample 3:

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

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

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

Examples of Background of The Study In Research

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

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

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

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

Examples of Background of The Study in Proposal

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

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

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

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

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

Examples of Background of The Study in Thesis

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

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

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

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

Examples of Background of The Study in Research Paper

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

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

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

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

Purpose of Background of The Study

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

More specifically, the background of the study aims to:

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

When to Write Background of The Study

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

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

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

Advantage of Background of The Study

The background of the study has several advantages, including:

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

Disadvantages of Background of The Study

Some Disadvantages of Background of The Study are as follows:

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

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• What Is Qualitative Research? | Methods & Examples

What Is Qualitative Research? | Methods & Examples

Published on June 19, 2020 by Pritha Bhandari . Revised on June 22, 2023.

Qualitative research involves collecting and analyzing non-numerical data (e.g., text, video, or audio) to understand concepts, opinions, or experiences. It can be used to gather in-depth insights into a problem or generate new ideas for research.

Qualitative research is the opposite of quantitative research , which involves collecting and analyzing numerical data for statistical analysis.

Qualitative research is commonly used in the humanities and social sciences, in subjects such as anthropology, sociology, education, health sciences, history, etc.

• How does social media shape body image in teenagers?
• How do children and adults interpret healthy eating in the UK?
• What factors influence employee retention in a large organization?
• How is anxiety experienced around the world?
• How can teachers integrate social issues into science curriculums?

Table of contents

Approaches to qualitative research, qualitative research methods, qualitative data analysis, advantages of qualitative research, disadvantages of qualitative research, other interesting articles, frequently asked questions about qualitative research.

Qualitative research is used to understand how people experience the world. While there are many approaches to qualitative research, they tend to be flexible and focus on retaining rich meaning when interpreting data.

Common approaches include grounded theory, ethnography , action research , phenomenological research, and narrative research. They share some similarities, but emphasize different aims and perspectives.

Note that qualitative research is at risk for certain research biases including the Hawthorne effect , observer bias , recall bias , and social desirability bias . While not always totally avoidable, awareness of potential biases as you collect and analyze your data can prevent them from impacting your work too much.

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Each of the research approaches involve using one or more data collection methods . These are some of the most common qualitative methods:

• Observations: recording what you have seen, heard, or encountered in detailed field notes.
• Interviews:  personally asking people questions in one-on-one conversations.
• Focus groups: asking questions and generating discussion among a group of people.
• Surveys : distributing questionnaires with open-ended questions.
• Secondary research: collecting existing data in the form of texts, images, audio or video recordings, etc.
• You take field notes with observations and reflect on your own experiences of the company culture.
• You distribute open-ended surveys to employees across all the company’s offices by email to find out if the culture varies across locations.
• You conduct in-depth interviews with employees in your office to learn about their experiences and perspectives in greater detail.

Qualitative researchers often consider themselves “instruments” in research because all observations, interpretations and analyses are filtered through their own personal lens.

For this reason, when writing up your methodology for qualitative research, it’s important to reflect on your approach and to thoroughly explain the choices you made in collecting and analyzing the data.

Qualitative data can take the form of texts, photos, videos and audio. For example, you might be working with interview transcripts, survey responses, fieldnotes, or recordings from natural settings.

Most types of qualitative data analysis share the same five steps:

• Prepare and organize your data. This may mean transcribing interviews or typing up fieldnotes.
• Review and explore your data. Examine the data for patterns or repeated ideas that emerge.
• Develop a data coding system. Based on your initial ideas, establish a set of codes that you can apply to categorize your data.
• Assign codes to the data. For example, in qualitative survey analysis, this may mean going through each participant’s responses and tagging them with codes in a spreadsheet. As you go through your data, you can create new codes to add to your system if necessary.
• Identify recurring themes. Link codes together into cohesive, overarching themes.

There are several specific approaches to analyzing qualitative data. Although these methods share similar processes, they emphasize different concepts.

Qualitative research often tries to preserve the voice and perspective of participants and can be adjusted as new research questions arise. Qualitative research is good for:

• Flexibility

The data collection and analysis process can be adapted as new ideas or patterns emerge. They are not rigidly decided beforehand.

• Natural settings

Data collection occurs in real-world contexts or in naturalistic ways.

• Meaningful insights

Detailed descriptions of people’s experiences, feelings and perceptions can be used in designing, testing or improving systems or products.

• Generation of new ideas

Open-ended responses mean that researchers can uncover novel problems or opportunities that they wouldn’t have thought of otherwise.

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Researchers must consider practical and theoretical limitations in analyzing and interpreting their data. Qualitative research suffers from:

• Unreliability

The real-world setting often makes qualitative research unreliable because of uncontrolled factors that affect the data.

• Subjectivity

Due to the researcher’s primary role in analyzing and interpreting data, qualitative research cannot be replicated . The researcher decides what is important and what is irrelevant in data analysis, so interpretations of the same data can vary greatly.

• Limited generalizability

Small samples are often used to gather detailed data about specific contexts. Despite rigorous analysis procedures, it is difficult to draw generalizable conclusions because the data may be biased and unrepresentative of the wider population .

• Labor-intensive

Although software can be used to manage and record large amounts of text, data analysis often has to be checked or performed manually.

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

• Chi square goodness of fit test
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

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

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

There are five common approaches to qualitative research :

• Grounded theory involves collecting data in order to develop new theories.
• Ethnography involves immersing yourself in a group or organization to understand its culture.
• Narrative research involves interpreting stories to understand how people make sense of their experiences and perceptions.
• Phenomenological research involves investigating phenomena through people’s lived experiences.
• Action research links theory and practice in several cycles to drive innovative changes.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organizations.

There are various approaches to qualitative data analysis , but they all share five steps in common:

• Prepare and organize your data.
• Review and explore your data.
• Develop a data coding system.
• Assign codes to the data.
• Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

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The purpose of qualitative research

Cite this chapter.

• Janice M. Morse 3 &
• Peggy Anne Field 4  

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Research fills a vital and important role in society: it is the means by which discoveries are made, ideas are confirmed or refuted, events controlled or predicted and theory developed or refined. All of these functions contribute to the development of knowledge. However, no single research approach fulfills all of these functions, and the contribution of qualitative research is both vital and unique to the goals of research in general. Qualitative research enables us to make sense of reality, to describe and explain the social world and to develop explanatory models and theories. It is the primary means by which the theoretical foundations of social sciences may be constructed or re-examined.

Research is to see what everybody has seen and to think what nobody has thought. (Albert Szent-Gyorgy)

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Morse, J.M., Field, P.A. (1996). The purpose of qualitative research. In: Nursing Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-4471-9_1

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• 1 University of Nebraska Medical Center
• 2 GDB Research and Statistical Consulting
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• PMID: 29262162
• Bookshelf ID: NBK470395

Qualitative research is a type of research that explores and provides deeper insights into real-world problems. Instead of collecting numerical data points or intervening or introducing treatments just like in quantitative research, qualitative research helps generate hypothenar to further investigate and understand quantitative data. Qualitative research gathers participants' experiences, perceptions, and behavior. It answers the hows and whys instead of how many or how much. It could be structured as a standalone study, purely relying on qualitative data, or part of mixed-methods research that combines qualitative and quantitative data. This review introduces the readers to some basic concepts, definitions, terminology, and applications of qualitative research.

Qualitative research, at its core, asks open-ended questions whose answers are not easily put into numbers, such as "how" and "why." Due to the open-ended nature of the research questions, qualitative research design is often not linear like quantitative design. One of the strengths of qualitative research is its ability to explain processes and patterns of human behavior that can be difficult to quantify. Phenomena such as experiences, attitudes, and behaviors can be complex to capture accurately and quantitatively. In contrast, a qualitative approach allows participants themselves to explain how, why, or what they were thinking, feeling, and experiencing at a particular time or during an event of interest. Quantifying qualitative data certainly is possible, but at its core, qualitative data is looking for themes and patterns that can be difficult to quantify, and it is essential to ensure that the context and narrative of qualitative work are not lost by trying to quantify something that is not meant to be quantified.

However, while qualitative research is sometimes placed in opposition to quantitative research, where they are necessarily opposites and therefore "compete" against each other and the philosophical paradigms associated with each other, qualitative and quantitative work are neither necessarily opposites, nor are they incompatible. While qualitative and quantitative approaches are different, they are not necessarily opposites and certainly not mutually exclusive. For instance, qualitative research can help expand and deepen understanding of data or results obtained from quantitative analysis. For example, say a quantitative analysis has determined a correlation between length of stay and level of patient satisfaction, but why does this correlation exist? This dual-focus scenario shows one way in which qualitative and quantitative research could be integrated.

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Conflict of interest statement

Disclosure: Steven Tenny declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle Brannan declares no relevant financial relationships with ineligible companies.

Disclosure: Grace Brannan declares no relevant financial relationships with ineligible companies.

• Introduction
• Issues of Concern
• Clinical Significance
• Enhancing Healthcare Team Outcomes
• Review Questions

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Market Research

Qualitative Research: Understanding the Goal and Benefits for Effective Analysis

As market trends evolve at lightning speed in the age of digital transformation, having an intimate understanding of consumer desires and motivations is more critical than ever. Enter qualitative research – the knight in shining armor of deep-dive data analysis. In this blog post, we’ll be exploring the profound purpose and impressive benefits behind qualitative research, unveiling how it anchors effective market analysis and strategy development. Brace yourselves for a mesmerizing journey into the realm of potent insights that power consequential decisions and breed groundbreaking innovation.

The primary goal of qualitative research is to obtain insights into participants’ experiences and understanding of the world. This type of research provides rich descriptions and explanations of processes in identifiable local contexts. Qualitative research has several benefits including providing an in-depth understanding, being flexible and adaptable, and generating descriptive data that can be used to create new theories using the inductive method. 

Qualitative Study’s Importance

Qualitative research holds a significant place in the realm of social science research and is integral for understanding the complexities of human behavior, experiences, and social interactions. Unlike quantitative research which focuses on numerical data and statistical analysis, qualitative research collects non-numerical data and emphasizes interpreting meaning from social contexts.

The importance of qualitative research lies in its ability to provide rich descriptions and explanations of processes in identifiable local contexts. It allows researchers to gain insights into participants’ experiences and understand the world as another person experiences it. This deeper understanding paves the way for more comprehensive analyses and the development of theories that accurately represent the intricacies of human life.

For instance, imagine a sociologist interested in studying how individuals cope with unemployment during economic downturns. By conducting qualitative research , these sociologists can immerse themselves in the lives of unemployed individuals, observe their daily routines, conduct in-depth interviews, and analyze their personal narratives. This approach goes beyond simply quantifying unemployment rates; it provides an intimate understanding of how people navigate through difficult situations and sheds light on the emotional, psychological, and societal impacts.

In addition to providing rich insight into human experiences, qualitative research offers numerous other benefits that contribute to effective analysis.

• Qualitative research is essential in social science research as it allows for a deeper understanding of human behavior and social interactions. Its focus on non-numerical data collection and interpretation of meaning helps researchers gain insights into participants’ experiences and contextual factors. Qualitative research also provides rich descriptions and explanations of processes in identifiable local contexts, leading to the development of comprehensive analysis and accurate theories. Overall, qualitative research offers numerous benefits that contribute to effective analysis in social science research.

Goals & Benefits Driving Research

The goals of qualitative research are multifaceted. One primary objective is to investigate the meanings people attribute to their behavior and interactions within specific social contexts. This focus on subjective interpretations helps uncover individual perspectives that may be overlooked by quantitative methods alone. Additionally, qualitative research aims to explore social phenomena that are not easily measurable or quantifiable.

Qualitative research also generates descriptive data that requires rigorous methods of analysis. Researchers employ various techniques such as thematic analysis or grounded theory to identify patterns, themes, and categories within their data. These analytical approaches ensure systematic interpretation while maintaining the integrity of participants’ lived experiences.

Beyond these goals, qualitative research offers several benefits that aid in reliable analysis. Firstly, it provides an in-depth understanding of complex social issues by capturing the nuances and subtleties of human behavior. This depth allows researchers to generate rich descriptions and explanations that facilitate a comprehensive comprehension of social phenomena.

For example, consider a study exploring the experience of minority students in predominantly white institutions. Through qualitative research methods like interviews and focus groups, researchers can delve into the students’ lived experiences, their perceptions of inclusion or exclusion, and their strategies for navigating through institutional challenges. This level of detail paints a holistic picture that goes beyond quantitative statistics such as enrollment numbers.

Another advantage of qualitative research is its flexibility and adaptability. Researchers can modify their data collection methods to account for new insights or unexpected findings during the research process. This responsiveness allows for deeper exploration and ensures that no valuable information is left unexamined.

However, it is essential to acknowledge that qualitative research also has its limitations. These include the limited scope and generalizability of findings due to the smaller sample sizes typically used in qualitative studies. Additionally, there is a potential for researcher bias since the individuals collecting and analyzing the data play an active role in shaping the research process.

Nonetheless, while objectivity may be seen as a myth in qualitative research, researchers should be honest and transparent about their own biases and assumptions. Reflexivity, which involves acknowledging and critically examining one’s subjectivity throughout the research process, is integral to ensuring integrity and minimizing undue influence.

• According to a report from the Journal of Social Issues, as of 2022, around 45% of psychological studies used qualitative methods, signaling strong recognition in the field for its unique insights into human behavior.
• A study conducted by the Market Research Society confirmed that out of all market research carried out worldwide, approximately 20% utilize qualitative methodologies. This highlights its crucial role in understanding customer behaviors and motivations.
• The National Center for Biotechnology Information (NCBI) indicated that nearly 70% of health research incorporates some elements of qualitative research, underscoring its importance in contributing to our understanding of complex health issues and interventions.

Comprehensive Approaches

When conducting qualitative research , adopting comprehensive approaches is essential for capturing the richness and depth of data required for effective analysis. These approaches involve a holistic perspective that considers multiple dimensions and contexts. One commonly used comprehensive approach is triangulation , which involves using multiple data sources, methods, or perspectives to cross-verify findings. By triangulating data, researchers can enhance the reliability and validity of their analysis.

Another important approach is thick description , which focuses on providing detailed and vivid accounts of participants’ experiences and contexts. This technique enables researchers to capture the nuances and complexities of social phenomena, ensuring a comprehensive understanding of the research topic. Thick descriptions typically include vivid narratives, dialogue excerpts, and detailed observations, providing readers with a rich portrayal of the study’s context.

Researchers may also adopt an iterative process in their analysis, where data collection and analysis occur simultaneously. This approach allows for constant refinement and adjustment of research questions and methods based on emerging findings. Through iteration, researchers can dive deeper into the topic, uncover unexpected insights, and explore various angles that contribute to a more comprehensive analysis.

It’s worth noting that comprehensive approaches in qualitative research require flexibility and openness to embracing emergent themes and unexpected directions. As researchers immerse themselves in the data, they should be willing to adapt their strategies accordingly.

Participant Engagement & Topic Exploration

Participant engagement plays a crucial role in qualitative research as it fosters a deeper understanding of participants’ perspectives and experiences. Effective engagement encourages open dialogue and trust between the researcher and participants, allowing for richer data collection. One way to promote participant engagement is through active listening . By attentively listening to participants’ stories, concerns, and viewpoints, researchers can demonstrate empathy and create a safe space for open expression.

Another aspect that greatly enhances participant engagement is establishing rapport . Building rapport involves creating a comfortable environment where participants feel at ease to share their thoughts and experiences. This can be achieved through transparent communication, respect for participants’ autonomy, and genuine interest in their stories. Researchers should establish a positive and respectful relationship with participants, positioning themselves as partners rather than authoritative figures.

In qualitative research, topic exploration is a dynamic and iterative process that allows researchers to uncover new insights and dimensions of the phenomenon under study. This involves probing deeper into participants’ responses, asking follow-up questions, and exploring unexpected avenues that emerge during data collection. By being open to revisiting research questions and digging deeper into topics, researchers can uncover valuable insights and gain a more comprehensive understanding of the subject matter.

It’s important to note that participant engagement and topic exploration go hand in hand. Engaged participants are more likely to provide rich and detailed responses, leading to enhanced exploration of the research topic. Conversely, skillful topic exploration can foster deeper engagement from participants by demonstrating genuine interest and curiosity in their perspectives.

Effective Data Accumulation Methods

In qualitative research, the collection of rich and meaningful data is a crucial step toward understanding the complexities of human experiences. To ensure effective analysis, researchers need to employ appropriate data accumulation methods that capture the depth of participants’ perspectives and insights. Let’s explore some strategies that can facilitate this process.

One common method used in qualitative research is participant observation. This involves immersing oneself in the research setting, actively observing, and taking detailed notes on behaviors, interactions, and cultural nuances. By being present in the natural context, researchers gain a deeper understanding of the social dynamics and can document valuable data that may go unnoticed otherwise.

For instance, imagine a researcher interested in studying the experiences of healthcare workers in a hospital. Through participant observation, they can shadow these workers, witness their daily routines, the challenges they face, and even engage in conversations during breaks. This method provides an intimate look into their lives and generates valuable insights.

Another effective technique is in-depth interviews. These interviews allow researchers to establish a personal connection with participants and delve into their thoughts, feelings, and motivations regarding the research topic. It’s crucial to create an open and comfortable environment where participants feel safe sharing their views openly.

Additionally, focus groups are utilized as a powerful data accumulation method. Bringing together a small group of individuals who share similar characteristics or experiences allows for stimulating discussions that uncover diverse perspectives. Participants can build upon each other’s ideas and provide deeper insights collectively.

Having explored effective data accumulation methods like participant observation, in-depth interviews, and focus groups, let’s now dive into another important aspect of qualitative research – harnessing sensory inputs & eliciting verbal responses.

Harnessing Sensory Inputs and Eliciting Verbal Responses

Qualitative research aims to understand phenomena from the perspective of individuals involved. One way to achieve this is by harnessing sensory inputs and eliciting verbal responses, allowing participants to express themselves fully. This approach taps into a range of human senses and encourages participants to describe their experiences vividly.

For instance, researchers might utilize photovoice techniques, where participants capture images related to the research topic using cameras or smartphones. These visual representations allow participants to share their perspectives in a unique and powerful way.

Imagine a study exploring the impact of urbanization on community well-being. Participants could be asked to take pictures of spaces they feel contribute positively or negatively to their quality of life. These images can then be used as stimuli for further discussion, sparking conversations about the emotional and sensory aspects of the built environment.

In addition to visuals, researchers can also engage participants’ sense of hearing through audio recordings. By recording interviews, focus group discussions, or even ambient sounds in a particular environment, researchers can capture subtle nuances that may not be conveyed through written transcripts alone.

By harnessing sensory inputs and giving participants the space for verbal expression, qualitative researchers foster an environment where rich and nuanced data can be collected. This multi-sensory approach enables a deeper understanding of individuals’ experiences and allows us to gain insights beyond mere words.

Parsing and Conclusion Derivation from Data

In qualitative research, one of the primary goals is to parse and derive meaningful conclusions from the collected data. Unlike quantitative research which relies on statistical analysis, qualitative research involves obtaining rich descriptions of participants’ experiences and understanding the world as another person experiences it. The process of parsing and deriving conclusions from qualitative data requires a meticulous examination of the data, identification of patterns, themes, and connections, and an inductive approach to theory development.

Qualitative researchers immerse themselves in the data collected through methods such as interviews, observations, and focus groups. They carefully analyze transcripts, field notes, or documents to identify recurring themes or significant incidents that shed light on the research question. Through this process of coding and categorizing, researchers start to make sense of the data and identify key findings that can be used to develop theories or inform specific contexts.

For example, imagine a researcher conducting an ethnographic study exploring the experiences of undocumented immigrants in their journey toward citizenship. Through interviews and participant observation, they gather compelling stories and narratives about the challenges faced by these individuals. By carefully analyzing these stories for common themes such as navigating legal systems or facing social stigma, the researcher can derive conclusions about the complex processes involved in seeking legal status.

“Analyzing qualitative data is like piecing together a puzzle. Each interview or observation provides a unique piece that contributes to the overall picture.”

However, it is important to note that deriving conclusions from qualitative data is not a simple linear process. It requires reflexivity on the part of the researcher to acknowledge their own biases and assumptions that may influence their interpretation of the data. Reflexivity encourages researchers to critically reflect on how their own subjectivity affects their analysis and conclusions.

Advantages & Drawbacks of This Research Type

Qualitative research offers several advantages that contribute to its effectiveness in providing rich insights into social phenomena. First and foremost, it allows researchers to gain an in-depth understanding of the experiences, perspectives, and meanings that individuals attribute to their behavior and interactions. This depth of understanding is often difficult to achieve through quantitative research methods alone.

Moreover, qualitative research is known for its flexibility and adaptability. Researchers can modify their research design or data collection methods as they delve deeper into the field, responding to emerging themes or new areas of investigation. The open-ended nature of qualitative research also enables participants to express themselves freely and provide nuanced responses, offering a more comprehensive view of complex social phenomena.

On the other hand, there are some drawbacks to consider when conducting qualitative research. One challenge is the limited scope and generalizability of findings. Due to the small sample sizes typically involved in qualitative studies, it can be challenging to extrapolate findings to broader populations or contexts. Additionally, there is potential for researcher bias as interpretations of qualitative data are subjective and influenced by researchers’ perspectives and assumptions.

Despite these limitations, the benefits of qualitative research outweigh its drawbacks in many cases. By providing detailed insights into participants’ experiences, qualitative research contributes valuable knowledge that can inform policy decisions, improve interventions, and enhance our understanding of social phenomena.

Unlock the power of qualitative research with Discuss

In a world driven by meaningful connections, Discuss stands at the forefront of qualitative research, empowering you to delve deeper, understand better, and innovate with confidence. Elevate your research game—choose Discuss for insights that go beyond the surface. Navigate cultural nuances effortlessly. Our platform is designed to facilitate cross-cultural research, helping you understand and appreciate the local context that shapes consumer behavior around the world.

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Home » Feature » Thesis » Significance of the Study Samples | Writing Tips

Significance of the Study Samples | Writing Tips

When you write a thesis , there is a section there that is allocated for the significance of the study. This article will provide different  significance of the study examples and will discuss tips on how to write this part.

Tips in Writing the Significance of the Study

Here are the tips that may be helpful when writing the significance of the study. These tips will tell you the basic components expected to be seen in the significance of the study content.

1. Refer to the Problem Statement

In writing the significance of the study, always refer to the statement of the problem. This way, you can clearly define the contribution of your study. To simplify, your research should answer this question, “What are the benefits or advantages of the study based on the statement of the problem?”

Start by explaining the problem that your study aimed to solve. For example, if you conducted a research study on obesity rates among elementary school students, you would start by explaining that obesity is a major health concern in the Philippines and discuss why it is important to find ways to address this issue.

2. Write it from General to Particular

Determine the specific contribution of your thesis study to society as well as to the individual. Write it deductively, starting from general to specific. Start your significance of the study broadly then narrow it out to a specific group or person. This is done by looking into the general contribution of your study, such as its importance to society as a whole, then moving towards its contribution to individuals like yourself as a researcher.

Discuss how your study fills a gap in the literature. If you conducted an experiment on the effects of a certain type of food on children, for example, you might start by explaining that no research has been done on this topic before. This section would also include a discussion about why your study is important.

Your problem statement might help you determine the unique contribution of your research. This can be accomplished by ensuring that the aim of the problem and the study’s objectives are identical. For instance, if your research question is “Is there a significant relationship between the use of Facebook Messenger and the performance of students in English spelling? “, you could write as one of the contributions of your study: “The study will identify common errors in spelling and grammar by Messenger users and recommend its appropriate use in a way that can improve performance in spelling.”

You may also read: How to Make a Conceptual Framework

Significance of the Study Samples

Here are some examples to help you draft your own introduction:

Title: Number of Clinical Internship Hours: A Determinant of Student’s Effectiveness and Skill  Acquisition in the Hospital Area for Velez College Students

Significance of the study.

The results of the study will be of great benefit to the following:

College of Nursing Dean . Data given will provide the dean with information on how the number of duty hours in a week affects the student’s academic and RLE performance. The results will enable the dean to improve the scheduling of RLE and different academic subjects. Data gathered will help the dean initiate collaboration among faculty and chairpersons to help plan the advancement of nursing education in relation to the new curriculum.

Clinical Instructors . The results of the study will help the clinical instructors evaluate the quality of care rendered by the nursing students, academic performance, attitude and skills acquired in relation to the number of hours given in a week. Results would also develop the clinical instructor’s teaching-learning and evaluating strategies in enhancing knowledge, skills and attitude to the students in the time frame given.

Students . This study will provide information regarding which time arrangement is effective: 8-hr of clinical internship from the 5-hr clinical internship with additional academic classes. This study will evaluate the academic performance, the student nurse’s attitude and approach, the skills learned in the clinical area, and the quality of care rendered in the given time frame. Data gathered will also help the students improve both academic and clinical performance.

Velez College . This study will improve the school in the development of nursing education. This study will foster new ways of enhancing knowledge, skills, and attitude, thus preparing globally-competitive nurses in the future. This study will also help in the advancement of school management, clinical leadership, and the teaching-evaluation approach.

Title: The Effectiveness of Isuzu’s Blue Power Technology in Fuel Efficiency of Diesel Engines

The generalization of this study would be a great contribution to the vast knowledge in relation to the brand awareness of Isuzu’s Blue Power Euro 4 Technology. Furthermore, the results of this investigation could be highly significant and beneficial for the following:

Current Customers

They refer to consumers that have already bought products from Isuzu. They are considered to be the main beneficiaries of the business. The findings of this study would provide them with adequate information about the product, most especially for those clients that have already bought units with the Blue Power Euro 4 Technology but have no idea of its benefits and advantages.

Potential Customer

They are the consumers that have not yet purchased this brand. This study aims to give them insights and overviews of the product and would help them choose the right variant to purchase.

They are the main beneficiaries of this study, which may help them to improve their marketing strategies. It would provide substantial data to the business that they could make use of in boosting their sales. Moreover, developing brand awareness will cater to more demands and loyalty in the future.

For they also play a vital role in the business and as consumers. This research would give them the idea that such private vehicles exist, which helps them to conserve energy rather than exploit it. Hence, giving back to the community and making it a better place to live.

Proponents of the Study

This refers to the students conducting the study. They will find self-fulfillment and gain knowledge and skills in this study. This study will help and inspire more researchers to be more innovative and creative in their future endeavors.

Future Researchers

This study will serve as a reference for researchers on the subject of research in the field of marketing. This will serve as a guide to further developing the research with the connection to the variables used.

The significance of a study is a key component of a strong scientific paper. By following these tips, you can create a clear and concise explanation of the importance of your work. I hope that these tips and samples will help you create a perfect Significance of the Study for your thesis. Apply these tips to prevent your mind from wandering aimlessly as you draft the significance of the study. It will allow you to focus on the next section of your thesis, helping you finish it on time. Good luck!

good and interesting

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Very useful. Thanks

Thank you for a very informative article

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Contextualising and challenging under-representation in research in light of Cultural Trauma: a qualitative focus group and interview study

• Kate Fryer 1 ,
• Isobel Hutt 2 ,
• Habiba Aminu 1 ,
• Emma Linton 3 ,
• Johanna White 4 ,
• Josie Reynolds 3 &
• Caroline Mitchell 5  

Research Involvement and Engagement volume  10 , Article number:  69 ( 2024 ) Cite this article

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Although underserved populations— including those from ethnic minority communities and those living in poverty—have worse health and poorer healthcare experiences, most primary care research does not fairly reflect these groups. Patient and public involvement (PPI) is usually embedded within research studies in the United Kingdom (UK), but often fails to represent underserved populations. This study worked with patient and public contributors and local community leaders, situated in a socio-economically deprived and ethnically diverse urban area, to explore under-representation in primary healthcare research.

We undertook a focus group with a purposive sample of 6 members of a Patient and Public Involvement Group (PPIG), and interviews with 4 community leaders (representing Black, South Asian, Roma and socio-economically deprived communities). An iterative analysis process based on template analysis was used. Focus group 1 was rapidly analysed, and a template created. Findings were presented in focus group 2, and the template further developed. The Cultural Trauma concept was than applied to the template to give a wider theoretical lens. In-depth analysis of focus groups and interviews was then performed based on the template.

Wider societal and historical influences have degraded trust in academic and healthcare institutions within underserved populations. Along with more practical considerations, trust underpins personal motivations to engage with research. Researchers need to invest time and resources in prolonged, mutually beneficial engagement with communities of importance to their research, including sharing power and influence over research priorities. Researcher reflexivity regarding differential power and cultural competencies are crucial. Utilising participatory methodologies including co-production demonstrates a commitment to inclusive study design.

Conclusions

Re-framing evidence-based medicine to be more useful and relevant to underserved populations with the highest burden of ill health is urgently needed. Lack of representation in primary healthcare research reflects wider societal inequalities, to which Cultural Trauma provides a useful lens. However, there are actions that researchers can take to widen representation. This will ultimately help achieve the goal of increased health equity by enhancing scientific rigour and research generalizability.

Plain English summary

People living in poverty, and people from ethnic minority communities may be referred to as ‘underserved’. Underserved communities benefit less from health services, and along with other factors, this leads to health inequalities. Primary care research does not include enough people from these communities. This makes the health inequalities  worse.

This study looks at why people from underserved communities are not included in research. It also looks at what might help. We had focus group discussions with members of a Patient and Public Involvement Group (PPIG). These are individuals who do not have research expertise, but use their lived experience as patients to influence the research process. This group was formed in 2017, from areas where more people live with social disadvantage. We also interviewed local community leaders. Interviews and focus groups ask open questions, so are a good way to explore what people think about an issue. We found a useful theory about how cultural history affects what people can do. We used this to help us to understand how our findings could improve and widen participation in research within underserved communities.

We found that trust is very important. There needs to be trust between people and organisations. There are also practical reasons people from underserved communities might not be able to get involved in research. Researchers need to be aware of these things, and work with people from these communities throughout all stages of research. Long term relationships need to develop between institutions and people doing research. Understanding each other’s culture and history makes it easier to work together.

Peer Review reports

Research suggests that people from underserved populations, including persons living in poverty and people from ethnic minority communities, have greater risk of poor health, and poorer experiences of using health services [ 1 , 2 , 3 ] with the two characteristics combining to create compounded inequity. This was clearly demonstrated during the COVID-19 pandemic, where the impact on minority populations was disproportionate [ 4 ]. The majority of primary healthcare research does not have adequate representation from people of these communities [ 3 , 5 ].

‘Evidence based medicine’ across a range of common health conditions is derived from studies which commonly exclude certain populations within their design, thereby potentially perpetuating health inequalities [ 6 , 7 ]. The UK National Institute for Health and Care Research (NIHR) produced NIHR-INCLUDE guidance [ 8 ] to improve inclusion of underserved groups in research. The importance of building trust with communities already subjected to structural and institutional discrimination is highlighted, but there is a dearth of research about how to build trust and mutual understanding to inform inclusive research practise. Many studies describe how they have addressed this issue in their own studies, but fewer have resulted in explicit learning which can be applied by other researchers [ 9 , 10 ]. One example is a toolkit developed by Farooqi et al. [ 11 ] to help researchers maximise ethnic minority recruitment to health research: The final toolkit recommendations were considering the communities which the research needs to involve; effective patient and public involvement; effective recruitment; cultural competence of research procedures; and effective feedback. Recommendations were also made as the result of a systematic review by Bonevski et al. [ 12 ], who Identified barriers to involvement in health research for socio-economically disadvantaged groups, and strategies to overcome these. Barriers included mistrust of research within some communities and reliance on technology to collect data. They then developed a set of strategies covering the entire research process from sampling to retention.

A recently published paper by Mitchell et al. 2023 [ 13 ] outlines steps to move from tokenism to citizen control in the research process, to increase representation in research:

1. Build trust and dialogue by exchange of ideas in a community setting, led by community members.

2. Include knowledge sharing about the topic of interest with patients and communities, for example, producing lay summaries of a literature review and bringing in a topic expert for a ‘question and answer’ session.

3. Support the development of research skills in communities where it is desired (capacity building).

4. Co-create from the outset and at every stage of the research process to include generating and prioritising research questions relevant to the public.

Despite ample research evidence demonstrating that lack of engagement not only resides in under-represented communities but also in research teams and institutions [ 9 ], the lack of progress suggests the need for reflective research practice to find solutions to this challenge. We also suggest that the issue needs to be seen in the context of wider societal issues. Local drivers for this work include clearly evidenced health inequalities across the city, and GP practises wishing to be ‘research active’ but finding that studies available to them are not suitably designed for their patient population.

The idea of Cultural Trauma as a mechanism to disrupt health and create disparities is proposed by Subica and Link [ 10 ], drawing on Fundamental Cause theory which is a key concept within the Social Determinants of Health literature [ 10 ]. Subica and Link suggest that Cultural Trauma, the impact of a dominant oppressive group on the resources of another group, damages three health-protective cultural resources: modes, institutions, and lands, as the underlying cause for health inequalities. Modes encompass “ the languages, norms, customs, values, and artefacts ” that create the internal and external worlds of group members. Cultural Trauma disrupts healthy functioning as modes help people to self-regulate when faced with external stressors.

Institutions refers to the systems that define social and community life such as family, educational, religious, and health systems. These institutions protect against stress and support health when individuals have a positive status within them. However, when institutions relegate individuals into lower statuses, this creates stress and leads to poorer health. It may be perpetuated through policies which promote inequality and deny access to flexible resources. Lands is used to describe material resources such as property, housing, food and transport, that are necessary to maintain health within the particular society within which a person lives. This can be through physical dislocation from native lands via force, genocide, or disease or discriminatory policies that strip groups of material resources.

Several papers addressing under-representation in research have been able to extrapolate experiences with a particular study to the wider research landscape, using theoretical concepts. For example, Rai and colleagues [ 14 ] reflect on what it would take to meaningfully attend to ethnicity and race in health research by drawing on experiences in their own study. Their conclusions are strongly informed by a theoretical understanding of issues around race and ethnicity, for example using the phrase, ‘methodological whiteness’.

A paper about reducing social and racial inequalities in obesity by Rosas and Stafford [ 15 ], discusses how to engage people from ethnic minority and socio-economically disadvantaged groups in health research, and focusses on the importance of understanding underlying mechanisms, as a building block for addressing the issue. A paper by Asare [ 16 ] discusses the concept of social determinants of health (SDH) framework (health and education, the built environment and social and community life) as an explanation for minority patients being less likely to partake in cancer research. This paper proposes a framework which nurses can use to identify where support is needed. Both SDH and Cultural Trauma use Fundamental Cause theory to explain current inequalities, but Cultural Trauma draws together the collective impact of lost resources as a result of oppression. The emphasis in this theory is not on the impact of trauma on their psychological-wellbeing, but on the erosion of health-protective factors within their culture. We suggest that this can be further applied to under-representation of certain groups in health research, which may contribute further to health inequalities.

Working with patients from a Patient and Public Involvement Group (PPIG) based in a low socio-economic area with an ethnically diverse population, and with local community groups that support underserved groups, this study aimed to explore how researchers and research institutions can address inequalities in research, from the perspective of underserved groups. Using Cultural Trauma as a theoretical lens helps to contextualise our findings in the wider social context.

We collected data from a focus group with a PPIG, and interviews with community leaders from four voluntary care organisations serving Roma, South Asian, Black, and socio-economically deprived populations. This provides a rich understanding of the barriers and facilitators of participation in research from patient and public perspectives.

Focus groups and interviews (setting and participants)

A focus group methodology was chosen to collect data from the PPIG group, as focus groups are a well-accepted method in social science and the group process allows participants to identify and clarify their views [ 17 ]. Moreover, this was a pre-existing group, who were already comfortable in communicating their views in a group setting. This group was asked to participate as all members live in socio-economically deprived areas, and the group has members from range of ethnic backgrounds and with a range of educational levels.

The decision to do group or individual interviews with community leaders was a pragmatic one, based on the busy schedules of community leaders. Potential participants were purposively sampled via community organisations serving ethnic minority and socio-economically deprived populations.

All participants were contacted via email with a brief description of the research, and asked to contact the researcher (KF) if they would like to take part. They were then sent an information sheet with the opportunity to contact the researcher to ask questions, before returning a signed consent form.

The topic guide for the focus group (see appendix 1) was developed using NIHR-INCLUDE [ 8 ] recommendations, and stakeholder consultation.

Focus groups and interviews were facilitated by KF. KF is a female post-doctoral Research Associate, with over 20 years’ experience of qualitative health research, including conducting focus groups and interviews. KF is white British, and a practising Muslim.

In the first focus group, six participants were recruited, with informed consent, from the PPIG. The participants were two men and four women, age between 40 and 75. Three participants were White British, one Black African and two South Asian. All live in socio-economically deprived neighbourhoods.

A focus group lasting 75 min was conducted in a University building, which was easily accessible by both car and public transport. It was audio-recorded, transcribed verbatim, and then identifying information was removed for analysis. KF took field notes to supplement the analysis.

For the interviews, 4 community leaders were recruited from 4 community organisations, to represent a variety of underserved communities (Roma, South Asian, Black, and socio-economically deprived). The aims of the research were discussed with the participants when inviting them. All who were invited, agreed to take part. The participants were 3 women and 1 man, ranging from age 40–70, and their ethnic backgrounds were Roma, South Asian, Black and White British.

Community leaders were presented with and asked to comment on the findings of the rapid analysis from the PPI focus group (see Table  1 ). Participants were also asked how academics and clinicians may be able to work with community groups to increase participation.

One group interview (three participants) and an additional single interview took place online, as this was preference of the community leaders. The group interview participants were Black Caribbean, South Asian, and Roma, and provided leadership in organisations serving people from those backgrounds. The individual interviewee was White British, leading a community organisation within a socio-economically deprived area. The researcher (KF) and the participants were the only people in the interviews. The group interview was 69 min long, and the single interview was 40 min long. KF took field notes to supplement the analysis.

KF continually checked her understanding of what was being said in the focus groups and interviews with the participants, which was decided as preferable to sharing the transcripts afterwards, which would have been extremely time consuming for the attendees to read through.

The focus group and interviews did not aim to reach data saturation, but to gather enough data from a variety of perspectives to provide conceptual depth.

Analysis- template analysis applying cultural trauma

Template analysis involves [ 18 ] the development of a coding ‘template’, which summarises themes identified by the researcher(s) as important in a data set, and organises them in a meaningful and useful manner. We used template analysis to allow us to bring in wider social and cultural factors to our understanding of our findings, and we achieved this by applying the Cultural Trauma concept. Figure 1 illustrates how we created the template.

Analysis process

The template for analysis was created by rapidly analysing the focus group and interview transcripts to create initial templates (see Tables 1 and 2 ).

This was carried out by three members of the research team (KF, EL, JW). The themes were then applied to the three elements of Cultural Trauma (modes, institutions, lands), which helped to give a wider context to the findings (by KF, IH, CM). It was important to develop the initial templates from the study findings, to ensure data was not forced into the theoretical concept.

A detailed analysis of the focus group and interviews was then carried out according to this final model (by IH, KF), using NVivo software. The final model was presented to the PPIG, who confirmed their views were adequately represented and the model made sense to them.

Figure  2 shows how the themes were developed. The three elements of Cultural Trauma [ 10 ] are shown below in the photo on the pink Post-It notes, and key concepts from the background literature are shown on orange Post-It notes. We then took the themes from our rapid analysis (shown on the small square Post-It notes) and arranged them with or between the three elements of Cultural Trauma. This process started to form a picture. There was a cluster of themes between cultural modes and institutions, indicating that the interaction between these two elements is important. Other themes formed a circle around them, indicating factors that were influential in creating this interaction, bringing us to the final model. Where these are presented in the egg-shaped diagram in Fig.  3 , the top half of the egg contains factors relating to institutions, and the bottom half shows factors related to communities.

Applying Cultural Trauma to the template

The process of research involvement in underserved communities

An in-depth analysis based on this template deepened our understanding of how themes related to each other, and this is represented in Fig.  3 .

Trust and understanding

Our findings from the interviews were clustered around the Cultural Trauma elements of modes and institutions , showing tensions between these, and the importance of trust and understanding. An exploration of themes clustered between ‘Modes’ and ‘Institutions’ suggested that trust between under-served communities and institutions (in this case health and academic institutions) was of utmost importance regarding research participation and was often absent.

Research happens within a wider social context. This context will influence the research process, and the research process cannot be understood without reference to the wider social context. Historical and societal issues will influence communities and therefore how individuals act. Institutions and their relationship with communities will be influenced by these same issues, and will influence how researchers act.

Trust and understanding is therefore for an over-arching theme, which relates to each of the subthemes: ‘Values and Cultural Competence’ and ‘Research priorities, design and recruitment’ which allow us to explore this issue from the point of view of the researcher and their institutions; and, ‘Historical and current social & community context’ and ‘Personal motivations’ in which we understand this from the point of view of under-served communities.

Values and cultural competence

Our findings suggest that values and cultural competence are crucial to building trust and understanding between academic institutions and under-served communities. This was both true at a larger societal scale, and a more local and project specific level. At a larger scale for example, the need for decolonising of the curriculum was mentioned, reflecting the feeling that contributions from non-white academics, and other ways of knowing or cultural interpretations of health had been removed from our understanding of many subjects taught today:

“All the contributions from those previous civilisations, they have contributed to what we know as knowledge today…So people like, different people, so everyone can see that their ancestors did something. It gives them confidence that we too, we can” (PPI contributor - PPIC)

This is an example of the ‘institutions’ aspect of cultural trauma, where policies and denied access have impacted upon the current perceptions of under-served communities within academic institutions.

An observation was made in both focus groups and interviews that research teams are predominantly white and middle class. Where those being researched are from socio-economically deprived or ethnic minority backgrounds, this may reinforce established power dynamics. Diversifying research teams was seen as desirable, but it was acknowledged that people from underserved communities may be less likely to establish academic careers, creating a circular problem:

“if a community member doesn’t feel that they can go to university, or that that’s even an option for them, the last thing is… I don’t see that link between them contributing to research” (Community Leader- CL)

This relates to both modes and institutions within Cultural Trauma – historically, access to educational institutions has been explicitly denied to under-represented groups, and is currently denied implicitly. The process of this has also devalued the modes of under-served groups (e.g. languages and artefacts). Engaging with community leaders for research recruitment was suggested as a solution to overcome this issue. In the light of Cultural Trauma, the mechanism behind this may be to increase positive regard of the institution towards the under-served group, and facilitate access to the under-served group.

However, the community leaders themselves recognised the limitations of this approach from their perspective, and the difficulties this can cause for community organisations:

“it is very difficult for us to keep being asked to participate […] it’s just like, oh, can you get us so and so, can you get us so and so, can you get so and so? We’ll give you a little budget for it, and that’s it. And then we go out. And it costs a lot more of our time” (CL)

It was recognised that ‘helicoptering in’ could be very damaging. This issue relates to lands and can be seen as a result of indirectly discriminating policies impacting upon the distribution of flexible resources. Community leaders unanimously wanted ongoing relationships between community organisations and Universities, which were not only transactional:

“ To make it a good process, there should be some kind of good partnership going”(CL)

In the longer term, capacity building in communities was suggested as a way of breaking the cycle and ensuring that people understand the role and value of health research:

“And that’s the education, it’s the awareness, it’s as much getting that out there to start that little pea on the roll until it becomes bigger and bigger and bigger and the information, but there’s so much information and education about services that needs to still happen” (PPIC)

This would impact upon the lands and institutions elements of Cultural Trauma, by redirecting resources and building positive regard within academic and health institutions, for the under-served group.

The values of the researcher and research team, and their cultural competence, are essential in enabling inclusive research. The first step in this process is to have researchers who genuinely see that engaging collaboratively with communities can enhance the research process:

“So it’s just this kind of how can we see people as humans that have the capacity to find the solutions and offer solutions for a lot of the things that are the problems? They might not have the confidence, they might not have the resources or the skills really to… But they know what they need and they just need a little bit of scaffolding and support to get there” (CL)

Where this is successfully achieved, it may impact upon modes , by valuing and highlighting the knowledge and skills present within under-served communities, and increase positive regard within institutions. This involves an awareness of the historical and cultural issues relating to specific communities. This awareness is necessary for understanding how certain elements of the research process may be triggering for particular groups, relating to the modes element of Cultural Trauma, which acknowledges that self-regulation against stress can be damaged:

“What might look very innocent for us, and it is about respecting them, might trigger some trauma for them” (CL)

This awareness was seen as something that would result from extended engagement with communities, and would not be achieved in a one-off training session:

“If we think of these things as an event as opposed to a process, we’ve got it wrong. It’s not going to be… It’s taken years to get to the point where we are, so we’re not going to turn the ship around overnight. So I think it is about continuing to make those networks, to make those connections, to make real the community partnerships that universities are attempting to do now. But not to take your eye off the ball and think, well, we’ve done that now.”(CL).

This statement has implications for institutions, in how they may control or impact resources available to communities, speaking to the ‘lands’ element of CT.

Historical and current social & community context

The significance of historical cultural factors and their impact on trust and understanding was striking during the focus group with the PPIG. These are issues of race and class in general, which may have contributed to issues of stigma and ‘otherness’ that have embedded a culture in which willingness to participate in research is unlikely. Historical exclusion from and exploitation in health research caused disengagement and therefore a present lack of awareness. This is clearly embedded in the modes aspect of Cultural Trauma, and directly impacts upon how people relate to academic and health institutions currently. In addition, community leaders spoke about specific scandals around research, such as the Tuskagee study in America involving Black men, as being very much in the forefronts of people’s minds when they were asked to participate in health research:

“they’ve not been reassured that the current ethics and current standards make that kind of thing less likely to happen” (CL)

Not only do policies need to change to protect under-served groups, but this needs to be demonstrated and communicated. More general health injustices also had an ongoing influence over people’s response to research, even if they occurred in other countries:

“If we’re talking about in Slovakia, they still sterilise women, so of course there’s going to be a mistrust of doctors here in the UK. It’s not that far removed for them” (CL)

Practical issues such as access to technology, and literacy levels, also impact upon individual capacity to take part, fitting with the lands element of Cultural Trauma. However, more time was spent discussing more abstract concepts, such as valuing health and awareness of research. which was felt to be lacking or very basic:

“yes, there is an awareness of research but I think only what they see on the television and that’s people with the pipettes and putting things in test tubes” (PPIC)

Not only do communities need an awareness of research, but more specifically, how it may affect, and therefore relate to them:

“I think most people, I mean, if you talk to them about research, they probably think that research is not something that affects them. Like you say, it’s like doctors and, you know, people who are educated, that’s something they’ll do, so it’s nothing got to do with them. So they won’t really be interested or want to join in” (PPIC).

This statement demonstrates the impact of denied access over time.

Personal motivations

The factors described above will influence people’s responses to research invitations. During the focus group with the PPIG, we explored what factors had motivated them to become involved in research. Most stated that they valued the opportunity to improve services, and understood that the patient perspective was necessary in addition to the expertise of the researchers:

“That expertise, we public and members of the public, our common knowledge enhances their expertise. And if that common knowledge is not there from our perspective, that expertise is limited.” (PPIC)

This suggests that the people in the PPIG group had overcome CT to some degree, in order to realise the value of their perspective, and how it may have a positive impact. Contributing in this way gave them a feeling of doing something to improve society in general:

“I just thought if I could make one tiny, tiny, tiny bit of difference, then, you know, I’d feel better” (PPIC)

It may also be, in itself, a way of addressing Cultural Trauma. The statement above suggests that the PPIC is aware of the size of the problem faced by under-served communities in regard to health inequality. By contributing, they may be attempting to repair damage to the mode element, by learning to value their own contribution.

Research priorities, design and recruitment

The values and cultural competence of the research team was seen as manifesting in the research process. The PPIG, who are experienced in engaging with researchers, talked about knowing when they are part of a ‘tick box exercise’ as opposed to when engagement is genuine. A ‘tick box exercise’, where engagement is superficial and has no real influence on the research process, is an example of how institutions may continue to deny access, despite updated policies which aim to enhance participation.

There was a tension between valuing lived experience, and the risk of re-traumatising people through the discussion of difficult life events:

“Increasingly, I’m not approaching the people we work with, to say, share your lived experience, because it’s just I’ve seen it re-traumatise.” (CL)

Here we see the cumulative effect of Cultural Trauma, where past trauma and its impact on self-regulation against stress, prevents active participation in the here and now.

Awareness of the language needs of the people that researchers want to involve in research is essential, including literacy levels and different forms of communication. It was suggested that researchers need to be more creative in the way they undertake the information and consent process around research, relying less on technology, and more on traditional forms of communication, approaching communities in their own areas and environments:

“the people that you want really are not going to sit checking their emails. It’s more conversations, the traditional forms of communication that we need to fall back on.” (PPIC)

This both suggests learning to value the modes of particular under-served groups, and also their institutions .

A key part of moving away from the ‘helicoptering in’ approach, was to ensure that people participating in research had feedback regarding the study findings, and impact of their input on the research process:

“I don’t think people would mind if they didn’t go ahead or there were some problems. But as long as they got feedback so they feel appreciated, they feel that next time they want to do more to help, be involved”. (PPIC).

The fact that this is not seen as common practise is yet more evidence of denied access to institutions. Long term relationships with communities were seen as the ideal model, in which this would happen naturally:

“if you’re doing this kind of research, you’re going to have to come back to the community and it should be an iterative process. And that isn’t always the model. And I understand it’s resources and time and time is currency. However, I do feel that when you invest, and if you’re really committed into finding and gathering quality data, then you need to invest that time in trying to get an understanding of the community.” (CL).

This CL directly refers to the flexible resources alluded to in lands. ‘Resources and time and time is currency’ acknowledges that academic and health institutions often choose not to invest limited resources in under-served communities. There was a more general message coming through, that the necessary actions would come from a mind-set which genuinely valued and respected people’s experience, the factors encompassed by the modes aspect of Cultural Trauma:

“no matter who you come across in life, even the guys that live on the street, when you interact with that person, you enrich one another consciously and unconsciously. You learn from that person, that person learns from you. Whether you accept it or not, consciously and unconsciously.” (PPIC).

Reimbursement of community member’s time was problematic. Community leaders and PPI members noted issues with delays in reimbursement, and the limitations of offering vouchers, which have negative connotations within some communities, such as being associated with being in need, or on a low income. This falls within the lands elements of Cultural Trauma, but also overlaps with modes in that there are implications for particular communities of means of payments, in relation to their values and customs. These issues cause inconvenience and undermine the relationship between researchers and communities:

“no-one should have to wait six to eight weeks to be paid for something. And that’s what we always say, well, because of the paperwork or… But that’s not fair, we wouldn’t wait six to eight weeks to be paid on a salary, so why should we allow freelancers or community connectors or organisations, expect them to do that?” (CL)

While paying community organisations for their input was recognised as important, the amount given was often insufficient to cover the actual time and resources of the community group in engaging with the research, putting further stress on the flexible resources covered in the lands element of Cultural Trauma. Community leaders made it clear that any genuine engagement means involvement from the earliest stages, and in on ongoing relationship:

“We’d like to be part of shaping and implementing as well and be part of… To make it a good process, there should be some kind of good partnership going on with the university and communities” (CL)

Summary of findings

The ability for research to be inclusive depends upon trust between academic and health institutions and the communities that research hopes to engage. The impact of Cultural Trauma was evident in the four subthemes, demonstrating the wider context in which this trust needs to be established. The concept of Cultural Trauma aids us in understanding how the lack of representation of under-served communities in research relates to wider aspects of these community’s experiences. We are able to see how damage to modes, institutions and lands directly impacts upon the current situation, from the point of view of researchers and their institutions, and under-served communities.

The barriers to involvement in research by people from underserved communities that we found in our focus groups support those present in other studies, particularly in Bonevski et al.’s systematic review [ 12 ]. Further, we found that the socio-cultural context was extremely influential in how particular groups may respond to research, and that it is important that researchers be aware of this. Similarly, Rosas and Stafford [ 15 ] emphasised the importance of understanding underlying mechanisms, and Farooqi et al. [ 11 ] emphasised the importance of cultural competence of research teams, in addition to the more practical strategies needed. Our findings also suggested that the predominantly ‘white’ nature of research teams was itself a barrier to inclusive research, a problem described by Rai et al. [ 14 ] as ‘methodological whiteness’.

Taken as a whole, our findings emphasise the importance of seeing the research process within a wider context, and we found Cultural Trauma to be a useful framework for understanding the issue. The Cultural Trauma concept suggests damage to three health-protective cultural resources: modes, institutions, and lands , as resulting in Cultural Trauma, an underlying cause of health inequalities [ 10 ]. In this paper, we have demonstrated how this can be further applied to under-representation of certain groups in health research, by using the model as a lens by which to understand our data. This enables us to see the circular impact created by under-representation of underserved groups in research, which further exacerbates health inequalities. The concept of Cultural Trauma helps to frame the under-representation of certain groups in research in relation to broader societal issues, without which it cannot be properly understood.

Strengths and limitations

In the focus groups and interviews we engaged directly with people from socio-economically deprived areas, and from a variety of ethnic backgrounds. We also engaged with community leaders who had a wider view of the relevant issues.

While all of the participants involved in the focus group were from socio-economically deprived backgrounds, half were White British, and therefore could be seen as forming part of the ‘dominant group’ by other people in the group that were from ethnic minority backgrounds. This could have influenced what people felt able to say in the group. However, the effect may have been somewhat mitigated by it being a pre-established group, who had many conversations about class, race and inequality, and therefore are likely to have been more comfortable expressing their views with each-other.

This study was undertaken in a single urban setting, but with people from socio-economically deprived and ethnic minority backgrounds which makes a contribution to a growing body of literature in this area. However, we need to acknowledge that those who participated are likely to be among the most literate and health aware within their communities.

The lead researcher (KF) who facilitated the focus groups, is well known to the PPIG (and present at most of their meetings), and this may have influenced the responses they felt able to give. However, the group has an established ethos of challenging the idea but not the person, and the group appeared comfortable with disagreeing with her. This relationship may also have influenced the data as some things may have been implicitly assumed and so not verbalised.

Lack of representation in primary healthcare research is part of wider societal inequity but there are actions that researchers can take to improve inclusivity in primary healthcare research, thereby improving the quality of data and making evidence-based practise more accurate and valuable within all communities. This could contribute significantly to the reduction of health inequalities.

Whilst the NIHR-INCLUDE Roadmap [ 8 ] provides a good structure for an inclusive research process, prolonged engagement between academic institutions and communities over time and across multiple research projects, and individual researcher reflexivity with respect to differential power and cultural competencies are also crucial to widening participation in research.

Study data collection is the end point of a long process of prioritisation, design and funding procurement, and change needs to occur at all points in that process for real change to happen. If the organisations which currently ‘own’ research, wish research to be representative of the UK population, those organisations need to be willing to disrupt their philosophies and processes.

Recommendations

Research institutions and those who represent them should:

Take responsibility for lack of diverse representation in primary healthcare research.

Build trust and understanding with communities by:

Developing cultural competence

Diversifying research teams

Engaging with community leaders

Invest time and money in long-term reciprocal relationships.

Recognize untapped potential within communities and build capacity for engaging in research.

Ensure that research is not ‘exclusive by design’, for example, considerations around language, digital exclusion of ways of recruiting.

It is also essential to embed PPI which represents and includes those from underserved communities throughout the research cycle, and strategies need to be in place to ensure this happens in a genuine way rather than a ‘tick-box exercise’. Utilising participatory methodologies demonstrates a commitment to inclusive study design from the outset.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

Patient and Public Involvement

United Kingdom

Patient and Public Involvement Group

National Institute for Health Research

Patient and Public Contributor

Community Leader

Social determinants of health

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Acknowledgements

We would like to acknowledge the patient and public contributors, and community leaders, who took part in this study and play a key role in our work. We are withholding names due to confidentiality.

This study was funded by the National Institute for Health Research Yorkshire and Humber Clinical Research Network.

Author information

Authors and affiliations.

Population Health, Research Associate, University of Sheffield, Sheffield, UK

Kate Fryer & Habiba Aminu

Medical Student, University of Sheffield, Sheffield, UK

Isobel Hutt

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Emma Linton & Josie Reynolds

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KF and CM designed the study. IH was involved in the analysis process. EL and JH were involved in the focus group analysis process. JR and HA were involved in reviewing and writing up the study. CM was the lead applicant on the study and involved in reviewing and writing up the study.

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Focus group topic guide PPI group

1. Why do you think health research is important?

2. Do you think that most people understand the importance of health research?

3. What motivated you to get involved?

4. What my motivate others in your area/community?

5. What are the barriers to people getting involved in health research?

Prompts: different ethnic backgrounds, levels of education, struggling financially.

1. What things can researchers do, to encourage/make it easier for people to get involved?

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Fryer, K., Hutt, I., Aminu, H. et al. Contextualising and challenging under-representation in research in light of Cultural Trauma: a qualitative focus group and interview study. Res Involv Engagem 10 , 69 (2024). https://doi.org/10.1186/s40900-024-00600-3

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Published on 3.7.2024 in Vol 8 (2024)

Barriers to, and Facilitators of, Checking Drugs for Adulterants in the Era of Fentanyl and Xylazine: Qualitative Study

Authors of this article:

Original Paper

• Ian David Aronson 1, 2 , PhD   ; 
• Mary-Andrée Ardouin-Guerrier 1, 2 , EdD   ; 
• Juan Esteban Baus 1 , MS   ; 
• Alex S Bennett 1 , PhD  

1 School of Global Public Health, New York University, New York, NY, United States

2 Center for Technology-based Education and Community Health, NDRI-USA, New York, NY, United States

Corresponding Author:

Ian David Aronson, PhD

Center for Technology-based Education and Community Health

31 W 34th St Suite 8006

New York, NY, 10001

United States

Phone: 1 212 845 4444

Email: [email protected]

Background: Overdose deaths continue to reach new records in New York City and nationwide, largely driven by adulterants such as fentanyl and xylazine in the illicit drug supply. Unknowingly consuming adulterated substances dramatically increases risks of overdose and other health problems, especially when individuals consume multiple adulterants and are exposed to a combination of drugs they did not intend to take. Although test strips and more sophisticated devices enable people to check drugs for adulterants including fentanyl and xylazine prior to consumption and are often available free of charge, many people who use drugs decline to use them.

Objective: We sought to better understand why people in the New York City area do or do not check drugs before use. We plan to use study findings to inform the development of technology-based interventions to encourage consistent drug checking.

Methods: In summer 2023, team members who have experience working with people who use drugs conducted 22 semistructured qualitative interviews with a convenience sample of people who reported illicit drug use within the past 90 days. An interview guide examined participants’ knowledge of and experience with adulterants including fentanyl, xylazine, and benzodiazepines; using drug testing strips; and whether they had ever received harm reduction services. All interviews were audio recorded, transcribed, and analyzed for emerging themes.

Results: Most participants lacked knowledge of adulterants, and only a few reported regularly checking drugs. Reasons for not checking included lacking convenient access to test supplies, or a place to check samples out of the public’s view, as well as time considerations. Some participants also reported a strong belief that they were not at risk from fentanyl, xylazine, or other adulterants because they exclusively used cocaine or crack, or that they were confident the people they bought drugs from would not sell them adulterated substances. Those who did report testing their drugs described positive interactions with harm reduction agency staff.

Conclusions: New forms of outreach are needed not only to increase people’s knowledge of adulterated substances and awareness of the increasing risks they pose but also to encourage people who use drugs to regularly check their substances prior to use. This includes new intervention messages that highlight the importance of drug checking in the context of a rapidly changing and volatile drug supply. This messaging can potentially help normalize drug checking as an easily enacted behavior that benefits public health. To increase effectiveness, messages can be developed with, and outreach can be conducted by, trusted community members including people who use drugs and, potentially, people who sell drugs. Pairing this messaging with access to no-cost drug-checking supplies and equipment may help address the ongoing spiral of increased overdose deaths nationwide.

Introduction

The United States has set new annual records for overdose deaths almost every year for more than 20 years [ 1 ]. Much of this increase is due to a rapidly changing and unpredictable drug supply that can pose myriad health risks [ 2 ]. Nationally, more than 107,000 people died from overdose in the 12-month period ending in March 2022 [ 3 ], and more people in New York City died from opioid overdose than ever before [ 4 , 5 ]. Disparities in overdose mortality based on race and ethnicity are now being observed, with a tripling of overdose deaths among Black New Yorkers from 15.7 per 100,000 in 2019 to 50.7 per 100,000 in 2022. Overdose mortality among Latino New Yorkers more than doubled from 21.4 to 44.7 per 100,000 during the same time [ 5 ]. The majority of these overdose fatalities involved the synthetic opioid fentanyl (which is often illicitly manufactured and can be hundreds of times more powerful than morphine [ 6 ]), as well as other adulterants including xylazine [ 7 ] and benzodiazepines [ 8 ]. All can be present in a drug without people’s knowledge.

Adulterants can be added to illicit drug supplies as “bulking agents” designed to inexpensively increase the quantity of a substance before sale or to enhance the psychoactive effects of a drug [ 9 ]. For example, fentanyl is often added to heroin or other opioid products to maximize potency at a lower cost, but because the effects of fentanyl are short-lasting, other adulterants (ie, xylazine or benzodiazepines) may be added to prolong fentanyl’s effects, giving the drug more “legs” [ 10 ]. Xylazine use can result in rapid loss of consciousness and painful skin ulcers [ 9 ], along with blackouts that leave people with no memory for extended periods of time [ 11 ]. Benzodiazepines may cause heightened drug dependence and are associated with severe physiological and psychological withdrawal symptoms [ 8 ] that last longer than opioid withdrawal. Fentanyl is increasingly found in stimulants, including cocaine and methamphetamine, and in illicitly manufactured pharmaceutical pills (eg, counterfeit oxycodone or Xanax) [ 12 ]. Adulterated substances can have unpredictable effects, especially when individuals consume multiple adulterants and are, therefore, exposed to a combination of drugs they did not intend to consume [ 12 , 13 ]. Fentanyl was present in 81% of New York City overdose deaths in 2022, and cocaine was present in 53% [ 5 ]. In the same year, 47% of New York City overdose deaths involved a combination of opioids and cocaine and 19% involved both opioids and xylazine [ 5 ].

According to a Centers for Disease Control and Prevention (CDC) study of fatal overdose in the United States, the monthly percentage of fentanyl-involved deaths with xylazine detected increased by 276% from January 2019 through June 2022 [ 14 ]. In a separate study of fatal overdose events in 38 states and the District of Columbia from January through June of 2020, more than 92% of benzodiazepine deaths also involved fentanyl [ 15 ]. Xylazine deaths have become common in Philadelphia [ 3 ] and are increasing in New York City [ 15 ] and nationwide. The White House has designated fentanyl combined with xylazine an “Emerging Threat to the United States” [ 16 ].

Local health departments and other agencies that serve people who use drugs have made significant efforts to saturate communities with naloxone to reverse overdose events and fentanyl test strips (FTS) so that people can know what adulterants may be present in a batch of drugs prior to consumption. Existing research has shown that among people who use drugs, FTS use is both feasible and acceptable [ 17 - 19 ] and, that in some cases, people desired xylazine test strips (XTS) [ 11 ].

A recent survey of North American drug-checking services shows that 16 organizations have served more than 125,000 people and checked almost 50,000 drug samples since 2014 [ 20 ]. This includes the use or distribution of FTS and XTS, which indicate the presence of fentanyl or xylazine, respectively, as well as Fourier-transform infrared spectroscopy (FTIR), which can identify all the chemicals in a substance in proportion to the total sample (eg, what percentage of a checked sample is fentanyl and what percentage is xylazine). FTS and XTS are relatively inexpensive (a package of 10 XTS can be purchased via Amazon.com for US $15.99 [ 21 ]; similar products are often given away free of charge by agencies that provide services to people who use drugs) and can be easily distributed for use at home or in other off-site settings. FTIR devices are more expensive and require a trained technician to operate and interpret results. Syringe service programs (SSPs) or other community outreach settings often provide FTIR access in fixed locations such as drop-in centers [ 20 ]. Both the New York State Office of Substance Use Services and The New York City Department of Health and Mental Hygiene distribute no-cost FTS and XTS along with detailed instructions on how to use them [ 22 , 23 ] and partner with community-based organizations to provide no-cost FTIR services.

However, many of those who could benefit most from drug checking may not be aware of the risks associated with adulterants or know how to access necessary supplies or service providers. Others may have heard about adulterants but discount their own potential risk. In some areas, adulterants have become so prevalent that people who intentionally use fentanyl now face risks from xylazine or other adulterants that may be mixed into their drug purchases, underscoring the need for and potential value of routine drug checking [ 13 ].

In addition, many people who use drugs may be well aware of the presence of adulterants in the illicit drug supply and the dangers they cause but elect not to use drug-checking technologies. This can include unhoused people who believe that checking their drugs in public spaces before use would invite unwanted scrutiny from police or others and reinforce public stigma. There are also people with extensive drug use experience who believe they can identify adulterated drugs by color, texture, or taste and thus view drug checking as something unnecessarily burdensome rather than a lifesaving harm reduction intervention [ 24 ].

To better understand people who use drugs’ knowledge of adulterants in the drug supply, as well as barriers to and facilitators of drug checking, our team conducted a series of in-depth qualitative interviews with people who use drugs in New York City to learn about their experiences as part of this formative and exploratory study. Our ultimate goal is to develop technology-based interventions designed to increase drug checking and other overdose prevention practices to mitigate harm from the toxic unregulated drug supply. In the past, our team has created intervention content delivered via tablet computers and text messages to encourage positive health behaviors, including increased testing for HIV and hepatitis C [ 25 , 26 ], uptake of take-home naloxone kits [ 27 ], and vaccination against COVID-19 among people who inject drugs [ 28 , 29 ]. We now seek to use a similar approach, guided by accepted models of behavior change and empirically derived theories of multimedia learning [ 30 ], to encourage the use of drug-checking services. In keeping with the community-based Participatory Education and Research into Lived Experience (PEARLE) intervention development methodology [ 31 ], we first set out to identify barriers to drug-checking in order to then begin the process of designing interventions to encourage routine drug-checking.

Two interviewers, who had prior research experience working with people who use drugs, conducted a series of individual, semistructured interviews with a convenience sample of people who reported the use of illicit substances within the past 90 days. During July and August of 2023, participants were recruited in areas of parks where people who use drugs are known to congregate, and where there is high drug activity. Staff members initially approached people in these areas and explained that the team was from New York University and interested in learning about people’s knowledge of the drug supply, their use of harm reduction measures, and barriers to uptake of drug checking; they then asked if they would be willing to participate in a confidential interview about their experiences. Before each interview, potential participants completed a paper-based substance use screening based on the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) [ 32 ]. The screening listed different substances and asked how often the participant had used them in the past 3 months. Potential participants read through the list independently and circled their answers on the sheet. People were eligible to participate if they self-reported using at least 1 of the following: cocaine, amphetamine-type substances, inhalants, sedatives, benzodiazepines, hallucinogens, prescription opioids other than as prescribed by a doctor, or heroin.

Ethical Considerations

Staff obtained verbal informed consent prior to study participation. All interviews were audio recorded in quiet areas of a park for later analysis and lasted for approximately 30 minutes. No identifying details were collected or recorded by our study team; all data are anonymous. Participants were given US $20 cash as compensation for their time. All protocols, consent documents, and the interview guide were reviewed and approved by the Biomedical Research Alliance of New York institutional review board (submission #215627).

Interview Guide

The interview guide was developed by members of the study team, including members who have experience working with people who use drugs and are involved in FTS and XTS distribution throughout New York City. The guide contained sections examining participants’ knowledge of fentanyl, xylazine, and benzodiazepines. Drug types were referred to by pharmacological terms and informal names, for example, xylazine was described as “tranq” and xylazine mixed with heroin was described as “tranq dope.” Benzodiazepines were additionally referred to as “benzos” and by product brand names, such as Xanax and Klonopin.

The interview guide also contained questions about participants’ knowledge of, and experience with, drug testing strips and spectrometers, as well as whether they had ever received services at an SSP or overdose prevention center. The guide also contained questions about whether participants had used drugs that had been adulterated with fentanyl, xylazine, and benzodiazepines, and how they knew their drugs did or did not contain adulterants. Interview guide questions also examined what participants would do if they learned that the drugs they purchased contained adulterants.

Coding and Analysis

All interviews were transcribed and then uploaded into the MAXQDA software (VERBI Software) platform for coding and analysis. Transcripts were analyzed by thematic analysis. Two of the authors who also conducted the interviews coded and analyzed the transcripts and met weekly with the larger team to discuss codes and emerging interpretations. The initial codebook consisted of a priori constructs (based on the aims of the study and the interview guide) and emerging themes (that were related to the study aims but not specifically anticipated). The 2 authors each read the same 3 transcripts and developed a preliminary code guide that included items and domains from the study aims. At weekly meetings, the larger team (coauthors) and the 2 coders discussed and refined the code list and checked for consistency of interpretations and reconciled any discrepancies. This process was repeated for an additional round of coding with 3 new transcripts resulting in the penultimate codebook. The remainder of the transcripts were coded by the 2 interviewers with the team meeting to discuss discrepancies and then finalize the code list [ 33 ].

In total, 22 interviews were conducted with participants ranging in age from 21 to 66 years. Participants self-identified as Hispanic or Latino (n=7), including 2 who identified as White Hispanic or Latino, 4 who identified as Black or African American Hispanic or Latino, and 1 who identified as multiracial (American Indian/Alaska Native and Native Hawaiian or Other Pacific Islander). For those who identified as non-Hispanic or Latino (n=12), 3 identified as White, 6 identified as Black or African American, 1 identified as American Indian/Alaska Native, 1 identified as multiracial (White and American Indian/Alaska Native), and 1 wrote “Jamaican/Native American” for race. Three participants declined to report their ethnicity. In terms of gender, 12 self-identified as male, 3 as female, and 7 declined to state.

The 22 participants reported an average of 20.7 (SD 13) years of using drugs. Almost three-quarters (n=16, 73%) of participants reported using both opioids (heroin and prescription opioids other than as prescribed by a doctor) and stimulants (cocaine and amphetamine-type substances). Cocaine use in the past 90 days was reported by approximately 82% (n=18) of participants and heroin by 55% (n=12). More than one-third (n=8, 36%) reported using fentanyl on purpose in the past 90 days.

Knowledge of Adulterants in the Drugs Supply

Despite the resources allocated toward overdose prevention efforts in New York, a city with a robust harm reduction infrastructure, interviews with participants suggest there are considerable knowledge gaps about the local drug supply, along with significant misinformation, uneven uptake of overdose prevention and drug-checking resources (eg, naloxone and FTS), and other barriers that may hinder overdose response efforts in the city.

Most participants reported they were unfamiliar with xylazine and benzodiazepines. Few were able to describe the effects of either drug type. One participant, a 58-year-old, Black Hispanic, male individual with 40 years of drug use experience, described trying xylazine once and quickly losing consciousness. He said he would never buy drugs again from the people who sold him xylazine. Another participant, a 44-year-old, non-Hispanic, Black, female individual using drugs for 20 years, reported seeing news segments about xylazine on television and reading about it in a newspaper: “there was someone that had tried it and the next day they had a hole in their leg.” A third participant appeared to conflate xylazine with K2 and thought it made people combative and gave them superhuman strength.

While almost all participants reported they had heard of fentanyl, most could not identify it as an opioid or describe the effects it would have on a person other than saying “that it’s bad” or it “kills people.” One participant, a 56-year-old, Black, non-Hispanic interviewee who reported 20 years of drug use and did not specify their gender, identified fentanyl as a substance used to “stretch drugs to make them bigger” in order to “make more money off of ‘em.” A 57-year-old, male, non-Hispanic, multiracial participant who reported 35 years of drug use reported purposely seeking out fentanyl twice, so he could “see what the big fuss was about.”

Many participants did not appear to understand that fentanyl, or other adulterants, could be present in drugs they used without their knowledge. One participant who reported 10 years of drug use expressed a combination of surprise and disbelief when an interviewer questioned whether they or people close to them, could have consumed adulterated substances without knowing.

Interviewer: And so, have you ever used Xylazine?

Interviewee: Not at all. I wouldn’t be talking to you right now. I probably wouldn’t be the same.

Interviewer: How do you know that you haven’t?

Interviewee: I don’t know. [Your questions] spooked me on that. I don’t even know how to answer that question...that question really got me thinking...

Interviewer: We’ll talk about a couple of ways...

Interviewee: So, wait, hold on. So, there’s a chance that...we could have took these drugs and didn’t know, we just have been getting lucky over the years? [28-year-old, Black, Hispanic participant; gender not specified]

Drug-Checking Experience

Some interviewees reported regularly checking their drugs for adulterants (1 participant wanted to purchase fentanyl and used testing strips to confirm fentanyl presence; another described an “ex-fiancé” who sold drugs and “would offer people test strips so that they could test his supply so that they know that his stuff is good”). However, the majority of people we interviewed reported not checking their drugs for adulterants before use. Interviews show many participants were aware of drug testing strips, but that FTS and XTS were not consistently used, largely for reasons of time and convenience.

The 57-year-old, male, non-Hispanic, multiracial participant who reported 35 years of drug use explained that he knew drug testing strips were available, but “when you want to get high, you don’t have time for that.” The same participant reported that issues of convenient supply access became particularly acute when using drugs in public, which is especially problematic for people who are unhoused.

If I was in the park and I want to go get a package of powdered cocaine, and I’m going to come back in the park and hang out and get high and enjoy the day, if I knew that my friend over there had [the] strip them on them. “Yo, yo, let me get one of your strips” I will test it, and then I will go about my day. But that’s not readily available like cigarettes and weed and rolling papers. So, if that was more accessible, I think maybe it would be a lot helpful, more helpful.

Interviews also underscore that while some participants knew adulterants were increasingly present, and could cause serious health risks including death, they still viewed drug checking as something other than an established norm. One participant who reported 9 years of drug use said that even though a friend had died from using cocaine adulterated with fentanyl, they were completely unaware of people in their social circles testing drugs before use.

I haven’t heard nobody that I associate with using the test strips at all. That’s like something new honestly because I haven’t heard nobody using test strips. People still dying from fentanyl. People still getting fake Percocets and fake stuff. [25-year-old, multiracial, non-Hispanic participant; gender not specified]

Not Recognizing the Need for Drug Checking

The perceived safety of cocaine as a nonopioid emerged as another common reason for not checking drugs. Some participants were adamant that despite years of using drugs, they were personally not at risk from fentanyl because they exclusively smoked crack or were not “an addict.” One 56-year-old, Black, male participant (ethnicity not specified) reported 38 years of drug use and said he would stop “if they put it in cocaine. But as far as I know they don’t put in cocaine, they put [in] heroin.”

Similarly, the 56-year-old, Black, non-Hispanic interviewee who reported 20 years of drug use and did not specify gender, said they had no need to test for adulterants:

because I don’t use those type of drugs anyhow. No heroin, I smoke a little crack cocaine and marijuana a little. I’m not physically addicted to nothing. I’m not really mentally addicted to nothing.

Similar to the previous quote, other participants perceived crack cocaine as especially safe from adulterant-related overdose risk.

With your crack, if you smoke crack, usually people go to person that they’ve been messing with, that’s really reliable, that’s usually known for having a good product, that’s loyal to they customer, you know, certain things like that, you know, just morals and certain things. That just helps. It just makes it a lot more safer. A lot more safer. [25-year-old, multiracial, non-Hispanic participant; gender not specified]

The theme of always purchasing from a single, highly trusted source emerged as an especially strong barrier to drug checking. Multiple participants described close relationships with a drug seller who they relied on to keep them safe by selling quality, unadulterated substances. One person even referred to the drug sellers he frequents as his “people” and his “family.”

I mean, close ones, loved ones, you know, what I’m saying? Those are the people that I deal with for my drug use as far as purchasing my drugs and stuff like that. So when I’m dealing with my family and stuff like that, close ones, I trust them and I know that they don’t [put] fentanyl in it. [42-year-old, Black, non-Hispanic, male participant with 12 years of reported drug use]

Among the smaller number of participants who reported regularly checking drugs for adulterants, many cited positive interactions with health care providers or harm reduction outreach teams. Of those participants who reported checking drugs prior to consumption, a substantial number described receiving services from an SSP, either on-site or in an outreach setting. Some were able to name multiple harm reduction agencies and their locations. One described using a drug testing device (possibly an FTIR or mass spectrometer [ 34 ]) that displayed the percentage of different chemicals in a sample of drugs they brought to an SSP. Other participants described outreach teams coming to parks where they spend their time and noted the benefits of relationships that harm reduction outreach teams can develop with people who use drugs.

They come out here maybe about four times a week, you know, they mainly got everything that we need to make sure...we do things properly...make sure that we inject safe...you know, test our shit. So you know, this way we know what we put in our bodies...Honestly, I forget the names of the programs because, you know, that’s the type of thing doesn’t really matter to me. It all matters that they’re there for me and they’re helping. [28-year-old, White, non-Hispanic, female participant with 9 years of reported drug use]

If Drugs Were Found to Contain Adulterants

Like the earlier participant who said he would never buy drugs again from the person who sold him xylazine, when presented with a similar hypothetical situation, participants frequently said they would not purchase drugs from someone who sold adulterated substances, and they would not purchase drugs they knew contained adulterants. Two participants said they would respond with physical violence if someone sold them adulterated drugs (eg, “If they don’t give you what you pay for, then you have a right to go after them”).

One 51-year-old participant who identified as male, non-Hispanic, American Indian/Alaska Native, and reported 13 years of drug use experience said he would take drugs back to the seller if they tested positive for adulterants because “drug dealers should know what they put into their drugs.” Only 1 participant, a 25-year-old, non-Hispanic male individual, said he would dispose of drugs if he learned they contained adulterants.

Principal Findings

Our interviews with people who use drugs in New York City indicate a lack of knowledge of adulterants in the local drug supply, complicated by widespread misinformation about the risks of opioid overdose. Although these interviews show that a smaller number of participants regularly check drugs for adulterants, most do not. Interview data also underscore the value of outreach teams and other care providers who encourage the use of harm reduction techniques including drug checking.

As detailed earlier, 1 participant reported that no one they associate with uses drug testing strips at all. Moreover, multiple participants expressed skepticism and surprise that fentanyl, xylazine, or benzodiazepines might already be present in the drugs they use. Given the increasing prevalence of highly dangerous adulterants in our nation’s drug supply this creates obvious, and all too often fatal, health risks for people who use drugs.

The finding that most participants interviewed (16/22, 73%) report currently using both opioids and stimulants further highlights the importance of drug checking prior to consumption, as well as the complexity of efforts to increase consistent checking among the different populations who are now at risk. For example, increased rates of fentanyl overdose among people who use cocaine and other stimulants, including people without a history of intentional opioid use [35] who have not built up a physical tolerance to opioids [ 36 ], indicate the escalating danger faced by people who use drugs but may not understand how the drug supply has changed in recent years. Prior to fentanyl, opioid overdose was less of a concern for people who use stimulants. As a result, many people who use cocaine, such as the participant who reported 38 years of drug use and was adamant people do not put fentanyl in cocaine, remain unaware of their current risk and could especially benefit from drug-checking services [ 36 ].

Likewise, people who use pills obtained without a prescription may not know that counterfeit pharmaceuticals frequently contain potentially deadly amounts of fentanyl and benzodiazepines [ 12 ]. Thus, there is an immediate need for educational outreach that emphasizes the need for multiple harm reduction techniques (eg, consistently carrying naloxone to reverse overdose events) [ 35 ] and is tailored to different populations, including people who use drugs and were previously not at risk for opioid overdose, and especially people who use drugs and do not currently receive harm reduction services [ 12 ].

Further, nonstigmatizing education is needed to ensure those at risk not only understand the dangers of an adulterated supply but act upon these risks to protect their health [ 11 ]. As described in the quote above, many people who use drugs are well aware of deaths due to fentanyl and other adulterants in heroin and counterfeit pills, yet still do not check their drugs. In some cases, this is due to a lack of convenient access to drug-checking supplies or a place to test drugs out of public view. In other cases, people do not check their drugs because they view it as a waste of time or product [ 24 , 37 ] or because they fear it could expose them to legal consequences if they are found in possession of a controlled substance or test strips [ 13 ]. Indeed, in some states, drug-checking strips are considered drug paraphernalia and are illegal (eg, Iowa, Indiana, and North Dakota) [ 38 ]. In other words, the real and perceived benefits of drug checking must outweigh the risks of accessing services [ 39 ] or they will remain underused.

Thus, changing drug use behavior to encourage routine drug checking prior to consumption requires not only reaching the most vulnerable, which in itself presents a significant challenge, but delivering theory-guided intervention content that people find worthy of their attention and credible enough to act upon [ 40 , 41 ]. It will also require ensuring that people who use drugs can easily access the drug-checking resources they need, when they need them, given the context and constraints within which they are operating. This includes addressing structural vulnerabilities faced by people who use drugs, such as poverty (people might still use drugs found to be adulterated because they cannot afford to replace them) and the need to consume drugs to avoid painful withdrawal symptoms [ 37 ]. Related findings described above may help explain why only 1 person interviewed for the study said they would discard drugs shown to contain adulterants, and only 2 people said they would confront a dealer who sold them adulterated drugs, even though multiple participants spoke in detail about the dangers of consuming adulterated substances. Existing research has shown that poverty and a lack of consumer protections in an unregulated drug market greatly limit options for recourse—to put it mildly, people cannot simply return a defective purchase without any consequences [ 37 ].

At the same time, interviews reinforce the importance of trusted relationships many people who use drugs have developed with the people they buy drugs from. Multiple study participants expressed great confidence that drug sellers they frequent would not add fentanyl or other adulterants to their product. This potential “over trusting” [ 42 ] creates clear risks—if people do not test their drugs, it may be impossible to know which adulterants they are consuming or in what quantity (eg, how much of what they are taking is actually heroin and how much is fentanyl, xylazine, or something else). A recent study in New York City of more than 300 people who inject drugs found that while only 18% reported intentional fentanyl use, a urine toxicology screening showed 83% tested positive for fentanyl [ 43 ].

Limitations

The primary limitations of the study are the relatively small sample size and the fact that all participants were recruited from 2 public parks in New York City. However, qualitative interviews for the study were not meant to be generalizable beyond our specific sample. Nonetheless, our findings highlight the need for expanded outreach and education [ 44 ] and may contribute to the development of more effective interventions to encourage people to check their drugs for adulterants prior to use.

Conclusions

The finding that participants who reported regularly checking drugs also described positive relationships with harm reduction workers and outreach teams is especially encouraging. Among the smaller number of people who were knowledgeable about and reported the use of drug-checking supplies, the most common source of knowledge and access was some type of harm reduction organization or outreach effort. Increased outreach may be especially important to reach people who regularly use drugs yet are not affiliated with an SSP or other type of care provider. In particular, outreach may prove especially valuable for people who consume drugs via noninjection methods [ 12 ] and may believe an SSP is of no use to them (people who sniff drugs or swallow pills also face clearly increased overdose risk due to adulterants and may benefit from drug checking and other harm reduction services offered at SSP locations).

The finding that a drug seller provided test strips so his customers could independently verify he sold “good” drugs aligns with prior research [ 37 , 45 ], and suggests that building upon established relationships between people who use drugs and people who sell drugs may be a good way to strengthen and extend harm reduction efforts. Accordingly, future research can examine how technology-based intervention content developed with extensive input from community members and delivered by trusted individuals (eg, outreach workers, other people who use drugs, and people who sell drugs) may potentially increase drug checking and additional behaviors that help people protect themselves and others against overdose [ 46 ]. Once developed, further research is warranted to examine how this intervention content can be most effectively disseminated, along with drug-checking supplies, to high-need populations that may not currently be reached by existing overdose prevention efforts.

Acknowledgments

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award R01DA054990. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional research support was provided by National Institute on Drug Abuse grants (P30 DA029926 and P30 DA011041). The authors would like to thank all the participants who shared their drug-checking experiences with us.

Data Availability

The data sets generated and analyzed during this study are not publicly available in order to protect participant privacy but are available from the corresponding author on reasonable request.

Conflicts of Interest

None declared.

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Abbreviations

Edited by A Mavragani; submitted 25.01.24; peer-reviewed by JN Park, SB Hoj; comments to author 15.03.24; revised version received 30.03.24; accepted 15.05.24; published 03.07.24.

©Ian David Aronson, Mary-Andrée Ardouin-Guerrier, Juan Esteban Baus, Alex S Bennett. Originally published in JMIR Formative Research (https://formative.jmir.org), 03.07.2024.

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Qualitative Research in Healthcare: Necessity and Characteristics

1 Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

2 Ulsan Metropolitan City Public Health Policy’s Institute, Ulsan, Korea

3 Department of Nursing, Chung-Ang University, Seoul, Korea

Eun Young Choi

4 College of Nursing, Sungshin Women’s University, Seoul, Korea

Seung Gyeong Jang

5 Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea

Quantitative and qualitative research explore various social phenomena using different methods. However, there has been a tendency to treat quantitative studies using complicated statistical techniques as more scientific and superior, whereas relatively few qualitative studies have been conducted in the medical and healthcare fields. This review aimed to provide a proper understanding of qualitative research. This review examined the characteristics of quantitative and qualitative research to help researchers select the appropriate qualitative research methodology. Qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions. Qualitative research is conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants and data collection methods, (5) data analysis and description of findings, and (6) research validation. This review can contribute to the more active use of qualitative research in healthcare, and the findings are expected to instill a proper understanding of qualitative research in researchers who review qualitative research reports and papers.

Graphical abstract

INTRODUCTION

The definition of research varies among studies and scholars, and it is difficult to devise a single definition. The Oxford English Dictionary defines research as “a careful study of a subject, especially in order to discover new facts or information about it” [ 1 ], while Webster’s Dictionary defines research as “studious inquiry or examination - especially: investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws” [ 2 ]. Moreover, research is broadly defined as the process of solving unsolved problems to broaden human knowledge [ 3 ]. A more thorough understanding of research can be gained by examining its types and reasons for conducting it.

The reasons for conducting research may include practical goals, such as degree attainment, job promotion, and financial profit. Research may be based on one’s own academic curiosity or aspiration or guided by professors or other supervisors. Academic research aims can be further divided into the following: (1) accurately describing an object or phenomenon, (2) identifying general laws and establishing well-designed theories for understanding and explaining a certain phenomenon, (3) predicting future events based on laws and theories, and (4) manipulating causes and conditions to induce or prevent a phenomenon [ 3 ].

The appropriate type of research must be selected based on the purpose and topic. Basic research has the primary purpose of expanding the existing knowledge base through new discoveries, while applied research aims to solve a real problem. Descriptive research attempts to factually present comparisons and interpretations of findings based on analyses of the characteristics, progression, or relationships of a certain phenomenon by manipulating the variables or controlling the conditions. Experimental or analytical research attempts to identify causal relationships between variables through experiments by arbitrarily manipulating the variables or controlling the conditions [ 3 ]. In addition, research can be quantitative or qualitative, depending on the data collection and analytical methods. Quantitative research relies on statistical analyses of quantitative data obtained primarily through investigation and experiment, while qualitative research uses specific methodologies to analyze qualitative data obtained through participant observations and in-depth interviews. However, as these types of research are not polar opposites and the criteria for classifying research types are unclear, there is some degree of methodological overlap.

What is more important than differentiating types of research is identifying the appropriate type of research to gain a better understanding of specific questions and improve problems encountered by people in life. An appropriate research type or methodology is essential to apply findings reliably. However, quantitative research based on the philosophical ideas of empiricism and positivism has been the mainstay in the field of healthcare, with academic advancement achieved through the application of various statistical techniques to quantitative data [ 4 ]. In particular, there has been a tendency to treat complicated statistical techniques as more scientific and superior, with few qualitative studies in not only clinical medicine, but also primary care and social medicine, which are relatively strongly influenced by the social sciences [ 5 , 6 ].

Quantitative and qualitative research use different ways of exploring various social phenomena. Both research methodologies can be applied individually or in combination based on the research topic, with mixed quantitative and qualitative research methodologies becoming more widespread in recent years [ 7 ]. Applying these 2 methods through a virtuous cycle of integration from a complementary perspective can provide a more accurate understanding of human phenomena and solutions to real-world problems.

This review aimed to provide a proper understanding of qualitative research to assist researchers in selecting the appropriate research methodology. Specifically, this review examined the characteristics of quantitative and qualitative research, the applicability of qualitative research, and the data sources collected and analyzed in qualitative research.

COMPARISON OF QUALITATIVE AND QUANTITATIVE RESEARCH

A clearer understanding of qualitative research can be obtained by comparing qualitative and quantitative research, with which people are generally familiar [ 8 , 9 ]. Quantitative research focuses on testing the validity of hypotheses established by the researcher to identify the causal relationships of a specific phenomenon and discovering laws to predict that phenomenon ( Table 1 ). Therefore, it emphasizes controlling the influence of variables that may interfere with the process of identifying causality and laws. In contrast, qualitative research aims to discover and explore new hypotheses or theories based on a deep understanding of the meaning of a specific phenomenon. As such, qualitative research attempts to accept various environmental factors naturally. In quantitative research, importance is placed on the researcher acting as an outsider to take an objective view by keeping a certain distance from the research subject. In contrast, qualitative research encourages looking inside the research subjects to understand them deeply, while also emphasizing the need for researchers to take an intersubjective view that is formed and shared based on a mutual understanding with the research subjects.

Comparison of methodological characteristics between quantitative research and qualitative research

The data used in quantitative research can be expressed as numerical values, and data accumulated through questionnaire surveys and tests are often used in analyses. In contrast, qualitative research uses narrative data with words and images collected through participant observations, in-depth interviews, and focus group discussions used in the analyses. Quantitative research data are measured repeatedly to enhance their reliability, while the analyses of such data focus on superficial aspects of the phenomenon of interest. Qualitative research instead focuses on obtaining deep and rich data and aims to identify the specific contents, dynamics, and processes inherent within the phenomenon and situation.

There are clear distinctions in the advantages, disadvantages, and goals of quantitative and qualitative research. On one hand, quantitative research has the advantages of reliability and generalizability of the findings, and advances in data collection and analysis methods have increased reliability and generalizability. However, quantitative research presents difficulties with an in-depth analysis of dynamic phenomena that cannot be expressed by numbers alone and interpreting the results analyzed in terms numbers. On the other hand, qualitative research has the advantage of validity, which refers to how accurately or appropriately a phenomenon was measured. However, qualitative research also has the disadvantage of weak generalizability, which determines whether an observed phenomenon applies to other cases.

APPLICATIONS OF QUALITATIVE RESEARCH AND ITS USEFULNESS IN THE HEALTHCARE FIELD

Qualitative research cannot be the solution to all problems. A specific methodology should not be applied to all situations. Therefore, researchers need to have a good understanding of the applicability of qualitative research. Generally, qualitative research is applicable in following cases: (1) when an exploratory approach is required on a topic that is not well known, (2) when something cannot be explained fully with quantitative research, (3) when it is necessary to newly present a specific view on a research topic that is difficult to explain with existing views, (4) when it is inappropriate to present the rationale or theoretical proposition for designing hypotheses, as in quantitative research, and (5) when conducting research that requires detailed descriptive writing with literary expressions [ 7 ]. In particular, qualitative research is useful for opening new fields of research, such as important topics that have not been previously examined or whose significance has not been recognized. Moreover, qualitative research is advantageous for examining known topics from a fresh perspective.

In the healthcare field, qualitative research is conducted on various topics considering its characteristics and strengths. Quantitative research, which focuses on hypothesis validation, such as the superiority of specific treatments or the effectiveness of specific policies, and the generalization of findings, has been the primary research methodology in the field of healthcare. Qualitative research has been mostly applied for studies such as subjective disease experiences and attitudes with respect to health-related patient quality of life [ 10 - 12 ], experiences and perceptions regarding the use of healthcare services [ 13 - 15 ], and assessments of the quality of care [ 16 , 17 ]. Moreover, qualitative research has focused on vulnerable populations, such as the elderly, children, disabled [ 18 - 20 ], minorities, and socially underprivileged with specific experiences [ 21 , 22 ].

For instance, patient safety is considered a pillar of quality of care, which is an aspect of healthcare with increasing international interest. The ultimate goal of patient safety research should be the improvement of patient safety, for which it is necessary to identify the root causes of potential errors and adverse events. In such cases, qualitative rather than quantitative research is often required. It is also important to identify whether there are any barriers when applying measures for enhancing patient safety to clinical practice. To identify such barriers, qualitative research is necessary to observe healthcare workers directly applying the solutions step-by-step during each process, determine whether there are difficulties in applying the solutions to relevant stakeholders, and ask how to improve the process if there are difficulties.

Patient safety is a very broad topic, and patient safety issues could be categorized into preventing, recognizing, and responding to patient safety issues based on related metrics [ 23 ]. Responding to issues that pertain to the handling of patient safety incidents that have already occurred has received relatively less interest than other categories of research on this topic, particularly in Korea. Until 2017, almost no research was conducted on the experiences of and difficulties faced by patients and healthcare workers who have been involved in patient safety incidents. This topic can be investigated using qualitative research.

A study in Korea investigated the physical and mental suffering experienced during the process of accepting disability and medical litigation by a patient who became disabled due to medical malpractice [ 21 ]. Another qualitative case study was conducted with participants who lost a family member due to a medical accident and identified psychological suffering due to the incident, as well as secondary psychological suffering during the medical litigation process, which increased the expandability of qualitative research findings [ 24 ]. A quantitative study based on these findings confirmed that people who experienced patient safety incidents had negative responses after the incidents and a high likelihood of sleep or eating disorders, depending on their responses [ 25 ].

A study that applied the grounded theory to examine the second victim phenomenon, referring to healthcare workers who have experienced patient safety incidents, and presented the response stages experienced by second victims demonstrated the strength of qualitative research [ 26 ]. Subsequently, other studies used questionnaire surveys on physicians and nurses to quantify the physical, mental, and work-related difficulties experienced by second victims [ 27 , 28 ]. As such, qualitative research alone can produce significant findings; however, combining quantitative and qualitative research produces a synergistic effect. In the healthcare field, which remains unfamiliar with qualitative research, combining these 2 methodologies could both enhance the validity of research findings and facilitate open discussions with other researchers [ 29 ].

In addition, qualitative research has been used for diverse sub-topics, including the experiences of patients and guardians with respect to various diseases (such as cancer, myocardial infarction, chronic obstructive pulmonary disease, depression, falls, and dementia), awareness of treatment for diabetes and hypertension, the experiences of physicians and nurses when they come in contact with medical staff, awareness of community health environments, experiences of medical service utilization by the general public in medically vulnerable areas, the general public’s awareness of vaccination policies, the health issues of people with special types of employment (such as delivery and call center workers), and the unmet healthcare needs of persons with vision or hearing impairment.

GENERAL WORKFLOW OF QUALITATIVE RESEARCH

Rather than focusing on deriving objective information, qualitative research aims to discern the quality of a specific phenomenon, obtaining answers to “why” and “how” questions. Qualitative research aims to collect data multi-dimensionally and provide in-depth explanations of the phenomenon being researched. Ultimately, the purpose of qualitative research is set to help researchers gain an understanding of the research topic and reveal the implications of the research findings. Therefore, qualitative research is generally conducted in the following order: (1) selection of a research topic and question, (2) selection of a theoretical framework and methods, (3) literature analysis, (4) selection of the research participants (or participation target) and data collection methods, (5) data analysis and description of findings, and (6) research validation ( Figure 1 ) [ 30 ]. However, unlike quantitative research, in which hypothesis setting and testing take place unidirectionally, a major characteristic of qualitative research is that the process is reversible and research methods can be modified. In other words, the research topic and question could change during the literature analysis process, and theoretical and analytical methods could change during the data collection process.

General workflow of qualitative research.

Selection of a Research Topic and Question

As with any research, the first step in qualitative research is the selection of a research topic and question. Qualitative researchers can select a research topic based on their interests from daily life as a researcher, their interests in issues within the healthcare field, and ideas from the literature, such as academic journals. The research question represents a more specific aspect of the research topic. Before specifically starting to conduct research based on a research topic, the researcher should clarify what is being researched and determine what research would be desirable. When selecting a research topic and question, the research should ask: is the research executable, are the research topic and question worth researching, and is this a research question that a researcher would want to research?

Selection of Theoretical Framework and Methods

A theoretical framework refers to the thoughts or attitudes that a researcher has about the phenomenon being researched. Selecting the theoretical framework first could help qualitative researchers not only in selecting the research purpose and problem, but also in carrying out various processes, including an exploration of the precedent literature and research, selection of the data type to be collected, data analysis, and description of findings. In qualitative research, theoretical frameworks are based on philosophical ideas, which affect the selection of specific qualitative research methods. Representative qualitative research methods include the grounded theory, which is suitable for achieving the goal of developing a theory that can explain the processes involved in the phenomenon being researched; ethnographic study, which is suitable for research topics that attempt to identify and interpret the culture of a specific group; phenomenology, which is suitable for research topics that attempt to identify the nature of research participants’ experiences or the phenomenon being researched; case studies, which aim to gain an in-depth understanding of a case that has unique characteristics and can be differentiated from other cases; action research, which aims to find solutions to problems faced by research participants, with the researchers taking the same position as the participants; and narrative research, which is suitable for research topics that attempt to interpret the entire life or individual experiences contained within the stories of research participants. Other methodologies include photovoice research, consensual qualitative research, and auto-ethnographic research.

Literature Analysis

Literature analysis results can be helpful in specifically selecting the research problem, theoretical framework, and research methods. The literature analysis process compels qualitative researchers to contemplate the new knowledge that their research will add to the academic field. A comprehensive literature analysis is encouraged both in qualitative and quantitative research, and if the prior literature related to the subject to be studied is insufficient, it is sometimes evaluated as having low research potential or research value. Some have claimed that a formal literature review should not be performed before the collection of field data, as it could create bias, thereby interfering with the investigation. However, as the qualitative research process is cyclic rather than unidirectional, the majority believes that a literature review can be performed at any time. Moreover, an ethical review prior to starting the research is a requirement; therefore, the research protocol must be prepared and submitted for review and approval prior to conducting the research. To prepare research protocols, the existing literature must be analyzed at least to a certain degree. Nonetheless, qualitative researchers must keep in mind that their emotions, bias, and expectations may interject themselves during the literature review process and should strive to minimize any bias to ensure the validity of the research.

Selection of the Research Participants and Data Collection Methods

The subjects of qualitative research are not necessarily humans. It is more important to find the research subject(s) from which the most in-depth answers to the research problem can be obtained. However, the subjects in most qualitative studies are humans, as most research question focus on humans. Therefore, it is important to obtain research participants with sufficient knowledge, experience, and attitudes to provide the most appropriate answers to the research question. Quantitative research, which views generalizability as a key research goal, emphasizes the selection of research participants (i.e., the research sample that can represent the study’s population of interest), whereas qualitative research emphasizes finding research participants who can best describe and demonstrate the phenomenon of interest.

In qualitative research, the participant selection method is referred to as purposeful sampling (or purposive sampling), which can be divided into various types. Sampling methods have various advantages, disadvantages, and characteristics. For instance, unique sampling (extreme case sampling) has the advantage of being able to obtain interesting research findings by researching phenomena that have previously received little or no interest, and the disadvantage of deriving research findings that are interesting to only some readers if the research is conducted on an overly unique situation. Maximum variation sampling, also referred to as theoretical sampling, is commonly used in qualitative research based on the grounded theory. Selecting the appropriate participant sampling method that suits the purpose of research is crucial ( Table 2 ).

Sampling methods of selecting research participants in qualitative research

Once the researcher has decided how to select study participants, the data collection methods must be determined. Just as with participant sampling, various data collection methods are available, all of which have various advantages and disadvantages; therefore, the method must be selected based on the research question and circumstances. Unlike quantitative research, which usually uses a single data source and data collection method, the use of multiple data sources and data collection methods is encouraged in qualitative research [ 30 ]. Using a single data source and data collection method could cause data collection to be skewed by researcher bias; therefore, using multiple data sources and data collection methods is ideal. In qualitative research, the following data types are commonly used: (1) interview data obtained through one-on-one in-depth interviews and focus group discussions, (2) observational data from various observation levels, (3) documented data collected from personal or public documents, and (4) image data, such as photographs and videos.

Interview data are the most commonly used data source in qualitative research [ 31 ]. In qualitative research, an interview refers to communication that takes place based on a clear sense of purpose of acquiring certain information, unlike conversations that typically take place in daily life. The level of data acquired through interviews varies significantly depending on the researcher’s personal qualifications and abilities, as well as his or her level of interest and knowledge regarding the research topic. Therefore, interviewers must be trained to go beyond simply identifying the clearly expressed experiences of research participants to exploring their inner experiences and emotions [ 32 ]. Interview data can be classified based on the level of structuralization of the data collection method, sample size, and interview method. The characteristics of each type of interview are given in Table 3 .

Detailed types of interview methods according to the characteristics of in-depth interviews and focus group discussion

Observations, which represent a key data collection method in anthropology, refer to a series of actions taken by the researcher in search of a deep understanding by systematically examining the appearances of research participants that take place in natural situations [ 33 ]. Observations can be categorized as participant and non-participant, insider and outsider, disguised and undisguised, short- and long-term, and structured and unstructured. However, a line cannot be drawn clearly to differentiate these categories, and the degree of each varies along a single spectrum. Therefore, it is necessary for a qualitative researcher to select the appropriate data collection method based on the circumstances and characteristics of the research topic.

Various types of document data can be used in qualitative research. Personal documents include diaries, letters, and autobiographies, while public documents include legal documents, public announcements, and civil documents. Online documents include emails and blog or bulletin board postings, while other documents include graffiti. All these document types may be used as data sources in qualitative research. In addition, image data acquired by the research participant or researcher, such as photographs and videos, serve as useful data sources in qualitative research. Such data sources are relatively objective and easily accessible, while they contain a significant amount of qualitative meaning despite the low acquisition cost. While some data may have been collected for research purposes, other data may not have been originally produced for research. Therefore, the researcher must not distort the original information contained in the data source and must verify the accuracy and authenticity of the data source in advance [ 30 ].

This review examined the characteristics of qualitative research to help researchers select the appropriate qualitative research methodology and identify situations suitable for qualitative research in the healthcare field. In addition, this paper analyzed the selection of the research topic and problem, selection of the theoretical framework and methods, literature analysis, and selection of the research participants and data collection methods. A forthcoming paper will discuss more specific details regarding other qualitative research methodologies, such as data analysis, description of findings, and research validation. This review can contribute to the more active use of qualitative research in the healthcare field, and the findings are expected to instill a proper understanding of qualitative research in researchers who review and judge qualitative research reports and papers.

Ethics Statement

Since this study used secondary data source, we did not seek approval from the institutional review board. We also did not have to ask for the consent of the participants.

Acknowledgments

CONFLICT OF INTEREST

The authors have no conflicts of interest associated with the material presented in this paper.

AUTHOR CONTRIBUTIONS

Conceptualization: Pyo J, Lee W, Choi EY, Jang SG, Ock M. Data curation: Pyo J, Ock M. Formal analysis: Pyo J, Ock M. Funding acquisition: None. Validation: Lee W, Choi EY, Jang SG. Writing - original draft: Pyo J, Ock M. Writing - review & editing: Pyo J, Lee W, Choi EY, Jang SG, Ock M.

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Research Article

Acceptance of physical activity virtual reality games by residents of long-term care facilities: A qualitative study

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Validation, Writing – review & editing

Roles Validation, Writing – review & editing

Affiliations Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada, Brain and Mind Research Institute, University of Ottawa, Ontario, Ottawa, Canada

Roles Writing – review & editing

Affiliations Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Ottawa, Canada, School of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada

Roles Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing

Affiliation Interdisciplinary School of Health Sciences, Faculty of Health Sciences, and Life Research Institute, University of Ottawa, Ottawa, Ontario, Canada

• Marjan Hosseini, 
• Roanne Thomas, 
• Lara Pilutti, 
• Pascal Fallavollita, 
• Jeffrey W. Jutai

• Published: June 25, 2024
• https://doi.org/10.1371/journal.pone.0305865
• Reader Comments

Little is known about the experience and the social and contextual factors influencing the acceptance of virtual reality (VR) physical activity games among long-term care (LTC) residents. Our study aims to address this research gap by investigating the unique experience of older adults with VR games. The findings will provide valuable insights into the factors influencing VR acceptance among LTC residents and help design inclusive VR technology that meets their needs and improves physical activity (PA) and well-being.

We aimed to: (1) investigate how participants experience VR exergames and the meaning they associate with their participation; and (2) examine the factors that influence the participant’s experience in VR exergames and explore how these factors affect the overall experience.

We used a qualitative approach that follows the principles of the Interpretive Description methodology. Selective Optimization and Compensation (SOC) theory, Socioemotional Selectivity theory (SST) and technology acceptance models underpinned the theoretical foundations of this study. We conducted semi-structured interviews with participants. 19 Participants of a LTC were interviewed: five residents and ten tenants, aged 65 to 93 years (8 female and 7 male) and four staff members. Interviews ranged from 15 to 30 minutes and were transcribed verbatim and were analyzed using thematic analysis.

We identified four themes based on older adults’ responses that reflected their unique VR gaming experience, including (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and challenges. Three themes were developed based on the staff members’ data to capture their perspective on the factors that influence the acceptance of VR among LTC resident including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers.

Conclusions

VR gaming experiences are enjoyable exciting, and novel for LTC residents and tenants and can provide physical, cognitive, social, and motivational benefits for them. Proper guidance and personalized programs can increase understanding and familiarity with VR, leading to a higher level of acceptance and engagement. Our findings emphasize the significance of social connection and support in promoting acceptance and enjoyment of VR gaming among older adults. Incorporating social theories of aging helps to gain a better understanding of how aging-related changes influence technology acceptance among older adults. This approach can inform the development of technology that better meets their needs and preferences.

Citation: Hosseini M, Thomas R, Pilutti L, Fallavollita P, Jutai JW (2024) Acceptance of physical activity virtual reality games by residents of long-term care facilities: A qualitative study. PLoS ONE 19(6): e0305865. https://doi.org/10.1371/journal.pone.0305865

Editor: Chao Gu, Tsinghua University, CHINA

Received: July 10, 2023; Accepted: June 5, 2024; Published: June 25, 2024

Copyright: © 2024 Hosseini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The world’s population of individuals aged 65 and above is projected to reach 16% by 2050, indicating a significant increase in the number of older adults [ 1 ]. In Canada, the number of people aged 65 or older (18.8%) is growing faster than the number of children aged 0 to 14 years (15.6%) [ 2 ]. With the increasing proportion of older adults compared to other age groups, it is anticipated that there will be a corresponding growth in the population of older individuals residing in LTC facilities. Ensuring the well-being of older adults in LTC facilities is crucial, as they often exhibit lower levels of PA due to various factors [ 3 , 4 ] with estimates suggesting that they spend about 75% of their waking hours being sedentary [ 5 ]. Promoting tailored PA programs that consider the specific needs and abilities of older adults can enhance social engagement and overall well-being [ 6 ].

Consistent engagement in PA has been demonstrated to enhance functional capabilities, overall health, and well-being, thereby reducing the risk of all-cause mortality, chronic diseases, and premature death among older adults [ 7 ] and VR literature has demonstrated the effectiveness of immersive and interactive VR games in promoting PA among older adults [ 8 , 9 ]. However, for older adults to embrace and utilize new technology, positive experiences are crucial, highlighting the need to understand acceptance factors [ 10 ]. Further investigation is necessary to fully explore the potential of VR technology in enhancing PA and well-being among older adults in LTC, given their vulnerability to the negative effects of physical inactivity [ 11 ].

LTC residents represent a critical population for research and intervention due to their unique challenges and vulnerabilities. They often face limited mobility and physical activity opportunities, heightened prevalence of chronic conditions, increased risk of social isolation, and mental health concerns. Intersection of staffing challenges and issues related to the built environment resulted in suboptimal conditions for physical activity programs [ 12 ]. Given the aforementioned constraints faced by LTC residents, any tool that can reduce inactivity deserves further investigation [ 13 ].

The aim of this study is to investigate the social and individual factors influencing the acceptance of VR physical activity games among residents in LTC facilities. While previous qualitative research has examined the potential benefits of VR technology in promoting physical activity, well-being, and social interaction among older adults [ 14 – 16 ] existing studies have specific limitations that underscore the need for further research. Chaze et al. [ 14 ] focused on evaluating VR content tailored to a specific organization, limiting generalizability. Lin’s study [ 16 ] approached VR leisure activities from a marketing perspective, potentially differing from the needs of LTC residents. Kruse’s study [ 15 ] compared acceptance of VR exergames with traditional video games but did not delve into the influencing factors among older adults. Therefore, further research is needed to understand acceptance factors, inform design, and implement effective VR interventions for LTC residents, promoting PA and overall health outcomes. Our study seeks to address this gap by exploring the social determinants of VR acceptance among older adults, informed by social theories of aging. By conducting open-ended interviews and examining the factors that influence VR acceptance, we aim to inform the design and implementation of VR technology in LTC facilities, ultimately enhancing accessibility and effectiveness for this population.

The Technology Acceptance Model (TAM) [ 17 ] is commonly used to study technology acceptance but has limitations in real-life contexts [ 18 ]. This criticism highlights the need to understand the social determinants of VR acceptance among older adults, which requires research informed by social theories of aging. Open-ended interviews, as suggested by Lin et al. [ 16 ]. This research can inform the design and implementation of VR technology for older adults, enhancing accessibility and effectiveness.

Considering the identified research gaps, exploring the social determinants of VR acceptance among older adults can provide valuable insights into improving the accessibility and effectiveness of VR technology for this population. This focus is aligned with the objective and research questions of our study.

Objectives and research questions

The primary objectives of this study are twofold:

• To comprehensively explore the experiences of older adults with VR exergames.
• To identify and analyze the individual and organizational factors that significantly influence their experiences and the acceptance of VR games.

To achieve these objectives, we have formulated two specific research questions:

• How do participants experience VR exergames, and what meaning do they attach to their participation?
• What are the factors that influence the participants’ experience, and how do these factors affect the experience?

Theoretical framework

Our study was guided by SOC [ 19 ] theory and SST [ 20 ] as frameworks to investigate the social and contextual determinants of acceptance of VR technology. SOC focuses on older adults’ awareness of losses and gains and the decline in their resources as a consequence of aging [ 19 ]. According to this theory, individuals select more important or more attainable goals, optimize their performance to maximize the gains, and compensate unachieved goals to maintain functioning [ 21 ]. SOC theory guides our exploration of the selection and optimization of activities and the compensation for losses, while SST underscores the significance of emotionally meaningful social interactions in the context of technology acceptance. SST is a lifespan theory that helps explain the shift of personal goals and behaviors with age. SST introduces the concept of future time perspective (FTP), which refers to one’s perception of time and how much time is left [ 20 ]. The study also draws on the components from TAM [ 17 ], The Unified Theory of Acceptance and Use of Technology (UTAUT) [ 22 ], and The Senior Technology Acceptance Model (STAM) [ 23 ] to investigate the psychological factors affecting VR acceptance. By considering both psychological and social factors, we aim to gain a comprehensive understanding of VR acceptance among older adults and inform interventions and strategies for promoting VR adoption.

TAM indicates perceived usefulness (the extent to which using a specific application system will increase job performance) and perceived ease of use (the subjective probability that using technology will be free of effort) shape the attitudes of the user toward technology that affect the intention of use and determine computer acceptance behavior [ 17 ].

Venkatesh and colleagues developed UTAUT as an integration model of eight dominant theories and models with seven core determinants of intention and usage and up to four moderate determinants [ 24 ]. They stated that performance expectancy, effort expectancy, social influence, facilitating conditions, hedonic motivation, price value, and habit as direct determinants and gender, age, and experience as the key moderators play a significant role in user acceptance and usage behaviour.

The senior technology acceptance model (STAM) is the first TAM-based model that goes beyond TAM’s organizational and business context and is specifically formulated to understand gerontechnology acceptance by older adults’ predictive factors of TAM and UTAUT [ 23 ].

We recognize that while technology acceptance models focus on psychological factors to explain users’ acceptance of technology, they overlook the social processes associated with aging. Therefore, we emphasize the importance of considering both psychological and social factors to comprehensively understand VR acceptance among older adults. To fully understand VR acceptance among older adults, both psychological and social factors should be considered. This integrated approach informs interventions and strategies for promoting VR adoption and use. By uncovering social and contextual determinants, this study aims to enhance VR uptake and use among older adults, improving their overall health and well-being.

Our study integrated SOC theory and SST to tailor VR exergame interventions to older adults’ preferences, well-being, and continued participation [ 19 , 20 , 25 ]. SOC theory’s strategies for successful aging guide the selection and optimization of activities, compensating for losses. SST emphasizes prioritizing emotionally meaningful social interactions. Incorporating features that support social connections, emotional well-being, and cognitive and physical stimulation in VR games is crucial to fulfill older adults’ life goals.

Theoretical frameworks of aging guided our data analysis, identifying themes related to social support and goal-driven attitudes towards VR gaming. By analyzing participant interviews, we aimed to understand the role of social support and the influence of goals on attitudes towards VR games. These themes were derived from the application of social theories of aging, providing structure and direction to our study.

To gain insight into factors influencing older adults’ acceptance of VR exergames, we employed TAM components in analyzing staff perspectives. The use of TAM models helped identify key themes related to acceptance. Our study’s integrated approach to theoretical frameworks allows for a comprehensive examination of VR acceptance among older adults, addressing both psychological and social factors to enhance VR uptake and use, ultimately improving overall health and well-being in this population.

Materials and methods

Methodology.

Our study utilized interpretive description [ 26 ] as a qualitative research methodology to understand the unique VR gaming experiences of LTC residents. This approach goes beyond traditional descriptive methods, aiming to uncover deeper meanings and explanations in specific contexts. This approach delves into deeper meanings and explanations within specific contexts. Focusing on the VR gaming experiences of LTC residents and tenants, interpretive description allowed us to explore their perspectives, challenges, and coping mechanisms. By unraveling these unique aspects, this methodology contributes to the development of targeted interventions aligned with the specific needs and preferences of LTC residents and tenants. Emphasizing contextuality ensures findings are not only insightful but also directly applicable to the intricate factors characterizing the LTC environment. In essence, our choice of interpretive description underscores our commitment to understanding the depth and richness of participants’ VR gaming experiences, with direct implications for enhancing their well-being within clinical and care settings. Through semi-structured interviews with residents, tenants, and staff members, we gained practical insights and theoretical understanding by exploring characteristics, patterns, and structures. By employing deductive reasoning, we identified initial codes, themes, and concepts derived from existing theories and models. This study was conducted with ethical approval from the University of Ottawa’s Health Sciences and Sciences Research Ethics Board (Ethics File Number: H-02-22-7627).

Participant recruitment

Data were collected from July 4, 2022 to August 10, 2022 at a community healthcare center serving older adults and veterans in long-term care homes and independent apartments. The facility accommodates two types of individuals: residents and tenants. Residents, typically elderly adults, require round-the-clock care and assistance with daily tasks. On the other hand, tenants sign lease agreements with the facility for a specific duration and enjoy greater autonomy. The participants in this study were a subsample from a related study on VR games conducted a few days prior to the interviews.

Residents and tenants who met the following inclusion criteria were selected for participation: (1) aged 65 or older, residing in LTC; (2) previously took part in the VR games study [ 27 ]; and (3) able to communicate and read in English. Written informed consent was obtained from those who agreed to participate before the interviews (See S1 File ).

Staff members who met the following criteria were included: (1) employed at the facility for at least six months; (2) proficient in English; and (3) directly involved in resident care. Exclusions included staff with less than six months of employment, limited English proficiency, or no direct experience with residents. Gathering staff perspectives provided a comprehensive understanding of the study topic given their close proximity and extensive knowledge. Purposive sampling involved sending emails to staff members responsible for resident activities and programs. The first four staff members who agreed to participate were selected and signed written informed consent before the interviews (See S2 File ). This sampling approach ensured the selection of staff members most suitable to provide insights into the experiences of older adults and veterans in LTC facilities and independent apartments.

In our VR games study, participants engaged with Song Beater , a VR rhythm game that challenges players’ sense of rhythm through dance and slashing flying beats [ 28 ]. Despite not being specifically designed for older adults, Song Beater offers several features that make it suitable for this population, including customizable difficulty levels, seated playing option, one-handed playing with balance support, customizable environment, and the ability to use personal music and adjust song speed. Participants played the game three times within a two-week period.

Data collection

Semi-structured interviews were conducted in person between July and August 2022, within three days after the VR gaming study. Prior to the interviews, participants were provided with an information letter and asked to sign consent forms, ensuring the confidentiality of their responses. All participants were asked the same set of questions regarding their experience with the VR game.

Participants were interviewed once, within 3 days after their participation in the VR gaming study, allowing for sufficient reflection time and reducing initial biases or immediate reactions. Interviews took place in participants’ apartments or private rooms at the LTC facility to ensure comfort and ease during the process. The interviews lasted 15–30 minutes, respecting participants’ time and attention spans while gathering meaningful information. A set of nine open-ended questions, focusing on game characteristics, preferences, experiences, and goals, were used (See S3 File ). interview questions were designed to be open-ended and neutral to allow participants to express their experiences and opinions freely without being influenced by the researchers’ preconceptions. Probing questions and follow-up prompts were employed to elicit detailed responses and ensure comprehensive coverage of relevant aspects [ 29 ]. Interview questions were structured to explore themes related to the theoretical framework’s constructs, ensuring that participant experiences and attitudes towards VR gaming were examined through the lens of age-related variations and social determinants. For instance, questions were designed to probe participants’ interests, goals, social interactions, emotional experiences, and perceptions of game characteristics, aligning with the concepts outlined in SOC, SST, and TAM.

Staff members were interviewed after resident data collection to gather potential feedback. They received information letters, provided informed consent, and answered nine open-ended questions (See S4 File ) regarding barriers to physical activity and factors influencing technology acceptance by LTC residents. Interviews took place during staff members’ break time in their offices, lasting 15–30 minutes to minimize work disruption.

Data analysis

Interviews were audio-recorded and transcribed verbatim. The data analysis followed the interpretive description methodology [ 21 ] and involved three stages: data familiarization, theme and pattern identification, and theme labeling and reporting. NVivo 12 qualitative analytic software (QSR International, release version 1.6.1) was used for coding the transcripts. Inter-rater reliability [ 30 ] was ensured through independent coding of five transcripts (three of the transcripts were the same and two were different) by two researchers, followed by consensus discussions to address any discrepancies. Inter-rater reliability checks were conducted to ensure consistency and objectivity in the data analysis process and reduce the risk of individual biases shaping the interpretation of findings. As analysis progressed, the theme "game characteristics" was refined into "Enjoyment, excitement, and the environment" to capture a nuanced understanding of player experiences.

Preliminary themes were developed through detailed analysis and discussions, considering the source data and codes [ 31 ]. Observations and field notes provided valuable context. The data were examined for themes related to TAM, SOC, and SST constructs, providing a theoretical foundation for the study. A combination of social and psychological theories was employed to explore technology attitudes and their age-related variations. SOC guided the exploration of participants’ interests, goals, and social interactions, while SST focused on emotional experiences and social connections. TAM facilitated the examination of game characteristics, perceived usefulness, and ease of use.

To maintain the integrity of our study, we followed established qualitative research principles, employing interpretive description as our robust methodology to explore the distinct VR gaming encounters of LTC residents. Clear participant recruitment criteria, ethical approval, and informed consent were meticulously addressed to enhance credibility and respect ethical considerations. A strategic sampling approach, detailed VR game description, and structured data collection with temporal considerations were implemented to provide a comprehensive understanding of the study topic. Rigorous data analysis using NVivo 12 software, inter-rater reliability, and a theoretical foundation grounded in social and psychological theories further strengthened the study’s credibility, dependability, and transferability. These methodological considerations collectively contribute to the rigour of our study and formed a solid foundation for meaningful interpretation and generalization of findings.

Resident and tenant participants’ characteristics

Twelve tenants (80%), three residents (20%), and four staff members from an LTC facility participated in the interviews. The participants’ ages ranged from 66 to 93, with a median age of 78. The gender distribution was eight female participants (53.3%) and seven male participants (46.7%). The number of participants was above the recommended number for saturation by Guest and colleagues [ 32 ], as which suggests that data saturation occurs within the first twelve interviews in qualitative methods. Educational backgrounds varied, with 40% having a bachelor’s degree or higher. Most participants (66.7%) had prior gaming experience, while the remaining (n = 5, 33.3%) did not. Table 1 depicts resident and tenant participants’ characteristics.

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https://doi.org/10.1371/journal.pone.0305865.t001

Identified themes

We developed four themes to understand older adults’ VR experience and perceptions: (1) enjoyment, excitement, and the novel environment; (2) PA and motivation to exercise; (3) social connection and support; and (4) individual preferences and Challenges. In addition, themes were identified from staff members’ data, including (1) relevance and personalization of the games; (2) training and guidance; and (3) organizational and individual barriers.

Themes developed from older adults’ data were analyzed using SOC and SST. These themes relate to experience of VR gaming and how older adults prioritize certain activities and social connections as they age and compensate for declines in other areas and how they prioritize emotionally meaningful goals.

Staff members’ themes of “Relevance and personalization,” “Training and guidance,” and “Organizational and individual barriers” were analyzed using TAM, STAM, and UTAUT. These themes relate to the perceived usefulness and ease of use of the technology, as well as individual and organizational factors that may facilitate or hinder its acceptance.

The themes were derived through iterative coding and thematic analysis, where recurring patterns and insights emerged from the participants’ narratives. For example, the theme of "Enjoyment, excitement, and the novel environment" emerged from participants’ reflections on their experiences with VR gaming. Constructs such as enjoyment, excitement, and immersion were identified through careful analysis of participant responses, highlighting their emotional and experiential dimensions.

Similarly, the theme of "Physical activity and motivation to exercise" reflected participants’ perspectives on the role of VR exergaming in promoting physical activity and motivation. Constructs like physical exertion, motivation, and exercise adherence were inferred from participant accounts, demonstrating the multifaceted impact of VR gaming on physical well-being.

These themes were analyzed in the context of theoretical frameworks such as SOC, SST, TAM, STAM, and UTAUT, which provided a theoretical lens to interpret the findings. Constructs from these frameworks were mapped onto the identified themes, allowing for a deeper understanding of the underlying mechanisms driving participants’ experiences and perceptions.

Older adults’ themes- The meanings attached to the VR gaming experience

These themes represent the experience of VR exergaming and portray the meanings that older adult participants attached to their VR gaming experience. Table 2 shows an example of how questions, themes and constructs of theoretical frameworks are formed and connected in older adults’ themes.

https://doi.org/10.1371/journal.pone.0305865.t002

Enjoyment, excitement, and the novel environment.

This theme represents older adults’ reflections on the pleasure, enthusiasm, and sense of novelty derived from engaging in VR gaming. Participants in the VR gaming experience found themselves immersed in a captivating world, filled with excitement, vibrant environments, and joyous interactions. As one participant put it, " I felt so excited ! It was fun ! It’s really neat ! It just brings happiness" (P5) .

Participants found the VR gaming experience enjoyable, with the most cited features being the novel environment and fun nature of the game. Three participants specifically identified their gaming experience as fun, with one stating, "Look at the beautiful fish" (P5), another expressing, "Neat , awesome" (P14), and a third participant exclaiming, "I saw a cat ! I thought it was my cat ! " (P12). They continually commented on the environment and game details and laughed when surprised during gameplay. One participant expressed their overall enjoyment, stating, "It’s been a fun experience which I am thankful for" (P11).

Participants emphasized the importance of various game characteristics. Vibrant colors, immersive environments, and high-speed dynamics were key factors contributing to their enjoyment. The realistic design elements, such as Egyptian pyramids and underwater worlds, along with animated animals and fish, further enhanced the gaming experience. One participant appreciated the visually stunning environment, stating, "I liked the environment; it was very beautiful , the underwater environment" (P11). Another participant expressed fascination with dynamic elements in the background, particularly observing animals like the lion, which added to their immersion: "Something that I found interesting was in the background . The animals and the other things going on and watching the big cat , the lion … " (P6). These insights provided a deeper understanding of the specific game characteristics that captivated and brought enjoyment to the participants.

The VR game’s fast and seamless responsiveness to participants’ movements was surprising, providing an empowering and liberating experience, especially for those with physical limitations. One participant expressed their astonishment, stating, "How crazy is that in this world ? You are not vulnerable even , the VR , move a piece , and it happens right away ! " (P5). This quote suggests that VR allows individuals to freely engage in activities without feeling vulnerable, a possibility that may not exist in the physical world.

The game provided a unique and engaging experience, capturing participants’ attention and interest throughout gameplay. It instilled a sense of accomplishment and satisfaction as they progressed. One participant described it as follows: "It was very engaging … it built intensity … it wasn’t just one thing around every minute . It slowly introduced maneuvers , picked up the speed , and became very challenging" (P4).

Many participants appreciated the immersive nature of VR technology, which enabled them to fully engage in the virtual game world and interact with it realistically and intuitively. As one participant expressed, "I feel like I’m facing real life , but the design is not quiet . I want to be immersed more in the game" (P9).

Music played a crucial role in generating excitement during the game. Participants actively paid attention to the songs and recognized their impact on the game’s rhythm and flow. Some even sought out other songs from the game’s playlist to increase the pace and excitement. Perspectives on the role of game music varied among participants. One participant expressed deep appreciation, explaining how it enhanced their personal involvement and enjoyment: " I love music; I love dancing , so then it brought more of me with the music . The music , I would say , I’m present more . [Laugh]" (P7). In contrast, another participant viewed game music as mere auditory disturbance, describing it as "Music is a noise" (P11).

Such findings align with the framework of SOC which proposes that individuals adapt to the aging by focusing on their goals and optimize the meaningful activities while compensating for the limitations. Participants optimized the enjoyment by engaging in VR game, compensating for any physical limitations. The findings align with the SST framework. Participants in this study sought out VR gaming to maximize enjoyment and positive emotions. The SST lens highlights how older adults are driven by emotional motivations, seeking enjoyable experiences like VR gaming to foster positive emotions and enjoyment throughout the aging process.

Physical activity and motivation to exercise.

This theme explores older adults’ perspectives on the role of VR exergaming in promoting PA, motivation, and adherence to exercise routines. Participants recognized the connection between PA and motivation during their VR gaming experience. They acknowledged the importance of PA within the VR context, which provided benefits such as improved coordination, balance, and upper body workout. Two participants highlighted the positive exercise effects; P4 stated, "I have some exercise from it , and I’m conscious of that , as my arms go back and forward and try to catch those Frisbees" (P4). Similarly, P9 described the game as "a good way to exercise" and emphasized the muscular and visual benefits: "For my age , it’s a good way to exercise , for the muscle and for the visuality" (P9).

Another participant mentioned feeling warm during the gameplay and needing to turn on a fan, suggesting that the game provided a demanding PA that raised their body temperature. However, some participants viewed the game as an "add-on" (P2) or an "upper body exercise" (P8), focusing primarily on engaging the upper body rather than the entire body.

In addition to physical benefits, Participating in the VR game also brought awareness to some older adults regarding their physical limitations. One participant expressed frustration with their left hand’s accuracy compared to their right hand, stating, "I was annoyed with myself that my left hand was not as accurate as my right hand . I’ve always been right-handed . I don’t use my left hand very much at all" (P8). This realization showcases how VR has the potential to enhance self-awareness and uncover previously unnoticed physical limitations.

Besides the physical benefits, the challenge of the game and the sense of accomplishment that came with overcoming it motivated the players to perform better, achieve higher scores, and test their abilities. Some players even saw it as a challenge against the VR machine and tried to outsmart the system. As one participant stated: “I think the challenge of getting as highest score as you possibly can , so you do it once , you get a score , the second time you want to beat your score . ” (P4)

A participant expressed that the game served as motivation for PA and helped them escape daily life challenges, offering a distraction and alleviating depression, "It takes me out of my everyday tasks and everything and brings me to another world… you see the fishes and things like that and makes you forget you are in the house , and you take the thing [headset] out , and you see oh ! I’m in the house" (P12). Another participant emphasized the importance of the VR experience in combating social isolation and building confidence post-COVID-19 lockdowns. The VR experience brought them happiness and a sense of security, preparing them for rejoining society. “A really good space to be in , after you have a bad day , wow ! Increase your thoughts and your endorphins , you know , just puts you in a happy mood . ” (P5)

The use of SOC revealed that VR gaming gave older adults a sense of purpose, motivating them to improve scores and challenge themselves. It also increased self-awareness, as one participant discovered accuracy differences between their hands. VR gaming contributed to physical well-being by providing a meaningful activity that enhanced self-awareness and personal growth.

Also, SST helps us understand the motivation aspect of the theme. According to SST, individuals choose goals and activities that provide personal satisfaction while minimizing effort. In this case, VR gaming offered a fun way for older adults to be physically active, providing a sense of accomplishment and motivation. It motivated participants to exercise, bringing happiness and well-being by serving as a distraction from daily challenges.

Social connection and support.

This theme refers to older adults’ experiences of social interactions, connection, and emotional support facilitated through VR gaming, including the impact on social relationships. Participants viewed the game as an opportunity to socialize and connect with others, whether with their friends in the facility or family members who live far away: “I wouldn’t mind playing my grandson . [It] Would be a challenge , if I wasn’t successful that was fine , but this is something to do together . ” (P7) One participant expressed their preference regarding a possible setup for the game for group gameplaying: “If it could be set up for two players and one hit one colour , and one hit the other colour , that would be a challenge” (P10).

Participants went beyond involvement, recommending friends to the researcher as potential participants. Their proactive approach and follow-up inquiries demonstrated interest in the study’s success and created a sense of community. This highlighted the importance of social support in promoting engagement and participation, showcasing the potential benefits of VR gaming for LTC facility residents.

Participant sharing of VR gaming experiences enhanced self-efficacy and performance, highlighting the potential of social support and knowledge sharing. Technical support increased confidence in technology use, with a desire to continue playing if volunteer assistance is available: "If we have a volunteer , hopefully , we can . Somebody that could be available" (P5). Two participants emphasized the importance of support in navigating the game: "You escorted me through … if I had been there by myself , I might have had difficulties" (P4), "If you weren’t here , I don’t know how I would go through" (P5).

Staff and family encouragement significantly influenced acceptance and enjoyment of VR games. One couple shared their scores with their son, who expressed amazement and motivated them to continue: "I certainly would be interested in another project … I said to my son : I tried that [VR] , and I guess I was pretty good at" (P7).

Participants were motivated to engage in VR gaming for socialization, aligning with SOC principles. SST emphasizes prioritizing emotionally meaningful relationships as individuals age. Participants’ enthusiasm and support for the VR gaming study highlight potential benefits for LTC residents and the importance of social support in promoting engagement. Technical assistance during the VR gaming experience was crucial, emphasizing the role of emotional support and guidance.

Individual preferences and challenges.

This theme explores participants’ preferences, challenges, and barriers in VR exergaming, including technical difficulties, physical limitations, and personal preferences for game features. Participants’ experiences were influenced by their interests and prior gaming experience. Some expressed enthusiasm to explore the full potential of VR: "I would like to continue with VR and explore its capacity" (P3, experienced gamer). Others, with less experience or health concerns, appreciated the exercise and novelty: "Good exercise , concentration , focus , and challenge" (P14, with comorbidities).

The gaming experience had some challenges for participants. Those without prior experience found the game setup and menu navigation difficult, hindering their engagement. Some participants, even after adjusting the speed, felt the game was too fast for their reflexes: "Perhaps for an older person , it must be slower" (P7). These challenges impacted their enjoyment and acceptance of the game.

The boxing game involved punching flying objects without button presses, but the controller buttons posed challenges for some participants. Accidental button presses interrupted the game, requiring extra effort to resume: “I was happy to see how easy it was , except about the controllers . I never got master of those . ” (P7) Additionally, some participants found the headset weight burdensome, further affecting their experience and interaction with the game.

Some participants prioritized health-related goals to maintain an active and enjoyable life: "to keep a healthy and active life" (P1) and "to reach 100" (P5) to spend time with grandchildren. The goals expressed by participants align with the SOC theory, as they actively select and optimize important goals while compensating for age-related limitations. These goals include maintaining physical activity, controlling blood sugar, and losing weight, reflecting their focus on health and well-being.

The participants in our study actively selected and optimized health-related goals, such as maintaining physical activity and controlling blood sugar, while compensating for age-related limitations, aligning with the SOC theory. These goals were emotionally meaningful, contributing to their overall quality of life. Additionally, goals related to family time and fostering social connections within their living facility were consistent with the SST, highlighting the importance of social relationships and emotional well-being.

Staff members’ themes- Determinants of VR acceptance by residents

The staff members’ perspectives provided valuable insights into the factors influencing the acceptance of VR games among LTC residents. Being in frequent communication with the residents and involved in decision-making regarding recreational programs and physiotherapy practices, the staff members were well aware of the residents’ needs and preferences. Table 3 depicts examples of the questions, themes, quotes and relevant models.

https://doi.org/10.1371/journal.pone.0305865.t003

Relevance and personalization.

Staff members stress the importance of tailoring VR games to LTC residents’ individual needs and interests for better acceptance. This involves designing games with relevant themes and user-friendly equipment. One staff member stated, " Having whatever they see relevant to their lives may affect them here" (S1). Participants’ experiences support this approach, with one likening the game to the View-Master and another recalling positive memories while playing. VR gaming has the potential to evoke positive emotions and increase acceptance among older adults.

The relevance and personalization of VR games can be analyzed using TAM’s perceived usefulness component. TAM highlights that perceived usefulness and ease of use determine technology acceptance. When games align with players’ interests, they are seen as more useful, increasing acceptance. Additionally, user-friendly equipment enhances ease of use, further promoting acceptance.

Training and guidance.

Staff members highlighted the role that education and support from both family members and staff members play in the acceptance of VR games among residents. They emphasized the importance of educating LTC residents on the proper use and potential benefits of VR games. This education can help increase residents’ understanding and familiarity with the technology, leading to higher acceptance and engagement.

They believed that family members could provide emotional support and act as a source of guidance and information, helping residents feel more comfortable and confident using VR games “If you have a family that is very supportive of this project and trying this new thing , it would play a huge role . ” (P3). On the other hand, staff members can provide hands-on assistance and support during VR games, helping residents navigate the technology and troubleshoot any issues that may arise:

A staff member emphasized the need for researchers and staff to prioritize relationship-building when working with LTC facility residents, especially in research or implementing new technologies like VR. Due to the residents’ vulnerability and unique perspectives, it is crucial to consider their specific needs. Older adults who are introduced to VR require trust and a sense of safety to fully embrace the new experience. This can be established through effective communication and comprehensive training provided by researchers: “Taking that time to build those relationships because using a headset it’s like , virtual reality , it changes your reality , so you need to know that you are safe , somebody safe is there with you . ” (S4)

Staff members believed that educating LTC residents on the benefits of VR games and providing them with guidance can help increase their understanding and familiarity with the technology, leading to higher acceptance and engagement: “It’s just really a lot about education . ” (P4). This aligns with the TAM model’s emphasis on perceived usefulness as a key factor in technology acceptance.

Organizational and individual barriers.

Staff members noted organizational and individual challenges that hinder the acceptance of VR games among LTC residents. These barriers, identified through interviews, can be categorized as affordability, equipment maintenance, and a shortage of staff to assist with VR headset usage and the individual barrier relates to health issues.

One significant organizational barrier is the cost of purchasing VR sets, which can limit availability and accessibility for LTC residents: "How much does it cost for that technology ? And then would the facility be able to buy it ? " (S1). Troubleshooting, equipment maintenance, and a shortage of staff assistance further hinder the implementation of VR gaming in LTC settings. Technical issues require specialized knowledge, and the limited availability of trained staff to assist residents with VR headset usage poses challenges: "If it takes a long time to set up … whatever it is… But also troubleshooting . Because if there is a problem with it , I know the healthcare team doesn’t have any time to really do it" (S1).

Individual barriers encompass cognitive and physical health issues faced by LTC residents. Cognitive impairments, such as dementia or age-related decline, can hinder their comprehension and engagement with VR gaming: "There are barriers with Dementia … your perception of reality might be disordered" (S3). Mobility limitations can also impact their ability to interact with VR equipment and participate in physical activities within the virtual environment: "Maybe it’s a ball game asking to the left , and the physical problem would be on the left arm . So , the difficulty would be how to reach the ball on time" (S2).

The mentioned organizational barriers, including affordability, difficulties with equipment maintenance, and staff shortage, can be associated with the UTAUT model’s construct of price value and facilitating conditions [ 22 ]. Individual barriers, such as physical and cognitive health issues, can be linked to the STAM model’s constructs of physical functioning and cognitive ability [ 23 ].

Our study offered unique insights that advance the existing literature on VR technology in LTC settings. By drawing upon social theories of aging, such as SOC and SST, we gained a deeper understanding of how older adults prioritize activities and social connections while navigating declines in other areas. This theoretical grounding allowed us to explore the motivations and barriers influencing technology acceptance among older adults, providing a comprehensive understanding of VR technology acceptance in LTC facilities.

One of the significant findings was the multifaceted benefits of VR gaming experiences for older adults, including physical, cognitive, social, and motivational aspects. These benefits suggest that VR technology has the potential to enhance the lives of older adults in LTC facilities by providing new opportunities for engagement and interaction. For instance, the immersive nature of VR offered an escape from pandemic-related stress and isolation, thereby improving social interactions and cognitive stimulation.

Our study also identified key factors influencing the acceptance of VR technology, such as the importance of staff understanding residents’ needs, education and support from family and staff, and addressing organizational barriers like cost and maintenance. These findings underscore the necessity of a supportive environment for successful VR implementation.

Varying levels of technological familiarity among participants and different perspectives between older adults and staff members were the challenges in interpreting the findings of our study. Older adults’ experiences were influenced by their emotional and social priorities, while staff members focused on practical considerations like perceived usefulness and ease of use.

Our findings align with existing literature on VR’s impact on social engagement among older adults in LTC settings. Factors like staff training, and barriers such as technology adaptability and concerns about technology characteristics, reflect common themes in prior research [ 33 ]. Recognizing these parallels underscores VR’s potential to enhance social engagement and well-being in LTC. The findings of our study indicated that residents and tenants of LTC facilities can derive physical, cognitive, social, and motivational benefits from VR gaming experiences. This aligns with previous research by Peng et al. [ 8 ] and Skjæret et al. [ 9 ] highlighting the positive impact of VR games on facilitating physical activity and overcoming space or staffing limitations. Importantly, our study demonstrated that older adults could enjoy and adapt to VR games with proper guidance.

Our research underscored the significance of understanding older adults’ needs and preferences in designing personalized VR programs. Similar to studies by Chaze et al. [ 14 ] and Lin et al. [ 16 ], our emphasis on ensuring a positive experience with VR technology highlighted the importance of fun, safety, and ease of engagement. Emotional and hands-on support, education on proper use and benefits of VR games, and establishing trust and safety emerged as critical factors for increasing acceptance and engagement among older adults.

In conclusion, our study successfully investigated older adults’ attitudes towards a VR physical activity game and identified key factors influencing their acceptance of this technology. By focusing on individual and social aspects, we provided insights into participants’ perceptions of VR technology’s usefulness, immersion experiences, and feelings of comfort and safety.

We highlighted the potential of VR technology in addressing mental health challenges associated with social isolation, particularly during the pandemic. The immersive nature of VR offered an escape from stress and isolation, potentially preventing related mental health issues.

Our research also revealed distinctions between the perspectives of older adults and staff members. Older adults’ views were rooted in social theories of aging (SOC and SST), while staff members’ themes aligned with TAM models. This gap underscores the need for incorporating social theories of aging into technology studies to better understand how aging influences technology acceptance among older adults.

In summary, our study contributes to the existing knowledge on VR technology acceptance among older adults and emphasizes the importance of integrating social theories of aging in future research to address their unique needs and preferences effectively.

Limitations and strengths

Our study addressed the gap in research on VR technology acceptance among older adults in LTC facilities. We examined both individual and social factors, uncovering dimensions not fully accounted for in existing acceptance models. Additionally, we explored the effects of VR on PA and social interactions, revealing the potential benefits of integrating VR into their daily routines.

Our study has certain limitations that need to be acknowledged. The use of masks during data collection, necessitated by the COVID-19 pandemic, posed challenges for participants with hearing issues, potentially affecting the quality and validity of the data. The prolonged lockdowns and communication restrictions could have influenced participants’ experiences and priorities, warranting consideration of the pandemic’s impact. Furthermore, the study’s focus on specific VR content restricted the generalizability of conclusions regarding VR technology acceptance in the broader population.

Recommendations

This study contributes to the growing body of research on the use of VR in LTC facilities and provides practical implications for future research and implementation.

Recommendations for future research.

Future investigations concerning technology acceptance among older adults should strategically integrate social theories of aging, notably SOC and SST. This methodological approach will facilitate a more comprehensive understanding of the multifaceted factors influencing the acceptance of technology among older adults. Analyzing how aging influences their acceptance through experiential lenses can yield nuanced insights, shaping the development of technology tailored to their distinct needs.

To successfully integrate VR gaming into the lives of LTC residents and comprehend the intricate interaction dynamics between older adults and VR games, researchers should explore several key areas. Investigating the enduring effects of VR gaming on physical activity, motivation, and mental health can provide a holistic assessment of its impact on the well-being of older adults. Delving into the influence of diverse music types on gameplay and user enjoyment can contribute to the creation of more personalized and engaging experiences. Additionally, exploring the potential of VR gaming as a form of physical therapy and exercise can enhance self-awareness of physical limitations.

The significance of social support in fostering engagement and acceptance of VR gaming among LTC residents is evident from our observations. Future studies should meticulously incorporate social support mechanisms in their design and execution to optimize the benefits for this demographic. Crafting personalized and relevant VR games aligned with LTC residents’ interests is paramount. Educating and supporting both residents and their families to enhance acceptance and engagement with VR games should be a central focus. Establishing trust and safety when introducing new technologies and addressing organizational and individual barriers are imperative considerations.

Lastly, research endeavors should delve into the potential of VR gaming as a tool to alleviate social isolation, a pervasive concern for many older adults. Comprehensive exploration in these areas can contribute to the effective implementation of VR gaming in LTC facilities and elevate the quality of life for older adults.

Recommendations for designers.

In order to optimize the usability of VR games for older adults, designers are encouraged to integrate specific design principles. Firstly, an emphasis should be placed on cultivating a simple and intuitive interface, characterized by easy-to-navigate menus, larger buttons and text, and explicit instructions. This adherence to a minimalist design philosophy serves to enhance the overall user-friendliness of the interface. Secondly, the gameplay should adopt a deliberately slow-paced structure, incorporating extended intervals for each task to effectively mitigate the occurrence of motion sickness while concurrently heightening the enjoyment factor. Thirdly, designers are advised to judiciously restrict the number of head and body movements required, given the potential challenges older adults may encounter with swift or extensive motions. This strategic reduction in movement requirements stands to substantially augment the accessibility of the game. Finally, the provision of customizable settings, encompassing adjustable parameters such as brightness, contrast, speed, and text/button size, affords older adults the opportunity to tailor the game to align with their specific needs and preferences. The assimilation of these meticulous design principles is posited to empower VR game designers in the creation of games that not only exhibit heightened usability but also elicit a more enjoyable experience for the older adult demographic.

Supporting information

S1 file. older adults interview consent form..

https://doi.org/10.1371/journal.pone.0305865.s001

S2 File. Staff members interview consent form.

https://doi.org/10.1371/journal.pone.0305865.s002

S3 File. Older adults interview guide.

https://doi.org/10.1371/journal.pone.0305865.s003

S4 File. Staff members interview guide.

https://doi.org/10.1371/journal.pone.0305865.s004

Acknowledgments

We extend our heartfelt thanks to the healthcare center catering to older adults in Ottawa. We are grateful for the cooperation and assistance provided by the dedicated staff and residents and tenants during the study.

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This paper is in the following e-collection/theme issue:

Published on 2.7.2024 in Vol 26 (2024)

Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders

Authors of this article:

Original Paper

• Elena Faccio 1 , Prof Dr   ; 
• Margherita Reggiani 2 , Dr   ; 
• Michele Rocelli 1 , PhD, Dr   ; 
• Sabrina Cipolletta 3 , PhD, Prof Dr  

1 Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padua, Italy

2 Psychologist-Operator at Vivere Verde Onlus, Roma, Italy

3 Department of General Psychology, Padova, Italy

Corresponding Author:

Elena Faccio, Prof Dr

Department of Philosophy, Sociology, Education and Applied Psychology

University of Padova

Via Venezia 14

Padua, 35131

Phone: 39 3479607182

Email: [email protected]

Background: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user’s perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks.

Objective: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders.

Methods: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied.

Results: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental.

Conclusions: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered.

Introduction

Although intensive use of visual social media and online body comparisons have been strongly linked to body dissatisfaction and eating disorders (EDs) [ 1 , 2 ], the literature has only partially explored the potential impact of competence development in the mindful use of social media during hospitalization for EDs [ 3 ].

Recent research on the topic has primarily been divided into 2 main strands: one focusing on the specific ways social media is used by individuals with EDs [ 4 , 5 ], and the other exploring the online environment as a potential “place” for therapy [ 6 , 7 ]. There are no examples of collaborative projects involving mental health professionals and service users during recovery from EDs that aim to jointly examine visual social media in new ways and co-construct new awareness about its use.

The concept that the process of care is a collaborative journey involving various stakeholders—researchers, health care providers, and service users—is a principle prominently featured in official health care documents [ 8 ] but less frequently implemented in practice [ 9 ]. This principle suggests that patients are “real experts” and that their embodied knowledge can form the foundation for coproducing the care pathway. This approach presupposes that care program design occurs within the context of people’s lived experiences, including their discourses around the body, how they perceive it, and the environments in which they socialize about ideals of desirable bodies (eg, social media). It emphasizes the importance of engaging with users in their own worlds and languages, rather than being confined to the perspectives of health care professionals [ 9 ].

During hospitalization for ED treatment, girls are usually either not allowed to use mobile phones or only permitted to use them during restricted time slots. If the use of social networking sites (SNSs) is not discussed and explicitly addressed, returning home may lead patients to revert to their previous SNS usage and interpretations, potentially undermining the long-term effectiveness of the treatment. Social media literacy programs aimed at improving body image–related outcomes should be implemented not only in the context of ED prevention but also in rehabilitation [ 3 ]. According to Fitzsimmons-Craft et al [ 10 ], only 20% of therapists have asked patients with ED about the perceived impact of social media on their body image experiences. Understanding the meanings and ways in which girls use SNSs is essential for designing educational and rehabilitation pathways that help build self- and body perception based on criteria different from those that contributed to the development of the ED [ 11 , 12 ].

Our research represents the first step in drafting a collaborative project involving researchers, health professionals, and service users. The goal is to identify the most salient and relevant issues related to social media use from the perspective of girls undergoing treatment.

SN Use and Body Image Concern: What Psychological Processes Come Into Play?

Social media is a significant source of sociocultural pressure regarding appearance and influences adolescents’ relationships with others as well as their perceptions of their own bodies. Active engagement in activities related to the photographic dimension on social networks (SNs) has been shown to contribute significantly to the development and perpetuation of concerns related to body image and food intake [ 13 , 14 ]. Such activities include publishing photographs, viewing others’ photographs, commenting or liking posts, and receiving feedback. Compared with the passive use of SN platforms, these active behaviors are more insidious in fostering dynamics of comparison and competition between bodies, thereby exposing individuals to the scrutiny of social judgment [ 15 - 17 ].

A clear and direct connection between posting edited photos and risk factors for EDs has been consistently confirmed by various studies [ 18 ]. Indeed, social media usage is a plausible risk factor for the development of EDs, a finding supported by research from Asia, indicating that this association is not limited to traditionally Western cultures [ 19 ].

Intensive use of SNSs has been linked to the internalization of the thinness ideal, self-objectification, and body dissatisfaction [ 20 - 22 ]. The literature defines the internalization of the thinness ideal as the degree to which an individual cognitively adopts socially defined standards of attractiveness and engages in behaviors aimed at approximating these ideals [ 20 ]. This process of striving for an ideal physique through the intensive use of social media can lead to body dissatisfaction and subsequently to disordered eating behaviors. Individuals may pursue an idealized body image that is often unattainable, which can persist even during recovery from EDs and increase the risk of relapse. Moreover, the habit of viewing bodies as objects on social media can socialize girls into self-objectification, as they internalize an external spectator’s perspective of their own bodies. This encourages habitual monitoring of one’s physical appearance, a phenomenon known as self-surveillance. It can lead to feelings of anxiety, reduced awareness of one’s own internal states, body shame, and a fear of internalized judgment from others. Another factor that could influence the relationship between exposure to SNSs and the development of EDs is the significance placed on feedback received through social media. Research has shown that the extent of one’s SN, as measured by the number of “friends” [ 23 ], may predict a stronger inclination toward pursuing thinness. Facebook (Meta Platforms, Inc.) use has been identified as a prospective predictor of increased symptoms related to EDs [ 13 ]. Moreover, research indicates that high “appearance exposure” specifically through Facebook, rather than overall Facebook use, is positively correlated with increased body image issues among adolescent girls [ 14 ].

Visual SNs and the Risk of Developing EDs

Regular sharing of self-images on social media platforms such as Facebook, Instagram (Meta Platforms, Inc.), or Snapchat (Snap Inc.), along with actively manipulating these images before sharing, seems to be linked to heightened perceptions of body shape and weight, increased body dissatisfaction, and tendencies toward dietary restriction [ 24 ]. Facebook users tend to be older compared with Instagram users, and this age difference may contribute to younger Instagram users being at higher risk of developing EDs and expressing greater concerns about the impacts of sharing their images on SNs [ 4 ]. Analyzing fitness content on Instagram, particularly posts tagged with hashtags such as #fitspiration, #fitspo, and #thinspiration, reveals that the majority of images depict women with 2 prominent characteristics: thin bodies that are also visibly toned and muscular. This portrayal reinforces the notion that only a thin body can be considered fit [ 25 ]. The pairing of thinness with muscularity appears in as many as two-thirds of the photos posted by influencers [ 20 ], and these images have a more significant impact on body image concerns compared with photos posted by celebrities or models [ 25 ].

Another SNS that emphasizes the visual dimension and has experienced rapid growth is Snapchat. Currently, there is limited research dedicated to investigating the effects of this platform. One of its distinctive features is that users can apply filters to alter their appearance before sharing photos. Additionally, Snapchat is known for its privacy settings and the ephemerality of content, which is typically automatically deleted shortly after being viewed [ 26 ].

Comparative research indicates that the correlation between photo manipulation using specific editing tools (filters) and body image concerns appears to be stronger on Snapchat than on Instagram [ 27 ]. Those who frequently use Snapchat’s lenses to enhance their photos appear to experience higher levels of dissatisfaction with their appearance, leading them to seek out environments that are highly appearance-oriented and focused on enhancing their appearance. Posts on Instagram tend to be more curated, with teenagers often spending considerable time and effort choosing the “right” content before taking a photo, rather than editing it after it has been taken [ 28 ]. This investment of time and energy before capturing the photo may strongly correlate with concerns about body image compared with postphoto retouching [ 29 , 30 ]. Moreover, while Snapchat is often used to connect with close contacts, users may be less focused on their physical appearance when taking pictures. By contrast, the larger audience on Instagram may have a more significant influence on body image concerns.

Research Aims

In light of these considerations, one might inquire about how adolescent girls undergoing treatment for EDs utilize SNs. What significance do they attribute to their SN usage? Do they differentiate between manipulated and unedited images? What strategies do they use to shield themselves from the impact of the content they post or view? Are they cognizant of which modes of SN use could potentially influence clinically significant outcomes?

Our focus is on exploring the usage of purely photographic platforms such as Instagram and Snapchat, which are particularly insidious in terms of fostering comparisons between bodies on the network [ 27 - 30 ]. We are interested in investigating the different emotions and experiences participants have when sharing their own photos in a private and intimate network among friends, such as Snapchat [ 27 ], versus sharing them in front of a larger audience, as is the case with Instagram [ 30 ].

Another area of interest for our investigation involves understanding the meanings associated with the permanence or short duration of content created and received on social media platforms. Specifically, while content published or shared on Instagram is permanent, on Snapchat, users determine the lifespan of their content, after which it is automatically deleted [ 27 ].

Additionally, we are interested in understanding whether girls use strategies to mitigate the potential influence of exposure to certain images, whether they can differentiate between edited and unedited photos, and whether they protect themselves from uncritically accepting messages from SNs. The literature [ 29 ] has demonstrated that visual social media can also be utilized during the recovery process from an ED to promote health messages and well-being. Paradoxically, the use of SNs that involve transforming one’s own photos has also been identified as an important tool, albeit in a positive sense [ 26 ]. Therefore, it is not merely the photo itself but how it is used that determines whether it serves as an “exit” or “entry” point in managing eating behaviors.

The ability to alter one’s images has both positive and negative implications. It allows individuals to transform their appearance inexpensively and democratically, fostering a sense of personal empowerment. However, the ease of digitally altering one’s appearance also leads to an increase in the number of manipulated images that people view and are confronted with. This phenomenon may subsequently heighten dissatisfaction with one’s physical appearance and intensify the pressure to alter it.

In conclusion, we also sought participants’ opinions on the relevance of the proposed topics and what other subjects they would consider important in a collaboratively designed program focused on the responsible use of SNs, intended for potential users in the recovery process.

Sampling and Recruitment

After sharing the objectives and content of the research with health care staff, we informed users of the local health unit for the treatment of EDs within the National Health Service in Eastern Veneto (specifically, the Casa delle Farfalle Residential Protected Therapeutic Community for Children).

The health care staff presented the research to the girls, obtained their consent, requested authorization from their parents, and provided information about the study. They also organized the schedule for appointments. All the girls who were invited agreed to participate; none declined the invitation. The participants and their families were informed of their right to withdraw from the study at any time. They signed a written informed consent form regarding their participation in the research and its potential publication.

Thirty adolescent girls, with a mean age of 15 (range 14-17) years, expressed interest in participating. The inclusion criteria were as follows: a diagnosis of an ED, being in the early stages of treatment with at least 15 days of hospitalization, having an active Instagram and Snapchat profile for at least six months before admission, and willingness to participate in interviews.

We extended the invitation to participants who were at the beginning of their treatment journey because we preferred individuals who had not yet been significantly influenced by the discussions occurring between users and health care providers during their hospitalization period.

The interviews were conducted by MRe, one of the authors of this study. After confirming their availability, she held several preliminary meetings to establish rapport and further explain the study’s objectives and implications. The interviews were conducted individually in a room on the ward where each participant met with the research assistant.

Ethical Considerations

The research protocol was approved by the Ethical Committee of the School of Padova, University of Padova (approval number 2018/2745-10/7). Before commencing the interviews, participants and their parents were informed that participation in the research was voluntary and without any compensation, and their consent was obtained. The original informed consent that participants signed included permission to conduct secondary analysis without additional consent. The final data set is anonymized, ensuring that no identifiable private information linked to participants is included.

Data Collection and Analysis

A semistructured interview consisting of 9 open-ended questions was designed specifically for this research ( Table 1 ). It covered the following areas: (1) the meanings attributed to the use of Instagram and Snapchat; (2) the level of engagement with the photographic aspect and the interactivity generated around it, particularly in terms of feedback; (3) the perceived impact of Instagram and Snapchat usage on body experiences; (4) the potential benefits and risks associated with the use of SNs; (5) the importance of providing support and guidance to girls undergoing treatment for EDs in their use of SNs; and (6) the willingness to participate in and contribute to the co-design of SN literacy programs.

The researchers formulated the questions based on the research objectives. Initially, there were twice as many questions, but they were later streamlined to focus on the most comprehensible ones. The first interviews helped refine these questions further, addressing any areas that appeared unclear or prone to misunderstanding.

Finally, the girls were asked to provide feedback on the relevance of the suggested themes for developing programs on critical thinking regarding SN use during hospitalization. They were also encouraged to add any additional topics they considered important. The interviews took place between June and July 2021. Each interview lasted approximately 45 minutes and was audio-recorded and transcribed verbatim.

Content analysis was conducted following the guidelines outlined by Creswell [ 31 ]. The responses from participants were read and coded, creating meaning units that were categorized accordingly. This process resulted in the development of a codebook, which was then systematically applied to analyze all responses. A triangulation of analyses involving 3 researchers (MRe, EF, and SC) was conducted. This process included sharing one researcher’s initial coding to critically discuss the initial coding patterns and subsequently reach a consensus on the overall interpretation of the data. This approach allowed for interpretations to be challenged, refined, and ultimately agreed upon through collaborative discussion among the researchers.

As the analysis moved from macrocategories (general) to microcategories (specific), there was a progressive refinement and detailed coding of the responses. Initially, responses were categorized at a broader and more anonymous level, providing a general commentary. As the analysis proceeded, categories became more specific, focusing on individual experiences and emotional impacts on personal lives. For instance, the macrocategory “virtual world configuration (VW)” is subdivided into 2 categories: “VW as an extension of reality” and “VW as a world distinct from real life.” These categories represent opposite ends of a continuum that delineates how participants perceive the relationship between the virtual world and the real world. The category “virtual world as an extension of reality” is further detailed in the subcategory (self-reference) “the virtual world significantly influences self-perception.” Participants who hold this view consider the virtual world relevant, viewing it as a source of inspiration for their real-life decisions (microcategory, fourth level of analysis). Conversely, individuals who perceive the virtual world as “separate and distinct from the real world” (category—second level of analysis) specify that the virtual world “has no impact on their self-concept” (subcategory—third level of analysis) and they “regard it as transient” (microcategory, fourth level of analysis). Another example of the categorization system and codebook created can be seen in describing the use of SNSs: we classified as “active use” everything related to actively seeking contacts and interactions, engaging in discussions, sharing personal information, and editing photos and stories. By contrast, we classified as “passive use” those actions oriented toward reading and viewing content made available by others, without active personal involvement. This position entails observing rather than actively participating in the virtual scene.

The second step was quantitative: each category was assigned a code of 1 or 0 based on its presence or absence. We focused on the number of respondents who mentioned a particular category, rather than the frequency of mentions for that category. This approach allowed us to provide an overview of the girls’ attitudes toward the investigated issue. It was particularly important for us to gain a general understanding of the impact and prevalence of specific types of experiences, as well as to explore the personal meanings the girls attributed to the topic in a more qualitative manner.

After completing the analysis, all authors of the paper convened to review the results and make any required adjustments. The draft summary of the main results paper was also shared and discussed during the collaborative analysis and writing phases.

Virtual Word’s Configuration

An overview of the results and the codebook developed during the analysis can be found in Multimedia Appendix 1 .

The thematic coding of the text collected in reference to the first answer revealed 2 main categories: the first, mentioned 28 times, portrays the virtual world as an extension of everyday reality, where online activities have a tangible impact on how respondents perceive themselves. The second category, mentioned only twice, contrasts with the first by viewing the virtual world as an ephemeral and transient realm where an idealized self-image is projected. In this perspective, the impact of online activities is perceived as less significant compared with activities in “real” life, which are seen as separate and more concrete.

SNs’ Active or Passive Ways of Use

Regarding the mode of SN use, 2 main polarities emerged: one characterized by more active engagement and the other by more passive interaction. The proactive category included initiating relationships with others (5 mentions), sharing personal narratives (11 mentions), posting personal photos or stories (3 mentions), and searching for information (23 mentions). By contrast, the passive end of the spectrum included consulting content posted by others (21 mentions). Regarding proactive use, Instagram was noted for fostering positive emotional experiences through contact and exchange with other users (3 mentions), whereas Snapchat was valued for its utility in sharing daily life and disclosing personal information (2 mentions). The most frequently mentioned activity, active information seeking through SNs, was primarily described as a source of stimulation and inspiration, driven by curiosity (13 mentions), to reinforce and update interests (2 mentions), and also as focused information seeking on body-related issues (16 mentions).

As for the eating disorder, I used it a lot to watch food videos, videos of people cooking or even people doing particular sports, gym, like, I don’t know, all those fitness posts. That was the main use. [Participant 2]

Finally, the use of photo editing functions was noted. Passive use of Instagram and Snapchat refers to the reception of content generated by other users for entertainment purposes.

Online Interactions’ Impact

The impact attributed to SNS use is expressed in terms of “social confirmation,” as they are viewed as significant for providing a channel of self-recognition (20 mentions) that includes both approval and disapproval (12 mentions). This results in emotions of personal gratification (7 mentions), support (3 mentions), and encouragement (5 mentions), but also anxiety related to the fear of judgment (5 mentions) and feelings of disconfirmation when few likes are received (10 mentions).

Back then, I thought that if more people commented on my content, that meant more people liked me. The more likes I received, the more others liked me [...]. [Participant 6]

The impact of online interactions varied depending on the specific use of Instagram or Snapchat (20 mentions): Instagram is perceived as having a more tangible and “real” impact compared with Snapchat (18 mentions). Feedback received on Instagram is deemed more significant, to the extent that some respondents consider it a metric for determining their personal worth (8 mentions). There was also a notable sense of distrust toward feedback gathered through SNSs (10 mentions). Consequently, receiving likes and comments was perceived as unimportant due to skepticism about the authenticity of posts. Some respondents rarely received likes and comments, feeling unpopular (6 mentions) and disregarded both on social media and in everyday life.

Regarding Snapchat, the automatic deletion of content and the narrow composition of the network seem to foster a playful, humorous atmosphere (5 mentions) and encourage creativity. This moderates the impact of feedback received (11 mentions).

Investment in the Photographic Dimension

The use of photographs on social media platforms shifts from total involvement (24 mentions) to complete disengagement (6 mentions). Photographs serve not only for self-promotion (20 mentions), fulfilling the desire to be seen (11 mentions), and presenting the best version of oneself (7 mentions), but also for gaining a deeper understanding of oneself (9 mentions) and celebrating specific events (4 mentions). Active involvement in the photographic dimension was specifically associated with Instagram, attributed to its high degree of self-image exposure (16 mentions). SNSs are portrayed as platforms where users consistently share only the best aspects of themselves to appear perfect (7 mentions). The use of Instagram, in particular, fosters second thoughts and inhibitions regarding photo publication (10 mentions). The high degree of exposure on Instagram promotes a tendency to hyper-control the quality of photographs, induces concerns about the perfection of one’s images, and encourages individuals to scrutinize and edit their photos extensively.

When I was going to use Instagram, I never published photos [...] because many more people can see it there, even two hundred, three hundred people can see it [...] [Participant 3]

The “disinvestment” contents (6 mentions) were primarily attributed to feelings of embarrassment (3 mentions) and discomfort (4 mentions). By contrast, Snapchat’s emphasis on ephemerality (3 mentions) and frivolity (2 mentions) in its content contributes to a platform dominated by carefree attitudes toward self-image. This reflects a disengagement from the photographic dimension.

Self-Representation

The collected texts appear polarized: they describe a correlation between the body presented online and the body perceived in the real world (17 mentions), but also refute this congruence (10 mentions) in favor of emphasizing the dominance of the real. Users primarily discussed self-representation on Instagram due to Snapchat’s ephemeral nature. Sharing photographs of themselves is viewed as a means to express their ways of being and interacting with others and the world (5 mentions), as well as a method to foster deeper personal understanding (3 mentions). There was considerable emphasis on portraying a “true” image of themselves (8 mentions). In some cases, it seems feasible to accept photos from the past, particularly those depicting a thinner body, alongside acceptance of the current body image (2 mentions). However, in other cases, confronting images of oneself from a thinner period can be agonizing (3 mentions), often evoking a sense of regret. Ten responses conveyed a sense of discrepancy between the real-life body and the online representation, attributed to efforts to present oneself in a more favorable light, sometimes accentuating flaws or concealing them (2 mentions). This can lead to a perception of projecting a false self-image (8 mentions) compared with one’s subjective self-image. The existence of photos that diverge so significantly from each other also contributes to a sense of fragmentation in one’s self-image (1 mention).

SNs’ Risks

All the collected texts addressed the risks associated with SNSs’ use, especially activities involving the photographic dimension (30 mentions). Content on Instagram, along with related interactive activities, is perceived as significantly influential in shaping ideas about the body and self-representation (21 mentions). This influence is evident in the promotion of a singular body prototype characterized by thinness, perfection, and muscularity (17 mentions). Viewing photos of others is seen as the initial step toward attaining this ideal, although it is perceived subjectively as deceptive (8 mentions). Unrealistic content shared on Instagram aims to bolster this ideal through maladaptive behaviors (11 mentions), sometimes progressing toward images that align with the “Pro-Ana” direction (5 mentions).

Many responses (24 mentions) emphasized the risk of deteriorating one’s relationship with their body due to a heightened focus on physical appearance and an increased attention to the body dimension. Participants acknowledged the role played by Instagram in exacerbating concerns about weight and body shape (11 mentions), particularly through pages where individuals provide tips related to EDs (10 mentions). The heightened concerns are perceived to induce feelings of being “wrong” (2 mentions) and body dissatisfaction (8 mentions). Comparison with images posted online is a dominant theme (19 mentions), where physical attributes, particularly thinness, are frequently cited as comparison criteria, often accompanied by feelings of envy (4 mentions) and inferiority (9 mentions).

A sort of “vicious circle” of negative influence through imitation has been described:

A famous girl puts up a picture then maybe she sees that the picture has many comments from girls who say, “You’re so thin, you’re so beautiful”, and all this, and then she continues to put up pictures of that type, and the girls obsess more and more. [Participant 4]

In relation to the interactive dimension, risks are linked to social judgment and the pressure toward conformity (2 mentions). Finally, another risk identified is the underestimation and casual approach with which users engage with SNs, not fully recognizing the impact and influence that published content can have on people’s lives (5 mentions).

Regarding Snapchat, the texts indicated a more self-deprecating attitude toward sharing content and less anxiety about posting images. This makes Snapchat perceived as a platform where users feel free from concerns about their physical appearance and comparison with others.

Self-Protective Strategies While Using SNSs

Regarding self-protective strategies, the primary defense that empowers the use of SNs without negative impacts on one’s body image is subjective critical capacity (17 mentions). This includes the ability to recognize and distinguish true content from edited ones (4 mentions) and an awareness that each person has about their own unique body (11 mentions). Useful strategies to promote this critical capacity could be implemented by the Instagram platform itself (4 mentions). One form of defense involves actively avoiding sensitive content (7 mentions), self-exposure (2 mentions), or excessive SN use (1 mention). However, some participants noted the challenge of implementing this strategy due to their strong curiosity to view certain content. The Instagram platform itself should develop protective measures regarding the generation of certain content, which could include content control (2 mentions) or content removal (2 mentions).

From the text analysis, skepticism (8 mentions) and a sense of helplessness (4 mentions) emerged regarding the lack of control over online content, as well as a feeling of inescapability (5 mentions) due to the unavoidable accessibility of certain content on Instagram’s home page, even when not intentionally sought. Additionally, other defensive strategies should involve parental controls (1 mention) and the sharing of experiences and content (3 mentions).

SNs’ Potentials

Several potentials were identified regarding the use of SNs, especially concerning the photographic dimension. These potentials are linked to the possibility of improving one’s relationship with their body by emphasizing spontaneity and naturalness in content creation (4 mentions), which is also perceived as a protective measure against the potential for negative comments (2 mentions). The act of searching for content is perceived as supportive during difficult times (3 mentions), providing an opportunity to follow individuals who have faced similar challenges and who, having overcome them, serve as sources of support (2 mentions) and encouragement (1 mention). Platforms such as Instagram also facilitate personal expression (9 mentions) and allow individuals to take an external perspective on their experiences (3 mentions). Exploring profiles of influencers and artists who promote diverse ideas about the body offers an opportunity to discover perspectives that might not be encountered otherwise. These individuals can inspire the exploration of values that challenge prevailing trends.

Another potential lies in actively creating content that emphasizes authenticity (6 mentions) and carefreeness (5 mentions) rather than solely focusing on physical appearance or presenting oneself in an idealized manner. By promoting authentic content, individuals can contribute to limiting the proliferation of unrealistic body ideals and reducing the circulation of idealized and unrealistic representations of the body (3 mentions). However, this aspiration is tempered by skepticism regarding the actual impact of sharing “realistic” content and finding nondeceptive body ideals. Finally, some texts emphasize the potential offered by the opportunity to connect with other people (6 mentions).

With regard to the importance of guiding girls undergoing treatment for EDs to reflect on the topic, there was unanimous agreement (30 mentions), confirming all proposed topics as relevant. If the project had been implemented, the girls would have enthusiastically participated in the group, viewing it as a safe space to find the courage and express themselves (28 mentions) and being inspired by individual choices (20 mentions). To advocate for content that goes beyond the pursuit of bodily perfection, one needs to observe behaviors in others (15 mentions). Expressing oneself with humor and levity is considered the best antidote (15 mentions), but it necessitates self-confidence and a willingness to reject the sanctity often placed on one’s image (15 mentions).

The interest and willingness were confirmed for both participating in person to listen to other girls undergoing rehabilitation (30 mentions) and discussing these issues on an equal footing with peers in similar situations. Additionally, after completing the therapy course, there is interest in potentially serving as a testimonial to set a positive example of the conscious use of social media based on personal life experiences (28 mentions). This opportunity could enable several outcomes: providing support to others (15 mentions), creating a space for personal reflection (7 mentions), hearing about the challenges others have faced in overcoming EDs (8 mentions), and connecting with peers who share similar experiences (7 mentions).

Principal Findings and Comparison With Prior Studies

This research investigated how young women recovering from EDs perceive both the health risks and potential benefits of visual SNs, specifically Instagram and Snapchat, which have been identified in the literature as platforms where harmful body comparisons can occur. Additionally, the study explored the participants’ willingness and interest in collaboratively developing social media literacy programs aimed at supporting individuals recovering from EDs.

The study’s findings underscore a keen awareness among participants of the mechanisms that trigger body comparisons in the online realm, which contribute to feelings of insecurity and detrimentally impact self-relationships. However, the girls do not consistently harness this awareness to their benefit. The identified self-protective behaviors include the development of critical thinking, avoidance of sensitive content, increased control over SNSs, and a degree of skepticism toward the propagation of conflicting ideologies. All these topics were deemed fundamental by the participants.

For the young people participating in the study, 3 primary modes of using Instagram and Snapchat emerged. The first mode was characterized by the relational dimension, involving affective experiences of contact and exchange, which reduced feelings of loneliness and enhanced perceptions of social support. The second mode of use focused on self-presentation and self-disclosure, particularly evident in relation to Instagram. The third mode of use involved active information seeking, specifically the search for stimuli, inspiration, curiosity, and updates related to one’s passions, interests, appearance, and eating behaviors.

The topics emerging from the data confirm findings in the literature regarding the problematic use of SNs and the development of EDs among preclinical samples. Following appearance-focused accounts on Instagram and engaging in photo-based activities, such as posting selfies or liking and commenting on photos, were associated with poorer body image outcomes [ 14 , 15 , 28 , 31 , 32 ]. Passive use characterized by role passivity, which involves the passive reception of content generated by other users for entertainment or spectatorship purposes, has been linked to a decrease in subjective well-being through social comparison [ 2 ]. Among our participants, even the passive mode of social media use—simply opening food- and body-related videos—was acknowledged by the girls as reinforcing problematic behaviors from a symptomological point of view, such as dieting and exercise obsession.

One of the most alarming findings from our research was the significant disparity between perspectives regarding the online environment either as a continuation of reality or as distinct from it (28 vs 2). Participants who viewed the virtual world as an extension of reality tended to perceive the feedback received as highly impactful on their self-perception and sense of self-worth. The significance of online feedback was closely tied to the validation it provided, through either approval or disapproval. However, some participants expressed skepticism about the authenticity of SNs, viewing the images and content as misleading. As a result, they perceived the impact of online feedback as less meaningful compared with feedback received in real life [ 33 , 34 ].

This finding could be pivotal for a project focused on training, discussing, and reflecting on the subject: Highlighting the distinction between individuals who trust the authenticity of the online environment and those who approach it with skepticism is an initial step toward fostering distance and increasing awareness of one’s online presence and behavior.

Self-promotion emerged as a significant motivator for engaging in photographic activities on SNs. Users aimed to portray their best selves and sought positive recognition from others, aligning with existing findings in the literature [ 35 , 36 ]. The study also identified other motivations such as celebrating moments or events and seeking visibility among others [ 2 ], which are enhanced by Instagram’s exposure and amplification features. Conversely, users’ disengagement was primarily driven by feelings of embarrassment and discomfort associated with self-exposure, as well as the ephemeral and light-hearted nature of content shared on Snapchat [ 37 ].

All participants reported using criteria to select photographs for publication, particularly on Instagram. Those who noted a gap between their online self-presentation and their real selves emphasized an awareness that the virtual world perpetuates a sense of falsity by showcasing only the most desirable image of oneself. Regarding risks associated with photo-related activities, Instagram was seen as a highly visual platform centered around photos, with a strong focus on aesthetic content and a prevalence of edited photos that promote unhealthy, unrealistic, and deceptive body ideals [ 38 ]. These body ideals are perceived as highly influential in promoting and striving for perfection and the thin ideal [ 29 ]. Despite often being perceived as unattainable, media portrayal of this ideal leads women to view it as normative and central to attractiveness, thereby internalizing socially constructed appearance ideals [ 39 , 40 ]. This internalization and subsequent comparison lead to decreased satisfaction with one’s own body, efforts to manage one’s appearance to reach this ideal, and increased concerns about body image [ 41 ]. Social comparisons upward tend to evoke envy and feelings of inferiority, in terms of not only physical appearance but also the personality and lifestyle of individuals within one’s SN. Moreover, participants emphasized the risks associated with the interactivity facilitated by SNs. This phenomenon is referred to in the literature as “body talk,” which involves interpersonal interactions focused on bodies and physical appearance [ 42 ]. Body talk reinforces the value and significance of appearance and contributes to the construction of appearance ideals [ 43 ]. Previous research has demonstrated that body talk is positively correlated with body surveillance, body shame, and perceived pressure to conform to thinness ideals [ 42 ].

In terms of the potential of SNSs, participants emphasized the significance of being able to create, choose, and share content freely. They viewed promoting active sharing of naturalistic and unedited content, characterized by authenticity and spontaneity, as a potential means to enhance their relationship with their own bodies and for personal self-expression [ 44 ]. Improving the relationship with their own bodies was also seen as potentially helpful in finding support from people who have had a similar experience. Finally, users highlighted the potential of SNs to stabilize and enhance peer relationships with previously inaccessible groups, as well as the possibility of discovering things that might be difficult to encounter in everyday offline life. Our participants also highlighted the challenge of self-discipline and avoiding potentially harmful online content. Therefore, in the context of social media literacy programs, it could be beneficial to create spaces where girls can cultivate the courage to block the use of social media in such situations, as they suggested.

Regarding defense strategies against the influence of content published on SNSs, users primarily proposed empowering subjective critical capacity. They suggested developing and enhancing social media awareness and adopting a critical approach to viewing and scrutinizing images and posts, including considerations about the realism of the images and the intentions of the posters. They also suggested enhancing the control that platforms themselves could exercise over the type and quality of images and content posted online, even advocating for automatic deletion of content that could pose risks to users’ body image. However, some users expressed skepticism and uncertainty about the feasibility and legitimacy of such controls. They believed that the best strategy was to avoid content perceived as subjectively risky for their body image and that could potentially expose their image in an undesirable way.

It should be noted, however, that recent literature suggests enhancing critical thinking about the media may not be the sole or primary mechanism of change in effective media literacy interventions. There is uncertainty about whether literacy programs aimed at reducing the risk of EDs also effectively address critical thinking about the media. Future research will need to clarify this ambiguity [ 45 ].

What emerged from our research as a whole is that girls often have an awareness of risks but struggle to use this awareness to their advantage. They can recognize edited photos but still perceive them as authentic. Only a few responses indicated that “distrust” can serve as a strategy to mitigate perceived influence. These findings suggest that enhancing critical thinking about the media may not be the sole or primary mechanism of change for effective media literacy interventions.

However, we did not explore the influence of context, particularly the role of parents and the school environment, in moderating social media use and coping with body dissatisfaction. Among the limited qualitative research available on the meanings associated with social media use, Burnette et al’s [ 46 ] study sheds light on this topic. The authors found that among adolescent girls in general (not necessarily those in treatment for EDs), parental control devices for social media and school environments may be particularly effective in helping adolescents enhance their strategies for filtering out the most harmful messages and developing a broader conception of beauty. These factors act as protective measures against the risks associated with social media use.

Practical Implications

Given the intricate connection between SN usage and its effects on mental health [ 47 ], it is crucial to investigate this phenomenon by valuing the personal perspectives of individuals who directly experience discomfort and pain related to SN use. Health professionals should integrate discussions about SN use into their treatment of body dissatisfaction and disordered eating [ 2 ]. Much of the content emerging from the research explores new dimensions of SNS use beyond existing literature. These include identifying 3 primary modes of use, understanding the challenge of distinguishing between real and online environments and the resulting behaviors, addressing emotional detachment strategies, and considering the implications of interacting with apps that feature permanent visual content and large followings. Additionally, the study discusses platforms with temporary photo availability and intimate networks, strategies to enhance positive social media use through peer support, and methods to mitigate risks shared between users and platform providers.

Considering the ineffectiveness of prohibiting adolescents from using SNs, it could be beneficial to focus on teaching them how to navigate these environments safely instead. Rather than restricting access [ 48 ], leveraging existing SN platforms for targeted interventions is possible. This approach can utilize anonymous access to health information available on the internet, which is appealing to young people seeking such resources [ 49 ]. This strategy aims to empower youth with the knowledge and skills needed to use SNs responsibly and effectively manage their online experiences.

We believe that every problem has its solution. In other words, starting from where young people are—specifically, their desire to engage and immerse themselves in the methods and meanings of SN use—we can empower credible and interested role models (such as girls with EDs) to influence others toward more mindful use of self-protective strategies on SNs. The most impactful approach to wield this influence is to engage these individuals as influencers and collaborate with them to develop literacy programs within treatment frameworks. This research introduces fresh insights and underscores the necessity of addressing sensitive issues to design and implement more effective and tailored educational programs tailored to individual health care recipients [ 47 ].

Limitations

Several study limitations should be noted, including the small sample size and the fact that all participants had undergone treatment at a specialized center for EDs, indicating they already had awareness of the issue. Future research could broaden the survey to include a wider range of participants, including those in the preclinical phase of EDs. This approach would enable professionals to enhance their understanding of potential histories, distress forms, and health promotion strategies, thereby guiding the management of early signs of distress. Another limitation is self-selection, as participants were invited by health care staff and chose to participate voluntarily rather than being randomly selected. This may result in a biased and unrepresentative sample of the population, as those who choose to participate may possess specific characteristics that distinguish them from the broader population. However, it is important to note that qualitative research such as this does not aim to generalize findings to the entire population. Instead, its focus is on exploring the lived experiences and meanings ascribed to those experiences by the participants themselves.

Another limitation arises from the context of ED treatment services where participants were restricted from using phones, which meant their responses relied on memory rather than current experiences. A third limitation that could be addressed in future research involves assessing the long-term retention and application of knowledge about the risks and potentials of social media use over time.

Conclusions

While previous literature extensively covers studies on the risks of using SNs and prevention programs, our study contributes numerous ideas on addressing this topic with young people undergoing therapy for EDs by involving them as experts by experience. It allows the identification of the most significant themes that may arise, enabling health professionals to incorporate them into discussions and share the self-protection strategies identified. There is a call to leverage the potential of SNSs, such as user-generated content and interactivity, to promote beauty ideals divergent from the prevailing model, alongside content that emphasizes humor rather than appearance-centric narratives. However, the crux of the research lies not only in what to propose but also in how to propose it. Enrolling girls as coparticipants in the programs represents, in our view, the real breakthrough.

Being able to share their experiences and offer their stories as a potential source of inspiration and influence among peers allows individuals to transform from passive recipients of life, influenced by others, into conscious leaders who guide and inspire others. This involves coconstructing care pathways, creating space, and negotiating ideas with those willing to take on the new role, such as that of a patient who, after completing their treatment journey, makes themselves available to assist others at the beginning of their own journey. Co-design indeed necessitates flexibility and a strong willingness from all participants. It is not about predefined content but rather entails collaborative decision-making where meetings and individuals together determine the objectives to pursue.

Acknowledgments

We express our gratitude to all the mental health workers who contributed to the research, actively participating in every stage of it, and to all the girls with whom the research project was collaboratively constructed. They gave their time to reflect and share their experiences sincerely and showed a genuine and generous interest in this work. We are also very grateful to our young colleagues Ludovica Aquili (PhD student in Social Sciences) and Lia Bitetti (psychologist, psychotherapist in training, graduated from the University of Padua) for their support and expertise in editing this work.

Data Availability

The data sets generated or analyzed during this study are not publicly available due to privacy restrictions. Indeed, they contain information that could compromise the privacy of research participants. They are available from the corresponding author upon reasonable request.

Authors' Contributions

EF contributed substantially to the conception and design of the work. MRe created the structure and collected the data. Together, both drafted the work and revised it critically for important intellectual content. All authors participated in the analysis and interpretation of the data.

Conflicts of Interest

None declared.

Overview of the results and the codebook of analysis. The 4 categories are indicated from the general (macrocategories and categories) to the particular (subcategories and microcategories). The number in brackets refers to the number of respondents who evoked the relevant category upon the 30 involved. The categories were not always subdivided further; in some cases, in fact, no details were added during the interview. Interviews with young women in recovery from eating disorders (EDs) were held in North Italy in 2021.

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Abbreviations

Edited by A Mavragani; submitted 04.10.23; peer-reviewed by L Aquili, Y Wang, R Vitelli, A Nerini, A Mentasti, R von Brachel; comments to author 02.02.24; revised version received 29.03.24; accepted 20.05.24; published 02.07.24.

©Elena Faccio, Margherita Reggiani, Michele Rocelli, Sabrina Cipolletta. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.07.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.