research paper review publish

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

• PLOS Biology
• PLOS Climate
• PLOS Complex Systems
• PLOS Computational Biology
• PLOS Digital Health
• PLOS Genetics
• PLOS Global Public Health
• PLOS Medicine
• PLOS Mental Health
• PLOS Neglected Tropical Diseases
• PLOS Pathogens
• PLOS Sustainability and Transformation
• PLOS Collections

Understanding the Publishing Process

What’s happening with my paper? The publication process explained

The path to publication can be unsettling when you’re unsure what’s happening with your paper. Learn about staple journal workflows to see the detailed steps required for ensuring a rigorous and ethical publication.

Your team has prepared the paper, written a cover letter and completed the submission form. From here, it can sometimes feel like a waiting game while the journal has your paper.  It can be unclear exactly who is currently handling your paper as most individuals are only involved in a few steps of the overall process. Journals are responsible for overseeing the peer review, publication and archival process: editors, reviewers, technical editors, production staff and other internal staff all have their roles in ensuring submissions meet rigorous scientific and ethical reporting standards. 

Read on for an inside look at how a conventional peer-reviewed journal helps authors transform their initial submission to a certified publication. 

Note that the description below is based on the process at PLOS journals. It is likely that at other journals, various roles (e.g. technical editor) may in fact also be played by the editor, and some journals may not have journal staff at all, with all roles played by volunteer academics. As such, please consider the processes and waypoints, rather than who performs them, as the key information.

Internal Checks on New Submissions

Estimated time: 10 days.

When a journal first receives your submission, there are typically two separate checks to confirm that the paper is appropriate and ready for peer review:

• Technical check.   Performed by a technical editor to ensure that the submission has been properly completed and is ready for further assessment. Blurry figures, missing ethical statements, and incomplete author affiliations are common issues that are addressed at this initial stage. Typically, there are three technical checks: upon initial submission, alongside the first decision letter, and upon acceptance. 
• Editorial screening . Once a paper passes the first check, an editor with subject expertise assesses the paper and determines whether it is within the journal’s scope and if it could potentially meet the required publication criteria. While there may be requests for further information and minor edits from the author as needed, the paper will either be desk rejected by the editor or allowed to proceed to peer review. 

Both editors at this point will additionally make notes for items to be followed-up on at later stages. The publication process involves finding a careful balance for when each check occurs. Early checks need to be thorough so that editors with relevant expertise can focus on the scientific content and more advanced reporting standards, but no one wants to be asked to reformat references only to have their paper desk rejected a few days later. 

Peer Review

Estimated time: 1 month.

Depending on the journal’s editorial structure, the editor who performed the initial assessment may also oversee peer review or another editor with more specific expertise may be assigned.  Regardless of the journal’s specific process, the various roles and responsibilities during peer review include:  

When you have questions or are unsure who your manuscripts is currently with, reach out to the journal staff for help (eg. [email protected]). They will be your lifeline, connecting you to all the other contributors working to assess the manuscript. 

Whether an editor needs a reminder that all reviews are complete or a reviewer has asked for an extension, the journal acts as a central hub of communication for those involved with the publication process. As editors and reviewers are used to hearing from journal staff about their duties, any messages you send to the journal can be forwarded to them with proper context and instructions on how to proceed appropriately. Additionally, journal staff will be able to inform you of any delays, such as reviewer availability during summer and holiday periods. 

Revision Decision

Estimated time: 1 day.

Editors evaluate peer reviewer feedback and their own expert assessment of the manuscript to reach a decision. After your editor submits a decision on your manuscript, the journal may review it before formally processing the decision and sending it on to you. 

A technical editor may scan the manuscript and the review comments to ensure that journal standards have been followed. At this stage, the technical editor will also add requests to ensure the paper, if published, will adhere to journal requirements for data sharing, copyright, ethical reporting and the like. 

Performing the second technical check at this stage and adding the journal requirements to the decision letter ultimately saves time by allowing authors to resolve the journal’s queries while making revisions based on comments from the reviewers. 

Revised Submission Received

Estimated time: 3 days.

Upon receiving your revised submission, a technical editor will assess the revisions to confirm that the requests from the journal have been properly addressed. Before the paper is returned to the editor for their consideration, the journal needs to be confident that the paper won’t have any issues related to the metadata and reporting standards that could prevent publication. The editor may contact you to resolve any serious issues, though minor items can wait until the paper is accepted.

Subsequent Peer Review

Estimated time: 2 weeks, highly variable.

When your resubmitted paper has passed the required checks, it’ll be assigned back to the same editor who handled it during the first round of peer review. At this point, your paper has gone through two sets of journal checks and one round of peer review. If all has gone well so far, the paper should feel quite solid both in terms of scientific content and proper reporting standards. 

When the editor receives your revised paper, they are asked to check if all reviewer comments have been adequately addressed and if the paper now adheres to the journal’s publication criteria. Depending on the situation, some editors may feel confident making this decision based on their own expertise while others may re-invite the previous reviewers for their opinions. 

Individual responsibilities are the same as the initial round of peer review, but it is generally expected that later stages of peer review proceed quicker unless new concerns have been introduced as part of the revision. 

Preliminary Acceptance

Estimated time: 1 week.

Your editor is satisfied with the scientific quality of your work and has chosen to accept it in principle. Before it can proceed to production and typesetting, the journal office will perform it’s third and final technical check, requesting any formatting changes or additional details that may be required. 

When fulfilling these final journal requests, double check the final files to confirm all information is correct. If you need to make changes beyond those specifically required in the decision letter, inform the journal and explain why you made the unrequested changes. Any change that could affect the scientific meaning of the work will need to be approved by the handling editor. While including your rationale for the changes will help avoid delays, if there are extensive changes made at this point the paper may need to go through another round of formal review.

Formal Acceptance and Publication

Estimated time: 2 weeks.

After a technical editor has confirmed that all requests from the provisional acceptance letter have been addressed, you will receive your formal acceptance letter. This letter indicates that your paper is being passed from the Editorial department to the production department—that all information has been editorially approved. The scientific content has been approved through peer review, and the journal’s publication requirements have been met. 

Congratulations to you and your co-authors! Your article will be available as soon as the journal transforms the submission into a typeset, consistently structured scientific manuscript, ready to be read and cited by your peers.

The contents of the Peer Review Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

• Research Process

Writing a good review article

• 3 minute read
• 78.9K views

Table of Contents

As a young researcher, you might wonder how to start writing your first review article, and the extent of the information that it should contain. A review article is a comprehensive summary of the current understanding of a specific research topic and is based on previously published research. Unlike research papers, it does not contain new results, but can propose new inferences based on the combined findings of previous research.

Types of review articles

Review articles are typically of three types: literature reviews, systematic reviews, and meta-analyses.

A literature review is a general survey of the research topic and aims to provide a reliable and unbiased account of the current understanding of the topic.

A systematic review , in contrast, is more specific and attempts to address a highly focused research question. Its presentation is more detailed, with information on the search strategy used, the eligibility criteria for inclusion of studies, the methods utilized to review the collected information, and more.

A meta-analysis is similar to a systematic review in that both are systematically conducted with a properly defined research question. However, unlike the latter, a meta-analysis compares and evaluates a defined number of similar studies. It is quantitative in nature and can help assess contrasting study findings.

Tips for writing a good review article

Here are a few practices that can make the time-consuming process of writing a review article easier:

• Define your question: Take your time to identify the research question and carefully articulate the topic of your review paper. A good review should also add something new to the field in terms of a hypothesis, inference, or conclusion. A carefully defined scientific question will give you more clarity in determining the novelty of your inferences.
• Identify credible sources: Identify relevant as well as credible studies that you can base your review on, with the help of multiple databases or search engines. It is also a good idea to conduct another search once you have finished your article to avoid missing relevant studies published during the course of your writing.
• Take notes: A literature search involves extensive reading, which can make it difficult to recall relevant information subsequently. Therefore, make notes while conducting the literature search and note down the source references. This will ensure that you have sufficient information to start with when you finally get to writing.
• Describe the title, abstract, and introduction: A good starting point to begin structuring your review is by drafting the title, abstract, and introduction. Explicitly writing down what your review aims to address in the field will help shape the rest of your article.
• Be unbiased and critical: Evaluate every piece of evidence in a critical but unbiased manner. This will help you present a proper assessment and a critical discussion in your article.
• Include a good summary: End by stating the take-home message and identify the limitations of existing studies that need to be addressed through future studies.
• Ask for feedback: Ask a colleague to provide feedback on both the content and the language or tone of your article before you submit it.
• Check your journal’s guidelines: Some journals only publish reviews, while some only publish research articles. Further, all journals clearly indicate their aims and scope. Therefore, make sure to check the appropriateness of a journal before submitting your article.

Writing review articles, especially systematic reviews or meta-analyses, can seem like a daunting task. However, Elsevier Author Services can guide you by providing useful tips on how to write an impressive review article that stands out and gets published!

• Manuscript Preparation

What are Implications in Research?

How to write the results section of a research paper

You may also like.

Descriptive Research Design and Its Myriad Uses

Five Common Mistakes to Avoid When Writing a Biomedical Research Paper

Making Technical Writing in Environmental Engineering Accessible

To Err is Not Human: The Dangers of AI-assisted Academic Writing

When Data Speak, Listen: Importance of Data Collection and Analysis Methods

Choosing the Right Research Methodology: A Guide for Researchers

Why is data validation important in research?

Scholarly Sources: What are They and Where can You Find Them?

Input your search keywords and press Enter.

How to Write and Publish a Research Paper for a Peer-Reviewed Journal

• Open access
• Published: 30 April 2020
• Volume 36 , pages 909–913, ( 2021 )

Cite this article

You have full access to this open access article

• Clara Busse   ORCID: orcid.org/0000-0002-0178-1000 1 &
• Ella August   ORCID: orcid.org/0000-0001-5151-1036 1 , 2  

272k Accesses

15 Citations

721 Altmetric

Explore all metrics

Communicating research findings is an essential step in the research process. Often, peer-reviewed journals are the forum for such communication, yet many researchers are never taught how to write a publishable scientific paper. In this article, we explain the basic structure of a scientific paper and describe the information that should be included in each section. We also identify common pitfalls for each section and recommend strategies to avoid them. Further, we give advice about target journal selection and authorship. In the online resource 1 , we provide an example of a high-quality scientific paper, with annotations identifying the elements we describe in this article.

Similar content being viewed by others

Literature reviews as independent studies: guidelines for academic practice

How to design bibliometric research: an overview and a framework proposal

Plagiarism in research

Avoid common mistakes on your manuscript.

Introduction

Writing a scientific paper is an important component of the research process, yet researchers often receive little formal training in scientific writing. This is especially true in low-resource settings. In this article, we explain why choosing a target journal is important, give advice about authorship, provide a basic structure for writing each section of a scientific paper, and describe common pitfalls and recommendations for each section. In the online resource 1 , we also include an annotated journal article that identifies the key elements and writing approaches that we detail here. Before you begin your research, make sure you have ethical clearance from all relevant ethical review boards.

Select a Target Journal Early in the Writing Process

We recommend that you select a “target journal” early in the writing process; a “target journal” is the journal to which you plan to submit your paper. Each journal has a set of core readers and you should tailor your writing to this readership. For example, if you plan to submit a manuscript about vaping during pregnancy to a pregnancy-focused journal, you will need to explain what vaping is because readers of this journal may not have a background in this topic. However, if you were to submit that same article to a tobacco journal, you would not need to provide as much background information about vaping.

Information about a journal’s core readership can be found on its website, usually in a section called “About this journal” or something similar. For example, the Journal of Cancer Education presents such information on the “Aims and Scope” page of its website, which can be found here: https://www.springer.com/journal/13187/aims-and-scope .

Peer reviewer guidelines from your target journal are an additional resource that can help you tailor your writing to the journal and provide additional advice about crafting an effective article [ 1 ]. These are not always available, but it is worth a quick web search to find out.

Identify Author Roles Early in the Process

Early in the writing process, identify authors, determine the order of authors, and discuss the responsibilities of each author. Standard author responsibilities have been identified by The International Committee of Medical Journal Editors (ICMJE) [ 2 ]. To set clear expectations about each team member’s responsibilities and prevent errors in communication, we also suggest outlining more detailed roles, such as who will draft each section of the manuscript, write the abstract, submit the paper electronically, serve as corresponding author, and write the cover letter. It is best to formalize this agreement in writing after discussing it, circulating the document to the author team for approval. We suggest creating a title page on which all authors are listed in the agreed-upon order. It may be necessary to adjust authorship roles and order during the development of the paper. If a new author order is agreed upon, be sure to update the title page in the manuscript draft.

In the case where multiple papers will result from a single study, authors should discuss who will author each paper. Additionally, authors should agree on a deadline for each paper and the lead author should take responsibility for producing an initial draft by this deadline.

Structure of the Introduction Section

The introduction section should be approximately three to five paragraphs in length. Look at examples from your target journal to decide the appropriate length. This section should include the elements shown in Fig.  1 . Begin with a general context, narrowing to the specific focus of the paper. Include five main elements: why your research is important, what is already known about the topic, the “gap” or what is not yet known about the topic, why it is important to learn the new information that your research adds, and the specific research aim(s) that your paper addresses. Your research aim should address the gap you identified. Be sure to add enough background information to enable readers to understand your study. Table 1 provides common introduction section pitfalls and recommendations for addressing them.

The main elements of the introduction section of an original research article. Often, the elements overlap

Methods Section

The purpose of the methods section is twofold: to explain how the study was done in enough detail to enable its replication and to provide enough contextual detail to enable readers to understand and interpret the results. In general, the essential elements of a methods section are the following: a description of the setting and participants, the study design and timing, the recruitment and sampling, the data collection process, the dataset, the dependent and independent variables, the covariates, the analytic approach for each research objective, and the ethical approval. The hallmark of an exemplary methods section is the justification of why each method was used. Table 2 provides common methods section pitfalls and recommendations for addressing them.

Results Section

The focus of the results section should be associations, or lack thereof, rather than statistical tests. Two considerations should guide your writing here. First, the results should present answers to each part of the research aim. Second, return to the methods section to ensure that the analysis and variables for each result have been explained.

Begin the results section by describing the number of participants in the final sample and details such as the number who were approached to participate, the proportion who were eligible and who enrolled, and the number of participants who dropped out. The next part of the results should describe the participant characteristics. After that, you may organize your results by the aim or by putting the most exciting results first. Do not forget to report your non-significant associations. These are still findings.

Tables and figures capture the reader’s attention and efficiently communicate your main findings [ 3 ]. Each table and figure should have a clear message and should complement, rather than repeat, the text. Tables and figures should communicate all salient details necessary for a reader to understand the findings without consulting the text. Include information on comparisons and tests, as well as information about the sample and timing of the study in the title, legend, or in a footnote. Note that figures are often more visually interesting than tables, so if it is feasible to make a figure, make a figure. To avoid confusing the reader, either avoid abbreviations in tables and figures, or define them in a footnote. Note that there should not be citations in the results section and you should not interpret results here. Table 3 provides common results section pitfalls and recommendations for addressing them.

Discussion Section

Opposite the introduction section, the discussion should take the form of a right-side-up triangle beginning with interpretation of your results and moving to general implications (Fig.  2 ). This section typically begins with a restatement of the main findings, which can usually be accomplished with a few carefully-crafted sentences.

Major elements of the discussion section of an original research article. Often, the elements overlap

Next, interpret the meaning or explain the significance of your results, lifting the reader’s gaze from the study’s specific findings to more general applications. Then, compare these study findings with other research. Are these findings in agreement or disagreement with those from other studies? Does this study impart additional nuance to well-accepted theories? Situate your findings within the broader context of scientific literature, then explain the pathways or mechanisms that might give rise to, or explain, the results.

Journals vary in their approach to strengths and limitations sections: some are embedded paragraphs within the discussion section, while some mandate separate section headings. Keep in mind that every study has strengths and limitations. Candidly reporting yours helps readers to correctly interpret your research findings.

The next element of the discussion is a summary of the potential impacts and applications of the research. Should these results be used to optimally design an intervention? Does the work have implications for clinical protocols or public policy? These considerations will help the reader to further grasp the possible impacts of the presented work.

Finally, the discussion should conclude with specific suggestions for future work. Here, you have an opportunity to illuminate specific gaps in the literature that compel further study. Avoid the phrase “future research is necessary” because the recommendation is too general to be helpful to readers. Instead, provide substantive and specific recommendations for future studies. Table 4 provides common discussion section pitfalls and recommendations for addressing them.

Follow the Journal’s Author Guidelines

After you select a target journal, identify the journal’s author guidelines to guide the formatting of your manuscript and references. Author guidelines will often (but not always) include instructions for titles, cover letters, and other components of a manuscript submission. Read the guidelines carefully. If you do not follow the guidelines, your article will be sent back to you.

Finally, do not submit your paper to more than one journal at a time. Even if this is not explicitly stated in the author guidelines of your target journal, it is considered inappropriate and unprofessional.

Your title should invite readers to continue reading beyond the first page [ 4 , 5 ]. It should be informative and interesting. Consider describing the independent and dependent variables, the population and setting, the study design, the timing, and even the main result in your title. Because the focus of the paper can change as you write and revise, we recommend you wait until you have finished writing your paper before composing the title.

Be sure that the title is useful for potential readers searching for your topic. The keywords you select should complement those in your title to maximize the likelihood that a researcher will find your paper through a database search. Avoid using abbreviations in your title unless they are very well known, such as SNP, because it is more likely that someone will use a complete word rather than an abbreviation as a search term to help readers find your paper.

After you have written a complete draft, use the checklist (Fig. 3 ) below to guide your revisions and editing. Additional resources are available on writing the abstract and citing references [ 5 ]. When you feel that your work is ready, ask a trusted colleague or two to read the work and provide informal feedback. The box below provides a checklist that summarizes the key points offered in this article.

Checklist for manuscript quality

Data Availability

Michalek AM (2014) Down the rabbit hole…advice to reviewers. J Cancer Educ 29:4–5

Article   Google Scholar  

International Committee of Medical Journal Editors. Defining the role of authors and contributors: who is an author? http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authosrs-and-contributors.html . Accessed 15 January, 2020

Vetto JT (2014) Short and sweet: a short course on concise medical writing. J Cancer Educ 29(1):194–195

Brett M, Kording K (2017) Ten simple rules for structuring papers. PLoS ComputBiol. https://doi.org/10.1371/journal.pcbi.1005619

Lang TA (2017) Writing a better research article. J Public Health Emerg. https://doi.org/10.21037/jphe.2017.11.06

Download references

Acknowledgments

Ella August is grateful to the Sustainable Sciences Institute for mentoring her in training researchers on writing and publishing their research.

Code Availability

Not applicable.

Author information

Authors and affiliations.

Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, 27599, Chapel Hill, NC, USA

Clara Busse & Ella August

Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

Ella August

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Ella August .

Ethics declarations

Conflicts of interests.

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note.

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

Electronic supplementary material

(PDF 362 kb)

Rights and permissions

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

Reprints and permissions

About this article

Busse, C., August, E. How to Write and Publish a Research Paper for a Peer-Reviewed Journal. J Canc Educ 36 , 909–913 (2021). https://doi.org/10.1007/s13187-020-01751-z

Download citation

Published : 30 April 2020

Issue Date : October 2021

DOI : https://doi.org/10.1007/s13187-020-01751-z

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Manuscripts
• Scientific writing
• Find a journal
• Publish with us
• Track your research

An official website of the United States government

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

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

• Publications
• Account settings

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

• Advanced Search
• Journal List

How to Write and Publish a Research Paper for a Peer-Reviewed Journal

Clara busse.

1 Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Dr, 27599 Chapel Hill, NC USA

Ella August

2 Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029 USA

Associated Data

Communicating research findings is an essential step in the research process. Often, peer-reviewed journals are the forum for such communication, yet many researchers are never taught how to write a publishable scientific paper. In this article, we explain the basic structure of a scientific paper and describe the information that should be included in each section. We also identify common pitfalls for each section and recommend strategies to avoid them. Further, we give advice about target journal selection and authorship. In the online resource 1 , we provide an example of a high-quality scientific paper, with annotations identifying the elements we describe in this article.

Electronic supplementary material

The online version of this article (10.1007/s13187-020-01751-z) contains supplementary material, which is available to authorized users.

Introduction

Writing a scientific paper is an important component of the research process, yet researchers often receive little formal training in scientific writing. This is especially true in low-resource settings. In this article, we explain why choosing a target journal is important, give advice about authorship, provide a basic structure for writing each section of a scientific paper, and describe common pitfalls and recommendations for each section. In the online resource 1 , we also include an annotated journal article that identifies the key elements and writing approaches that we detail here. Before you begin your research, make sure you have ethical clearance from all relevant ethical review boards.

Select a Target Journal Early in the Writing Process

We recommend that you select a “target journal” early in the writing process; a “target journal” is the journal to which you plan to submit your paper. Each journal has a set of core readers and you should tailor your writing to this readership. For example, if you plan to submit a manuscript about vaping during pregnancy to a pregnancy-focused journal, you will need to explain what vaping is because readers of this journal may not have a background in this topic. However, if you were to submit that same article to a tobacco journal, you would not need to provide as much background information about vaping.

Information about a journal’s core readership can be found on its website, usually in a section called “About this journal” or something similar. For example, the Journal of Cancer Education presents such information on the “Aims and Scope” page of its website, which can be found here: https://www.springer.com/journal/13187/aims-and-scope .

Peer reviewer guidelines from your target journal are an additional resource that can help you tailor your writing to the journal and provide additional advice about crafting an effective article [ 1 ]. These are not always available, but it is worth a quick web search to find out.

Identify Author Roles Early in the Process

Early in the writing process, identify authors, determine the order of authors, and discuss the responsibilities of each author. Standard author responsibilities have been identified by The International Committee of Medical Journal Editors (ICMJE) [ 2 ]. To set clear expectations about each team member’s responsibilities and prevent errors in communication, we also suggest outlining more detailed roles, such as who will draft each section of the manuscript, write the abstract, submit the paper electronically, serve as corresponding author, and write the cover letter. It is best to formalize this agreement in writing after discussing it, circulating the document to the author team for approval. We suggest creating a title page on which all authors are listed in the agreed-upon order. It may be necessary to adjust authorship roles and order during the development of the paper. If a new author order is agreed upon, be sure to update the title page in the manuscript draft.

In the case where multiple papers will result from a single study, authors should discuss who will author each paper. Additionally, authors should agree on a deadline for each paper and the lead author should take responsibility for producing an initial draft by this deadline.

Structure of the Introduction Section

The introduction section should be approximately three to five paragraphs in length. Look at examples from your target journal to decide the appropriate length. This section should include the elements shown in Fig.  1 . Begin with a general context, narrowing to the specific focus of the paper. Include five main elements: why your research is important, what is already known about the topic, the “gap” or what is not yet known about the topic, why it is important to learn the new information that your research adds, and the specific research aim(s) that your paper addresses. Your research aim should address the gap you identified. Be sure to add enough background information to enable readers to understand your study. Table ​ Table1 1 provides common introduction section pitfalls and recommendations for addressing them.

The main elements of the introduction section of an original research article. Often, the elements overlap

Common introduction section pitfalls and recommendations

Methods Section

The purpose of the methods section is twofold: to explain how the study was done in enough detail to enable its replication and to provide enough contextual detail to enable readers to understand and interpret the results. In general, the essential elements of a methods section are the following: a description of the setting and participants, the study design and timing, the recruitment and sampling, the data collection process, the dataset, the dependent and independent variables, the covariates, the analytic approach for each research objective, and the ethical approval. The hallmark of an exemplary methods section is the justification of why each method was used. Table ​ Table2 2 provides common methods section pitfalls and recommendations for addressing them.

Common methods section pitfalls and recommendations

Results Section

The focus of the results section should be associations, or lack thereof, rather than statistical tests. Two considerations should guide your writing here. First, the results should present answers to each part of the research aim. Second, return to the methods section to ensure that the analysis and variables for each result have been explained.

Begin the results section by describing the number of participants in the final sample and details such as the number who were approached to participate, the proportion who were eligible and who enrolled, and the number of participants who dropped out. The next part of the results should describe the participant characteristics. After that, you may organize your results by the aim or by putting the most exciting results first. Do not forget to report your non-significant associations. These are still findings.

Tables and figures capture the reader’s attention and efficiently communicate your main findings [ 3 ]. Each table and figure should have a clear message and should complement, rather than repeat, the text. Tables and figures should communicate all salient details necessary for a reader to understand the findings without consulting the text. Include information on comparisons and tests, as well as information about the sample and timing of the study in the title, legend, or in a footnote. Note that figures are often more visually interesting than tables, so if it is feasible to make a figure, make a figure. To avoid confusing the reader, either avoid abbreviations in tables and figures, or define them in a footnote. Note that there should not be citations in the results section and you should not interpret results here. Table ​ Table3 3 provides common results section pitfalls and recommendations for addressing them.

Common results section pitfalls and recommendations

Discussion Section

Opposite the introduction section, the discussion should take the form of a right-side-up triangle beginning with interpretation of your results and moving to general implications (Fig.  2 ). This section typically begins with a restatement of the main findings, which can usually be accomplished with a few carefully-crafted sentences.

Major elements of the discussion section of an original research article. Often, the elements overlap

Next, interpret the meaning or explain the significance of your results, lifting the reader’s gaze from the study’s specific findings to more general applications. Then, compare these study findings with other research. Are these findings in agreement or disagreement with those from other studies? Does this study impart additional nuance to well-accepted theories? Situate your findings within the broader context of scientific literature, then explain the pathways or mechanisms that might give rise to, or explain, the results.

Journals vary in their approach to strengths and limitations sections: some are embedded paragraphs within the discussion section, while some mandate separate section headings. Keep in mind that every study has strengths and limitations. Candidly reporting yours helps readers to correctly interpret your research findings.

The next element of the discussion is a summary of the potential impacts and applications of the research. Should these results be used to optimally design an intervention? Does the work have implications for clinical protocols or public policy? These considerations will help the reader to further grasp the possible impacts of the presented work.

Finally, the discussion should conclude with specific suggestions for future work. Here, you have an opportunity to illuminate specific gaps in the literature that compel further study. Avoid the phrase “future research is necessary” because the recommendation is too general to be helpful to readers. Instead, provide substantive and specific recommendations for future studies. Table ​ Table4 4 provides common discussion section pitfalls and recommendations for addressing them.

Common discussion section pitfalls and recommendations

Follow the Journal’s Author Guidelines

After you select a target journal, identify the journal’s author guidelines to guide the formatting of your manuscript and references. Author guidelines will often (but not always) include instructions for titles, cover letters, and other components of a manuscript submission. Read the guidelines carefully. If you do not follow the guidelines, your article will be sent back to you.

Finally, do not submit your paper to more than one journal at a time. Even if this is not explicitly stated in the author guidelines of your target journal, it is considered inappropriate and unprofessional.

Your title should invite readers to continue reading beyond the first page [ 4 , 5 ]. It should be informative and interesting. Consider describing the independent and dependent variables, the population and setting, the study design, the timing, and even the main result in your title. Because the focus of the paper can change as you write and revise, we recommend you wait until you have finished writing your paper before composing the title.

Be sure that the title is useful for potential readers searching for your topic. The keywords you select should complement those in your title to maximize the likelihood that a researcher will find your paper through a database search. Avoid using abbreviations in your title unless they are very well known, such as SNP, because it is more likely that someone will use a complete word rather than an abbreviation as a search term to help readers find your paper.

After you have written a complete draft, use the checklist (Fig. ​ (Fig.3) 3 ) below to guide your revisions and editing. Additional resources are available on writing the abstract and citing references [ 5 ]. When you feel that your work is ready, ask a trusted colleague or two to read the work and provide informal feedback. The box below provides a checklist that summarizes the key points offered in this article.

Checklist for manuscript quality

(PDF 362 kb)

Acknowledgments

Ella August is grateful to the Sustainable Sciences Institute for mentoring her in training researchers on writing and publishing their research.

Code Availability

Not applicable.

Data Availability

Compliance with ethical standards.

The authors declare that they have no conflict of interest.

Publisher’s Note

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

Home → Get Published → How to Publish a Research Paper: A Step-by-Step Guide

How to Publish a Research Paper: A Step-by-Step Guide

Jordan Kruszynski

• January 4, 2024

You’re in academia.

You’re going steady.

Your research is going well and you begin to wonder: ‘ How exactly do I get a research paper published?’

If this is the question on your lips, then this step-by-step guide is the one for you. We’ll be walking you through the whole process of how to publish a research paper.

Publishing a research paper is a significant milestone for researchers and academics, as it allows you to share your findings, contribute to your field of study, and start to gain serious recognition within the wider academic community. So, want to know how to publish a research paper? By following our guide, you’ll get a firm grasp of the steps involved in this process, giving you the best chance of successfully navigating the publishing process and getting your work out there.

Understanding the Publishing Process

To begin, it’s crucial to understand that getting a research paper published is a multi-step process. From beginning to end, it could take as little as 2 months before you see your paper nestled in the pages of your chosen journal. On the other hand, it could take as long as a year .

Below, we set out the steps before going into more detail on each one. Getting a feel for these steps will help you to visualise what lies ahead, and prepare yourself for each of them in turn. It’s important to remember that you won’t actually have control over every step – in fact, some of them will be decided by people you’ll probably never meet. However, knowing which parts of the process are yours to decide will allow you to adjust your approach and attitude accordingly.

Each of the following stages will play a vital role in the eventual publication of your paper:

• Preparing Your Research Paper
• Finding the Right Journal
• Crafting a Strong Manuscript
• Navigating the Peer-Review Process
• Submitting Your Paper
• Dealing with Rejections and Revising Your Paper

Step 1: Preparing Your Research Paper

It all starts here. The quality and content of your research paper is of fundamental importance if you want to get it published. This step will be different for every researcher depending on the nature of your research, but if you haven’t yet settled on a topic, then consider the following advice:

• Choose an interesting and relevant topic that aligns with current trends in your field. If your research touches on the passions and concerns of your academic peers or wider society, it may be more likely to capture attention and get published successfully.
• Conduct a comprehensive literature review (link to lit. review article once it’s published) to identify the state of existing research and any knowledge gaps within it. Aiming to fill a clear gap in the knowledge of your field is a great way to increase the practicality of your research and improve its chances of getting published.
• Structure your paper in a clear and organised manner, including all the necessary sections such as title, abstract, introduction (link to the ‘how to write a research paper intro’ article once it’s published) , methodology, results, discussion, and conclusion.
• Adhere to the formatting guidelines provided by your target journal to ensure that your paper is accepted as viable for publishing. More on this in the next section…

Step 2: Finding the Right Journal

Understanding how to publish a research paper involves selecting the appropriate journal for your work. This step is critical for successful publication, and you should take several factors into account when deciding which journal to apply for:

• Conduct thorough research to identify journals that specialise in your field of study and have published similar research. Naturally, if you submit a piece of research in molecular genetics to a journal that specialises in geology, you won’t be likely to get very far.
• Consider factors such as the journal’s scope, impact factor, and target audience. Today there is a wide array of journals to choose from, including traditional and respected print journals, as well as numerous online, open-access endeavours. Some, like Nature , even straddle both worlds.
• Review the submission guidelines provided by the journal and ensure your paper meets all the formatting requirements and word limits. This step is key. Nature, for example, offers a highly informative series of pages that tells you everything you need to know in order to satisfy their formatting guidelines (plus more on the whole submission process).
• Note that these guidelines can differ dramatically from journal to journal, and details really do matter. You might submit an outstanding piece of research, but if it includes, for example, images in the wrong size or format, this could mean a lengthy delay to getting it published. If you get everything right first time, you’ll save yourself a lot of time and trouble, as well as strengthen your publishing chances in the first place.

Step 3: Crafting a Strong Manuscript

Crafting a strong manuscript is crucial to impress journal editors and reviewers. Look at your paper as a complete package, and ensure that all the sections tie together to deliver your findings with clarity and precision.

• Begin by creating a clear and concise title that accurately reflects the content of your paper.
• Compose an informative abstract that summarises the purpose, methodology, results, and significance of your study.
• Craft an engaging introduction (link to the research paper introduction article) that draws your reader in.
• Develop a well-structured methodology section, presenting your results effectively using tables and figures.
• Write a compelling discussion and conclusion that emphasise the significance of your findings.

Step 4: Navigating the Peer-Review Process

Once you submit your research paper to a journal, it undergoes a rigorous peer-review process to ensure its quality and validity. In peer-review, experts in your field assess your research and provide feedback and suggestions for improvement, ultimately determining whether your paper is eligible for publishing or not. You are likely to encounter several models of peer-review, based on which party – author, reviewer, or both – remains anonymous throughout the process.

When your paper undergoes the peer-review process, be prepared for constructive criticism and address the comments you receive from your reviewer thoughtfully, providing clear and concise responses to their concerns or suggestions. These could make all the difference when it comes to making your next submission.

The peer-review process can seem like a closed book at times. Check out our discussion of the issue with philosopher and academic Amna Whiston in The Research Beat podcast!

Step 5: Submitting Your Paper

As we’ve already pointed out, one of the key elements in how to publish a research paper is ensuring that you meticulously follow the journal’s submission guidelines. Strive to comply with all formatting requirements, including citation styles, font, margins, and reference structure.

Before the final submission, thoroughly proofread your paper for errors, including grammar, spelling, and any inconsistencies in your data or analysis. At this stage, consider seeking feedback from colleagues or mentors to further improve the quality of your paper.

Step 6: Dealing with Rejections and Revising Your Paper

Rejection is a common part of the publishing process, but it shouldn’t discourage you. Analyse reviewer comments objectively and focus on the constructive feedback provided. Make necessary revisions and improvements to your paper to address the concerns raised by reviewers. If needed, consider submitting your paper to a different journal that is a better fit for your research.

For more tips on how to publish your paper out there, check out this thread by Dr. Asad Naveed ( @dr_asadnaveed ) – and if you need a refresher on the basics of how to publish under the Open Access model, watch this 5-minute video from Audemic Academy !

Final Thoughts

Successfully understanding how to publish a research paper requires dedication, attention to detail, and a systematic approach. By following the advice in our guide, you can increase your chances of navigating the publishing process effectively and achieving your goal of publication.

Remember, the journey may involve revisions, peer feedback, and potential rejections, but each step is an opportunity for growth and improvement. Stay persistent, maintain a positive mindset, and continue to refine your research paper until it reaches the standards of your target journal. Your contribution to your wider discipline through published research will not only advance your career, but also add to the growing body of collective knowledge in your field. Embrace the challenges and rewards that come with the publication process, and may your research paper make a significant impact in your area of study!

Looking for inspiration for your next big paper? Head to Audemic , where you can organise and listen to all the best and latest research in your field!

Keep striving, researchers! ✨

Table of Contents

Related articles.

You’re in academia. You’re going steady. Your research is going well and you begin to wonder: ‘How exactly do I get a

Behind the Scenes: What Does a Research Assistant Do?

Have you ever wondered what goes on behind the scenes in a research lab? Does it involve acting out the whims of

How to Write a Research Paper Introduction: Hook, Line, and Sinker

Want to know how to write a research paper introduction that dazzles? Struggling to hook your reader in with your opening sentences?

Blog Podcast

Privacy policy Terms of service

Subscribe to our newsletter!

Discover more from Audemic: Access any academic research via audio

Subscribe now to keep reading and get access to the full archive.

Type your email…

Continue reading

Page Content

Overview of the review report format, the first read-through, first read considerations, spotting potential major flaws, concluding the first reading, rejection after the first reading, before starting the second read-through, doing the second read-through, the second read-through: section by section guidance, how to structure your report, on presentation and style, criticisms & confidential comments to editors, the recommendation, when recommending rejection, additional resources, step by step guide to reviewing a manuscript.

When you receive an invitation to peer review, you should be sent a copy of the paper's abstract to help you decide whether you wish to do the review. Try to respond to invitations promptly - it will prevent delays. It is also important at this stage to declare any potential Conflict of Interest.

The structure of the review report varies between journals. Some follow an informal structure, while others have a more formal approach.

" Number your comments!!! " (Jonathon Halbesleben, former Editor of Journal of Occupational and Organizational Psychology)

Informal Structure

Many journals don't provide criteria for reviews beyond asking for your 'analysis of merits'. In this case, you may wish to familiarize yourself with examples of other reviews done for the journal, which the editor should be able to provide or, as you gain experience, rely on your own evolving style.

Formal Structure

Other journals require a more formal approach. Sometimes they will ask you to address specific questions in your review via a questionnaire. Or they might want you to rate the manuscript on various attributes using a scorecard. Often you can't see these until you log in to submit your review. So when you agree to the work, it's worth checking for any journal-specific guidelines and requirements. If there are formal guidelines, let them direct the structure of your review.

In Both Cases

Whether specifically required by the reporting format or not, you should expect to compile comments to authors and possibly confidential ones to editors only.

Following the invitation to review, when you'll have received the article abstract, you should already understand the aims, key data and conclusions of the manuscript. If you don't, make a note now that you need to feedback on how to improve those sections.

The first read-through is a skim-read. It will help you form an initial impression of the paper and get a sense of whether your eventual recommendation will be to accept or reject the paper.

Keep a pen and paper handy when skim-reading.

Try to bear in mind the following questions - they'll help you form your overall impression:

• What is the main question addressed by the research? Is it relevant and interesting?
• How original is the topic? What does it add to the subject area compared with other published material?
• Is the paper well written? Is the text clear and easy to read?
• Are the conclusions consistent with the evidence and arguments presented? Do they address the main question posed?
• If the author is disagreeing significantly with the current academic consensus, do they have a substantial case? If not, what would be required to make their case credible?
• If the paper includes tables or figures, what do they add to the paper? Do they aid understanding or are they superfluous?

While you should read the whole paper, making the right choice of what to read first can save time by flagging major problems early on.

Editors say, " Specific recommendations for remedying flaws are VERY welcome ."

Examples of possibly major flaws include:

• Drawing a conclusion that is contradicted by the author's own statistical or qualitative evidence
• The use of a discredited method
• Ignoring a process that is known to have a strong influence on the area under study

If experimental design features prominently in the paper, first check that the methodology is sound - if not, this is likely to be a major flaw.

You might examine:

• The sampling in analytical papers
• The sufficient use of control experiments
• The precision of process data
• The regularity of sampling in time-dependent studies
• The validity of questions, the use of a detailed methodology and the data analysis being done systematically (in qualitative research)
• That qualitative research extends beyond the author's opinions, with sufficient descriptive elements and appropriate quotes from interviews or focus groups

Major Flaws in Information

If methodology is less of an issue, it's often a good idea to look at the data tables, figures or images first. Especially in science research, it's all about the information gathered. If there are critical flaws in this, it's very likely the manuscript will need to be rejected. Such issues include:

• Insufficient data
• Unclear data tables
• Contradictory data that either are not self-consistent or disagree with the conclusions
• Confirmatory data that adds little, if anything, to current understanding - unless strong arguments for such repetition are made

If you find a major problem, note your reasoning and clear supporting evidence (including citations).

After the initial read and using your notes, including those of any major flaws you found, draft the first two paragraphs of your review - the first summarizing the research question addressed and the second the contribution of the work. If the journal has a prescribed reporting format, this draft will still help you compose your thoughts.

The First Paragraph

This should state the main question addressed by the research and summarize the goals, approaches, and conclusions of the paper. It should:

• Help the editor properly contextualize the research and add weight to your judgement
• Show the author what key messages are conveyed to the reader, so they can be sure they are achieving what they set out to do
• Focus on successful aspects of the paper so the author gets a sense of what they've done well

The Second Paragraph

This should provide a conceptual overview of the contribution of the research. So consider:

• Is the paper's premise interesting and important?
• Are the methods used appropriate?
• Do the data support the conclusions?

After drafting these two paragraphs, you should be in a position to decide whether this manuscript is seriously flawed and should be rejected (see the next section). Or whether it is publishable in principle and merits a detailed, careful read through.

Even if you are coming to the opinion that an article has serious flaws, make sure you read the whole paper. This is very important because you may find some really positive aspects that can be communicated to the author. This could help them with future submissions.

A full read-through will also make sure that any initial concerns are indeed correct and fair. After all, you need the context of the whole paper before deciding to reject. If you still intend to recommend rejection, see the section "When recommending rejection."

Once the paper has passed your first read and you've decided the article is publishable in principle, one purpose of the second, detailed read-through is to help prepare the manuscript for publication. You may still decide to recommend rejection following a second reading.

" Offer clear suggestions for how the authors can address the concerns raised. In other words, if you're going to raise a problem, provide a solution ." (Jonathon Halbesleben, Editor of Journal of Occupational and Organizational Psychology)

Preparation

To save time and simplify the review:

• Don't rely solely upon inserting comments on the manuscript document - make separate notes
• Try to group similar concerns or praise together
• If using a review program to note directly onto the manuscript, still try grouping the concerns and praise in separate notes - it helps later
• Note line numbers of text upon which your notes are based - this helps you find items again and also aids those reading your review

Now that you have completed your preparations, you're ready to spend an hour or so reading carefully through the manuscript.

As you're reading through the manuscript for a second time, you'll need to keep in mind the argument's construction, the clarity of the language and content.

With regard to the argument’s construction, you should identify:

• Any places where the meaning is unclear or ambiguous
• Any factual errors
• Any invalid arguments

You may also wish to consider:

• Does the title properly reflect the subject of the paper?
• Does the abstract provide an accessible summary of the paper?
• Do the keywords accurately reflect the content?
• Is the paper an appropriate length?
• Are the key messages short, accurate and clear?

Not every submission is well written. Part of your role is to make sure that the text’s meaning is clear.

Editors say, " If a manuscript has many English language and editing issues, please do not try and fix it. If it is too bad, note that in your review and it should be up to the authors to have the manuscript edited ."

If the article is difficult to understand, you should have rejected it already. However, if the language is poor but you understand the core message, see if you can suggest improvements to fix the problem:

• Are there certain aspects that could be communicated better, such as parts of the discussion?
• Should the authors consider resubmitting to the same journal after language improvements?
• Would you consider looking at the paper again once these issues are dealt with?

On Grammar and Punctuation

Your primary role is judging the research content. Don't spend time polishing grammar or spelling. Editors will make sure that the text is at a high standard before publication. However, if you spot grammatical errors that affect clarity of meaning, then it's important to highlight these. Expect to suggest such amendments - it's rare for a manuscript to pass review with no corrections.

A 2010 study of nursing journals found that 79% of recommendations by reviewers were influenced by grammar and writing style (Shattel, et al., 2010).

1. The Introduction

A well-written introduction:

• Sets out the argument
• Summarizes recent research related to the topic
• Highlights gaps in current understanding or conflicts in current knowledge
• Establishes the originality of the research aims by demonstrating the need for investigations in the topic area
• Gives a clear idea of the target readership, why the research was carried out and the novelty and topicality of the manuscript

Originality and Topicality

Originality and topicality can only be established in the light of recent authoritative research. For example, it's impossible to argue that there is a conflict in current understanding by referencing articles that are 10 years old.

Authors may make the case that a topic hasn't been investigated in several years and that new research is required. This point is only valid if researchers can point to recent developments in data gathering techniques or to research in indirectly related fields that suggest the topic needs revisiting. Clearly, authors can only do this by referencing recent literature. Obviously, where older research is seminal or where aspects of the methodology rely upon it, then it is perfectly appropriate for authors to cite some older papers.

Editors say, "Is the report providing new information; is it novel or just confirmatory of well-known outcomes ?"

It's common for the introduction to end by stating the research aims. By this point you should already have a good impression of them - if the explicit aims come as a surprise, then the introduction needs improvement.

2. Materials and Methods

Academic research should be replicable, repeatable and robust - and follow best practice.

Replicable Research

This makes sufficient use of:

• Control experiments
• Repeated analyses
• Repeated experiments

These are used to make sure observed trends are not due to chance and that the same experiment could be repeated by other researchers - and result in the same outcome. Statistical analyses will not be sound if methods are not replicable. Where research is not replicable, the paper should be recommended for rejection.

Repeatable Methods

These give enough detail so that other researchers are able to carry out the same research. For example, equipment used or sampling methods should all be described in detail so that others could follow the same steps. Where methods are not detailed enough, it's usual to ask for the methods section to be revised.

Robust Research

This has enough data points to make sure the data are reliable. If there are insufficient data, it might be appropriate to recommend revision. You should also consider whether there is any in-built bias not nullified by the control experiments.

Best Practice

During these checks you should keep in mind best practice:

• Standard guidelines were followed (e.g. the CONSORT Statement for reporting randomized trials)
• The health and safety of all participants in the study was not compromised
• Ethical standards were maintained

If the research fails to reach relevant best practice standards, it's usual to recommend rejection. What's more, you don't then need to read any further.

3. Results and Discussion

This section should tell a coherent story - What happened? What was discovered or confirmed?

Certain patterns of good reporting need to be followed by the author:

• They should start by describing in simple terms what the data show
• They should make reference to statistical analyses, such as significance or goodness of fit
• Once described, they should evaluate the trends observed and explain the significance of the results to wider understanding. This can only be done by referencing published research
• The outcome should be a critical analysis of the data collected

Discussion should always, at some point, gather all the information together into a single whole. Authors should describe and discuss the overall story formed. If there are gaps or inconsistencies in the story, they should address these and suggest ways future research might confirm the findings or take the research forward.

4. Conclusions

This section is usually no more than a few paragraphs and may be presented as part of the results and discussion, or in a separate section. The conclusions should reflect upon the aims - whether they were achieved or not - and, just like the aims, should not be surprising. If the conclusions are not evidence-based, it's appropriate to ask for them to be re-written.

5. Information Gathered: Images, Graphs and Data Tables

If you find yourself looking at a piece of information from which you cannot discern a story, then you should ask for improvements in presentation. This could be an issue with titles, labels, statistical notation or image quality.

Where information is clear, you should check that:

• The results seem plausible, in case there is an error in data gathering
• The trends you can see support the paper's discussion and conclusions
• There are sufficient data. For example, in studies carried out over time are there sufficient data points to support the trends described by the author?

You should also check whether images have been edited or manipulated to emphasize the story they tell. This may be appropriate but only if authors report on how the image has been edited (e.g. by highlighting certain parts of an image). Where you feel that an image has been edited or manipulated without explanation, you should highlight this in a confidential comment to the editor in your report.

6. List of References

You will need to check referencing for accuracy, adequacy and balance.

Where a cited article is central to the author's argument, you should check the accuracy and format of the reference - and bear in mind different subject areas may use citations differently. Otherwise, it's the editor’s role to exhaustively check the reference section for accuracy and format.

You should consider if the referencing is adequate:

• Are important parts of the argument poorly supported?
• Are there published studies that show similar or dissimilar trends that should be discussed?
• If a manuscript only uses half the citations typical in its field, this may be an indicator that referencing should be improved - but don't be guided solely by quantity
• References should be relevant, recent and readily retrievable

Check for a well-balanced list of references that is:

• Helpful to the reader
• Fair to competing authors
• Not over-reliant on self-citation
• Gives due recognition to the initial discoveries and related work that led to the work under assessment

You should be able to evaluate whether the article meets the criteria for balanced referencing without looking up every reference.

7. Plagiarism

By now you will have a deep understanding of the paper's content - and you may have some concerns about plagiarism.

Identified Concern

If you find - or already knew of - a very similar paper, this may be because the author overlooked it in their own literature search. Or it may be because it is very recent or published in a journal slightly outside their usual field.

You may feel you can advise the author how to emphasize the novel aspects of their own study, so as to better differentiate it from similar research. If so, you may ask the author to discuss their aims and results, or modify their conclusions, in light of the similar article. Of course, the research similarities may be so great that they render the work unoriginal and you have no choice but to recommend rejection.

"It's very helpful when a reviewer can point out recent similar publications on the same topic by other groups, or that the authors have already published some data elsewhere ." (Editor feedback)

Suspected Concern

If you suspect plagiarism, including self-plagiarism, but cannot recall or locate exactly what is being plagiarized, notify the editor of your suspicion and ask for guidance.

Most editors have access to software that can check for plagiarism.

Editors are not out to police every paper, but when plagiarism is discovered during peer review it can be properly addressed ahead of publication. If plagiarism is discovered only after publication, the consequences are worse for both authors and readers, because a retraction may be necessary.

For detailed guidelines see COPE's Ethical guidelines for reviewers and Wiley's Best Practice Guidelines on Publishing Ethics .

8. Search Engine Optimization (SEO)

After the detailed read-through, you will be in a position to advise whether the title, abstract and key words are optimized for search purposes. In order to be effective, good SEO terms will reflect the aims of the research.

A clear title and abstract will improve the paper's search engine rankings and will influence whether the user finds and then decides to navigate to the main article. The title should contain the relevant SEO terms early on. This has a major effect on the impact of a paper, since it helps it appear in search results. A poor abstract can then lose the reader's interest and undo the benefit of an effective title - whilst the paper's abstract may appear in search results, the potential reader may go no further.

So ask yourself, while the abstract may have seemed adequate during earlier checks, does it:

• Do justice to the manuscript in this context?
• Highlight important findings sufficiently?
• Present the most interesting data?

Editors say, " Does the Abstract highlight the important findings of the study ?"

If there is a formal report format, remember to follow it. This will often comprise a range of questions followed by comment sections. Try to answer all the questions. They are there because the editor felt that they are important. If you're following an informal report format you could structure your report in three sections: summary, major issues, minor issues.

• Give positive feedback first. Authors are more likely to read your review if you do so. But don't overdo it if you will be recommending rejection
• Briefly summarize what the paper is about and what the findings are
• Try to put the findings of the paper into the context of the existing literature and current knowledge
• Indicate the significance of the work and if it is novel or mainly confirmatory
• Indicate the work's strengths, its quality and completeness
• State any major flaws or weaknesses and note any special considerations. For example, if previously held theories are being overlooked

Major Issues

• Are there any major flaws? State what they are and what the severity of their impact is on the paper
• Has similar work already been published without the authors acknowledging this?
• Are the authors presenting findings that challenge current thinking? Is the evidence they present strong enough to prove their case? Have they cited all the relevant work that would contradict their thinking and addressed it appropriately?
• If major revisions are required, try to indicate clearly what they are
• Are there any major presentational problems? Are figures & tables, language and manuscript structure all clear enough for you to accurately assess the work?
• Are there any ethical issues? If you are unsure it may be better to disclose these in the confidential comments section

Minor Issues

• Are there places where meaning is ambiguous? How can this be corrected?
• Are the correct references cited? If not, which should be cited instead/also? Are citations excessive, limited, or biased?
• Are there any factual, numerical or unit errors? If so, what are they?
• Are all tables and figures appropriate, sufficient, and correctly labelled? If not, say which are not

Your review should ultimately help the author improve their article. So be polite, honest and clear. You should also try to be objective and constructive, not subjective and destructive.

You should also:

• Write clearly and so you can be understood by people whose first language is not English
• Avoid complex or unusual words, especially ones that would even confuse native speakers
• Number your points and refer to page and line numbers in the manuscript when making specific comments
• If you have been asked to only comment on specific parts or aspects of the manuscript, you should indicate clearly which these are
• Treat the author's work the way you would like your own to be treated

Most journals give reviewers the option to provide some confidential comments to editors. Often this is where editors will want reviewers to state their recommendation - see the next section - but otherwise this area is best reserved for communicating malpractice such as suspected plagiarism, fraud, unattributed work, unethical procedures, duplicate publication, bias or other conflicts of interest.

However, this doesn't give reviewers permission to 'backstab' the author. Authors can't see this feedback and are unable to give their side of the story unless the editor asks them to. So in the spirit of fairness, write comments to editors as though authors might read them too.

Reviewers should check the preferences of individual journals as to where they want review decisions to be stated. In particular, bear in mind that some journals will not want the recommendation included in any comments to authors, as this can cause editors difficulty later - see Section 11 for more advice about working with editors.

You will normally be asked to indicate your recommendation (e.g. accept, reject, revise and resubmit, etc.) from a fixed-choice list and then to enter your comments into a separate text box.

Recommending Acceptance

If you're recommending acceptance, give details outlining why, and if there are any areas that could be improved. Don't just give a short, cursory remark such as 'great, accept'. See Improving the Manuscript

Recommending Revision

Where improvements are needed, a recommendation for major or minor revision is typical. You may also choose to state whether you opt in or out of the post-revision review too. If recommending revision, state specific changes you feel need to be made. The author can then reply to each point in turn.

Some journals offer the option to recommend rejection with the possibility of resubmission – this is most relevant where substantial, major revision is necessary.

What can reviewers do to help? " Be clear in their comments to the author (or editor) which points are absolutely critical if the paper is given an opportunity for revisio n." (Jonathon Halbesleben, Editor of Journal of Occupational and Organizational Psychology)

Recommending Rejection

If recommending rejection or major revision, state this clearly in your review (and see the next section, 'When recommending rejection').

Where manuscripts have serious flaws you should not spend any time polishing the review you've drafted or give detailed advice on presentation.

Editors say, " If a reviewer suggests a rejection, but her/his comments are not detailed or helpful, it does not help the editor in making a decision ."

In your recommendations for the author, you should:

• Give constructive feedback describing ways that they could improve the research
• Keep the focus on the research and not the author. This is an extremely important part of your job as a reviewer
• Avoid making critical confidential comments to the editor while being polite and encouraging to the author - the latter may not understand why their manuscript has been rejected. Also, they won't get feedback on how to improve their research and it could trigger an appeal

Remember to give constructive criticism even if recommending rejection. This helps developing researchers improve their work and explains to the editor why you felt the manuscript should not be published.

" When the comments seem really positive, but the recommendation is rejection…it puts the editor in a tough position of having to reject a paper when the comments make it sound like a great paper ." (Jonathon Halbesleben, Editor of Journal of Occupational and Organizational Psychology)

Visit our Wiley Author Learning and Training Channel for expert advice on peer review.

Watch the video, Ethical considerations of Peer Review

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

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• 29 August 2018
• Correction 13 September 2018

Publish peer reviews

• Jessica K. Polka 0 ,
• Robert Kiley 1 ,
• Boyana Konforti 2 ,
• Bodo Stern 3 &
• Ronald D. Vale 4

Jessica K. Polka is executive director of ASAPbio in San Francisco, California, USA.

You can also search for this author in PubMed   Google Scholar

Robert Kiley is head of open research at the Wellcome Trust in London.

Boyana Konforti is director of scientific strategy and development at the Howard Hughes Medical Institute in Chevy Chase, Maryland, USA.

Bodo Stern is chief development and strategy officer at the Howard Hughes Medical Institute in Chevy Chase, Maryland, USA.

Ronald D. Vale is president of ASAPbio in San Francisco, California, USA; a professor of cellular and molecular pharmacology at the University of California, San Francisco; and an HHMI investigator.

Illustration by David Parkins

Long shrouded in secrecy, the contents of peer review are coming into the open. In the past decade, outlets such as eLife , F1000Research , Royal Society Open Science , Annals of Anatomy , Nature Communications , PeerJ and EMBO Press have begun to publish referee reports. Publishers including Copernicus, BMJ and BMC (the latter is owned by Springer Nature) have been doing so for even longer (see ‘Revealing peer review’). Last year, the organizers of Peer Review Week embraced the topic in a broader discussion of transparency.

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 51 print issues and online access

185,98 € per year

only 3,65 € per issue

Rent or buy this article

Prices vary by article type

Prices may be subject to local taxes which are calculated during checkout

Nature 560 , 545-547 (2018)

doi: https://doi.org/10.1038/d41586-018-06032-w

Updates & Corrections

Correction 13 September 2018 : An earlier version of the timeline in this Comment stated that peer review began to be published at The EMBO Journal in 2010.

Ross-Hellauer, T. F1000Research 6 , 588 (2017).

Article   PubMed   Google Scholar  

Ross-Hellauer, T., Deppe, A. & Schmidt, B. PLoS ONE 12 , e0189311 (2017).

Publishing Research Consortium. PRC Peer Review Survey 2015 (Mark Ware Consulting, 2016).

Google Scholar  

Pulverer, B. EMBO J. 29 , 3891–3892 (2010).

Nature Commun. 7 , 13626 (2016).

van Rooyen, S., Delamothe, T. & Evans, S. J. W. Br. Med. J. 341 , c5729 (2010).

Article   Google Scholar  

Tregenza, T. Trends Ecol. Evol. 17 , 349–350 (2002).

Shen, Y. A., Webster, J. M., Shoda, Y. & Fine, I. Preprint at bioRxiv https://doi.org/10.1101/275362 (2018).

Download references

Reprints and permissions

Related Articles

• Peer review
• Research management

Plagiarism in peer-review reports could be the ‘tip of the iceberg’

Nature Index 01 MAY 24

Algorithm ranks peer reviewers by reputation — but critics warn of bias

Nature Index 25 APR 24

Structure peer review to make it more robust

World View 16 APR 24

I’m worried I’ve been contacted by a predatory publisher — how do I find out?

Career Feature 15 MAY 24

Illuminating ‘the ugly side of science’: fresh incentives for reporting negative results

Career Feature 08 MAY 24

Mount Etna’s spectacular smoke rings and more — April’s best science images

News 03 MAY 24

US halts funding to controversial virus-hunting group: what researchers think

News 16 MAY 24

Japan can embrace open science — but flexible approaches are key

Correspondence 07 MAY 24

US funders to tighten oversight of controversial ‘gain of function’ research

News 07 MAY 24

Overseas Talent, Embarking on a New Journey Together at Tianjin University

We cordially invite outstanding young individuals from overseas to apply for the Excellent Young Scientists Fund Program (Overseas).

Tianjin, China

Tianjin University (TJU)

Chair Professor Positions in the School of Pharmaceutical Science and Technology

SPST seeks top Faculty scholars in Pharmaceutical Sciences.

Chair Professor Positions in the School of Precision Instruments and Optoelectronic Engineering

We are committed to accomplishing the mission of achieving a world-top-class engineering school.

Chair Professor Positions in the School of Mechanical Engineering

Aims to cultivate top talents, train a top-ranking faculty team, construct first-class disciplines and foster a favorable academic environment.

Chair Professor Positions in the School of Materials Science and Engineering

SMSE consists of materials science-related majors and research, including metallic materials, ceramic materials, polymeric materials...

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Quick links

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

• SpringerLink shop

How to publish an article? – Step by step

If you plan to submit an article to one of our journals, or have any questions during the publication process, this helpdesk will guide you through manuscript submission, production and the services you can expect after your article’s publication.

1. Before you start

The following topics will be important during the early stages of writing your article.

• Publishing Ethics
• Open Access
• Impact Factor
• Rights, permissions and licensing
• Copyright and plagiarism

2. Turning your manuscript into an article

Preparation, publication.

- Find the right journal for your manuscript

- The Springer Journal Selector

- Manuscript preparation (reference styles, artwork guidelines, etc.)

Read more about Preparation

- Electronic submission

- Reviewing and acceptance

- Managing copyright  – The "MyPublication" process

Read more about Submission

- Copy editing and language polishing

- Data processing and type setting

- Article Tracking

- Checking your article: proofing procedure

- e.Proofing – Makes editing easy!

Read more about Production

- Publishing your article "Online First"

- Publishing your article in a journal issue

Read more about Publication

3. After publication

If your article has been published, the following topics are important for you:

• Abstracting & Indexing
• Online access to my article
• Citation Alert
• Book discounts
• Marketing to worldwide audiences

• PRO Courses Guides New Tech Help Pro Expert Videos About wikiHow Pro Upgrade Sign In
• EDIT Edit this Article
• EXPLORE Tech Help Pro About Us Random Article Quizzes Request a New Article Community Dashboard This Or That Game Popular Categories Arts and Entertainment Artwork Books Movies Computers and Electronics Computers Phone Skills Technology Hacks Health Men's Health Mental Health Women's Health Relationships Dating Love Relationship Issues Hobbies and Crafts Crafts Drawing Games Education & Communication Communication Skills Personal Development Studying Personal Care and Style Fashion Hair Care Personal Hygiene Youth Personal Care School Stuff Dating All Categories Arts and Entertainment Finance and Business Home and Garden Relationship Quizzes Cars & Other Vehicles Food and Entertaining Personal Care and Style Sports and Fitness Computers and Electronics Health Pets and Animals Travel Education & Communication Hobbies and Crafts Philosophy and Religion Work World Family Life Holidays and Traditions Relationships Youth
• Browse Articles
• Learn Something New
• Quizzes Hot
• This Or That Game
• Train Your Brain
• Explore More
• Support wikiHow
• About wikiHow
• Log in / Sign up
• Education and Communications
• College University and Postgraduate
• Academic Writing
• Research Papers

How to Write and Publish Your Research in a Journal

Last Updated: February 26, 2024 Fact Checked

Choosing a Journal

Writing the research paper, editing & revising your paper, submitting your paper, navigating the peer review process, research paper help.

This article was co-authored by Matthew Snipp, PhD and by wikiHow staff writer, Cheyenne Main . C. Matthew Snipp is the Burnet C. and Mildred Finley Wohlford Professor of Humanities and Sciences in the Department of Sociology at Stanford University. He is also the Director for the Institute for Research in the Social Science’s Secure Data Center. He has been a Research Fellow at the U.S. Bureau of the Census and a Fellow at the Center for Advanced Study in the Behavioral Sciences. He has published 3 books and over 70 articles and book chapters on demography, economic development, poverty and unemployment. He is also currently serving on the National Institute of Child Health and Development’s Population Science Subcommittee. He holds a Ph.D. in Sociology from the University of Wisconsin—Madison. There are 13 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 699,660 times.

Publishing a research paper in a peer-reviewed journal allows you to network with other scholars, get your name and work into circulation, and further refine your ideas and research. Before submitting your paper, make sure it reflects all the work you’ve done and have several people read over it and make comments. Keep reading to learn how you can choose a journal, prepare your work for publication, submit it, and revise it after you get a response back.

Things You Should Know

• Create a list of journals you’d like to publish your work in and choose one that best aligns with your topic and your desired audience.
• Prepare your manuscript using the journal’s requirements and ask at least 2 professors or supervisors to review your paper.
• Write a cover letter that “sells” your manuscript, says how your research adds to your field and explains why you chose the specific journal you’re submitting to.

• Ask your professors or supervisors for well-respected journals that they’ve had good experiences publishing with and that they read regularly.
• Many journals also only accept specific formats, so by choosing a journal before you start, you can write your article to their specifications and increase your chances of being accepted.
• If you’ve already written a paper you’d like to publish, consider whether your research directly relates to a hot topic or area of research in the journals you’re looking into.

• Review the journal’s peer review policies and submission process to see if you’re comfortable creating or adjusting your work according to their standards.
• Open-access journals can increase your readership because anyone can access them.

• Scientific research papers: Instead of a “thesis,” you might write a “research objective” instead. This is where you state the purpose of your research.
• “This paper explores how George Washington’s experiences as a young officer may have shaped his views during difficult circumstances as a commanding officer.”
• “This paper contends that George Washington’s experiences as a young officer on the 1750s Pennsylvania frontier directly impacted his relationship with his Continental Army troops during the harsh winter at Valley Forge.”

• Scientific research papers: Include a “materials and methods” section with the step-by-step process you followed and the materials you used. [5] X Research source
• Read other research papers in your field to see how they’re written. Their format, writing style, subject matter, and vocabulary can help guide your own paper. [6] X Research source

• If you’re writing about George Washington’s experiences as a young officer, you might emphasize how this research changes our perspective of the first president of the U.S.
• Link this section to your thesis or research objective.
• If you’re writing a paper about ADHD, you might discuss other applications for your research.

• Scientific research papers: You might include your research and/or analytical methods, your main findings or results, and the significance or implications of your research.
• Try to get as many people as you can to read over your abstract and provide feedback before you submit your paper to a journal.

• They might also provide templates to help you structure your manuscript according to their specific guidelines. [11] X Research source

• Not all journal reviewers will be experts on your specific topic, so a non-expert “outsider’s perspective” can be valuable.

• If you have a paper on the purification of wastewater with fungi, you might use both the words “fungi” and “mushrooms.”
• Use software like iThenticate, Turnitin, or PlagScan to check for similarities between the submitted article and published material available online. [15] X Research source

• Header: Address the editor who will be reviewing your manuscript by their name, include the date of submission, and the journal you are submitting to.
• First paragraph: Include the title of your manuscript, the type of paper it is (like review, research, or case study), and the research question you wanted to answer and why.
• Second paragraph: Explain what was done in your research, your main findings, and why they are significant to your field.
• Third paragraph: Explain why the journal’s readers would be interested in your work and why your results are important to your field.
• Conclusion: State the author(s) and any journal requirements that your work complies with (like ethical standards”).
• “We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.”
• “All authors have approved the manuscript and agree with its submission to [insert the name of the target journal].”

• Submit your article to only one journal at a time.
• When submitting online, use your university email account. This connects you with a scholarly institution, which can add credibility to your work.

• Accept: Only minor adjustments are needed, based on the provided feedback by the reviewers. A first submission will rarely be accepted without any changes needed.
• Revise and Resubmit: Changes are needed before publication can be considered, but the journal is still very interested in your work.
• Reject and Resubmit: Extensive revisions are needed. Your work may not be acceptable for this journal, but they might also accept it if significant changes are made.
• Reject: The paper isn’t and won’t be suitable for this publication, but that doesn’t mean it might not work for another journal.

• Try organizing the reviewer comments by how easy it is to address them. That way, you can break your revisions down into more manageable parts.
• If you disagree with a comment made by a reviewer, try to provide an evidence-based explanation when you resubmit your paper.

• If you’re resubmitting your paper to the same journal, include a point-by-point response paper that talks about how you addressed all of the reviewers’ comments in your revision. [22] X Research source
• If you’re not sure which journal to submit to next, you might be able to ask the journal editor which publications they recommend.

Expert Q&A

You might also like.

• If reviewers suspect that your submitted manuscript plagiarizes another work, they may refer to a Committee on Publication Ethics (COPE) flowchart to see how to move forward. [23] X Research source Thanks Helpful 0 Not Helpful 0

• ↑ https://www.wiley.com/en-us/network/publishing/research-publishing/choosing-a-journal/6-steps-to-choosing-the-right-journal-for-your-research-infographic
• ↑ https://link.springer.com/article/10.1007/s13187-020-01751-z
• ↑ https://libguides.unomaha.edu/c.php?g=100510&p=651627
• ↑ http://www.canberra.edu.au/library/start-your-research/research_help/publishing-research
• ↑ https://writingcenter.fas.harvard.edu/conclusions
• ↑ https://writing.wisc.edu/handbook/assignments/writing-an-abstract-for-your-research-paper/
• ↑ https://www.springer.com/gp/authors-editors/book-authors-editors/your-publication-journey/manuscript-preparation
• ↑ https://apus.libanswers.com/writing/faq/2391
• ↑ https://academicguides.waldenu.edu/library/keyword/search-strategy
• ↑ https://ifis.libguides.com/journal-publishing-guide/submitting-your-paper
• ↑ https://www.springer.com/kr/authors-editors/authorandreviewertutorials/submitting-to-a-journal-and-peer-review/cover-letters/10285574
• ↑ http://www.apa.org/monitor/sep02/publish.aspx
• ↑ Matthew Snipp, PhD. Research Fellow, U.S. Bureau of the Census. Expert Interview. 26 March 2020.

About This Article

To publish a research paper, ask a colleague or professor to review your paper and give you feedback. Once you've revised your work, familiarize yourself with different academic journals so that you can choose the publication that best suits your paper. Make sure to look at the "Author's Guide" so you can format your paper according to the guidelines for that publication. Then, submit your paper and don't get discouraged if it is not accepted right away. You may need to revise your paper and try again. To learn about the different responses you might get from journals, see our reviewer's explanation below. Did this summary help you? Yes No

• Send fan mail to authors

Reader Success Stories

RAMDEV GOHIL

Oct 16, 2017

Did this article help you?

David Okandeji

Oct 23, 2019

Revati Joshi

Feb 13, 2017

Shahzad Khan

Jul 1, 2017

Apr 7, 2017

Featured Articles

Trending Articles

Watch Articles

• Terms of Use
• Privacy Policy
• Do Not Sell or Share My Info
• Not Selling Info

Get all the best how-tos!

Sign up for wikiHow's weekly email newsletter

• Privacy Policy

Home » How to Publish a Research Paper – Step by Step Guide

How to Publish a Research Paper – Step by Step Guide

Table of Contents

Publishing a research paper is an important step for researchers to disseminate their findings to a wider audience and contribute to the advancement of knowledge in their field. Whether you are a graduate student, a postdoctoral fellow, or an established researcher, publishing a paper requires careful planning, rigorous research, and clear writing. In this process, you will need to identify a research question , conduct a thorough literature review , design a methodology, analyze data, and draw conclusions. Additionally, you will need to consider the appropriate journals or conferences to submit your work to and adhere to their guidelines for formatting and submission. In this article, we will discuss some ways to publish your Research Paper.

How to Publish a Research Paper

To Publish a Research Paper follow the guide below:

• Conduct original research : Conduct thorough research on a specific topic or problem. Collect data, analyze it, and draw conclusions based on your findings.
• Write the paper : Write a detailed paper describing your research. It should include an abstract, introduction, literature review, methodology, results, discussion, and conclusion.
• Choose a suitable journal or conference : Look for a journal or conference that specializes in your research area. You can check their submission guidelines to ensure your paper meets their requirements.
• Prepare your submission: Follow the guidelines and prepare your submission, including the paper, abstract, cover letter, and any other required documents.
• Submit the paper: Submit your paper online through the journal or conference website. Make sure you meet the submission deadline.
• Peer-review process : Your paper will be reviewed by experts in the field who will provide feedback on the quality of your research, methodology, and conclusions.
• Revisions : Based on the feedback you receive, revise your paper and resubmit it.
• Acceptance : Once your paper is accepted, you will receive a notification from the journal or conference. You may need to make final revisions before the paper is published.
• Publication : Your paper will be published online or in print. You can also promote your work through social media or other channels to increase its visibility.

How to Choose Journal for Research Paper Publication

Here are some steps to follow to help you select an appropriate journal:

• Identify your research topic and audience : Your research topic and intended audience should guide your choice of journal. Identify the key journals in your field of research and read the scope and aim of the journal to determine if your paper is a good fit.
• Analyze the journal’s impact and reputation : Check the impact factor and ranking of the journal, as well as its acceptance rate and citation frequency. A high-impact journal can give your paper more visibility and credibility.
• Consider the journal’s publication policies : Look for the journal’s publication policies such as the word count limit, formatting requirements, open access options, and submission fees. Make sure that you can comply with the requirements and that the journal is in line with your publication goals.
• Look at recent publications : Review recent issues of the journal to evaluate whether your paper would fit in with the journal’s current content and style.
• Seek advice from colleagues and mentors: Ask for recommendations and suggestions from your colleagues and mentors in your field, especially those who have experience publishing in the same or similar journals.
• Be prepared to make changes : Be prepared to revise your paper according to the requirements and guidelines of the chosen journal. It is also important to be open to feedback from the editor and reviewers.

List of Journals for Research Paper Publications

There are thousands of academic journals covering various fields of research. Here are some of the most popular ones, categorized by field:

General/Multidisciplinary

• Nature: https://www.nature.com/
• Science: https://www.sciencemag.org/
• PLOS ONE: https://journals.plos.org/plosone/
• Proceedings of the National Academy of Sciences (PNAS): https://www.pnas.org/
• The Lancet: https://www.thelancet.com/
• JAMA (Journal of the American Medical Association): https://jamanetwork.com/journals/jama

Social Sciences/Humanities

• Journal of Personality and Social Psychology: https://www.apa.org/pubs/journals/psp
• Journal of Consumer Research: https://www.journals.uchicago.edu/journals/jcr
• Journal of Educational Psychology: https://www.apa.org/pubs/journals/edu
• Journal of Applied Psychology: https://www.apa.org/pubs/journals/apl
• Journal of Communication: https://academic.oup.com/joc
• American Journal of Political Science: https://ajps.org/
• Journal of International Business Studies: https://www.jibs.net/
• Journal of Marketing Research: https://www.ama.org/journal-of-marketing-research/

Natural Sciences

• Journal of Biological Chemistry: https://www.jbc.org/
• Cell: https://www.cell.com/
• Science Advances: https://advances.sciencemag.org/
• Chemical Reviews: https://pubs.acs.org/journal/chreay
• Angewandte Chemie: https://onlinelibrary.wiley.com/journal/15213765
• Physical Review Letters: https://journals.aps.org/prl/
• Journal of Geophysical Research: https://agupubs.onlinelibrary.wiley.com/journal/2156531X
• Journal of High Energy Physics: https://link.springer.com/journal/13130

Engineering/Technology

• IEEE Transactions on Neural Networks and Learning Systems: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=5962385
• IEEE Transactions on Power Systems: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=59
• IEEE Transactions on Medical Imaging: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=42
• IEEE Transactions on Control Systems Technology: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=87
• Journal of Engineering Mechanics: https://ascelibrary.org/journal/jenmdt
• Journal of Materials Science: https://www.springer.com/journal/10853
• Journal of Chemical Engineering of Japan: https://www.jstage.jst.go.jp/browse/jcej
• Journal of Mechanical Design: https://asmedigitalcollection.asme.org/mechanicaldesign

Medical/Health Sciences

• New England Journal of Medicine: https://www.nejm.org/
• The BMJ (formerly British Medical Journal): https://www.bmj.com/
• Journal of the American Medical Association (JAMA): https://jamanetwork.com/journals/jama
• Annals of Internal Medicine: https://www.acpjournals.org/journal/aim
• American Journal of Epidemiology: https://academic.oup.com/aje
• Journal of Clinical Oncology: https://ascopubs.org/journal/jco
• Journal of Infectious Diseases: https://academic.oup.com/jid

List of Conferences for Research Paper Publications

There are many conferences that accept research papers for publication. The specific conferences you should consider will depend on your field of research. Here are some suggestions for conferences in a few different fields:

Computer Science and Information Technology:

• IEEE International Conference on Computer Communications (INFOCOM): https://www.ieee-infocom.org/
• ACM SIGCOMM Conference on Data Communication: https://conferences.sigcomm.org/sigcomm/
• IEEE Symposium on Security and Privacy (SP): https://www.ieee-security.org/TC/SP/
• ACM Conference on Computer and Communications Security (CCS): https://www.sigsac.org/ccs/
• ACM Conference on Human-Computer Interaction (CHI): https://chi2022.acm.org/

Engineering:

• IEEE International Conference on Robotics and Automation (ICRA): https://www.ieee-icra.org/
• International Conference on Mechanical and Aerospace Engineering (ICMAE): http://www.icmae.org/
• International Conference on Civil and Environmental Engineering (ICCEE): http://www.iccee.org/
• International Conference on Materials Science and Engineering (ICMSE): http://www.icmse.org/
• International Conference on Energy and Power Engineering (ICEPE): http://www.icepe.org/

Natural Sciences:

• American Chemical Society National Meeting & Exposition: https://www.acs.org/content/acs/en/meetings/national-meeting.html
• American Physical Society March Meeting: https://www.aps.org/meetings/march/
• International Conference on Environmental Science and Technology (ICEST): http://www.icest.org/
• International Conference on Natural Science and Environment (ICNSE): http://www.icnse.org/
• International Conference on Life Science and Biological Engineering (LSBE): http://www.lsbe.org/

Social Sciences:

• Annual Meeting of the American Sociological Association (ASA): https://www.asanet.org/annual-meeting-2022
• International Conference on Social Science and Humanities (ICSSH): http://www.icssh.org/
• International Conference on Psychology and Behavioral Sciences (ICPBS): http://www.icpbs.org/
• International Conference on Education and Social Science (ICESS): http://www.icess.org/
• International Conference on Management and Information Science (ICMIS): http://www.icmis.org/

How to Publish a Research Paper in Journal

Publishing a research paper in a journal is a crucial step in disseminating scientific knowledge and contributing to the field. Here are the general steps to follow:

• Choose a research topic : Select a topic of your interest and identify a research question or problem that you want to investigate. Conduct a literature review to identify the gaps in the existing knowledge that your research will address.
• Conduct research : Develop a research plan and methodology to collect data and conduct experiments. Collect and analyze data to draw conclusions that address the research question.
• Write a paper: Organize your findings into a well-structured paper with clear and concise language. Your paper should include an introduction, literature review, methodology, results, discussion, and conclusion. Use academic language and provide references for your sources.
• Choose a journal: Choose a journal that is relevant to your research topic and audience. Consider factors such as impact factor, acceptance rate, and the reputation of the journal.
• Follow journal guidelines : Review the submission guidelines and formatting requirements of the journal. Follow the guidelines carefully to ensure that your paper meets the journal’s requirements.
• Submit your paper : Submit your paper to the journal through the online submission system or by email. Include a cover letter that briefly explains the significance of your research and why it is suitable for the journal.
• Wait for reviews: Your paper will be reviewed by experts in the field. Be prepared to address their comments and make revisions to your paper.
• Revise and resubmit: Make revisions to your paper based on the reviewers’ comments and resubmit it to the journal. If your paper is accepted, congratulations! If not, consider revising and submitting it to another journal.
• Address reviewer comments : Reviewers may provide comments and suggestions for revisions to your paper. Address these comments carefully and thoughtfully to improve the quality of your paper.
• Submit the final version: Once your revisions are complete, submit the final version of your paper to the journal. Be sure to follow any additional formatting guidelines and requirements provided by the journal.
• Publication : If your paper is accepted, it will be published in the journal. Some journals provide online publication while others may publish a print version. Be sure to cite your published paper in future research and communicate your findings to the scientific community.

How to Publish a Research Paper for Students

Here are some steps you can follow to publish a research paper as an Under Graduate or a High School Student:

• Select a topic: Choose a topic that is relevant and interesting to you, and that you have a good understanding of.
• Conduct research : Gather information and data on your chosen topic through research, experiments, surveys, or other means.
• Write the paper : Start with an outline, then write the introduction, methods, results, discussion, and conclusion sections of the paper. Be sure to follow any guidelines provided by your instructor or the journal you plan to submit to.
• Edit and revise: Review your paper for errors in spelling, grammar, and punctuation. Ask a peer or mentor to review your paper and provide feedback for improvement.
• Choose a journal : Look for journals that publish papers in your field of study and that are appropriate for your level of research. Some popular journals for students include PLOS ONE, Nature, and Science.
• Submit the paper: Follow the submission guidelines for the journal you choose, which typically include a cover letter, abstract, and formatting requirements. Be prepared to wait several weeks to months for a response.
• Address feedback : If your paper is accepted with revisions, address the feedback from the reviewers and resubmit your paper. If your paper is rejected, review the feedback and consider revising and resubmitting to a different journal.

How to Publish a Research Paper for Free

Publishing a research paper for free can be challenging, but it is possible. Here are some steps you can take to publish your research paper for free:

• Choose a suitable open-access journal: Look for open-access journals that are relevant to your research area. Open-access journals allow readers to access your paper without charge, so your work will be more widely available.
• Check the journal’s reputation : Before submitting your paper, ensure that the journal is reputable by checking its impact factor, publication history, and editorial board.
• Follow the submission guidelines : Every journal has specific guidelines for submitting papers. Make sure to follow these guidelines carefully to increase the chances of acceptance.
• Submit your paper : Once you have completed your research paper, submit it to the journal following their submission guidelines.
• Wait for the review process: Your paper will undergo a peer-review process, where experts in your field will evaluate your work. Be patient during this process, as it can take several weeks or even months.
• Revise your paper : If your paper is rejected, don’t be discouraged. Revise your paper based on the feedback you receive from the reviewers and submit it to another open-access journal.
• Promote your research: Once your paper is published, promote it on social media and other online platforms. This will increase the visibility of your work and help it reach a wider audience.

Journals and Conferences for Free Research Paper publications

Here are the websites of the open-access journals and conferences mentioned:

Open-Access Journals:

• PLOS ONE – https://journals.plos.org/plosone/
• BMC Research Notes – https://bmcresnotes.biomedcentral.com/
• Frontiers in… – https://www.frontiersin.org/
• Journal of Open Research Software – https://openresearchsoftware.metajnl.com/
• PeerJ – https://peerj.com/

Conferences:

• IEEE Global Communications Conference (GLOBECOM) – https://globecom2022.ieee-globecom.org/
• IEEE International Conference on Computer Communications (INFOCOM) – https://infocom2022.ieee-infocom.org/
• IEEE International Conference on Data Mining (ICDM) – https://www.ieee-icdm.org/
• ACM SIGCOMM Conference on Data Communication (SIGCOMM) – https://conferences.sigcomm.org/sigcomm/
• ACM Conference on Computer and Communications Security (CCS) – https://www.sigsac.org/ccs/CCS2022/

Importance of Research Paper Publication

Research paper publication is important for several reasons, both for individual researchers and for the scientific community as a whole. Here are some reasons why:

• Advancing scientific knowledge : Research papers provide a platform for researchers to present their findings and contribute to the body of knowledge in their field. These papers often contain novel ideas, experimental data, and analyses that can help to advance scientific understanding.
• Building a research career : Publishing research papers is an essential component of building a successful research career. Researchers are often evaluated based on the number and quality of their publications, and having a strong publication record can increase one’s chances of securing funding, tenure, or a promotion.
• Peer review and quality control: Publication in a peer-reviewed journal means that the research has been scrutinized by other experts in the field. This peer review process helps to ensure the quality and validity of the research findings.
• Recognition and visibility : Publishing a research paper can bring recognition and visibility to the researchers and their work. It can lead to invitations to speak at conferences, collaborations with other researchers, and media coverage.
• Impact on society : Research papers can have a significant impact on society by informing policy decisions, guiding clinical practice, and advancing technological innovation.

Advantages of Research Paper Publication

There are several advantages to publishing a research paper, including:

• Recognition: Publishing a research paper allows researchers to gain recognition for their work, both within their field and in the academic community as a whole. This can lead to new collaborations, invitations to conferences, and other opportunities to share their research with a wider audience.
• Career advancement : A strong publication record can be an important factor in career advancement, particularly in academia. Publishing research papers can help researchers secure funding, grants, and promotions.
• Dissemination of knowledge : Research papers are an important way to share new findings and ideas with the broader scientific community. By publishing their research, scientists can contribute to the collective body of knowledge in their field and help advance scientific understanding.
• Feedback and peer review : Publishing a research paper allows other experts in the field to provide feedback on the research, which can help improve the quality of the work and identify potential flaws or limitations. Peer review also helps ensure that research is accurate and reliable.
• Citation and impact : Published research papers can be cited by other researchers, which can help increase the impact and visibility of the research. High citation rates can also help establish a researcher’s reputation and credibility within their field.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

How to Cite Research Paper – All Formats and...

Delimitations in Research – Types, Examples and...

Research Paper Format – Types, Examples and...

Research Design – Types, Methods and Examples

Research Paper Title – Writing Guide and Example

Research Paper Introduction – Writing Guide and...

Find the right journal

If you know the name of the journal you want to submit to, view all journals .

If you would like us to recommend the journal/s that are best suited to publish your article, use our Journal Suggester . All you need is an abstract or description of your article to find matching journals.

Tips for finding the right journal

Submitting a manuscript to unsuitable journals is a common mistake, and can cause journal editors to reject the manuscript before peer review. Choosing a relevant journal makes it more likely that your manuscript will be accepted. Some factors to consider are:

• The topics the journal publishes. If your research is applied, target a journal that publishes applied science; if it is clinical, target a clinical journal; if it is basic research, target a journal that publishes basic research. You may find it easier to browse a list of journals by subject area.
• The journal's audience. Will researchers in related fields be interested in your study? If so, a journal that covers a broad range of topics may be best. If only researchers in your field are likely to want to read your study, then a field-specific journal would be best.
• The types of articles the journal publishes. If you are looking to publish a review, case study or a theorem, ensure that your target journal accepts theses type of manuscripts.
• The reputation of the journal. A journal's Impact Factor is one measure of its reputation, but not always the most important. You should consider the prestige of the authors that publish in the journal and whether your research is of a similar level.
• What are your personal requirements: Does the journal usually publish articles quickly; is the "time to publication" important for you?

When looking for suitable journals in which to publish your own results, start with what you have read. You should already be familiar with published studies that are similar to yours. Which journal were those studies published in? The same journals may be appropriate for your manuscript, so make a list of them. If you need more journals to consider, you can do literature searches for other published articles in your field that are similar in scope and impact on the field, and see where they were published.

When you have a list of potential target journals, visit and read the websites for these journals. Every journal should have a page that provides instructions for authors, including information on many of the factors listed above.

Journals on your list that are not a match for your manuscript based on the factors listed above should be eliminated from consideration. Among the remaining journals, it is likely that one or more will stand out as a very good candidate. Consider if any additional experiments will give you a better chance of achieving publication in your top choice. If you are in a hurry to publish, consider which of the remaining journals offers rapid publication; if none do, consider which has the highest publication frequency. If your main goal is to reach as many readers as possible, strongly consider candidate journals that provide an open access option. Open access allows anyone to read your article, free of charge, online, which can make your article more likely to be read and cited.

When you have chosen the journal you think is the best fit for your study and your goals, it is usually a good idea to also identify your second- and third-choice journals. That way, if your paper is rejected from your first-choice journal, you can quickly submit to your second-choice journal.

• Open access
• Published: 13 May 2024

Sexual and reproductive health implementation research in humanitarian contexts: a scoping review

• Alexandra Norton 1 &
• Hannah Tappis 2  

Reproductive Health volume  21 , Article number:  64 ( 2024 ) Cite this article

202 Accesses

6 Altmetric

Metrics details

Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited.

A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included.

Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process.

This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.

Plain English summary

Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.

Peer Review reports

Over the past few decades, the field of public health implementation research (IR) has grown as a means by which the real-world conditions affecting health improvement efforts can be better understood. Peters et al. put forward the following broad definition of IR for health: “IR is the scientific inquiry into questions concerning implementation – the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions)” [ 1 ].

As IR emphasizes real-world circumstances, the context within which a health intervention is delivered is a core consideration. However, much IR implemented to date has focused on higher-resource settings, with many proposed frameworks developed with particular utility for a higher-income setting [ 2 ]. In recognition of IR’s potential to increase evidence across a range of settings, there have been numerous reviews of the use of IR in lower-resource settings as well as calls for broader use [ 3 , 4 ]. There have also been more focused efforts to modify various approaches and frameworks to strengthen the relevance of IR to low- and middle-income country settings (LMICs), such as the work by Means et al. to adapt a specific IR framework for increased utility in LMICs [ 2 ].

Within LMIC settings, the centrality of context to a health intervention’s impact is of particular relevance in humanitarian settings, which present a set of distinct implementation challenges [ 5 ]. Humanitarian responses to crisis situations operate with limited resources, under potential security concerns, and often under pressure to relieve acute suffering and need [ 6 ]. Given these factors, successful implementation of a particular health intervention may require different qualities than those that optimize intervention impact under more stable circumstances [ 7 ]. Despite increasing recognition of the need for expanded evidence of health interventions in humanitarian settings, the evidence base remains limited [ 8 ]. Furthermore, despite its potential utility, there is not standardized guidance on IR in humanitarian settings, nor are there widely endorsed recommendations for the frameworks best suited to analyze implementation in these settings.

Sexual and reproductive health (SRH) is a core aspect of the health sector response in humanitarian settings [ 9 ]. Yet, progress in addressing SRH needs has lagged far behind other services because of challenges related to culture and ideology, financing constraints, lack of data and competing priorities [ 10 ]. The Minimum Initial Service Package (MISP) for SRH in Crisis Situations is the international standard for the minimum set of SRH services that should be implemented in all crisis situations [ 11 ]. However, as in other areas of health, there is need for expanded evidence for planning and implementation of SRH interventions in humanitarian settings. Recent systematic reviews of SRH in humanitarian settings have focused on the effectiveness of interventions and service delivery strategies, as well as factors affecting utilization, but have not detailed whether IR frameworks were used [ 12 , 13 , 14 , 15 ]. There have also been recent reviews examining IR frameworks used in various settings and research areas, but none have explicitly focused on humanitarian settings [ 2 , 16 ].

Given the need for an expanded evidence base for SRH interventions in humanitarian settings and the potential for IR to be used to expand the available evidence, a scoping review was undertaken. This scoping review sought to identify IR approaches that have been used in the last ten years to evaluate SRH interventions in humanitarian settings.

This review also sought to shed light on whether there is a need for a common framework to guide research design, analysis, and reporting for SRH interventions in humanitarian settings and if so, if there are any established frameworks already in use that would be fit-for-purpose or could be tailored to meet this need.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was utilized to guide the elements of this review [ 17 ]. The review protocol was retrospectively registered with the Open Science Framework ( https://osf.io/b5qtz ).

Search strategy

A two-fold search strategy was undertaken for this review, which covered the last 10 years (2013–2022). First, recent systematic reviews pertaining to research or evaluation of SRH interventions in humanitarian settings were identified through keyword searches on PubMed and Google Scholar. Four relevant systematic reviews were identified [ 12 , 13 , 14 , 15 ] Table 1 .

Second, a literature search mirroring these reviews was conducted to identify relevant papers published since the completion of searches for the most recent review (April 2017). Additional file 1 includes the search terms that were used in the literature search [see Additional file 1 ].

The literature search was conducted for papers published from April 2017 to December 2022 in the databases that were searched in one or more of the systematic reviews: PubMed, Embase, PsycInfo, CINAHL and Global Health. Searches were completed in January 2023 Table 2 .

Two reviewers screened each identified study for alignment with inclusion criteria. Studies in the four systematic reviews identified were considered potentially eligible if published during the last 10 years. These papers then underwent full-text review to confirm satisfaction of all inclusion criteria, as inclusion criteria were similar but not fully aligned across the four reviews.

Literature search results were exported into a citation manager (Covidence), duplicates were removed, and a step-wise screening process for inclusion was applied. First, all papers underwent title and abstract screening. The remaining papers after abstract screening then underwent full-text review to confirm satisfaction of all inclusion criteria. Title and abstract screening as well as full-text review was conducted independently by both authors; disagreements after full-text review were resolved by consensus.

Data extraction and synthesis

The following content areas were summarized in Microsoft Excel for each paper that met inclusion criteria: publication details including author, year, country, setting [rural, urban, camp, settlement], population [refugees, internally displaced persons, general crisis-affected], crisis type [armed conflict, natural disaster], crisis stage [acute, chronic], study design, research methods, SRH intervention, and intervention target population [specific beneficiaries of the intervention within the broader population]; the use of an IR framework; details regarding the IR framework, how it was used, and any rationale given for the framework used; factors cited as impacting SRH interventions, either positively or negatively; and other key findings deemed relevant to this review.

As the focus of this review was on the approach taken for SRH intervention research and evaluation, the quality of the studies themselves was not assessed.

Twenty papers underwent full-text review due to their inclusion in one or more of the four systematic reviews and meeting publication date inclusion criteria. The literature search identified 7,016 unique papers. After full-text screening, 69 met all inclusion criteria and were included in the review. Figure  1 illustrates the search strategy and screening process.

Flow chart of paper identification

Papers published in each of the 10 years of the review timeframe (2013–2022) were included. 29% of the papers originated from the first five years of the time frame considered for this review, with the remaining 71% papers coming from the second half. Characteristics of included publications, including geographic location, type of humanitarian crisis, and type of SRH intervention, are presented in Table  3 .

A wide range of study designs and methods were used across the papers, with both qualitative and quantitative studies well represented. Twenty-six papers were quantitative evaluations [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], 17 were qualitative [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ], and 26 used mixed methods [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ]. Within the quantitative evaluations, 15 were observational, while five were quasi-experimental, five were randomized controlled trials, and one was an economic evaluation. Study designs as classified by the authors of this review are summarized in Table  4 .

Six papers (9%) explicitly cited use of an IR framework. Three of these papers utilized the Consolidated Framework for Implementation Research (CFIR) [ 51 , 65 , 70 ]. The CFIR is a commonly used determinant framework that—in its originally proposed form in 2009—is comprised of five domains, each of which has constructs to further categorize factors that impact implementation. The CFIR domains were identified as core content areas influencing the effectiveness of implementation, and the constructs within each domain are intended to provide a range of options for researchers to select from to “guide diagnostic assessments of implementation context, evaluate implementation progress, and help explain findings.” [ 87 ] To allow for consistent terminology throughout this review, the original 2009 CFIR domains and constructs are used.

Guan et al. conducted a mixed methods study to assess the feasibility and effectiveness of a neonatal hepatitis B immunization program in a conflict-affected rural region of Myanmar. Guan et al. report mapping data onto the CFIR as a secondary analysis step. They describe that “CFIR was used as a comprehensive meta-theoretical framework to examine the implementation of the Hepatitis B Virus vaccination program,” and implementation themes from multiple study data sources (interviews, observations, examination of monitoring materials) were mapped onto CFIR constructs. They report their results in two phases – Pre-implementation training and community education, and Implementation – with both anchored in themes that they had mapped onto CFIR domains and constructs. All but six constructs were included in their analysis, with a majority summarized in a table and key themes explored further in the narrative text. They specify that most concerns were identified within the Outer Setting and Process domains, while elements identified within the Inner Setting domain provided strength to the intervention and helped mitigate against barriers [ 70 ].

Sarker et al. conducted a qualitative study to assess provision of maternal, newborn and child health services to Rohingya refugees residing in camps in Cox’s Bazar, Bangladesh. They cite using CFIR as a guide for thematic analysis, applying it after a process of inductive and deductive coding to index these codes into the CFIR domains. They utilized three of the five CFIR domains (Outer Setting, Inner Setting, and Process), stating that the remaining two domains (Intervention Characteristics and Characteristics of Individuals) were not relevant to their analysis. They then proposed two additional CFIR domains, Context and Security, for use in humanitarian contexts. In contrast to Guan et al., CFIR constructs are not used nor mentioned by Sarker et al., with content under each domain instead synthesized as challenges and potential solutions. Regarding the CFIR, Sarker et al. write, “The CFIR guided us for interpretative coding and creating the challenges and possible solutions into groups for further clarification of the issues related to program delivery in a humanitarian crisis setting.” [ 51 ]

Sami et al. conducted a mixed methods case study to assess the implementation of a package of neonatal interventions at health facilities within refugee and internally displaced persons camps in South Sudan. They reference use of the CFIR earlier in the study than Sarker et al., basing their guides for semi-structured focus group discussions on the CFIR framework. They similarly reference a general use of the CFIR framework as they conducted thematic analysis. Constructs are referenced once, but they do not specify whether their application of the CFIR framework included use of domains, constructs, or both. This may be in part because they then applied an additional framework, the World Health Organization (WHO) Health System Framework, to present their findings. They describe a nested approach to their use of these frameworks: “Exploring these [CFIR] constructs within the WHO Health Systems Framework can identify specific entry points to improve the implementation of newborn interventions at critical health system building blocks.” [ 65 ]

Three papers cite use of different IR frameworks. Bolan et al. utilized the Theoretical Domains Framework in their mixed methods feasibility study and pilot cluster randomized trial evaluating pilot use of the Safe Delivery App by maternal and newborn health workers providing basic emergency obstetric and newborn care in facilities in the conflict-affected Maniema province of the Democratic Republic of the Congo (DRC). They used the Theroetical Domains Framework in designing interview questions, and further used it as the coding framework for their analysis. Similar to the CFIR, the Theoretical Domains Framework is a determinant framework that consists of domains, each of which then includes constructs. Bolan et al. utilized the Theoretical Domains Framework at the construct level in interview question development and at the domain level in their analysis, mapping interview responses to eight of the 14 domains [ 83 ]. Berg et al. report using an “exploratory design guided by the principles of an evaluation framework” developed by the Medical Research Council to analyze the implementation process, mechanisms of impact, and outcomes of a three-pillar training intervention to improve maternal and neonatal healthcare in the conflict-affected South Kivu province of the DRC [ 67 , 88 ]. Select components of this evaluation framework were used to guide deductive analysis of focus group discussions and in-depth interviews [ 67 ]. In their study of health workers’ knowledge and attitudes toward newborn health interventions in South Sudan, before and after training and supply provision, Sami et al. report use of the Conceptual Framework of the Role of Attitudes in Evidence-Based Practice Implementation in their analysis process. The framework was used to group codes following initial inductive coding analysis of in-depth interviews [ 72 ].

Three other papers cite use of specific frameworks in their intervention evaluation [ 19 , 44 , 76 ]. As a characteristic of IR is the use of an explicit framework to guide the research, the use of the frameworks in these three papers meets the intention of IR and serves the purpose that an IR framework would have in strengthening the analytical rigor. Castle et al. cite use of their program’s theory of change as a framework for a mixed methods evaluation of the provision of family planning services and more specifically uptake of long-acting reversible contraception use in the DRC. They describe use of the theory of change to “enhance effectiveness of [long-acting reversible contraception] access and uptake.” [ 76 ] Thommesen et al. cite use of the AAAQ (Availability, Accessibility, Acceptability and Quality) framework in their qualitative study assessing midwifery services provided to pregnant women in Afghanistan. This framework is focused on the “underlying elements needed for attainment of optimum standard of health care,” but the authors used it in this paper to evaluate facilitators and barriers to women accessing midwifery services [ 44 ]. Jarrett et al. cite use of the Centers for Disease Control and Prevention’s (CDC) Guidelines for Evaluating Public Health Surveillance Systems to explore the characteristics of a population mobility, mortality and birth surveillance system in South Kivu, DRC. Use of these CDC guidelines is cited as one of four study objectives, and commentary is included in the Results section pertaining to each criteria within these guidelines, although more detail regarding use of these guidelines or the authors’ experience with their use in the study is not provided [ 19 ].

Overall, 22 of the 69 papers either explicitly or implicitly identified IR as relevant to their work. Nineteen papers include a focus on feasibility (seven of which did not otherwise identify the importance of exploring questions concerning implementation), touching on a common outcome of interest in implementation research [ 89 ].

While a majority of papers did not explicitly or implicitly use an IR framework to evaluate their SRH intervention of focus, most identified factors that facilitated implementation when they were present or served as a barrier when absent. Sixty cite factors that served as facilitators and 49 cite factors that served as barriers, with just three not citing either. Fifty-nine distinct factors were identified across the papers.

Three of the six studies that explicitly used an IR framework used the CFIR, and the CFIR is the only IR framework that was used by multiple studies. As previously mentioned, Means et al. put forth an adaptation of the CFIR to increase its relevance in LMIC settings, proposing a sixth domain (Characteristics of Systems) and 11 additional constructs [ 2 ]. Using the expanded domains and constructs as proposed by Means et al., the 59 factors cited by papers in this review were thematically grouped into the six domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. Within each domain, alignment with CFIR constructs was assessed for, and alignment was found with 29 constructs: eight of Means et al.’s 11 constructs, and 21 of the 39 standard CFIR constructs. Three factors did not align with any construct (all fitting within the Outer Setting domain), and 14 aligned with a construct label but not the associated definition. Table 5 synthesizes the mapping of factors affecting SRH intervention implementation to CFIR domains and constructs, with the construct appearing in italics if it is considered to align with that factor by label but not by definition.

Table 6 lists the CFIR constructs that were not found to have alignment with any factor cited by the papers in this review.

This scoping review sought to assess how IR frameworks have been used to bolster the evidence base for SRH interventions in humanitarian settings, and it revealed that IR frameworks, or an explicit IR approach, are rarely used. All four of the systematic reviews identified with a focus on SRH in humanitarian settings articulate the need for more research examining the effectiveness of SRH interventions in humanitarian settings, with two specifically citing a need for implementation research/science [ 12 , 13 ]. The distribution of papers across the timeframe included in this review does suggest that more research on SRH interventions for crisis-affected populations is taking place, as a majority of relevant papers were published in the second half of the review period. The papers included a wide range of methodologies, which reflect the differing research questions and contexts being evaluated. However, it also invites the question of whether there should be more standardization of outcomes measured or frameworks used to guide analysis and to facilitate increased comparison, synthesis and application across settings.

Three of the six papers that used an IR framework utilized the CFIR. Guan et al. used the CFIR at both a domain and construct level, Sarker et al. used the CFIR at the domain level, and Sami et al. did not specify which CFIR elements were used in informing the focus group discussion guide [ 51 , 65 , 70 ]. It is challenging to draw strong conclusions about the applicability of CFIR in humanitarian settings based on the minimal use of CFIR and IR frameworks within the papers reviewed, although Guan et al. provides a helpful model for how analysis can be structured around CFIR domains and constructs. It is worth considering that the minimal use of IR frameworks, and more specifically CFIR constructs, could be in part because that level of prescriptive categorization does not allow for enough fluidity in humanitarian settings. It also raises questions about the appropriate degree of standardization to pursue for research done in these settings.

The mapping of factors affecting SRH intervention implementation provides an example of how a modified CFIR framework could be used for IR in humanitarian contexts. This mapping exercise found factors that mapped to all five of the original CFIR domains as well as the sixth domain proposed by Means et al. All factors fit well within the definition for the selected domain, indicating an appropriate degree of fit between these existing domains and the factors identified as impacting SRH interventions in humanitarian settings. On a construct level, however, the findings were more variable, with one-quarter of factors not fully aligning with any construct. Furthermore, over 40% of the CFIR constructs (including the additional constructs from Means et al.) were not found to align with any factors cited by the papers in this review, also demonstrating some disconnect between the parameters posed by the CFIR constructs and the factors cited as relevant in a humanitarian context.

It is worth noting that while the CFIR as proposed in 2009 was used in this assessment, as well as in the included papers which used the CFIR, an update was published in 2022. Following a review of CFIR use since its publication, the authors provide updates to construct names and definitions to “make the framework more applicable across a range of innovations and settings.” New constructs and subconstructs were also added, for a total of 48 constructs and 19 subconstructs across the five domains [ 90 ]. A CFIR Outcomes Addendum was also published in 2022, based on recommendations for the CFIR to add outcomes and intended to be used as a complement to the CFIR determinants framework [ 91 ]. These expansions to the CFIR framework may improve applicability of the CFIR in humanitarian settings. Several constructs added to the Outer Setting domain could be of particular utility – critical incidents, local attitudes, and local conditions, each of which could help account for unique challenges faced in contexts of crisis. Sub-constructs added within the Inner Setting domain that seek to clarify structural characteristics and available resources would also be of high utility based on mapping of the factors identified in this review to the original CFIR constructs. As outcomes were not formally included in the CFIR until the 2022 addendum, a separate assessment of implementation outcomes was not undertaken in this review. However, analysis of the factors cited by papers in this review as affecting implementation was derived from the full text of the papers and thus captures content relevant to implementation determinants that is contained within the outcomes.

Given the demonstrated need for additional flexibility within an IR framework for humanitarian contexts, while not a focus of this review, it is worth considering whether a different framework could provide a better fit than the CFIR. Other frameworks have differing points of emphasis that would create different opportunities for flexibility but that do not seem to resolve the challenges experienced in applying the CFIR to a humanitarian context. As one example, the EPIS (Exploration, Preparation, Implementation, Sustainment) Framework considers the impact of inner and outer context on each of four implementation phases; while the constructs within this framework are broader than the CFIR, an emphasis on the intervention characteristics is missing, a domain where stronger alignment within the CFIR is also needed [ 92 ]. Alternatively, the PRISM (Practical, Robust Implementation and Sustainability Model) framework is a determinant and evaluation framework that adds consideration of context factors to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes framework. It has a stronger emphasis on intervention aspects, with sub-domains to account for both organization and patient perspectives within the intervention. While PRISM does include aspects of context, external environment considerations are less robust and intentionally less comprehensive in scope, which would not provide the degree of alignment possible between the Characteristics of Systems and Outer Setting CFIR domains for the considerations unique to humanitarian environments [ 93 ].

Reflecting on their experience with the CFIR, Sarker et al. indicate that it can be a “great asset” in both evaluating current work and developing future interventions. They also encourage future research of humanitarian health interventions to utilize the CFIR [ 51 ]. The other papers that used the CFIR do not specifically reflect on their experience utilizing it, referring more generally to having felt that it was a useful tool [ 65 , 70 ]. On their use of an evaluation framework, Berg et al. reflected that it lent useful structure and helped to identify aspects affecting implementation that otherwise would have gone un-noticed [ 67 ]. The remaining studies that utilized an IR framework did not specifically comment on their experience with its use [ 72 , 83 ]. While a formal IR framework was not engaged by other studies, a number cite a desire for IR to contribute further detail to their findings [ 21 , 37 ].

In their recommendations for strengthening the evidence base for humanitarian health interventions, Ager et al. speak to the need for “methodologic innovation” to develop methodologies with particular applicability in humanitarian settings [ 7 ]. As IR is not yet routinized for SRH interventions, this could be opportune timing for the use of a standardized IR framework to gauge its utility. Using an IR framework to assess factors influencing implementation of the MISP in initial stages of a humanitarian response, and interventions to support more comprehensive SRH service delivery in protracted crises, could lend further rigor and standardization to SRH evaluations, as well as inform strategies to improve MISP implementation over time. Based on categorizing factors identified by these papers as relevant for intervention evaluation, there does seem to be utility to a modified CFIR approach. Given the paucity of formal IR framework use within SRH literature, it would be worth conducting similar scoping exercises to assess for explicit use of IR frameworks within the evidence base for other health service delivery areas in humanitarian settings. In the interim, the recommended approach from this review for future IR on humanitarian health interventions would be a modified CFIR approach with domain-level standardization and flexibility for constructs that may standardize over time with more use. This would enable use of a common analytical framework and vocabulary at the domain level for stakeholders to describe interventions and the factors influencing the effectiveness of implementation, with constructs available to use and customize as most appropriate for specific contexts and interventions.

This review had a number of limitations. As this was a scoping review and a two-part search strategy was used, the papers summarized here may not be comprehensive of those written pertaining to SRH interventions over the past 10 years. Papers from 2013 to 2017 that would have met this scoping review’s inclusion criteria may have been omitted due to being excluded from the systematic reviews. The review was limited to papers available in English. Furthermore, this review did not assess the quality of the papers included or seek to assess the methodology used beyond examination of the use of an IR framework. It does, however, serve as a first step in assessing the extent to which calls for implementation research have been addressed, and identify entry points for strengthening the science and practice of SRH research in humanitarian settings.

With one in 23 people worldwide in need of humanitarian assistance, and financing required for response plans at an all-time high, the need for evidence to guide resource allocation and programming for SRH in humanitarian settings is as important as ever [ 94 ]. Recent research agenda setting initiatives and strategies to advance health in humanitarian settings call for increased investment in implementation research—with priorities ranging from research on effective strategies for expanding access to a full range of contraceptive options to integrating mental health and psychosocial support into SRH programming to capturing accurate and actionable data on maternal and perinatal mortality in a wide range of acute and protracted emergency contexts [ 95 , 96 ]. To truly advance guidance in these areas, implementation research will need to be conducted across diverse humanitarian settings, with clear and consistent documentation of both intervention characteristics and outcomes, as well as contextual and programmatic factors affecting implementation.

Conclusions

Implementation research has potential to increase impact of health interventions particularly in crisis-affected settings where flexibility, adaptability and context-responsive approaches are highlighted as cornerstones of effective programming. There remains significant opportunity for standardization of research in the humanitarian space, with one such opportunity occurring through increased utilization of IR frameworks such as a modified CFIR approach. Investing in more robust sexual and reproductive health research in humanitarian contexts can enrich insights available to guide programming and increase transferability of learning across settings.

Availability of data and materials

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

Abbreviations

Availability, Accessibility, Acceptability and Quality

Centers for Disease Control and Prevention

Consolidated Framework for Implementation Research

Democratic Republic of the Congo

Exploration, Preparation, Implementation, Sustainment

• Implementation research

Low and middle income country

Minimum Initial Service Package

Practical, Robust Implementation and Sustainability Model

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Reach, Effectiveness, Adoption, Implementation, Maintenance

• Sexual and reproductive health

World Health Organization

Peters DH, et al. Implementation research: what it is and how to do it. RESEARCH METHODS. 2013;347:7.

Means AR, et al. Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implement Sci. 2020;15(1):17.

Article   PubMed   PubMed Central   Google Scholar  

Alonge O, et al. How is implementation research applied to advance health in low-income and middle-income countries? BMJ Glob Health. 2019;4(2):e001257.

Ridde V, Pérez D, Robert E. Using implementation science theories and frameworks in global health. BMJ Glob Health. 2020;5(4):e002269.

Gaffey MF, et al. Delivering health and nutrition interventions for women and children in different conflict contexts: a framework for decision making on what, when, and how. Lancet (London, England). 2021;397(10273):543–54.

Article   PubMed   Google Scholar  

Singh NS, et al. Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies? The Lancet. 2021;397(10273):533–42.

Article   Google Scholar  

Ager A, et al. Strengthening the evidence base for health programming in humanitarian crises. Science. 2014;345(6202):1290–2.

Article   CAS   PubMed   Google Scholar  

Blanchet K, et al. Evidence on public health interventions in humanitarian crises. The Lancet. 2017;390(10109):2287–96.

Sphere A. The Sphere Handbook | Standards for quality humanitarian response. 2018.

Google Scholar  

Barot S. In a State of Crisis: Meeting the Sexual and Reproductive Health Needs of Women in Humanitarian Situations. Guttmacher Policy Rev. 2017;20:7.

Crisis, I.-A.W.G.f.R.H.i., Minimum Initial Service Package. 2020: https://www.unfpa.org/resources/minimum-initial-service-package-misp-srh-crisis-situations .

Casey SE. Evaluations of reproductive health programs in humanitarian settings: a systematic review. Confl Heal. 2015;9(1):S1.

Singh NS, et al. A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises. BMJ Glob Health. 2018;3(2):e000682.

Singh NS, et al. Evaluating the effectiveness of sexual and reproductive health services during humanitarian crises: A systematic review. PLoS ONE. 2018;13(7):e0199300.

Warren E, et al. Systematic review of the evidence on the effectiveness of sexual and reproductive health interventions in humanitarian crises. BMJ Open. 2015;5(12):e008226.

Dadich A, Piper A, Coates D. Implementation science in maternity care: a scoping review. Implement Sci. 2021;16(1):16.

Tricco AC, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467–73.

Devine A, et al. Strategies for the prevention of perinatal hepatitis B transmission in a marginalized population on the Thailand-Myanmar border: a cost-effectiveness analysis. BMC Infect Dis. 2017;17(1):552.

Jarrett P, et al. Evaluation of a population mobility, mortality, and birth surveillance system in South Kivu. Democratic Republic of the Congo Disasters. 2020;44(2):390–407.

PubMed   Google Scholar  

Logie CH, et al. A Psycho-Educational HIV/STI Prevention Intervention for Internally Displaced Women in Leogane, Haiti: Results from a Non-Randomized Cohort Pilot Study. PLoS ONE. 2014;9(2):e89836.

O’Laughlin KN, et al. A cohort study to assess a communication intervention to improve linkage to HIV care in Nakivale Refugee Settlement. Uganda Glob Public Health. 2021;16(12):1848–55.

Adam I. The influence of maternal health education on the place of delivery in conflict settings of Darfur. Sudan Conflict and Health. 2015;9:31.

Adam IF, et al. Relationship between implementing interpersonal communication and mass education campaigns in emergency settings and use of reproductive healthcare services: evidence from Darfur, Sudan. BMJ Open. 2015;5(9):e008285.

Edmond K, et al. Mobile outreach health services for mothers and children in conflict-affected and remote areas: a population-based study from Afghanistan. Arch Dis Child. 2020;105(1):18–25.

Nasir S, et al. Dissemination and implementation of the e-MCHHandbook, UNRWA’s newly released maternal and child health mobile application: a cross-sectional study. BMJ Open. 2020;10(3):e034885.

O’Laughlin KN, et al. Feasibility and acceptability of home-based HIV testing among refugees: a pilot study in Nakivale refugee settlement in southwestern Uganda. BMC Infect Dis. 2018;18(1):332.

Adam I. Evidence from cluster surveys on the association between home-based counseling and use of family planning in conflict-affected Darfur. Int J Gynecol Obstet. 2016;133(2):221–5.

Casey S, et al. Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: Evidence from cross-sectional baseline and endline cluster surveys. Glob Public Health. 2013;8(3):284–97.

Corna F, et al. Supporting maternal mental health of Rohingya refugee women during the perinatal period to promote child health and wellbeing: a field study in Cox’s Bazar. Intervention, the Journal of Mental Health & Psychosocial Support in Conflict Affected Areas. 2019;17(2):160–8.

Glass N, et al. Effectiveness of the Communities Care programme on change in social norms associated with gender-based violence (GBV) with residents in intervention compared with control districts in Mogadishu, Somalia. BMJ Open. 2019;9(3):e023819.

James LE, et al. Development and Testing of a Community-Based Intervention to Address Intimate Partner Violence among Rohingya and Syrian Refugees: A Social Norms-Based Mental Health-Integrated Approach. Int J Environ Res Public Health. 2021;18(21):11674.

Le Roux E, et al. Engaging with faith groups to prevent VAWG in conflict-affected communities: results from two community surveys in the DRC. BMC Int Health Hum Rights. 2020;20(1):27.

Morris CN, et al. When political solutions for acute conflict in Yemen seem distant, demand for reproductive health services is immediate: a programme model for resilient family planning and post-abortion care services. Sex Reprod Health Matters. 2019;27(2):1610279.

Anibueze AU, et al. Impact of counseling visual multimedia on use of family planning methods among displaced Nigerian families. Health Promot Int. 2022;37(3):daac060.

Doocy S, et al. Cash-based assistance and the nutrition status of pregnant and lactating women in the Somalia food crisis: A comparison of two transfer modalities. PLoS ONE. 2020;15(4):e0230989.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Draiko CV, et al. The effect of umbilical cord cleansing with chlorhexidine gel on neonatal mortality among the community births in South Sudan: a quasi-experimental study. Pan Afr Med J. 2021;38:78.

Edmond KM, et al. Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study. BMC Med. 2018;16(1):106.

Edmond KM, et al. Conditional cash transfers to improve use of health facilities by mothers and newborns in conflict affected countries, a prospective population based intervention study from Afghanistan. BMC Pregnancy Childbirth. 2019;19(1):193.

Bakesiima R, et al. Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial. PLoS ONE. 2021;16(9):e0256479.

Greene MC, et al. Evaluation of an integrated intervention to reduce psychological distress and intimate partner violence in refugees: Results from the Nguvu cluster randomized feasibility trial. PLoS ONE. 2021;16(6):e0252982.

Gupta J, et al. Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d’Ivoire: a randomized controlled pilot study. BMC Int Health Hum Rights. 2013;13(1):46.

Hossain M, et al. Working with men to prevent intimate partner violence in a conflict-affected setting: a pilot cluster randomized controlled trial in rural Côte d’Ivoire. BMC Public Health. 2014;14(1):339.

Vaillant J, et al. Engaging men to transform inequitable gender attitudes and prevent intimate partner violence: a cluster randomised controlled trial in North and South Kivu, Democratic Republic of Congo. BMJ Glob Health. 2020;5(5):e002223.

Thommesen T, et al. “The midwife helped me … otherwise I could have died”: women’s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman. BMC Pregnancy Childbirth. 2020;20(1):140.

Awasom-Fru A, et al. Doctors’ experiences providing sexual and reproductive health care at Catholic Hospitals in the conflict-affected North-West region of Cameroon: a qualitative study. Reprod Health. 2022;19(1):126.

Kabakian-Khasholian T, Makhoul J, Ghusayni A. “A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care. BMC Pregnancy and Childbirth. 2022;22(1):748.

Lilleston P, et al. Evaluation of a mobile approach to gender-based violence service delivery among Syrian refugees in Lebanon. Health Policy Plan. 2018;33(7):767–76.

Mugo NS, et al. Barriers Faced by the Health Workers to Deliver Maternal Care Services and Their Perceptions of the Factors Preventing Their Clients from Receiving the Services: A Qualitative Study in South Sudan. Matern Child Health J. 2018;22(11):1598–606.

Persson M, et al. A qualitative study on health care providers’ experiences of providing comprehensive abortion care in Cox’s Bazar, Bangladesh. Conflict and Health. 2021;15(1):6.

Phanwichatkul T, et al. The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study. Women Birth. 2022;35(4):e356–68.

Sarker M, et al. Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions. PLoS ONE. 2020;15(3):e0230732.

Tousaw E, et al. “Without this program, women can lose their lives”: migrant women’s experiences with the Safe Abortion Referral Programme in Chiang Mai. Thailand Reprod Health Matters. 2017;25(51):58–68.

Tousaw E, et al. “It is just like having a period with back pain”: exploring women’s experiences with community-based distribution of misoprostol for early abortion on the Thailand-Burma border. Contraception. 2018;97(2):122–9.

West L, et al. Factors in use of family planning services by Syrian women in a refugee camp in Jordan. Journal of Family Planning and Reproductive Health Care. 2017;43(2):96–102.

O’Connell KA, et al. Meeting the Sexual and Reproductive Health Needs of Internally Displaced Persons in Ethiopia’s Somali Region: A Qualitative Process Evaluation. Glob Health Sci Pract. 2022;10(5):e2100818.

Orya E, et al. Strengthening close to community provision of maternal health services in fragile settings: an exploration of the changing roles of TBAs in Sierra Leone and Somaliland. BMC Health Serv Res. 2017;17(1):460.

Perera SM, et al. Barriers to seeking post-abortion care in Paktika Province, Afghanistan: a qualitative study of clients and community members. BMC Womens Health. 2021;21(1):390.

Tanabe M, et al. Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma. Confl Heal. 2013;7(1):12.

Tran NT, et al. Clinical outreach refresher trainings in crisis settings (S-CORT): clinical management of sexual violence survivors and manual vacuum aspiration in Burkina Faso, Nepal, and South Sudan. Reprod Health Matters. 2017;25(51):103–13.

Yankah E, et al. Feasibility and acceptability of mobile phone platforms to deliver interventions to address gender-based violence among Syrian adolescent girls and young women in Izmir. Turkey Vulnerable Children and Youth Studies. 2020;15(2):133–43.

Muuo S, et al. Barriers and facilitators to care-seeking among survivors of gender-based violence in the Dadaab refugee complex. Sex Reprod Health Matters. 2020;28(1):1722404.

Amsalu R, et al. Essential newborn care practice at four primary health facilities in conflict affected areas of Bossaso, Somalia: a cross-sectional study. Conflict and Health. 2019;13(13):27.

Myers A, et al. Facilitators and barriers in implementing the Minimum Initial Services Package (MISP) for reproductive health in Nepal post-earthquake. Conflict and Health. 2018;12:35.

Santo L.C.d, et al. Feasibility and acceptability of a video library tool to support community health worker counseling in rural Afghan districts: a cross-sectional assessment. Conflict and Health. 2020;14:56.

Sami S, et al. Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study. BMC Pregnancy Childbirth. 2018;18(1):325.

Amsalu R, et al. Effectiveness of clinical training on improving essential newborn care practices in Bossaso, Somalia: a pre and postintervention study. BMC Pediatr. 2020;20(1):215.

Berg M, Mwambali SN, Bogren M. Implementation of a three-pillar training intervention to improve maternal and neonatal healthcare in the Democratic Republic Of Congo: a process evaluation study in an urban health zone. Glob Health Action. 2022;15(1):2019391.

Castillo M, et al. Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments. Biomed Res Int. 2016;2016:1–9.

Foster AM, Arnott G, Hobstetter M. Community-based distribution of misoprostol for early abortion: evaluation of a program along the Thailand-Burma border. Contraception. 2017;96(4):242–7.

Guan TH, et al. Implementation of a neonatal hepatitis B immunization program in rural Karenni State, Myanmar: A mixed-methods study. PLoS ONE. 2021;16(12):e0261470.

Logie, C.H., et al., Mixed-methods findings from the Ngutulu Kagwero (agents of change) participatory comic pilot study on post-rape clinical care and sexual violence prevention with refugee youth in a humanitarian setting in Uganda. Global Public Health, 2022((Logie C.H., [email protected]) Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada(Logie C.H., [email protected]) Women’s College Research Institute, Women’s College Hospital, Toronto, Canada(Logie C.H., carmen.l).

Sami S, et al. “You have to take action”: changing knowledge and attitudes towards newborn care practices during crisis in South Sudan. Reprod Health Matters. 2017;25(51):124–39.

Smith JR, et al. Clinical care for sexual assault survivors multimedia training: a mixed-methods study of effect on healthcare providers’ attitudes, knowledge, confidence, and practice in humanitarian settings. Confl Heal. 2013;7(1):14.

Stevens A, et al. Folate supplementation to prevent birth abnormalities: evaluating a community-based participatory action plan for refugees and migrant workers on the Thailand-Myanmar border. Public Health. 2018;161:83–9.

Nguyen Toan T, et al. Strengthening healthcare providers’ capacity for safe abortion and postabortion care services in humanitarian settings: lessons learned from the clinical outreach refresher training model (S-CORT) in Uganda, Nigeria, and the Democratic Republic of Congo. Conflict and Health. 2021;15(1):20.

Castle S, et al. Successful programmatic approaches to facilitating IUD uptake: CARE’s experience in DRC. BMC Womens Health. 2019;19(1):104.

Deitch J, et al. “They Love Their Patients”: Client Perceptions of Quality of Postabortion Care in North and South Kivu, the Democratic Republic of the Congo. Global health, science and practice. 2019;7(Suppl 2):S285–98.

Ferreyra C, et al. Evaluation of a community-based HIV test and start program in a conflict affected rural area of Yambio County, South Sudan. PLoS ONE. 2021;16(7):e0254331.

Ho LS, Wheeler E. Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo. Glob Health Sci Pract. 2018;6(1):161–77.

Klabbers RE, et al. Health Worker Perspectives on Barriers and Facilitators of Assisted Partner Notification for HIV for Refugees and Ugandan Nationals: A Mixed Methods Study in West Nile Uganda. AIDS Behav. 2021;25(10):3206–22.

Turner C, et al. Neonatal Intensive Care in a Karen Refugee Camp: A 4 Year Descriptive Study. PLoS ONE. 2013;8(8):e72721.

Vries Id, et al. Key lessons from a mixed-method evaluation of a postnatal home visit programme in the humanitarian setting of Gaza. Eastern Mediterr Health J. 2021;27(6):546–52.

Bolan NE, et al. mLearning in the Democratic Republic of the Congo: A Mixed-Methods Feasibility and Pilot Cluster Randomized Trial Using the Safe Delivery App. Global health, science and practice. 2018;6(4):693–710.

Khan MN, et al. Evaluating feasibility and acceptability of a local psycho-educational intervention for pregnant women with common mental problems affected by armed conflict in Swat, Pakistan: A parallel randomized controlled feasibility trial. Int J Soc Psychiatry. 2017;63(8):724–35.

Hynes M, et al. Using a quality improvement approach to improve maternal and neonatal care in North Kivu, Democratic Republic of Congo. Reprod Health Matters. 2017;25(51):140–50.

Gibbs A, et al. The impacts of combined social and economic empowerment training on intimate partner violence, depression, gender norms and livelihoods among women: an individually randomised controlled trial and qualitative study in Afghanistan. BMJ Glob Health. 2020;5(3):e001946.

Damschroder L, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science: IS; 2009.

Moore GF, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258.

Proctor E, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Adm Policy Ment Health. 2011;38(2):65–76.

Damschroder LJ, et al. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75.

Damschroder LJ, et al. Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implement Sci. 2022;17(1):7.

Aarons GA, Hurlburt M, Horwitz SM. Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors. Administration and Policy in Mental Health and Mental Health Services Research. 2011;38(1):4–23.

Feldstein AC, Glasgow RE. A Practical, Robust Implementation and Sustainability Model (PRISM) for Integrating Research Findings into Practice. The Joint Commission Journal on Quality and Patient Safety. 2008;34(4):228–43.

OCHA. Global Humanitarian Overview 2023. 2022 [cited 2023 8/3/2023]; Available from: https://humanitarianaction.info/node/13073/article/glance-0 . Accessed 8 Mar 2023.

Kobeissi L, et al. Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings. Confl Heal. 2021;15(1):16.

Save the, C., et al. Roadmap to Accelerate Progress for Every Newborn in Humanitarian Settings 2020 – 2024. 2020. p. 52.

Inter-Agency Working Group on Reproductive Health in, C. Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. 2018.

Download references

Acknowledgements

Not applicable.

The authors received no funding for this study.

Author information

Authors and affiliations.

Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA

Alexandra Norton

Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA

Hannah Tappis

You can also search for this author in PubMed   Google Scholar

Contributions

AN and HT designed the scoping review. AN conducted the literature search. AN and HT screened records for inclusion. AN extracted data from included studies. Both authors contributed to synthesis of results. AN drafted the manuscript and both authors contributed to editorial changes.

Corresponding author

Correspondence to Alexandra Norton .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

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

Supplementary Information

Additional file 1.

. Literature search terms: Exact search terms used in literature search, with additional detail on the methodology to determine search terms and definitions used for each component of the search

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Norton, A., Tappis, H. Sexual and reproductive health implementation research in humanitarian contexts: a scoping review. Reprod Health 21 , 64 (2024). https://doi.org/10.1186/s12978-024-01793-2

Download citation

Received : 06 November 2023

Accepted : 12 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s12978-024-01793-2

Share this article

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

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

Provided by the Springer Nature SharedIt content-sharing initiative

• Humanitarian settings

Reproductive Health

ISSN: 1742-4755

• General enquiries: [email protected]

Cultural Relativity and Acceptance of Embryonic Stem Cell Research

Article sidebar.

Main Article Content

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

INTRODUCTION

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

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

I.     Global Cultural Perspective of Embryonic Stem Cells

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

a.     US and Rights-Based Cultures

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

b.     Ubuntu and Collective Cultures

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

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

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

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

c.     Asia

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

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

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

d.     Middle East

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

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

e.     Europe

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

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

II.     Religious Perspectives on ESC

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

The Qur'an states:

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

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

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

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

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

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

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

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

III.     A Flexible Ethical Approach

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

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

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

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

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

IV.     Concerns

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

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

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

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

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

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

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

[1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk ; Kimmelman, J., Hyun, I., Benvenisty, N.  et al.  Policy: Global standards for stem-cell research.  Nature   533 , 311–313 (2016). https://doi.org/10.1038/533311a

[4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk

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

Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research.  The New England journal of medicine ,  351 (3), 207–209. https://doi.org/10.1056/NEJMp048145 ; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos . The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos ; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy , 38 (2/3), 264–284. http://www.jstor.org/stable/24439776 ; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells.  The New England journal of medicine ,  351 (3), 209–211. https://doi.org/10.1056/NEJMp048147 ; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality.  Bosnian journal of basic medical sciences ,  4 (1), 5–14. https://doi.org/10.17305/bjbms.2004.3453

[6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review.  Restorative neurology and neuroscience ,  28 (4), 589–603. https://doi.org/10.3233/RNN-2010-0543

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech.

[26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

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

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

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

Article Details

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

MIT Technology Review

• Newsletters

Google helped make an exquisitely detailed map of a tiny piece of the human brain

A small brain sample was sliced into 5,000 pieces, and machine learning helped stitch it back together.

• Cassandra Willyard archive page

A team led by scientists from Harvard and Google has created a 3D, nanoscale-resolution map of a single cubic millimeter of the human brain. Although the map covers just a fraction of the organ—a whole brain is a million times larger—that piece contains roughly 57,000 cells, about 230 millimeters of blood vessels, and nearly 150 million synapses. It is currently the highest-resolution picture of the human brain ever created.

To make a map this finely detailed, the team had to cut the tissue sample into 5,000 slices and scan them with a high-speed electron microscope. Then they used a machine-learning model to help electronically stitch the slices back together and label the features. The raw data set alone took up 1.4 petabytes. “It’s probably the most computer-intensive work in all of neuroscience,” says Michael Hawrylycz, a computational neuroscientist at the Allen Institute for Brain Science, who was not involved in the research. “There is a Herculean amount of work involved.”

Many other brain atlases exist, but most provide much lower-resolution data. At the nanoscale, researchers can trace the brain’s wiring one neuron at a time to the synapses, the places where they connect. “To really understand how the human brain works, how it processes information, how it stores memories, we will ultimately need a map that’s at that resolution,” says Viren Jain, a senior research scientist at Google and coauthor on the paper, published in Science on May 9 . The data set itself and a preprint version of this paper were released in 2021 .

Brain atlases come in many forms. Some reveal how the cells are organized. Others cover gene expression. This one focuses on connections between cells, a field called “connectomics.” The outermost layer of the brain contains roughly 16 billion neurons that link up with each other to form trillions of connections. A single neuron might receive information from hundreds or even thousands of other neurons and send information to a similar number. That makes tracing these connections an exceedingly complex task, even in just a small piece of the brain..  

To create this map, the team faced a number of hurdles. The first problem was finding a sample of brain tissue. The brain deteriorates quickly after death, so cadaver tissue doesn’t work. Instead, the team used a piece of tissue removed from a woman with epilepsy during brain surgery that was meant to help control her seizures.

Once the researchers had the sample, they had to carefully preserve it in resin so that it could be cut into slices, each about a thousandth the thickness of a human hair. Then they imaged the sections using a high-speed electron microscope designed specifically for this project. 

Next came the computational challenge. “You have all of these wires traversing everywhere in three dimensions, making all kinds of different connections,” Jain says. The team at Google used a machine-learning model to stitch the slices back together, align each one with the next, color-code the wiring, and find the connections. This is harder than it might seem. “If you make a single mistake, then all of the connections attached to that wire are now incorrect,” Jain says. 

“The ability to get this deep a reconstruction of any human brain sample is an important advance,” says Seth Ament, a neuroscientist at the University of Maryland. The map is “the closest to the  ground truth that we can get right now.” But he also cautions that it’s a single brain specimen taken from a single individual. 

The map, which is freely available at a web platform called Neuroglancer , is meant to be a resource other researchers can use to make their own discoveries. “Now anybody who’s interested in studying the human cortex in this level of detail can go into the data themselves. They can proofread certain structures to make sure everything is correct, and then publish their own findings,” Jain says. (The preprint has already been cited at least 136 times .) 

The team has already identified some surprises. For example, some of the long tendrils that carry signals from one neuron to the next formed “whorls,” spots where they twirled around themselves. Axons typically form a single synapse to transmit information to the next cell. The team identified single axons that formed repeated connections—in some cases, 50 separate synapses. Why that might be isn’t yet clear, but the strong bonds could help facilitate very quick or strong reactions to certain stimuli, Jain says. “It’s a very simple finding about the organization of the human cortex,” he says. But “we didn’t know this before because we didn’t have maps at this resolution.”

The data set was full of surprises, says Jeff Lichtman, a neuroscientist at Harvard University who helped lead the research. “There were just so many things in it that were incompatible with what you would read in a textbook.” The researchers may not have explanations for what they’re seeing, but they have plenty of new questions: “That’s the way science moves forward.” 

Biotechnology and health

How scientists traced a mysterious covid case back to six toilets.

When wastewater surveillance turns into a hunt for a single infected individual, the ethics get tricky.

An AI-driven “factory of drugs” claims to have hit a big milestone

Insilico is part of a wave of companies betting on AI as the "next amazing revolution" in biology

• Antonio Regalado archive page

There is a new most expensive drug in the world. Price tag: $4.25 million

But will the latest gene therapy suffer the curse of the costliest drug?

The effort to make a breakthrough cancer therapy cheaper

CAR-T cells could revolutionize the treatment of a wide variety of diseases, if only we can make them cheaper.

Stay connected

Get the latest updates from mit technology review.

Discover special offers, top stories, upcoming events, and more.

Thank you for submitting your email!

It looks like something went wrong.

We’re having trouble saving your preferences. Try refreshing this page and updating them one more time. If you continue to get this message, reach out to us at [email protected] with a list of newsletters you’d like to receive.

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 83, Issue 6
• EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0003-0920-888X Tuva Moseng 1 ,
• http://orcid.org/0000-0001-6322-3859 Theodora P M Vliet Vlieland 2 ,
• Simone Battista 3 ,
• David Beckwée 4 ,
• Vladimira Boyadzhieva 5 ,
• http://orcid.org/0000-0002-3478-5665 Philip G Conaghan 6 ,
• Daniela Costa 7 ,
• Michael Doherty 8 ,
• Andrew G Finney 9 , 10 ,
• Tsvetoslav Georgiev 11 ,
• Milena Gobbo 12 ,
• Norelee Kennedy 13 ,
• Ingvild Kjeken 1 ,
• http://orcid.org/0000-0002-8940-0582 Féline P B Kroon 14 , 15 ,
• http://orcid.org/0000-0002-5424-9448 L Stefan Lohmander 16 ,
• Hans Lund 17 ,
• Christian D Mallen 18 ,
• Karel Pavelka 19 ,
• Irene A Pitsillidou 20 ,
• Margaret P Rayman 21 ,
• Anne Therese Tveter 1 ,
• http://orcid.org/0000-0003-4783-8663 Johanna E Vriezekolk 22 ,
• Dieter Wiek 23 ,
• Gustavo Zanoli 24 ,
• http://orcid.org/0000-0001-8602-342X Nina Østerås 1
• 1 Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) , Diakonhjemmet Hospital , Oslo , Norway
• 2 Department of Orthopaedics, Rehabilitation and Physical Therapy , Leiden University Medical Center (LUMC) , Leiden , Netherlands
• 3 University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health , Genova , Italy
• 4 Rehabilitation Research Department , Vrije Universiteit Brussel , Brussel , Belgium
• 5 UMHAT “St. Iv. Rilski” Clinic of Rheumatology, Medical University Sofia , Sofia , Bulgaria
• 6 Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds and NIHR Leeds Biomechanical Reserch Centre , Leeds , UK
• 7 Comprehensive Health Research Center (CHRC) , Universidade Nova de Lisboa , Lisboa , Portugal
• 8 Department of Academic Rheumatology , University of Nottingham , Nottingham , UK
• 9 Research Institute for Primary Care and Health Sciences , Keele University School of Medicine , Keele , UK
• 10 School of Nursing and Midwifery , Keele University , Keele , UK
• 11 Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine , Medical University Varna , Varna , Bulgaria
• 12 Positivamente Centro de Psicología , Madrid , Spain
• 13 School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute , University of Limerick , Limerick , Ireland
• 14 Department of Rheumatology , Leiden University Medical Center (LUMC) , Leiden , The Netherlands
• 15 Department of Rheumatology , Zuyderland Medical Centre Heerlen , Heerlen , The Netherlands
• 16 Department of Clinical Sciences Lund, Orthopaedics , Lund University , Lund , Sweden
• 17 Centre for Evidence-Based Practice , Western Norway University of Applied Sciences , Bergen , Norway
• 18 Keele University School of Medicine , Keele , UK
• 19 Institute of Rheumatology, Department of Rheumatology , Charles University First Faculty of Medicine , Praha , Czech Republic
• 20 EULAR Patient Research Partner , Cyprus League Against Rheumatism , Nicosia , Cyprus
• 21 Department of Nutritional Sciences , University of Surrey Faculty of Health and Medical Sciences , Guildford , UK
• 22 Research & Innovation , Sint Maartenskliniek , Nijmegen , The Netherlands
• 23 EULAR Patient Research Partner , Deutsche Rheuma-Liga , Bonn , Germany
• 24 Orthopaedic Ward , Casa di Cura Santa Maria Maddalena , Novara , Italy
• Correspondence to Dr Tuva Moseng, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; tuva.moseng{at}diakonsyk.no

Introduction Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

Methods The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

Results The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0–10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

Conclusions The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

• Osteoarthritis, Knee
• Osteoarthritis
• Rehabilitation
• Physical Therapy Modalities
• Therapeutics

This is an open access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/ard-2023-225041

Statistics from Altmetric.com

Request permissions.

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

Introduction

Osteoarthritis (OA) is the most common joint disease worldwide, 1 with an increasing global burden of disability and healthcare utilisation. 2 The number of people with OA globally rose by 28% from 2010 to 2019, affecting over 500 million people, and about 6%, worldwide. 3 Due to an ageing population, increasing obesity and sport-related joint injuries, the disease will become even more prevalent in the forthcoming years. 2 In 2019, OA was the 15th highest-ranked cause of years lived with disability (YLDs) worldwide and was responsible for 2% of the total global YLDs. 3 OA is regarded as a severe disease, and serious condition and people with OA commonly experience pain, stiffness and associated functional loss. 4 Optimal management of hip and knee OA has important implications for the individual and society through the potential for improving individual health, work participation and utilisation of healthcare services. However, most people with OA do not receive optimal management. 5 6 In order to reduce the evidence-to-practice gap and the future burden 7 of this disease, the healthcare services’, policy-makers’ and the population awareness of the importance and benefits of evidence-based management of OA must be improved.

EULAR recommendations, including priorities for implementation and future research, can play a role in increasing awareness and uptake of best evidence care. In 2013, an EULAR Task Force (TF) developed recommendations for the non-pharmacological core management of hip and knee OA. 8 Since then there remains no cure in sight for OA, and effective disease-modifying drugs are lacking. 2 Therefore, non-pharmacological approaches are still considered a core treatment for people with hip and knee OA, aiming to alleviate symptoms and improve or maintain physical function. Since the publication of the 2013 recommendations, a large number of studies on the effectiveness of core non-pharmacological treatment modalities and new methods for delivery and follow-up of such treatments have been published. An update of these recommendations would potentially have implications for the level of evidence (LoE) categories and could lead to revisions of the recommendations and formulation of new recommendations with important implications for OA management.

The main aim of this TF process was to update the 2013 evidence-based recommendations for non-pharmacological core management, provide additional details on effectiveness, safety and cost-effectiveness, and formulate research and educational agendas and priorities for implementation activities. The target groups for the updated recommendations are people with hip or knee OA, all healthcare providers involved in the delivery of non-pharmacological interventions in OA care, researchers in the field of OA, officials in healthcare governance and reimbursement agencies and policy-makers.

The Standardised Operating Procedures for EULAR-endorsed Recommendations 9 were used as a framework for this project. The structure of the manuscript is guided by the Appraisal of Guidelines, Research and Evaluation instrument. 10

To pursue the task of updating the 2013 recommendations, a multidisciplinary TF with in-depth knowledge of non-pharmacological OA care was established. The TF consisted of 25 members from 14 European countries and included 9 physiotherapists, 6 rheumatologists, 2 orthopaedic surgeons, 2 psychologists, 2 patient research partners, 1 occupational therapist, 1 nurse, 1 general practitioner and 1 nutrition expert. A steering group, including a convenor (NØ), a methodologist (TPMVV) and a research fellow (TM), managed the process.

During the first digital TF meeting, the rationale for the update of the recommendations was presented, and the definition of core non-pharmacological management was clarified. The TF agreed on 11 research questions based on the research propositions from the 2013 recommendation. For the subsequent systematic literature review (SLR), the research questions were organised according to the population, intervention, control and outcome (PICO) format with associated search terms ( online supplemental file 1 ). The new search terms added to the previous search strategy were related to the following topics: remote care, shared decision-making, psychological interventions/cognitive behaviour therapy (CBT)-based interventions and specific exercise modalities (eg, strength training and aerobic exercise). Due to the expected large body of published literature since the previous literature review from 2012, combined with the available resources and strict timeline for this update, it was decided that this SLR should primarily focus on evidence from systematic reviews (SRs) and meta-analyses of randomised controlled trials (RCTs) and secondarily on evidence from single RCTs. As this SLR was an update of a previously unpublished SLR, along with its pragmatic approach, it was decided that the details were best presented as online supplemental file 1 rather than a publication of its own.

Supplemental material

The SLR was conducted by the fellow and convenor in close collaboration with an experienced librarian (HIF) and with support from the methodologist. Three main literature searches were conducted in the databases Medline (Ovid), Embase (Ovid), AMED (Ovid), Cochrane Library (Cochrane TRIALS), CINAHL (Ebsco) and Epistemonikos (SR search only).

The primary literature search aimed at identifying relevant SRs of RCTs investigating the effectiveness of core non-pharmacological management strategies as specified in the PICOs. The search was conducted from 2012 (the end year of the previous search) until 17 February 2022 and later updated until 27 May 2022 ( online supplemental file 1 ). Based on the PICOs, two authors (TM and NØ) independently screened titles and abstracts. Potentially relevant studies were read and evaluated in full text. Studies were included if they were SRs, including a meta-analysis of two or more RCTs on people diagnosed with hip or knee OA or with persisting knee pain in people 45 years or older and investigating non-pharmacological core management strategies. Relevant comparisons were no intervention, usual care or any other intervention. Relevant outcomes were pain, physical function, quality of life (QoL), patient global assessment of target joint, adverse effects or cost-effectiveness. The included studies were categorised under the 11 research questions. If relevant, one study could inform multiple research questions. The quality of the included SRs was evaluated with A MeaSurement Tool to Assess systematic Reviews (AMSTAR II). 11 The assessments were conducted independently by three assessors (GS, EAB and IS), working in pairs independent of the TF, with experience in quality assessment of SRs and RCTs. Disagreements between the assessors were resolved through discussion.

A second literature search with a comparable search strategy was conducted to identify newer RCTs not included in the latest published SR on the same topic, or relevant RCTs not included in any SRs, or RCTs on research questions for which no relevant SRs were identified. To identify such RCTs published in the past four to 5 years, the search was conducted from 1 January 2018 to 27 May 2022.

A third literature search was conducted with a similar search strategy from 1 January 2012 to 31 December 2017, aiming to identify relevant RCTs specifically on the research questions for which no relevant SRs had been identified. The two last searches were screened independently by the same two authors, and relevant studies were read and evaluated in full text. Studies were included if they were RCTs relevant to the PICOs. The quality of the included RCTs was assessed with the Cochrane Risk of Bias tool 2 (RoB2) 12 independently by two researchers (EAB and IS) independent of the TF. Disagreements between the assessors were resolved through discussion.

In the period before the second TF meeting, five digital subgroup meetings were arranged. Groups of 4–5 TF members and the steering group participated in each meeting. The purpose of the subgroup meetings was to go through the relevant results from the SLR and to discuss and prepare preliminary suggestions for revisions and updates of the recommendations to guide the discussion at the second TF meeting. The group discussed between 1 and 3 of the previous 11 recommendations in each subgroup meeting. This method was implemented to allow all TF members to express their opinions in smaller forums and potentially to reduce the workload of the second TF meeting.

During the second digital TF meeting, the results from the SLR, along with the proposed updates from the subgroups, were presented to the whole TF. The previous recommendations and the proposed updates were then discussed in light of the SLR and the expertise of the group. After the discussions and revisions, the TF members voted for consensus on each revised overarching principle and recommendation (defined as 75% or more in favour of the suggested updates). After the meeting, the updated list of recommendations was collated and emailed to the TF members in a digital survey to rate the level of agreement (LoA) on a 0–10 point scale (0=totally disagree, 10=totally agree). Further, the TF voted on the prioritised order of the recommendations for implementation activities. The TF also formulated a research agenda based on identified gaps in the evidence. The steering group defined the LoE and strength of each recommendation in accordance with the Oxford Levels of Evidence. 13 The steering group also formulated the educational agenda on behalf of the TF.

The three systematic literature searches yielded a total of 6816 references after the removal of duplicates ( figure 1 ). From these, 67 SRs and 31 RCTs were initially considered relevant for the SLR. However, we chose to extract data from 36 of the SRs due to reasons elaborated in online supplemental file 1, p.49 ,. The most frequent reason was that the interventions under study were not considered relevant for this review. The quality of the included SRs was generally poor, with 35 of 36 studies being rated with an overall low or critically low quality by the AMSTAR II tool ( online supplemental file 1 ). The critical items that most often contributed to the overall low quality of the studies were: the lack of an explicit statement that the review methods were established prior to the conduct of the review; the lack of the use of a comprehensive literature search strategy; and lack of a list of excluded studies with reasons for exclusion. There was large variation in the overall quality of the included RCTs as assessed by the RoB2 tool ( online supplemental file 1 ). Most studies with a low risk of bias were on exercise interventions and delivery, whereas there were higher concerns related to the studies on, for example, lifestyle-related interventions. Most commonly, these concerns were related to the elements of measurement of the outcome (eg, the lack of a blinded outcome assessor).

• Download figure
• Open in new tab
• Download powerpoint

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

The main updates to the recommendations are summarised in box 1 . The TF agreed to rephrase and change two previous recommendations into overarching principles. These were the recommendations on: (1) the use of a biopsychosocial approach in the initial assessment and (2) the recommendation on individualisation of treatment. It was decided that these were generic statements used to inform the basis for management rather than specific treatment recommendations. Inherent to the nature of these statements, relevant studies were absent from the SLR. 14

What is new?

The updated recommendations have been reorganised into two overarching principles and eight treatment recommendations.

The wording of each recommendation is condensed.

The level of agreement is above 9 for all recommendations.

The level of evidence is 1a/1b for seven of the eight recommendations.

It was further decided to revise the nine previous recommendations into eight updated recommendations by merging the recommendations on footwear and walking aids, other assistive devices and adaptations. Moreover, to improve readability the previous recommendations were shortened, and subsections were rewritten and moved to the explanatory text. In addition, the TF also discussed the order for the presentation of the recommendations and decided to change this into a more logical sequence.

High LoAs were achieved for all eight recommendations, and seven recommendations were graded with LoE 1a/1b and strength level A. Recommendation 2—on delivery of information, patient education and self-management—was ranked by the TF as having the highest priority for implementation. Table 1 summarises the updated overarching principles, recommendations, LoA, LoE, strength of recommendation and priority for implementation.

• View inline

Overarching principles and specific recommendations for the non-pharmacological core management of hip and knee osteoarthritis

Recommendation 1

People with hip or knee OA should be offered an individualised, multicomponent management plan that includes the recommended core non-pharmacological approaches.

This recommendation deals with the provision of an integrated package of care rather than single treatments alone or in succession. The majority of new, relevant SRs and RCTs informing this recommendation investigated the effectiveness of the combination of patient education and exercise or the combination of patient education, exercise and diet or the combination of behaviour change techniques/pain-coping skills training and exercise, compared with information or one of the treatments alone. 15–18 The updated evidence shows that combining treatments leads to larger effects on pain and function compared with providing the treatments separately, thereby providing a rationale for combining different treatment modalities. The combination of education, exercise and dietary weight management was also considered cost-effective compared with physician-delivered usual care investigated in five healthcare systems. 19 The TF discussed that, although not all potential combinations of treatments are investigated in meta-analyses or newer RCTs, the results of available studies are likely to be generalisable to different combinations. Thus, the TF agreed on the general consideration of multicomponent treatments from a broader spectrum of potential combinations based on an assessment of a patient’s individual needs and preferences.

Through the SLR, no specific evidence was retrieved with regard to the effects of pacing and maintenance of activity. This specific element was therefore removed from the recommendation.

Recommendation 2

People with hip or knee OA should be offered information, education and advice on self-management strategies (considering available modes of delivery) and these should be included and reinforced at subsequent clinical encounters.

Recommendation 2 concerns the delivery of information, education and advice on self-management strategies. New evidence from the SLR showed zero to small significant effects on pain and function from patient education as a single intervention in the short term, which is in line with the previous recommendation. 15 20 In 2013, this recommendation focused on how education and information should be delivered in terms of being individualised, being included in every aspect of management, and specifically addressing the nature, causes, consequences and prognosis of OA. Moreover, it was stated that this should be reinforced and developed, supported by written or other types of material, including partners or carers of the individual, if relevant. The current TF acknowledged the importance of these aspects to ensure the effective delivery of information and education for people with hip and knee OA. However, none of the studies from the SLR could provide specific evidence for any of these aspects, except with regard to delivery method. One SR reported the effects of patient education delivered through telephone when compared with usual care, but the results were not significant for pain or disability. 20 The TF further chose to add self-management to the updated recommendation. Evidence from two SRs, including seven RCTs, compared structured self-management programmes against a large range of control interventions. Zero to small favourable effects were found for self-management, delivered face to face or digitally, compared with routine/usual care. 21 22 Despite the limited effects reported in the literature, the TF agreed that self-management is a concept closely related both to the delivery of information and education in a clinical setting and to the uptake of other relevant treatment modalities.

Recommendation 3

All people with hip or knee OA should be offered an exercise programme (eg, strength, aerobic, flexibility or neuromotor) of adequate dosage with progression tailored to their physical function, preferences and available services.

The body of literature investigating the effects of different types of exercise regimes was already large when the 2013 recommendations were published. Aiming to progress the knowledge on the effects of exercise for hip and knee OA, the current SLR did not focus on studies investigating the effects of general exercise on hip and knee OA as these effects were well established previously. 23 24 The aim was rather to identify studies investigating the effects of well-defined exercise modalities, as well as studies looking more specifically into exercise dosage.

For hip OA, one SR summarised the effects of supervised, progressive resistance training, which reported beneficial effects on pain, function and QoL. The effect sizes, however, were small with large CIs. 25

For knee OA, four SRs and five additional RCTs were identified on the exercise 26–28 modalities Tai Chi, yoga, stationary cycling, proprioceptive training, weight-bearing and non-weight bearing exercise, and neuromuscular exercise combined with strength training. 29–33 Overall, the results showed small to moderate positive effects on pain and function for all these exercise modalities compared with no-exercise control (no intervention, waiting list or non-exercise interventions). Still, the results were less clear in head-to-head comparisons of different exercise types, modalities or doses.

In summary, results showed that a variety of exercise modalities might lead to improved pain and function for people with hip or knee OA, making it difficult to recommend one type of exercise over another. The optimal exercise dosage is also difficult to establish, with evidence from 1 SR on hip OA (including 12 RCTs) and 1 SR on knee OA (including 45 RCTs) providing some evidence that exercise in line with dose recommendations from the American College of Sports Medicine provided larger improvements in pain compared with non-compliant exercise programmes. 34–36 The differences, however, were small, and the clinical relevance is debatable. Two newer RCTs on knee OA, comparing high-intensity to low-intensity resistance training or no-exercise control, found no or only small between-group differences with regard to pain and function, 37 38 thus making it difficult to make explicit recommendations on exercise dosage.

With respect to safety, adverse events in exercise studies for hip and knee OA were investigated in two SRs. 39 40 The two studies concluded that, although the report of adverse events in exercise studies was inconsistent and some patient drop-outs were potentially misclassified, adverse events were generally uncommon and non-serious, and that exercise seemed to be associated with minimal risk of harm. Concerning the economic aspects of exercise, one SR on cost-effectiveness found that in the majority of the 12 included studies, exercise for hip and knee OA showed cost-effectiveness at conventional willingness-to-pay thresholds. 19

The TF chose to update this recommendation, highlighting that the choice of exercise should be based on individual function, patient preferences and available services. 41 Overall, exercise is by far the most studied and strongly recognised non-pharmacological core management treatment option and this recommendation has the strongest evidence base. The TF also expressed the importance of maintaining exercise over time for the positive effects to persist.

Recommendation 4

The mode of delivery of exercises (eg, individual or group sessions, supervised or unsupervised, face to face or by using digital technology, land-based or aquatic exercise) should be selected according to local availability and patient preferences. The exercises preferably should be embedded in an individual plan for physical activity.

As established in the description of recommendation 3, there is convincing evidence for the effectiveness of various exercise modalities on pain and function in hip and knee OA. However, the delivery method of exercise programmes varies largely across studies and may influence study outcomes.

One SR found superior effects from technology-supported exercise compared with control with non-technological or no care services on pain, function and QoL, 42 whereas another SR found superior effects from telehealth-based exercise compared with no-telehealth exercise control for pain but not for function or QoL. 43 The reported effect sizes were small. One additional RCT found a small, significant effect on function at 6 months follow-up for an education combined with strengthening exercise follow-up through telephone calls compared with education alone, but no other between-group differences in pain and function were detected after 6 and 12 months. 44 Another RCT comparing access to an educational website combined with exercise supported by automated behaviour change text messages to access to the educational website alone found significant superior effects of the combined first intervention on pain and function after 24 weeks. 45 For aquatic exercise, one SR reported small short-term beneficial effects for pain and function compared with no intervention or usual care. However, another SR comparing aquatic exercise to land-based exercise did not find any of these modes superior to the other. 46 47 One RCT of a three-stage stepped care exercise programme compared with educational materials found beneficial, although not clinically relevant, effects of the stepped care programme on pain and function at 3 and 9 months, but not at 6 months. 48 Analyses of the cost-effectiveness of the same stepped-care intervention concluded that there is a high probability of short-term cost-effectiveness. 49

The new evidence adds information on technology-supported delivery of exercise, aquatic exercise and a stepped care strategy for exercise delivery. The results from these studies show a wide variety of potentially effective delivery methods for exercise, which in clinical practice should be aligned with patient preferences and the availability of local services. The TF also underlined the importance of the exercise programme being embedded in an individual plan for physical activity. Such plans should be set up in accordance with well-recognised recommendations for physical activity, such as from the WHO or EULAR. 41 50 General physical activity has multiple health benefits and is also important for the management of common comorbidities associated with OA, such as cardiovascular disease and diabetes. 51 52

Recommendation 5

People with hip or knee OA should be offered education on the importance of maintaining a healthy weight. Those overweight or obese should be offered support to achieve and maintain weight loss.

In the updated SLR, three SRs were identified, including one network meta-analysis investigating the effects of weight loss interventions. Two were on studies of knee OA, 19 53 whereas the third included studies of both hip and knee OA, although only 2 of the 19 trials included in that study were conducted on a mixed hip and knee OA population. 54 The results from this SR showed beneficial effects, compared with minimal care, of both diet and multifocused weight-loss interventions (combining diets, telephone coaching, psychological pain-coping interventions/CBT, specialist referral education and exercise) on pain and disability, with the largest effect size on pain for multifocused interventions. Further, it was reported that when comparing weight-loss-focused interventions (diets) to exercise, no between-group differences were detected for pain or disability. When comparing combined interventions of dietary weight loss and exercise to dietary weight loss or exercise alone, small effects were found in favour of the combined intervention.

In the network meta-analysis, bariatric surgery was the most effective pain-reducing intervention, followed by a low-calorie diet combined with exercise intervention. 53 The last SR on knee OA used cost-effectiveness as an outcome and reported that an intensive 18-month diet and exercise intervention with the goal of 5% weigth loss was likely to be an efficient use of healthcare resources compared with a healthy lifestyle control. 19

The above-mentioned studies made it clear that there is increasing evidence supporting multifocused weight loss interventions as beneficial for OA pain and disability. Therefore, the TF recommended that people with overweight or obesity and OA should be offered support to achieve and maintain weight loss. The TF notes that the amount of evidence mainly stems from studies on knee OA. As overweight and obesity are strong risk factors for the development and progression of OA, and in particular knee OA, 2 the TF also wanted to add to the recommendation the importance of education on the benefits of maintaining a healthy weight.

Recommendation 6

For people with hip or knee OA, consider walking aids, appropriate footwear, assistive devices and adaptations at home and at work to reduce pain and increase participation.

Through the SLR, four SRs investigating the effects on knee OA of lateral wedge insoles compared with other types of insoles, including flat/neutral insoles or knee braces, were retrieved. These studies did not report any between-group differences for any comparisons on pain or function. 55–58 On the other hand, one RCT reported a small between-group difference in favour of lateral wedge insoles compared with neutral insoles on a single pain scale in people prescreened to knee adduction moment improvements (but not on other pain scales, function or QoL). 59 For footwear, one RCT found positive effects of biomechanical footwear with individually adjustable external convex pods attached to the outsole compared with control footwear. 60 Another RCT found small effects after 6 months on pain, but not on function, from wearing stable, supportive shoes over flat flexible shoes for at least 6 hours per day. 61

Summarised, most evidence did not support the use of any lateral wedged or other insoles to affect pain or function in knee OA. The results from one RCT provided some support for the use of stable, supportive shoes. The TF wanted to add that from a clinical perspective, the use of comfortable shoes, big enough to give ample space for the toes when weight-bearing, is still a general recommendation for people with hip and knee OA.

For other types of assistive aids and devices, two RCTs comparing the use of canes to the non-use of auxiliary gait devices were identified. The results were contradictory, and conclusions on the effect of cane were difficult to draw from the available evidence. 62 63 No studies were retrieved for other types of assistive devices or home adaptations. Based on the expert knowledge of the group, it was argued that such devices could still be useful to some people with hip or knee OA in terms of reducing pain, undertaking daily activities and improving participation. The TF wanted to emphasise that improving participation is an important aspect underpinning this specific recommendation. Assistive devices may serve as means to reduce pain and improve participation both at home and at work and should, therefore, be considered in that context. Examples of such devices might be devices to aid dressing, height-adjustable chairs, raised toilet seats, handrails in staircases or the use of appropriate walking aids.

Recommendation 7

People with hip or knee OA with or at risk of work disability should be offered timely advice on modifiable work-related factors and, where appropriate, referral for expert advice.

OA is one of the leading causes of reduced work participation, and the disease may critically affect the number of sick days and, ultimately, the extension of a person’s work career. 64 Although there are well-known occupational risk factors, such as heavy lifting and knee straining activities associated with the development of knee OA, 65 it was noted that there is a lack of studies on vocational rehabilitation for people with hip or knee OA. In the current update, only one relevant RCT was retrieved. This study used workability as an outcome, whereas the study intervention in both groups focused on self-management with the addition of an activity tracker in the intervention group. In this study, no between-group differences were reported for workability. 66

Although little research has been conducted, the TF considered that appropriate interventions to increase work participation for people with hip and knee OA are highly relevant. A proper assessment of the individual work situation may have a large impact and should receive attention during consultations. 67 Health professionals, in cooperation with the employer, should be able to offer timely advice on modifiable work-related factors such as working from home, the use of height-adjustable desks and office chairs, the possibility of changing work tasks, commuting to/from work, use of assistive technology, and receiving support from management, colleagues and family towards employment. The TF also noted that adaptations to improve workability might be considered and applied not only at the workplace but also in the home.

Recommendation 8

Consider employing elements of behaviour change techniques when lifestyle modifications are needed (eg, physical activity, weight loss) for people with hip or knee OA.

This recommendation concerns the potential need for lifestyle change in people with hip and knee OA. It focuses specifically on physical activity and weight loss as part of a healthy lifestyle since these aspects are specifically relevant for people with hip or knee OA. One SR and eight additional RCTs were identified on various interventions to enhance a healthy lifestyle, mainly through maintaining physical activity over time. The SR reported small to moderate effects of adding booster sessions to exercise programmes to improve mid-term to long-term adherence to exercise. 68 Furthermore, one RCT reported statistically significant improvements in pain and function from a combined programme of pain coping skills training and lifestyle behavioural weight management lasting 24 weeks compared with these interventions alone or standard care. 69 Interventions from the other RCTs aiming to support people with OA to improve their lifestyle and sustain such changes over time, included interventions of behaviour-graded activity, improving exercise adherence with telephone counselling, an app to enhance a healthy lifestyle, physical activity with telephone follow-up and a self-management lifestyle intervention. 70–72 However, when the effects on pain and function of these interventions were compared with standard care or other minimal interventions, none to very small between-group differences were observed for the comparisons. The TF wanted to enhance the importance of long-term follow-up on health behaviour change and not just recommend lifestyle change as a single intervention. The TF also discussed that the EULAR recommendation on core competencies for health professionals in rheumatology underlines that health professionals should be able to provide the principles of behaviour change techniques in the management of people with rheumatic and musculoskeletal disorders. 73

Research and educational agendas

The proposed research agenda ( table 2 ) was based on gaps identified in the literature and on topics which emerged during discussions among the TF members.

Research agenda for the non-pharmacological core management of people with hip and knee osteoarthritis

The education agenda ( table 3 ) highlights activities relevant to promote appropriate management of people with hip and knee OA.

Educational agenda for the non-pharmacological core management of people with hip and knee OA

Through this update, the recommendations for the non-pharmacological core management of hip and knee OA have been revised into two overarching principles and eight treatment recommendations. The revisions are based on research evidence, expert discussions and consensus. Since the publication of the 2013 recommendations, a number of new studies have been published on non-pharmacological treatment modalities and their methods of delivery. The updates to the recommendations are thus well anchored in evidence from research and the perspectives of the TF members, representing different professional, cultural and personal backgrounds, including the perspective of people with OA. The process led to a broad consensus within the TF on the updated principles and recommendations, reflected by the high LoA for all the revised recommendations. Such strong consensus gives reason to believe that the recommendations are suitable for use and implementation across European healthcare systems. These recommendations are also in line with recently published treatment recommendations for hip and knee OA by other societies. 74–76

The number of relevant SRs and RCTs retrieved through the SLR was high, especially for the research questions concerning exercise and delivery of exercise, with data drawn from a total of 15 SRs and 11 additional RCTs. The number of new studies led to an upgrade of the LoE for most of the recommendations, and seven of eight recommendations are now supported by level 1a or 1b evidence. However, it should be noted that the stated LoE does not necessarily involve all aspects of every recommendation and does not distinguish between hip and knee OA. The number of studies on hip OA was markedly lower than those on knee OA for all the treatment modalities. Therefore, the recommendations are generally weaker for hip OA than knee OA. There is an increasing recognition of differences between hip and knee OA, which heightens the need for more hip OA-specific studies to improve outcomes for this group specifically. 77 This is also highlighted in the proposed research agenda ( table 2 ). Further, as the aim was to address relevant non-pharmacological core management strategies, the recommendations do not specifically advise the management of subgroups of the OA population, for instance, younger adults or adults with a high burden of comorbidities. The authors are also aware of a number of ongoing studies addressing a range of innovative digital programmes in OA care. Such approaches will likely receive further attention in future updates of these recommendations. 78–81

With regard to outcomes, most of the included studies reported effects primarily on pain and physical function. To follow the recommendations on prioritised outcomes in OA research, 82 more studies investigating the effects of interventions on QoL and patients’ global assessment of the target joint may have provided additional relevant information. Workability and cost-effectiveness are two other outcomes of increasing interest when investigating the effect of interventions from a broader perspective. This SLR identified some studies including these outcomes, thus adding new and important knowledge to the recommendations. Nevertheless, additional studies with a focus on interventions to prevent the decline in workability and studies examining cost-effectiveness are still needed as such knowledge is important for healthcare governance and policy-makers when planning and prioritising effective OA care. Another relevant aspect of this update is the inclusion of studies investigating potential harm or adverse events from the interventions under study. Only two SRs specifically looking into this subject were identified. Still, the results add new knowledge to this important, although understudied, aspect of non-pharmacological interventions. 83

The challenges of implementing recommended care for people with hip and knee OA are well documented. 84 It is also apparent that developing recommendations is not sufficient on its own to influence practice. 85 Therefore, efforts have been made to address the impact and to develop strategies for the implementation of treatment recommendations. For future implementation, collaboration with other organisations focusing on OA care, such as The Osteoarthritis Research Society International, must be considered. EULAR highlights that implementing all recommendations at once is probably not feasible in practice. 86 The TF voted that the recommendation on information, education and self-management was ranked as the recommendation with the highest priority for implementation. This recommendation may play an important role as a basis for all other management and may improve people’s ability to live a good life with OA, as well as being an enabler of, aspects such as physical activity. 87 The prioritisation of the recommendations for implementation activities is also important with respect to the effective utilisation of healthcare services. As the OA population is growing, the need for effective healthcare utilisation and sustainable management strategies to improve outcomes will be vital to minimising the burden of OA at an individual and a societal level. 88

To conclude, the TF reached a broad consensus on the updated recommendation for non-pharmacological core OA management as well as on a research agenda highlighting the current evidence gaps, on an educational agenda and on the priority of the recommendations to support implementation activities.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

We thank the librarian Hilde Iren Flaatten, University of Oslo, Norway, for supporting the literature searches and Emilie Andrea Bakke, Ingrid Skaalvik and Geir Smedslund, Diakonhjemmet Hospital, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway, for their thorough work in the AMSTAR II and Cochrane risk of bias assessments of the included studies.

PGC is funded in part by the National Institute for Health and Care Research (NIHR) through the Leeds Biomedical Research Centre.

• EULAR RheumaMap
• Hunter DJ ,
• Bierma-Zeinstra S
• Global Burden of Disease Collaborative Network
• Basedow M ,
• Smedslund G ,
• Østerås N , et al
• Kolahi A-A ,
• Smith E , et al
• Fernandes L ,
• Bijlsma JW , et al
• van der Heijde D ,
• Aletaha D ,
• Carmona L , et al
• Brouwers MC ,
• Browman GP , et al
• Reeves BC ,
• Wells G , et al
• Higgins JPT SJ ,
• Elbers RG , et al
• OCEBM Levels of Evidence Working Group*
• de Rooij M ,
• van der Leeden M ,
• Cheung J , et al
• De Oliveira Silva D ,
• Merolli M , et al
• Alrushud AS ,
• Rushton AB ,
• Kanavaki AM , et al
• Castelein B ,
• Wittoek R , et al
• Pitsillides A ,
• Stasinopoulos D ,
• Giannakou K
• Mazzei DR ,
• Ademola A ,
• Abbott JH , et al
• O’Brien KM ,
• Hodder RK ,
• Wiggers J , et al
• Zhu Y , et al
• Jackson J ,
• Sheffield D
• Uthman OA ,
• van der Windt DA ,
• Jordan JL , et al
• Verhagen AP ,
• Ferreira M ,
• Reijneveld-van de Vendel EAE , et al
• Mikkelsen LR ,
• Overgaard S , et al
• Bennell KL ,
• Nelligan RK ,
• Kimp AJ , et al
• Yen H-Y , et al
• Schrøder HM ,
• Wernbom M , et al
• Liu X , et al
• Pranata A , et al
• El-Ansary D ,
• Adams R , et al
• Chen Z , et al
• Garber CE ,
• Blissmer B ,
• Deschenes MR , et al
• Dagfinrud H ,
• Smedslund G , et al
• Bartholdy C ,
• Christensen R , et al
• de Zwart AH ,
• Roorda LD , et al
• Messier SP ,
• Mihalko SL ,
• Beavers DP , et al
• von Heideken J ,
• Chowdhry S ,
• Borg J , et al
• Rausch Osthoff A-K ,
• Niedermann K ,
• Braun J , et al
• Cai Y , et al
• Hinman RS ,
• Campbell PK ,
• Lawford BJ , et al
• Kasza J , et al
• Xu S , et al
• Zhou P , et al
• Woolson S ,
• Hoenig HM , et al
• Kaufman BG ,
• Coffman CJ , et al
• World Health Organization
• Williams MF ,
• London DA ,
• Husni EM , et al
• Mamas MA , et al
• Panunzi S ,
• Maltese S ,
• De Gaetano A , et al
• Robson EK ,
• Kamper SJ , et al
• Khosravi M ,
• Daryabor A , et al
• Yang J , et al
• Liang L , et al
• Felson DT ,
• Carter S , et al
• Reichenbach S ,
• Hincapié CA , et al
• Paterson KL ,
• Campbell PK , et al
• Silva AC , et al
• Van Ginckel A ,
• Wrigley TV , et al
• Viikari-Juntura E ,
• Solovieva S
• McWilliams DF ,
• Muthuri SG , et al
• Östlind E ,
• Stigmar K , et al
• Gwinnutt JM ,
• Wieczorek M ,
• Balanescu A , et al
• Nicolson PJA ,
• Dobson FL , et al
• Somers TJ ,
• Blumenthal JA ,
• Guilak F , et al
• Bendrik R ,
• Kallings LV ,
• Bröms K , et al
• LaValley MP ,
• Brown C , et al
• Lombard C ,
• Hussain SM , et al
• Edelaar L ,
• Nikiphorou E ,
• Fragoulis GE , et al
• National Institute for Health and Care Excellence: Guidelines
• Kolasinski SL ,
• Hochberg MC , et al
• Bannuru RR ,
• Vaysbrot EE , et al
• van der Esch M ,
• Hinman RS , et al
• Knox G , et al
• de Almeida AC ,
• de Noronha M , et al
• Groves-Williams D ,
• McHugh GA ,
• Bennell KL , et al
• Hawker GA ,
• Hunter DJ , et al
• Boutron I ,
• Baron G , et al
• Golightly YM ,
• Dziedzic KS ,
• EULAR European alliance of Associatons for rheumatology
• Kanavaki AM ,
• Rushton A ,
• Efstathiou N , et al
• Turkiewicz A ,
• Petersson IF ,
• Björk J , et al

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Handling editor Josef S Smolen

X @DrS_Battista

Contributors TM was the research fellow for the project, undertaking the SLR in cooperation with NØ. The fellow was supervised by the steering group consisting of NØ (convenor) and TPMVV (methodologist). NØ and TPMVV supervised the process of the SLR. NØ organised and chaired the TF meetings. TM drafted the manuscript with advice from NØ and TPMVV. All authors have contributed to the recommendations by participating in the TF meetings; during discussion and agreement on the recommendations; revising and approving the manuscript for publication.

Funding This study was funded by European League Against Rheumatism (HPR055).

Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Competing interests TPMVV was the Vice president EULAR health professionals 2020–2022 and is part of the EULAR Advocacy Committee 2020–present. MG holds a leadership position in OpenReuma/Spanish Association of Health Professionals in Rheumatology (unpaid). CDM received Grants from Versus Arthritis, MRC, NIHR (paid to Keele University) and is the director of the NIHR School for Primary Care Research. SL received payment as scientific consultant from Arthro Therapeutics AB and received payment from AstraZeneca as a member of DSMB. DC received grants from Fundação para a Ciência e Tecnologia SFRH/BD/148420/2019 and Pfizer (ID 64165707). GZ received payment for expert testimony from Casa di Cura San Francesco, Verona and Support for attending meetings and/or travel from Orthotech and Jtech, payment for participation on a Data Safety Monitoring Board or Advisory Board from VIVENKO for Gruenenthal and Ethos for Angelini and holds other financial interests related to clinical practice as an orthopedic surgeon (performing total joint replacement, arthroscopies and other types of surgeries), either directly from private patients or indirectly from the health system or insurances acting as a private consultant. JEV has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly Netherlands BV. TG has received paid honoraria for lectures by Abbvie, Novartis, Boehringer Ingelheim, UCB, Berlin-Chemie/A. Menarini Bulgaria, Sandoz and received support for attending meetings by Abbvie, Pfizer and UCB. DW is an International Advisory Board Member of DRFZ (Germany) 2019–current and was the EULAR PARE Chair 2015–2017and an EULAR Vice President representing PARE 2017–2021.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Read the full text or download the PDF:

Two decades of studies suggest health benefits associated with plant-based diets

But researchers caution against broad diet recommendations until remaining knowledge gaps are filled.

Vegetarian and vegan diets are generally associated with better status on various medical factors linked to cardiovascular health and cancer risk, as well as lower risk of cardiovascular diseases, cancer, and death, according to a new review of 49 previously published papers. Angelo Capodici and colleagues present these findings in the open-access journal PLOS ONE on May 15, 2024.

Prior studies have linked certain diets with increased risk of cardiovascular disease and cancer. A diet that is poor in plant products and rich in meat, refined grains, sugar, and salt is associated with higher risk of death. Reducing consumption of animal-based products in favor of plant-based products has been suggested to lower the risk of cardiovascular disease and cancer. However, the overall benefits of such diets remain unclear.

To deepen understanding of the potential benefits of plant-based diets, Capodici and colleagues reviewed 48 papers published between January 2000 and June 2023 that themselves compiled evidence from multiple prior studies. Following an "umbrella" review approach, they extracted and analyzed data from the 48 papers on links between plant-based diets, cardiovascular health, and cancer risk.

Their analysis showed that, overall, vegetarian and vegan diets have a robust statistical association with better health status on a number of risk factors associated with cardiometabolic diseases, cancer, and mortality, such as blood pressure, management of blood sugar, and body mass index. Such diets are associated with reduced risk of ischemic heart disease, gastrointestinal and prostate cancer, and death from cardiovascular disease.

However, among pregnant women specifically, those with vegetarian diets faced no difference in their risk of gestational diabetes and hypertension compared to those on non-plant-based diets.

Overall, these findings suggest that plant-based diets are associated with significant health benefits. However, the researchers note, the statistical strength of this association is significantly limited by the many differences between past studies in terms of the specific diet regimens followed, patient demographics, study duration, and other factors. Moreover, some plant-based diets may introduce vitamin and mineral deficiencies for some people. Thus, the researchers caution against large-scale recommendation of plant-based diets until more research is completed.

The authors add: "Our study evaluates the different impacts of animal-free diets for cardiovascular health and cancer risk showing how a vegetarian diet can be beneficial to human health and be one of the effective preventive strategies for the two most impactful chronic diseases on human health in the 21st century."

• Diet and Weight Loss
• Diseases and Conditions
• Colon Cancer
• Endangered Plants
• Veterinary Medicine
• Colorectal cancer
• Ovarian cancer
• Polyphenol antioxidant
• Stomach cancer
• Cervical cancer
• HPV vaccine
• Breast cancer

Story Source:

Materials provided by PLOS . Note: Content may be edited for style and length.

Journal Reference :

• Angelo Capodici, Gabriele Mocciaro, Davide Gori, Matthew J. Landry, Alice Masini, Francesco Sanmarchi, Matteo Fiore, Angela Andrea Coa, Gisele Castagna, Christopher D. Gardner, Federica Guaraldi. Cardiovascular health and cancer risk associated with plant based diets: An umbrella review . PLOS ONE , 2024; 19 (5): e0300711 DOI: 10.1371/journal.pone.0300711

Cite This Page :

Explore More

• High-Efficiency Photonic Integrated Circuit
• Life Expectancy May Increase by 5 Years by 2050
• Toward a Successful Vaccine for HIV
• Highly Efficient Thermoelectric Materials
• Toward Human Brain Gene Therapy
• Whale Families Learn Each Other's Vocal Style
• AI Can Answer Complex Physics Questions
• Otters Use Tools to Survive a Changing World
• Monogamy in Mice: Newly Evolved Type of Cell
• Sustainable Electronics, Doped With Air

Trending Topics

Strange & offbeat.