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Peer Review and Primary Literature: An Introduction: Is it Primary Research? How Do I Know?

• Scholarly Journal vs. Magazine
• Peer Review: What is it?
• Finding Peer-Reviewed Articles
• Primary Journal Literature
• Is it Primary Research? How Do I Know?

Components of a Primary Research Study

As indicated on a previous page, Peer-Reviewed Journals also include non -primary content. Simply limiting your search results in a database to "peer-reviewed" will not retrieve a list of only primary research studies.

Learn to recognize the parts of a primary research study. Terminology will vary slightly from discipline to discipline and from journal to journal.  However, there are common components to most research studies.

When you run a search, find a promising article in your results list and then look at the record for that item (usually by clicking on the title). The full database record for an item usually includes an abstract or summary--sometimes prepared by the journal or database, but often written by the author(s) themselves. This will usually give a clear indication of whether the article is a primary study.  For example, here is a full database record from a search for family violence and support in SocINDEX with Full Text :

Although the abstract often tells the story, you will need to read the article to know for sure. Besides scanning the Abstract or Summary, look for the following components: (I am only capturing small article segments for illustration.)

Look for the words METHOD or METHODOLOGY . The authors should explain how they conducted their research.

NOTE: Different Journals and Disciplines will use different terms to mean similar things. If instead of " Method " or " Methodology " you see a heading that says " Research Design " or " Data Collection ," you have a similar indicator that the scholar-authors have done original research.

Look for the section called RESULTS . This details what the author(s) found out after conducting their research.

Charts , Tables , Graphs , Maps and other displays help to summarize and present the findings of the research.

A Discussion indicates the significance of findings, acknowledges limitations of the research study, and suggests further research.

References , a Bibliography or List of Works Cited indicates a literature review and shows other studies and works that were consulted. USE THIS PART OF THE STUDY! If you find one or two good recent studies, you can identify some important earlier studies simply by going through the bibliographies of those articles.

A FINAL NOTE:  If you are ever unclear about whether a particular article is appropriate to use in your paper, it is best to show that article to your professor and discuss it with them.  The professor is the final judge since they will be assigning your grade.

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Peer-review and primary research.

• Getting Started With Peer-Reviewed Literature

Primary Research

Identifying a primary research article.

• Finding Peer-Reviewed Journal Articles
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STEM Librarian

Primary research or a primary study refers to a research article that is an author’s original research that is almost always published in a peer-reviewed journal. A primary study reports on the details, methods and results of a research study. These articles often have a standard structure of a format called IMRAD, referring to sections of an article: Introduction, Methods, Results and Discussion. Primary research studies will start with a review of the previous literature, however, the rest of the article will focus on the authors’ original research. Literature reviews can be published in peer-reviewed journals, however, they are not primary research.

Primary studies are part of primary sources but should not be mistaken for primary documents. Primary documents are usually original sources such as a letter, a diary, a speech or an autobiography. They are a first person view of an event or a period. Typically, if you are a Humanities major, you will be asked to find primary documents for your paper however, if you are in Social Sciences or the Sciences you are most likely going to be asked to find primary research studies. If you are unsure, ask your professor or a librarian for help.

A primary research or study is an empirical research that is published in peer-reviewed journals. Some ways of recognizing whether an article is a primary research article when searching a database:

1. The abstract includes a research question or a hypothesis,  methods and results.

2. Studies can have tables and charts representing data findings.

3. The article includes a section for "methods” or “methodology” and "results".

4. Discussion section indicates findings and discusses limitations of the research study, and suggests further research.

5. Check the reference section because it will refer you to the studies and works that were consulted. You can use this section to find other studies on that particular topic.

The following are not to be confused with primary research articles:

- Literature reviews

- Meta-analyses or systematic reviews (these studies make conclusions based on research on many other studies)

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Introduction to Primary Research: Observations, Surveys, and Interviews

Primary Research: Definitions and Overview

   How research is defined varies widely from field to field, and as you progress through your college career, your coursework will teach you much more about what it means to be a researcher within your field.* For example, engineers, who focus on applying scientific knowledge to develop designs, processes, and objects, conduct research using simulations, mathematical models, and a variety of tests to see how well their designs work. Sociologists conduct research using surveys, interviews, observations, and statistical analysis to better understand people, societies, and cultures. Graphic designers conduct research through locating images for reference for their artwork and engaging in background research on clients and companies to best serve their needs. Historians conduct research by examining archival materials—newspapers, journals, letters, and other surviving texts—and through conducting oral history interviews. Research is not limited to what has already been written or found at the library, also known as secondary research. Rather, individuals conducting research are producing the articles and reports found in a library database or in a book. Primary research, the focus of this essay, is research that is collected firsthand rather than found in a book, database, or journal.

   Primary research is often based on principles of the scientific method, a theory of investigation first developed by John Stuart Mill in the nineteenth century in his book Philosophy of the Scientific Method .  Although the application of the scientific method varies from field to field, the general principles of the scientific method allow researchers to learn more about the world and observable phenomena. Using the scientific method, researchers develop research questions or hypotheses and collect data on events, objects, or people that is measurable, observable, and replicable. The ultimate goal in conducting primary research is to learn about something new that can be confirmed by others and to eliminate our own biases in the process.

Essay Overview and Student Examples

     The essay begins by providing an overview of ethical considerations when conducting primary research, and then covers the stages that you will go through in your primary research: planning, collecting, analyzing, and writing. After the four stages comes an introduction to three common ways of conducting primary research in first year writing classes:

Observations . Observing and measuring the world around you, including observations of people and other measurable events.

Interviews . Asking participants questions in a one-on-one or small group setting.

Surveys . Asking participants about their opinions and behaviors through a short questionnaire.

In addition, we will be examining two student projects that used substantial portions of primary research:

    Derek Laan, a nutrition major at Purdue University, wanted to learn more about student eating habits on campus. His primary re-search included observations of the campus food courts, student behavior while in the food courts, and a survey of students’ daily food intake. His secondary research included looking at national student eating trends on college campuses, information from the United States Food and Drug Administration, and books on healthy eating.

    Jared Schwab, an agricultural and biological engineering major at Purdue, was interested in learning more about how writing and communication took place in his field. His primary research included interviewing a professional engineer and a student who was a senior majoring in engineering. His secondary research included examining journals, books, professional organizations, and writing guides within the field of engineering.

Ethics of Primary Research

   Both projects listed above included primary research on human participants; therefore, Derek and Jared both had to consider research ethics throughout their primary research process. As Earl Babbie writes in The Practice of Social Research , throughout the early and middle parts of the twentieth century researchers took advantage of participants and treated them unethically. During World War II, Nazi doctors performed heinous experiments on prisoners without their consent, while in the U.S., a number of medical and psychological experiments on caused patients undue mental and physical trauma and, in some cases, death. Because of these and other similar events, many nations have established ethical laws and guidelines for researchers who work with human participants. In the United States, the guidelines for the ethical treatment of human research participants are described in The Belmont Report , released in 1979. Today, universities have Institutional Review Boards (or IRBs) that oversee research. Students conducting research as part of a class may not need permission from the university’s IRB, although they still need to ensure that they follow ethical guidelines in research. The following provides a brief overview of ethical considerations:

• Voluntary participation . The Belmont Report suggests that, in most cases, you need to get permission from people before you involve them in any primary research you are conducting. If you are doing a survey or interview, your participants must first agree to fill out your survey or to be interviewed. Consent for observations can be more complicated, and is dis-cussed later in the essay.

Confidentiality and anonymity . Your participants may reveal embarrassing or potentially damaging information such as racist comments or unconventional behavior. In these cases, you should keep your participants’ identities anonymous when writing your results. An easy way to do this is to create a “pseudonym” (or false name) for them so that their identity is protected.

Researcher bias . There is little point in collecting data and learning about something if you already think you know the answer! Bias might be present in the way you ask questions, the way you take notes, or the conclusions you draw from the data you collect.

   The above are only three of many considerations when involving human participants in your primary research. For a complete under-standing of ethical considerations please refer to The Belmont Report .

   Now that we have considered the ethical implications of research, we will examine how to formulate research questions and plan your primary research project.

Planning Your Primary Research Project

   The primary research process is quite similar to the writing process, and you can draw upon your knowledge of the writing process to understand the steps involved in a primary research project. Just like in the writing process, a successful primary research project begins with careful planning and background research. This section first describes how to create a research timeline to help plan your research. It then walks you through the planning stages by examining when primary research is useful or appropriate for your first year composition course, narrowing down a topic, and developing research questions.

The Research Timeline

   When you begin to conduct any kind of primary research, creating a timeline will help keep you on task. Because students conducting primary research usually focus on the collection of data itself, they often overlook the equally important areas of planning (invention), analyzing data, and writing. To help manage your time, you should create a research timeline, such as the sample timeline presented here.

When Primary Research Is Useful or Appropriate

   In Evaluating Scientific Research: Separating Fact from Fiction , Fred Leavitt explains that primary research is useful for questions that can be answered through asking others and direct observation. For first year writing courses, primary research is particularly useful when you want to learn about a problem that does not have a wealth of published information. This may be because the problem is a recent event or it is something not commonly studied. For example, if you are writing a paper on a new political issue, such as changes in tax laws or healthcare, you might not be able to find a wealth of peer-reviewed research because the issue is only several weeks old. You may find it necessary to collect some of your own data on the issue to supplement what you found at the library. Primary research is also useful when you are studying a local problem or learning how a larger issue plays out at the local level. Although you might be able to find information on national statistics for healthy eating, whether or not those statistics are representative of your college campus is something that you can learn through primary research.

   However, not all research questions and topics are appropriate for primary research. As Fred Leavitt writes, questions of an ethical, philosophical, or metaphysical nature are not appropriate because these questions are not testable or observable. For example, the question “Does an afterlife exist?” is not a question that can be answered with primary research. However, the question “How many people in my community believe in an afterlife?” is something that primary research can answer.

Narrowing Your Topic

   Just like the writing process, you should start your primary research process with secondary (library) research to learn more about what is already known and what gaps you need to fill with your own data. As you learn more about the topic, you can narrow down your interest area and eventually develop a research question or hypothesis, just as you would with a secondary research paper.

Developing Research Questions or Hypotheses

   As John Stuart Mill describes, primary research can use both inductive and deductive approaches, and the type approach is usually based on the field of inquiry. Some fields use deductive reasoning , where researchers start with a hypothesis or general conclusion and then collect specific data to support or refute their hypothesis. Other fields use inductive reasoning , where researchers start with a question and collect information that eventually leads to a conclusion.

   Once you have spent some time reviewing the secondary research on your topic, you are ready to write a primary research question or hypothesis. A research question or hypothesis should be something that is specific, narrow, and discoverable through primary research methods. Just like a thesis statement for a paper, if your research question or hypothesis is too broad, your research will be unfocused and your data will be difficult to analyze and write about. Here is a set of sample research questions:

Poor Research Question : What do college students think of politics and the economy?

Revised Research Question : What do students at Purdue University believe about the current economic crisis in terms of economic recoverability?

   The poor research question is unspecific as to what group of students the researcher is interested in—i.e. students in the U.S.? In a particular state? At their university? The poor research question was also too broad; terms like “politics” and the “economy” cover too much ground for a single project. The revised question narrows down the topic to students at a particular university and focuses on a specific issue related to the economy: economic recoverability. The research question could also be rephrased as a testable hypothesis using deductive reasoning: “Purdue University college students are well informed about economic recoverability plans.” Because they were approaching their projects in an exploratory, inductive manner, both Derek and Jared chose to ask research questions:

Derek: Are students’ eating habits at Purdue University healthy or unhealthy? What are the causes of students’ eating behavior?

Jared: What are the major features of writing and communication in agricultural and biological engineering? What are the major controversies? 

   A final step in working with a research question or hypothesis is determining what key terms you are using and how you will define them. Before conducting his research, Derek had to define the terms “healthy” and “unhealthy”; for this, he used the USDA’s Food Pyramid as a guide. Similarly, part of what Jared focused on in his interviews was learning more about how agricultural and biological engineers defined terms like “writing” and “communication.” Derek and Jared thought carefully about the terms within their research questions and how these terms might be measured. 

Choosing a Data Collection Method 

    Once you have formulated a research question or hypothesis, you will need to make decisions about what kind of data you can collect that will best address your research topic. Derek chose to examine eating habits by observing both what students ate at lunch and surveying students about eating behavior. Jared decided that in-depth interviews with experienced individuals in his field would provide him with the best information.

   To choose a data collection method for your research question, read through the next sections on observations, interviews, and surveys.

Observations

   Observations have lead to some of the most important scientific discoveries in human history. Charles Darwin used observations of the animal and marine life at the Galapagos Islands to help him formulate his theory of evolution that he describes in On the Origin of Species . Today, social scientists, natural scientists, engineers, computer scientists, educational researchers, and many others use observations as a primary research method.

   Observations can be conducted on nearly any subject matter, and the kinds of observations you will do depend on your research question. You might observe traffic or parking patterns on campus to get a sense of what improvements could be made. You might observe clouds, plants, or other natural phenomena. If you choose to observe people, you will have several additional considerations including the manner in which you will observe them and gain their consent.

   If you are observing people, you can choose between two common ways to observe: participant observation and unobtrusive observation. Participant observation is a common method within ethnographic research in sociology and anthropology. In this kind of observation, a researcher may interact with participants and become part of their community. Margaret Mead, a famous anthropologist, spent extended periods of time living in, and interacting with, communities that she studied. Conversely, in unobtrusive observation, you do not interact with participants but rather simply record their behavior. Although in most circumstances people must volunteer to be participants in research, in some cases it is acceptable to not let participants know you are observing them. In places that people perceive as public, such as a campus food court or a shopping mall, people do not expect privacy, and so it is generally acceptable to observe without participant consent. In places that people perceive as private, which can include a church, home, classroom, or even an intimate conversation at a restaurant, participant consent should be sought. 

   The second issue about participant consent in terms of unobtrusive observation is whether or not getting consent is feasible for the study. If you are observing people in a busy airport, bus station, or campus food court, getting participant consent may be next to impossible. In Derek’s study of student eating habits on campus, he went to the campus food courts during meal times and observed students purchasing food. Obtaining participant consent for his observations would have been next to impossible because hundreds of students were coming through the food court during meal times. Since Derek’s research was in a place that participants would perceive as public, it was not practical to get their consent, and since his data was anonymous, he did not violate their privacy.

Eliminating Bias in Your Observation Notes

The ethical concern of being unbiased is important in recording your observations. You need to be aware of the difference between an observation (recording exactly what you see) and an interpretation (making assumptions and judgments about what you see). When you observe, you should focus first on only the events that are directly observable. Consider the following two example entries in an observation log:

• The student sitting in the dining hall enjoys his greasy, oil-soaked pizza. He is clearly oblivious of the calorie content and damage it may do to his body.
• The student sits in the dining hall. As he eats his piece of pizza, which drips oil, he says to a friend, “This pizza is good.”

The first entry is biased and demonstrates judgment about the event. First, the observer makes assumptions about the internal state of the student when she writes “enjoys” and “clearly oblivious to the calorie content.” From an observer’s standpoint, there is no way of ascertaining what the student may or may not know about pizza’s nutritional value nor how much the student enjoys the pizza. The second entry provides only the details and facts that are observable.

   To avoid bias in your observations, you can use something called a “double-entry notebook.” This is a type of observation log that encourages you to separate your observations (the facts) from your feelings and judgments about the facts.

• Observations Thoughts
• The student sits in the dining hall. As he eats his piece of pizza, which drips oil, he says to a friend, "this pizza is good."  It seems like the student really enjoys the high-calorie-content pizza. 
• I observed cash register #1 for 15 minutes. During that time, 22 students paid for meals. Of those 22 students, 15 grabbed a candy bar or granola bar. 3 of the 22 students had a piece of fruit on their plate Fruit is less accessible than candy bars (it is further back in the dining court). Is this why more students are reaching for candy bars?

Figure 3: Two sample entries from a double-entry notebook.

   Observations are only one strategy in collecting primary research. You may also want to ask people directly about their behaviors, beliefs, or attitudes—and for this you will need to use surveys or interviews.

Surveys and Interviews: Question Creation

Sometimes it is very difficult for a researcher to gain all of the necessary information through observations alone. Along with his observations of the dining halls, Derek wanted to know what students ate in a typical day, and so he used a survey to have them keep track of their eating habits. Likewise, Jared wanted to learn about writing and communication in engineering and decided to draw upon expert knowledge by asking experienced individuals within the field.

   Interviews and surveys are two ways that you can gather information about people’s beliefs or behaviors. With these methods, the information you collect is not first-hand (like an observation) but rather “self-reported” data, or data collected in an indirect manner. William Shadish, Thomas Cook, and Donald Campbell argued that people are inherently biased about how they see the world and may report their own actions in a more favorable way than they may actually behave. Despite the issues in self-reported data, surveys and interviews are an excellent way to gather data for your primary research project.

Survey or Interview? 

How do you choose between conducting a survey or an interview? It depends on what kind of information you are looking for. You should use surveys if you want to learn about a general trend in people’s opinions, experiences, and behavior. Surveys are particularly useful to find small amounts of information from a wider selection of people in the hopes of making a general claim. Interviews are best used when you want to learn detailed information from a few specific people. Interviews are also particularly useful if you want to interview experts about their opinions, as Jared did. In sum, use interviews to gain de-tails from a few people, and surveys to learn general patterns from many people.

Writing Good Questions

One of the greatest challenges in conducting surveys and interviews is writing good questions. As a researcher, you are always trying to eliminate bias, and the questions you ask need to be unbiased and clear. Here are some suggestions on writing good questions:

Ask about One Thing at a Time

A poorly written question can contain multiple questions, which can confuse participants or lead them to answer only part of the question you are asking. This is called a “double-barreled question” in journalism. The following questions are taken from Jared’s research:

Poor question: What kinds of problems are being faced in the field today and where do you see the search for solutions to these problems going?

Revised question #1: What kinds of problems are being faced in the field today?

Revised question #2: Where do you see the search for solutions to these problems going?

Avoid Leading Questions

A leading question is one where you prompt the participant to respond in a particular way, which can create bias in the answers given:

Leading question: The economy is clearly in a crisis, wouldn’t you agree?

Revised question: Do you believe the economy is currently in a crisis? Why or why not?

Understand When to Use Open and Closed Questions

Closed questions, or questions that have yes/no or other limited responses, should be used in surveys. However, avoid these kinds of questions in interviews because they discourage the interviewee from going into depth. The question sample above, “Do you believe the economy currently is in a crisis?” could be answered with a simple yes or no, which could keep a participant from talking more about the issue. The “why or why not?” portion of the question asks the participant to elaborate. On a survey, the question “Do you believe the economy currently is in a crisis?” is a useful question because you can easily count the number of yes and no answers and make a general claim about participant responses.

Write Clear Questions

When you write questions, make sure they are clear, concise, and to the point. Questions that are too long, use unfamiliar vocabulary, or are unclear may confuse participants and you will not get quality responses.

Now that question creation has been addressed, we will next examine specific considerations for interviews and surveys.

Interviews, or question and answer sessions with one or more people, are an excellent way to learn in-depth information from a person for your primary research project. This section presents information on how to conduct a successful interview, including choosing the right person, ways of interviewing, recording your interview, interview locations, and transcribing your interview.

Choosing the Right Person

One of the keys to a successful interview is choosing the right person to interview. Think about whom you would like to interview and whom you might know. Do not be afraid to ask people you do not know for interviews. When asking, simply tell them what the interview will be about, what the interview is for, and how much time it will take. Jared used his Purdue University connection to locate both of the individuals that he ended up interviewing—an advanced Purdue student and a Purdue alum working in an Engineering firm.

Face-to-Face and Virtual Interviews

When interviewing, you have a choice of conducting a traditional, face-to-face interview or an interview using technology over the Internet. Face-to-face interviews have the strength that you can ask follow-up questions and use non-verbal communication to your advantage. Individuals are able to say much more in a face-to-face interview than in an email, so you will get more information from a face-to-face interview. However, the Internet provides a host of new possibilities when it comes to interviewing people at a distance. You may choose to do an email interview, where you send questions and ask the person to respond. You may also choose to use a video or audio conferencing program to talk with the person virtually. If you are choosing any Internet-based option, make sure you have a way of recording the interview. You may also use a chat or instant messaging program to interview your participant—the benefit of this is that you can ask follow-up questions during the interview and the interview is already transcribed for you. Because one of his interviewees lived several hours away, Jared chose to interview the Purdue student face-to-face and the Purdue alum via email.

Finding a Suitable Location

If you are conducting an in-person interview, it is essential that you find a quiet place for your interview. Many universities have quiet study rooms that can be reserved (often found in the university library). Do not try to interview someone in a coffee shop, dining hall, or other loud area, as it is difficult to focus and get a clear recording.

Recording Interviews

One way of eliminating bias in your research is to record your interviews rather than rely on your memory. Recording interviews allows you to directly quote the individual and re-read the interview when you are writing. It is recommended that you have two recording devices for the interview in case one recording device fails. Most computers, MP3 players, and even cell phones come with recording equipment built in. Many universities also offer equipment that students can check out and use, including computers and recorders. Before you record any interview, be sure that you have permission from your participant.

Transcribing Your Interview

Once your interview is over, you will need to transcribe your interview to prepare it for analysis. The term transcribing means creating a written record that is exactly what was said—i.e. typing up your interviews. If you have conducted an email or chat interview, you already have a transcription and can move on to your analysis stage.

Other than the fact that they both involve asking people questions, interviews and surveys are quite different data collection methods. Creating a survey may seem easy at first, but developing a quality survey can be quite challenging. When conducting a survey, you need to focus on the following areas: survey creation, survey testing, survey sampling, and distributing your survey.

Survey Creation: Length and Types of Questions

One of the keys to creating a successful survey is to keep your survey short and focused. Participants are unlikely to fill out a survey that is lengthy, and you’ll have a more difficult time during your analysis if your survey contains too many questions. In most cases, you want your survey to be something that can be filled out within a few minutes. The target length of the survey also depends on how you will distribute the survey. If you are giving your survey to other students in your dorm or classes, they will have more time to complete the survey. Therefore, five to ten minutes to complete the survey is reasonable. If you are asking students as they are walking to class to fill out your survey, keep it limited to several questions that can be answered in thirty seconds or less. Derek’s survey took about ten minutes and asked students to describe what they ate for a day, along with some demographic information like class level and gender.

   Use closed questions to your advantage when creating your survey. A closed question is any set of questions that gives a limited amount of choices (yes/no, a 1–5 scale, choose the statement that best describes you). When creating closed questions, be sure that you are accounting for all reasonable answers in your question creation. For example, asking someone “Do you believe you eat healthy?” and providing them only “yes” and “no” options means that a “neutral” or “undecided” option does not exist, even though the survey respondent may not feel strongly either way. Therefore, on closed questions you may find it helpful to include an “other” category where participants can fill in an answer. It is also a good idea to have a few open-ended questions where participants can elaborate on certain points or earlier responses. How-ever, open-ended questions take much longer to fill out than closed questions. 

Survey Creation: Testing Your Survey

To make sure your survey is an appropriate length and that your questions are clear, you can “pilot test” your survey. Prior to administering your survey on a larger scale, ask several classmates or friends to fill it out and give you feedback on the survey. Keep track of how long the survey takes to complete. Ask them if the questions are clear and make sense. Look at their answers to see if the answers match what you wanted to learn. You can revise your survey questions and the length of your survey as necessary.

Sampling and Access to Survey Populations

“Sampling” is a term used within survey research to describe the subset of people that are included in your study. Derek’s first research question was: “Are students’ eating habits at Purdue University healthy or unhealthy?” Because it was impossible for Derek to survey all 38,000 students on Purdue’s campus, he had to choose a representative sample of students. Derek chose to survey students who lived in the dorms because of the wide variety of student class levels and majors in the dorms and his easy access to this group. By making this choice, however, he did not account for commuter students, graduate students, or those who live off campus. As Derek’s case demonstrates, it is very challenging to get a truly representative sample.

   Part of the reason that sampling is a challenge is that you may find difficulty in finding enough people to take your survey. In thinking about how get people to take your survey, consider both your everyday surroundings and also technological solutions. Derek had access to many students in the dorms, but he also considered surveying students in his classes in order to reach as many people as possible. Another possibility is to conduct an online survey. Online surveys greatly increase your access to different kinds of people from across the globe, but may decrease your chances of having a high survey response rate. An email or private message survey request is more likely to be ignored due to the impersonal quality and high volume of emails most people receive.

Analyzing and Writing About Primary Research

Once you collect primary research data, you will need to analyze what you have found so that you can write about it. The purpose of analyzing your data is to look at what you collected (survey responses, interview answers to questions, observations) and to create a cohesive, systematic interpretation to help answer your research question or examine the validity of your hypothesis.

   When you are analyzing and presenting your findings, remember to work to eliminate bias by being truthful and as accurate as possible about what you found, even if it differs from what you expected to find. You should see your data as sources of information, just like sources you find in the library, and you should work to represent them accurately.

The following are suggestions for analyzing different types of data.

If you’ve counted anything you were observing, you can simply add up what you counted and report the results. If you’ve collected descriptions using a double-entry notebook, you might work to write thick descriptions of what you observed into your writing. This could include descriptions of the scene, behaviors you observed, and your overall conclusions about events. Be sure that your readers are clear on what were your actual observations versus your thoughts or interpretations of those observations.

If you’ve interviewed one or two people, then you can use your summary, paraphrasing, and quotation skills to help you accurately describe what was said in the interview. Just like in secondary research when working with sources, you should introduce your interviewees and choose clear and relevant quotes from the interviews to use in your writing. An easy way to find the important information in an interview is to print out your transcription and take a highlighter and mark the important parts that you might use in your paper. If you have conducted a large number of interviews, it will be helpful for you to create a spreadsheet of responses to each question and compare the responses, choosing representative answers for each area you want to describe.

Surveys can contain quantitative (numerical) and qualitative (written answers/descriptions) data. Quantitative data can be analyzed using a spreadsheet program like Microsoft Excel to calculate the mean (average) answer or to calculate the percentage of people who responded in a certain way. You can display this information in a chart or a graph and also describe it in writing in your paper. If you have qualitative responses, you might choose to group them into categories and/or you may choose to quote several representative responses.

Writing about Primary Research

In formal research writing in a variety of fields, it is common for research to be presented in the following format: introduction/background; methods; results; discussions; conclusion. Not all first year writing classes will require such an organizational structure, although it is likely that you will be required to present many of these elements in your paper. Because of this, the next section examines each of these in depth.

Introduction (Review of Literature)

The purpose of an introduction and review of literature in a research paper is to provide readers with information that helps them under-stand the context, purpose, and relevancy of your research. The introduction is where you provide most of your background (library) research that you did earlier in the process. You can include articles, statistics, research studies, and quotes that are pertinent to the issues at hand. A second purpose in an introduction is to establish your own credibility (ethos) as a writer by showing that you have researched your topic thoroughly. This kind of background discussion is required in nearly every field of inquiry when presenting research in oral or written formats.

   Derek provided information from the Food and Drug Administration on healthy eating and national statistics about eating habits as part of his background information. He also made the case for healthy eating on campus to show relevancy:

Currently Americans are more overweight than ever. This is coming at a huge cost to the economy and government. If current trends in increasing rates of overweight and obesity continue it is likely that this generation will be the first one to live shorter lives than their parents did. Looking at the habits of university students is a good way to see how a new generation behaves when they are living out on their own for the first time.

Describing What You Did (Methods)

When writing, you need to provide enough information to your readers about your primary research process for them to understand what you collected and how you collected it. In formal research papers, this is often called a methods section. Providing information on your study methods also adds to your credibility as a writer. For surveys, your methods would include describing who you surveyed, how many surveys you collected, decisions you made about your survey sample, and relevant demographic information about your participants (age, class level, major). For interviews, introduce whom you interviewed and any other relevant information about interviewees such as their career or expertise area. For observations, list the locations and times you observed and how you recorded your observations (i.e. double-entry notebook). For all data types, you should describe how you analyzed your data.

The following is a sample from Jared about his participants:

In order to gain a better understanding of the discourse community in environmental and resource engineering, I interviewed Anne Dare, a senior in environmental and natural resource engineering, and Alyson Keaton an alumnus of Purdue University. Alyson is a current employee of the Natural Resource Conservation Service (NRCS), which is a division of the United States Department of Agriculture (USDA).

Here is a sample from Derek’s methods section:

I conducted a survey so that I could find out what students at Purdue actually eat on a typical day. I handed out surveys asking students to record what they ate for a day . . . I received 29 back and averaged the results based on average number of servings from each food group on the old food guide pyramid. The group included students from the freshman to the graduate level and had 8 women and 21 men respond.

Describing Your Study Findings (Results)

In a formal research paper, the results section is where you describe what you found. The results section can include charts, graphs, lists, direct quotes, and overviews of findings. Readers find it helpful if you are able to provide the information in different formats. For example, if you have any kind of numbers or percentages, you can talk about them in your written description and then present a graph or chart showing them visually. You should provide specific details as supporting evidence to back up your findings. These details can be in the form of direct quotations, numbers, or observations.

Jared describes some of his interview results:

Alyson also mentioned the need for phone conversation. She stated, “The phone is a large part of my job. I am communicating with other NRCS offices daily to find out the status of our jobs.” She needs to be in constant contact in order to insure that everything is running smoothly. This is common with those overseeing projects. In these cases, the wait for a response to an email or a memo can be too long to be effective.

Interpreting What You Learned (Discussion)

In formal research papers, the discussion section presents your own interpretation of your results. This may include what you think the results mean or how they are useful to your larger argument. If you are making a proposal for change or a call to action, this is where you make it. For example, in Derek’s project about healthy eating on campus, Derek used his primary research on students’ unhealthy eating and observations of the food courts to argue that the campus food courts needed serious changes. Derek writes, “Make healthy food options the most accessible in every dining hall while making unhealthy foods the least. Put nutrition facts for everything that is served in the dining halls near the food so that students can make more informed decisions on what to eat.”

   Jared used the individuals he interviewed as informants that helped him learn more about writing in agricultural and biological engineering. He integrated the interviews he conducted with secondary research to form a complete picture of writing and communication in agricultural and biological engineering. He concludes:

Writing takes so many forms, and it is important to know about all these forms in one way or another. The more forms of writing you can achieve, the more flexible you can be. This ability to be flexible can make all the difference in writing when you are dealing with a field as complex as engineering.

Primary Research and Works Cited or References Pages

The last part of presenting your primary research project is a works cited or references page. In general, since you are working with data you collected yourself, there is no source to cite an external source. Your methods section should describe in detail to the readers how and where the data presented was obtained. However, if you are working with interviews, you can cite these as “personal communication.” The MLA and APA handbooks both provide clear listings of how to cite personal communication in a works cited/references page.

This essay has presented an overview to three commonly used methods of primary research in first year writing courses: observations, interviews, and surveys. By using these methods, you can learn more about the world around you and craft meaningful written discussions of your findings.

• Primary research techniques show up in more places than just first year writing courses. Where else might interviews, surveys, or observations be used? Where have you seen them used?
• The chapter provides a brief discussion of the ethical considerations of research. Can you think of any additional ethical considerations when conducting primary research? Can you think of ethical considerations unique to your own research project?
• Primary research is most useful for first year writing students if it is based in your local community or campus. What are some current issues on your campus or in your community that could be investigated using primary research methods?
• In groups or as a class, make a list of potential primary research topics. After each topic on the list, consider what method of inquiry (observation, interview, or survey) you would use to study the topic and answer why that method is a good choice.

Suggested Resources

For more information on the primary methods of inquiry described here, please see the following sources:

Works Cited

This essay was written by Dana Lynn Driscoll and was published as a chapter in Writing Spaces: Readings on Writing , Volume 2, a peer-reviewed open textbook series for the writing classroom. This work is licensed under the Attribution-NonCommercial-ShareAlike 3.0 Unported License (CC BY-NC-SA 3.0) . Please keep this information on this material if you use, adapt, and/or share it.  

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Primary Research: What It Is, Purpose & Methods + Examples

As we continue exploring the exciting research world, we’ll come across two primary and secondary data approaches. This article will focus on primary research – what it is, how it’s done, and why it’s essential. 

We’ll discuss the methods used to gather first-hand data and examples of how it’s applied in various fields. Get ready to discover how this research can be used to solve research problems , answer questions, and drive innovation.

What is Primary Research: Definition

Primary research is a methodology researchers use to collect data directly rather than depending on data collected from previously done research. Technically, they “own” the data. Primary research is solely carried out to address a certain problem, which requires in-depth analysis .

There are two forms of research:

• Primary Research
• Secondary Research

Businesses or organizations can conduct primary research or employ a third party to conduct research. One major advantage of primary research is this type of research is “pinpointed.” Research only focuses on a specific issue or problem and on obtaining related solutions.

For example, a brand is about to launch a new mobile phone model and wants to research the looks and features they will soon introduce. 

Organizations can select a qualified sample of respondents closely resembling the population and conduct primary research with them to know their opinions. Based on this research, the brand can now think of probable solutions to make necessary changes in the looks and features of the mobile phone.

Primary Research Methods with Examples

In this technology-driven world, meaningful data is more valuable than gold. Organizations or businesses need highly validated data to make informed decisions. This is the very reason why many companies are proactive in gathering their own data so that the authenticity of data is maintained and they get first-hand data without any alterations.

Here are some of the primary research methods organizations or businesses use to collect data:

1. Interviews (telephonic or face-to-face)

Conducting interviews is a qualitative research method to collect data and has been a popular method for ages. These interviews can be conducted in person (face-to-face) or over the telephone. Interviews are an open-ended method that involves dialogues or interaction between the interviewer (researcher) and the interviewee (respondent).

Conducting a face-to-face interview method is said to generate a better response from respondents as it is a more personal approach. However, the success of face-to-face interviews depends heavily on the researcher’s ability to ask questions and his/her experience related to conducting such interviews in the past. The types of questions that are used in this type of research are mostly open-ended questions . These questions help to gain in-depth insights into the opinions and perceptions of respondents.

Personal interviews usually last up to 30 minutes or even longer, depending on the subject of research. If a researcher is running short of time conducting telephonic interviews can also be helpful to collect data.

2. Online surveys

Once conducted with pen and paper, surveys have come a long way since then. Today, most researchers use online surveys to send to respondents to gather information from them. Online surveys are convenient and can be sent by email or can be filled out online. These can be accessed on handheld devices like smartphones, tablets, iPads, and similar devices.

Once a survey is deployed, a certain amount of stipulated time is given to respondents to answer survey questions and send them back to the researcher. In order to get maximum information from respondents, surveys should have a good mix of open-ended questions and close-ended questions . The survey should not be lengthy. Respondents lose interest and tend to leave it half-done.

It is a good practice to reward respondents for successfully filling out surveys for their time and efforts and valuable information. Most organizations or businesses usually give away gift cards from reputed brands that respondents can redeem later.

3. Focus groups

This popular research technique is used to collect data from a small group of people, usually restricted to 6-10. Focus group brings together people who are experts in the subject matter for which research is being conducted.

Focus group has a moderator who stimulates discussions among the members to get greater insights. Organizations and businesses can make use of this method, especially to identify niche markets to learn about a specific group of consumers.

4. Observations

In this primary research method, there is no direct interaction between the researcher and the person/consumer being observed. The researcher observes the reactions of a subject and makes notes.

Trained observers or cameras are used to record reactions. Observations are noted in a predetermined situation. For example, a bakery brand wants to know how people react to its new biscuits, observes notes on consumers’ first reactions, and evaluates collective data to draw inferences .

Primary Research vs Secondary Research – The Differences

Primary and secondary research are two distinct approaches to gathering information, each with its own characteristics and advantages. 

While primary research involves conducting surveys to gather firsthand data from potential customers, secondary market research is utilized to analyze existing industry reports and competitor data, providing valuable context and benchmarks for the survey findings.

Find out more details about the differences: 

1. Definition

• Primary Research: Involves the direct collection of original data specifically for the research project at hand. Examples include surveys, interviews, observations, and experiments.
• Secondary Research: Involves analyzing and interpreting existing data, literature, or information. This can include sources like books, articles, databases, and reports.

2. Data Source

• Primary Research: Data is collected directly from individuals, experiments, or observations.
• Secondary Research: Data is gathered from already existing sources.

3. Time and Cost

• Primary Research: Often time-consuming and can be costly due to the need for designing and implementing research instruments and collecting new data.
• Secondary Research: Generally more time and cost-effective, as it relies on readily available data.

4. Customization

• Primary Research: Provides tailored and specific information, allowing researchers to address unique research questions.
• Secondary Research: Offers information that is pre-existing and may not be as customized to the specific needs of the researcher.
• Primary Research: Researchers have control over the research process, including study design, data collection methods , and participant selection.
• Secondary Research: Limited control, as researchers rely on data collected by others.

6. Originality

• Primary Research: Generates original data that hasn’t been analyzed before.
• Secondary Research: Involves the analysis of data that has been previously collected and analyzed.

7. Relevance and Timeliness

• Primary Research: Often provides more up-to-date and relevant data or information.
• Secondary Research: This may involve data that is outdated, but it can still be valuable for historical context or broad trends.

Advantages of Primary Research

Primary research has several advantages over other research methods, making it an indispensable tool for anyone seeking to understand their target market, improve their products or services, and stay ahead of the competition. So let’s dive in and explore the many benefits of primary research.

• One of the most important advantages is data collected is first-hand and accurate. In other words, there is no dilution of data. Also, this research method can be customized to suit organizations’ or businesses’ personal requirements and needs .
• I t focuses mainly on the problem at hand, which means entire attention is directed to finding probable solutions to a pinpointed subject matter. Primary research allows researchers to go in-depth about a matter and study all foreseeable options.
• Data collected can be controlled. I T gives a means to control how data is collected and used. It’s up to the discretion of businesses or organizations who are collecting data how to best make use of data to get meaningful research insights.
• I t is a time-tested method, therefore, one can rely on the results that are obtained from conducting this type of research.

Disadvantages of Primary Research

While primary research is a powerful tool for gathering unique and firsthand data, it also has its limitations. As we explore the drawbacks, we’ll gain a deeper understanding of when primary research may not be the best option and how to work around its challenges.

• One of the major disadvantages of primary research is it can be quite expensive to conduct. One may be required to spend a huge sum of money depending on the setup or primary research method used. Not all businesses or organizations may be able to spend a considerable amount of money.
• This type of research can be time-consuming. Conducting interviews and sending and receiving online surveys can be quite an exhaustive process and require investing time and patience for the process to work. Moreover, evaluating results and applying the findings to improve a product or service will need additional time.
• Sometimes, just using one primary research method may not be enough. In such cases, the use of more than one method is required, and this might increase both the time required to conduct research and the cost associated with it.

Every research is conducted with a purpose. Primary research is conducted by organizations or businesses to stay informed of the ever-changing market conditions and consumer perception. Excellent customer satisfaction (CSAT) has become a key goal and objective of many organizations.

A customer-centric organization knows the importance of providing exceptional products and services to its customers to increase customer loyalty and decrease customer churn. Organizations collect data and analyze it by conducting primary research to draw highly evaluated results and conclusions. Using this information, organizations are able to make informed decisions based on real data-oriented insights.

QuestionPro is a comprehensive survey platform that can be used to conduct primary research. Users can create custom surveys and distribute them to their target audience , whether it be through email, social media, or a website.

QuestionPro also offers advanced features such as skip logic, branching, and data analysis tools, making collecting and analyzing data easier. With QuestionPro, you can gather valuable insights and make informed decisions based on the results of your primary research. Start today for free!

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• Primary Research | Definition, Types, & Examples

Primary Research | Definition, Types, & Examples

Published on 15 January 2023 by Tegan George .

Primary research is a research method that relies on direct data collection , rather than relying on data that’s already been collected by someone else. In other words, primary research is any type of research that you undertake yourself, firsthand, while using data that has already been collected is called secondary research.

Primary research is often used in qualitative research , particularly in survey methodology, questionnaires, focus groups, and various types of interviews . While quantitative primary research does exist, it’s not as common.

Table of contents

When to use primary research, types of primary research, examples of primary research, advantages and disadvantages of primary research, frequently asked questions.

Primary research is any research that you conduct yourself. It can be as simple as a 2-question survey, or as in-depth as a years-long longitudinal study . The only key is that data must be collected firsthand by you.

Primary research is often used to supplement or strengthen existing secondary research. It is usually exploratory in nature, concerned with examining a research question where no preexisting knowledge exists. It is also sometimes called original research for this reason.

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Primary research can take many forms, but the most common types are:

• Surveys and questionnaire
• Observational studies
• Interviews and focus groups
• Surveys and questionnaires

Surveys and questionnaires collect information about a group of people by asking them questions and analyzing the results. They are a solid choice if your research topic seeks to investigate something about the characteristics, preferences, opinions, or beliefs of a group of people.

Surveys and questionnaires can take place online, in person, or through the mail. It is best to have a combination of open-ended and closed-ended questions, and how the questions are phrased matters. Be sure to avoid leading questions, and ask any related questions in groups, starting with the most basic ones first.

Observational studies are an easy and popular way to answer a research question based purely on what you, the researcher, observes. If there are practical or ethical concerns that prevent you from conducting a traditional experiment , observational studies are often a good stopgap.

There are three types of observational studies: cross-sectional studies , cohort studies, and case-control studies. If you decide to conduct observational research, you can choose the one that’s best for you. All three are quite straightforward and easy to design – just beware of confounding variables and observer bias creeping into your analysis.

Similarly to surveys and questionnaires, interviews and focus groups also rely on asking questions to collect information about a group of people. However, how this is done is slightly different. Instead of sending your questions out into the world, interviews and focus groups involve two or more people – one of whom is you, the interviewer, who asks the questions.

There are 3 main types of interviews:

• Structured interviews ask predetermined questions in a predetermined order.
• Unstructured interviews are more flexible and free-flowing, proceeding based on the interviewee’s previous answers.
• Semi-structured interviews fall in between, asking a mix of predetermined questions and off-the-cuff questions.

While interviews are a rich source of information, they can also be deceptively challenging to do well. Be careful of interviewer bias creeping into your process. This is best mitigated by avoiding double-barreled questions and paying close attention to your tone and delivery while asking questions.

Alternatively, a focus group is a group interview, led by a moderator. Focus groups can provide more nuanced interactions than individual interviews, but their small sample size means that external validity is low.

Primary research can often be quite simple to pursue yourself. Here are a few examples of different research methods you can use to explore different topics.

Primary research is a great choice for many research projects, but it has distinct advantages and disadvantages.

Advantages of primary research

Advantages include:

• The ability to conduct really tailored, thorough research, down to the ‘nitty-gritty’ of your topic . You decide what you want to study or observe and how to go about doing that.
• You maintain control over the quality of the data collected, and can ensure firsthand that it is objective, reliable , and valid .
• The ensuing results are yours, for you to disseminate as you see fit. You maintain proprietary control over what you find out, allowing you to share your findings with like-minded individuals or those conducting related research that interests you for replication or discussion purposes.

Disadvantages of primary research

Disadvantages include:

• In order to be done well, primary research can be very expensive and time consuming. If you are constrained in terms of time or funding, it can be very difficult to conduct your own high-quality primary research.
• Primary research is often insufficient as a standalone research method, requiring secondary research to bolster it.
• Primary research can be prone to various types of research bias . Bias can manifest on the part of the researcher as observer bias , Pygmalion effect , or demand characteristics . It can occur on the part of participants as a Hawthorne effect or social desirability bias .

The 3 main types of primary research are:

Exploratory research explores the main aspects of a new or barely researched question.

Explanatory research explains the causes and effects of an already widely researched question.

There are several methods you can use to decrease the impact of confounding variables on your research: restriction, matching, statistical control, and randomisation.

In restriction , you restrict your sample by only including certain subjects that have the same values of potential confounding variables.

In matching , you match each of the subjects in your treatment group with a counterpart in the comparison group. The matched subjects have the same values on any potential confounding variables, and only differ in the independent variable .

In statistical control , you include potential confounders as variables in your regression .

In randomisation , you randomly assign the treatment (or independent variable) in your study to a sufficiently large number of subjects, which allows you to control for all potential confounding variables.

A questionnaire is a data collection tool or instrument, while a survey is an overarching research method that involves collecting and analysing data from people using questionnaires.

When conducting research, collecting original data has significant advantages:

• You can tailor data collection to your specific research aims (e.g., understanding the needs of your consumers or user testing your website).
• You can control and standardise the process for high reliability and validity (e.g., choosing appropriate measurements and sampling methods ).

However, there are also some drawbacks: data collection can be time-consuming, labour-intensive, and expensive. In some cases, it’s more efficient to use secondary data that has already been collected by someone else, but the data might be less reliable.

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Everything you need to know about primary research

Last updated

28 February 2023

Reviewed by

Miroslav Damyanov

They might search existing research to find the data they need—a technique known as secondary research .

Alternatively, they might prefer to seek out the data they need independently. This is known as primary research.

Analyze your primary research

Bring your primary research together inside Dovetail and uncover actionable insights

• What is primary research?

During primary research, the researcher collects the information and data for a specific sample directly.

Types of primary research

Primary research can take several forms, depending on the type of information studied. Here are the four main types of primary research:

Observations

Focus groups

When conducting primary research, you can collect qualitative or quantitative data (or both).

Qualitative primary data collection provides a vast array of feedback or information about products and services. However, it may need to be interpreted before it is used to make important business decisions.

Quantitative primary data collection , on the other hand, involves looking at the numbers related to a specific product or service.

• What types of projects can benefit from primary research?

Data obtained from primary research may be more accurate than if it were obtained from previous data samples.

Primary research may be used for

Salary guides

Industry benchmarks

Government reports

Any information based on the current state of the target, including statistics related to current information

Scientific studies

Current market research

Crafting user-friendly products

Primary research can also be used to capture any type of sentiment that cannot be represented statistically, verbally, or through transcription. This may include tone of voice, for example. The researcher might want to find out if the subject sounds hesitant, uncertain, or unhappy.

• Methods for conducting primary research

Your methods for conducting primary research may vary based on the information you’re looking for and how you prefer to interact with your target market.

Surveys are a method to obtain direct information and feedback from the target audience. Depending on the target market’s specific needs, they can be conducted over the phone, online, or face-to-face.

Observation

In some cases, primary research will involve watching the behaviors of consumers or members of the target audience.

Communication with members of the target audience who can share direct information and feedback about products and services.

Test marketing

Explore customer response to a product or marketing campaign before a wider release.

Competitor visits

Competitor visits allow you to check out what competitors have to offer to get a better feel for how they interact with their target markets. This approach can help you better understand what the market might be looking for.

This involves bringing a group of people together to discuss a specific product or need within the industry. This approach could help provide essential insights into the needs of that market.

Usability testing

Usability testing allows you to evaluate a product’s usability when you launch a live prototype. You might recruit representative users to perform tasks while you observe, ask questions, and take notes on how they use your product.

• When to conduct primary research

Primary research is needed when you want first-hand information about your product, service, or target market. There are several circumstances where primary research may be the best strategy for getting the information you need.

You might use it to:

Understand pricing information, including what price points customers are likely to purchase at. 

Get insight into your sales process. For example, you might look at screenshots of a sales demo, listen to audio recordings of the sales process, or evaluate key details and descriptions. 

Learn about problems your consumers might be having and how your business can solve them.

Gauge how a company feels about its competitors. For example, you might want to ask an e-tailer if they plan to offer free shipping to compete with Amazon, Walmart, and other major retailers.

• How to get started with primary research

Step one: Define the problem you’re trying to answer. Clearly identify what you want to know and why it’s important. Does the customer want you to perform the “usual?” This is often the case if they are new, inexperienced, or simply too busy and want to have the task taken care of.

Step two: Determine the best method for getting those answers. Do you need quantitative data , which can be measured in multiple-choice surveys? Or do you need more detailed qualitative data , which may require focus groups or interviews?

Step three: Select your target. Where will you conduct your primary research? You may already have a focus group available; for example, a social media group where people already gather to discuss your brand.

Step four: Compile your questions or define your method. Clearly set out what information you need and how you plan to gather it.

Step five: Research!

• Advantages of primary research

Primary research offers a number of potential advantages. Most importantly, it offers you information that you can’t get elsewhere.

It provides you with direct information from consumers who are already members of your target market or using your products.

You are able to get feedback directly from your target audience, which can allow you to immediately improve products or services and provide better support to your target market.

Primary data is current. Secondary sources may contain outdated data.

Primary data is reliable. You will know what methods you used and how the data relates to your research because you collected it yourself.

• Disadvantages of primary research

You might decide primary research isn’t the best option for your research project when you consider the disadvantages.

Primary research can be time-consuming. You will have to put in the time to collect data yourself, meaning the research may take longer to complete.

Primary research may be more expensive to conduct if it involves face-to-face interactions with your target audience, subscriptions for insight platforms, or participant remuneration.

The people you engage with for your research may feel disrupted by information-gathering methods, so you may not be able to use the same focus group every time you conduct that research.

It can be difficult to gather accurate information from a small group of people, especially if you deliberately select a focus group made up of existing customers. 

You may have a hard time accessing people who are not already members of your customer base.

Biased surveys can be a challenge. Researchers may, for example, inadvertently structure questions to encourage participants to respond in a particular way. Questions may also be too confusing or complex for participants to answer accurately.

Despite the researcher’s best efforts, participants don’t always take studies seriously. They may provide inaccurate or irrelevant answers to survey questions, significantly impacting any conclusions you reach. Therefore, researchers must take extra caution when examining results.

Conducting primary research can help you get a closer look at what is really going on with your target market and how they are using your product. That research can then inform your efforts to improve your services and products.

What is primary research, and why is it important?

Primary research is a research method that allows researchers to directly collect information for their use. It can provide more accurate insights into the target audience and market information companies really need.

What are primary research sources?

Primary research sources may include surveys, interviews, visits to competitors, or focus groups.

What is the best method of primary research?

The best method of primary research depends on the type of information you are gathering. If you need qualitative information, you may want to hold focus groups or interviews. On the other hand, if you need quantitative data, you may benefit from conducting surveys with your target audience.

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Primary Research Articles

• Library vs. Google
• Background Reading
• Keyword Searching
• Evaluating Sources
• Citing Sources
• Need more help?

How Can I Find Primary Research Articles?

Many of the recommended databases in this subject guide contain primary research articles (also known as empirical articles or research studies). Search in databases like ScienceDirect  and MEDLINE .

Primary Research Articles: How Will I Know One When I See One?

Primary research articles  to conduct and publish an experiment or research study, an author or team of authors designs an experiment, gathers data, then analyzes the data and discusses the results of the experiment. a published experiment or research study will therefore  look  very different from other types of articles (newspaper stories, magazine articles, essays, etc.) found in our library databases. the following guidelines will help you recognize a primary research article, written by the researchers themselves and published in a scholarly journal., structure of a primary research article typically, a primary research article has the following sections:.

• The author summarizes her article
• The author discusses the general background of her research topic; often, she will present a literature review, that is, summarize what other experts have written on this particular research topic
• The author describes the study she designed and conducted
• The author presents the data she gathered during her experiment
• The author offers ideas about the importance and implications of her research findings, and speculates on future directions that similar research might take
• The author gives a References list of sources she used in her paper

The structure of the article will often be clearly shown with headings: Introduction, Method, Results, Discussion.

A primary research article will almost always contains statistics, numerical data presented in tables. Also, primary research articles are written in very formal, very technical language.

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• Last Updated: Jan 4, 2024 4:22 PM
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Purdue Online Writing Lab Purdue OWL® College of Liberal Arts

Analyzing Your Primary Data

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Now that you've collected your primary data, it's time to figure out what that data means and what you can learn from it. The keys to analyzing your data are to pull out information that is the most pertinent to your writing, information you can highlight and discuss, and information that will support your claims (if you are making any).

Interviews are fairly easy to analyze, as you simply have to go back through the answers you received and decide how to use them within your writing. You can group the answers into categories and create a chart of how those answers may best fit within your paper or article.

If you recorded the interview with a tape or digital recorder, you may want to listen to it and type a transcript of the interview. Since transcription is a tedious process, only use this option if you need to.

When analyzing surveys, you want to get the raw data into a form that you can manipulate. If you were using a numerical system or yes/no answer system for your survey, you may find it helpful to enter the results into a spreadsheet program such as Microsoft Excel. If the survey was an open-ended question style, see if you can fit your answers into categories of responses.

Observations

Observations are more difficult to analyze because when you are taking notes, you often write down everything that you see. Start by organizing your notes into categories or by some criteria. Once you have everything organized, see if you can make some generalizations about what you have observed.

Over-generalizing your results

Your first attempts at primary research will most likely include small groups of people and may not be representative of the population as a whole. It is important to remember not to over-generalize your findings--in other words, don't assume that your findings are necessarily true of every person within the group or every person in a society.

Triangulation of Data

One of the benefits of combining primary research with secondary research is data triangulation. Data triangulation is when a piece of data, a finding, or a generalization is able to be verified with several different research methods. This helps add to your credibility and makes your findings stronger.

For example, you are studying binge drinking on campus. You find national averages that indicate that 45% of college students binge-drink nationwide. You conduct your own research at the Purdue campus. You find that 47% of the individuals you surveyed drink; you also interview a counselor on campus who reports that approximately 1/3 of the students they see suffer from a binge-drinking problem. Thus, your results from an interview with an expert and your own survey support the national averages.

Finding Scholarly Articles: Home

What's a Scholarly Article?

Your professor has specified that you are to use scholarly (or primary research or peer-reviewed or refereed or academic) articles only in your paper. What does that mean?

Scholarly or primary research articles are peer-reviewed , which means that they have gone through the process of being read by reviewers or referees  before being accepted for publication. When a scholar submits an article to a scholarly journal, the manuscript is sent to experts in that field to read and decide if the research is valid and the article should be published. Typically the reviewers indicate to the journal editors whether they think the article should be accepted, sent back for revisions, or rejected.

To decide whether an article is a primary research article, look for the following:

• The author’s (or authors') credentials and academic affiliation(s) should be given;
• There should be an abstract summarizing the research;
• The methods and materials used should be given, often in a separate section;
• There are citations within the text or footnotes referencing sources used;
• Results of the research are given;
• There should be discussion   and  conclusion ;
• With a bibliography or list of references at the end.

Caution: even though a journal may be peer-reviewed, not all the items in it will be. For instance, there might be editorials, book reviews, news reports, etc. Check for the parts of the article to be sure.   

You can limit your search results to primary research, peer-reviewed or refereed articles in many databases. To search for scholarly articles in  HOLLIS , type your keywords in the box at the top, and select  Catalog&Articles  from the choices that appear next.   On the search results screen, look for the  Show Only section on the right and click on  Peer-reviewed articles . (Make sure to  login in with your HarvardKey to get full-text of the articles that Harvard has purchased.)

Many of the databases that Harvard offers have similar features to limit to peer-reviewed or scholarly articles.  For example in Academic Search Premier , click on the box for Scholarly (Peer Reviewed) Journals  on the search screen.

Review articles are another great way to find scholarly primary research articles.   Review articles are not considered "primary research", but they pull together primary research articles on a topic, summarize and analyze them.  In Google Scholar , click on Review Articles  at the left of the search results screen. Ask your professor whether review articles can be cited for an assignment.

A note about Google searching.  A regular Google search turns up a broad variety of results, which can include scholarly articles but Google results also contain commercial and popular sources which may be misleading, outdated, etc.  Use Google Scholar  through the Harvard Library instead.

About Wikipedia .  W ikipedia is not considered scholarly, and should not be cited, but it frequently includes references to scholarly articles. Before using those references for an assignment, double check by finding them in Hollis or a more specific subject  database .

Still not sure about a source? Consult the course syllabus for guidance, contact your professor or teaching fellow, or use the Ask A Librarian service.

• Last Updated: Oct 3, 2023 3:37 PM
• URL: https://guides.library.harvard.edu/FindingScholarlyArticles

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Research Process

• Brainstorming
• Explore Google This link opens in a new window
• Explore Web Resources
• Explore Background Information
• Explore Books
• Explore Scholarly Articles
• Narrowing a Topic
• Primary and Secondary Resources
• Academic, Popular & Trade Publications
• Scholarly and Peer-Reviewed Journals
• Grey Literature
• Clinical Trials
• Evidence Based Treatment
• Scholarly Research
• Database Research Log
• Search Limits
• Keyword Searching
• Boolean Operators
• Phrase Searching
• Truncation & Wildcard Symbols
• Proximity Searching
• Field Codes
• Subject Terms and Database Thesauri
• Reading a Scientific Article
• Website Evaluation
• Article Keywords and Subject Terms
• Cited References
• Citing Articles
• Related Results
• Search Within Publication
• Database Alerts & RSS Feeds
• Personal Database Accounts
• Persistent URLs
• Literature Gap and Future Research
• Web of Knowledge
• Annual Reviews
• Systematic Reviews & Meta-Analyses
• Finding Seminal Works
• Exhausting the Literature
• Finding Dissertations
• Researching Theoretical Frameworks
• Research Methodology & Design
• Tests and Measurements
• Organizing Research & Citations This link opens in a new window
• Scholarly Publication
• Learn the Library This link opens in a new window

Primary Sources

Primary resources contain first-hand information, meaning that you are reading the author’s own account on a specific topic or event that s/he participated in. Examples of primary resources include scholarly research articles, books, and diaries. Primary sources such as research articles often do not explain terminology and theoretical principles in detail. Thus, readers of primary scholarly research should have foundational knowledge of the subject area. Use primary resources to obtain a first-hand account to an actual event and identify original research done in a field. For many of your papers, use of primary resources will be a requirement.

Examples of a primary source are:

• Original documents such as diaries, speeches, manuscripts, letters, interviews, records, eyewitness accounts, autobiographies
• Empirical scholarly works such as research articles, clinical reports, case studies, dissertations
• Creative works such as poetry, music, video, photography

How to locate primary research in NU Library:

• From the Library's homepage, begin your search in NavigatorSearch or select a subject-specific database from the A-Z Databases .
• Use the Scholarly/Peer-Reviewed Journal limiter to narrow your search to journal articles.
• Once you have a set of search results, remember to look for articles where the author has conducted original research. A primary research article will include a literature review, methodology, population or set sample, test or measurement, discussion of findings and usually future research directions.

Secondary Sources

Secondary sources describe, summarize, or discuss information or details originally presented in another source; meaning the author, in most cases, did not participate in the event. This type of source is written for a broad audience and will include definitions of discipline specific terms, history relating to the topic, significant theories and principles, and summaries of major studies/events as related to the topic. Use secondary sources to obtain an overview of a topic and/or identify primary resources. Refrain from including such resources in an annotated bibliography for doctoral level work unless there is a good reason.

Examples of a secondary source are:

• Publications such as textbooks, magazine articles, book reviews, commentaries, encyclopedias, almanacs

Locate  secondary resources in NU Library within the following databases:

• Annual Reviews (scholarly article reviews)
• Credo Reference (encyclopedias, dictionaries, handbooks & more)
• Ebook Central (ebooks)
• ProQuest (book reviews, bibliographies, literature reviews & more )
• SAGE Reference Methods, SAGE Knowledge & SAGE Navigator (handbooks, encyclopedias, major works, debates & more)
• Most other Library databases include secondary sources. 

Beginning the Resarch Process Workshop

This workshop introduces to the beginning stages of the research process, focusing on identifying different types of information, as well as gathering background information through electronic books.

• Beginning the Research Process Workshop Outline

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Research Papers 101: Source roles: primary, secondary, and tertiary

• Pre-writing : an overview
• The concept of *authority* in academic writing
• Source roles: primary, secondary, and tertiary
• Source types : least to most authoritative
• Scholarly sources defined
• Popular sources discussed
• Our website : a magic key
• Accessing books & ILL
• Scholarly conversation + Making sense of scholarly sources
• Writing an annotated bibliography

Source roles: primary, secondary, tertiary

Defining sources by their relationship to the topic.

One important consideration when we are evaluating how useful and authoritative a source is in a given context is to consider the source's role, or its relationship to the topic.

Is this source a kind of raw, unfiltered evidence that needs to be analyzed and put into context? Because they provide firsthand evidence of a topic, these types of sources are called primary sources .

Is this source an outside observer who can compile and analyze the evidence and provide an overall, bird's-eye view of the situation? These secondhand compilers, commenters, and analyzers are called secondary sources .

There's a third type of source which aims to make the information and expertise provided by secondary sources accessible to people who are new to the topic, whether by offering a dictionary or a glossary of key terms, or summarizing the various issues that make up the larger discussion about the topic. These types of sources can be called tertiary sources .

Each of these source types is suitable for certain purposes, but inappropriate for others, as a result of the nature of their relationship to the given topic.

Primary sources: Firsthand accounts;

Direct, undigested evidence.

Primary sources are sources that provide raw evidence or direct testimony about a topic. A primary source could be an eyewitness account of historical events, or it could be a historical object or a painting.

It is oftentimes the case that a source of information may not have enough credibility to serve as a secondary source, but can be used as a primary source.

( NOTE: There are any number of reasons why a primary source might not be considered 100% reliable just by itself; a major role of secondary sources is to put primary sources in context and evaluate their usefulness and reliability.)

One useful way to think about how to appropriately use primary and secondary sources is to remember: primary sources get analyzed , while secondary sources do the analyzing .

For example, a Youtube video may not have enough authoritativeness to be used as a reliable source of information about a topic, but it can get analyzed by a secondary source as an example of what discourse exists on Youtube about that topic.

(This is an important but subtle distinction: proving something about the topic vs. proving something about the discourse about that topic --not the same thing!)

Secondary sources: Analyzing the Topic From Afar

Secondary sources analyze the events or topic in question from afar, bringing together the evidence from multiple primary sources and other secondary sources to put the topic in context and provide deep analysis.

Examples of secondary sources include:

• A print or TV journalist reporting the news
• A review of an artist's new album, an author's new book, or a museum exhibit
• A technical manual showing how to repair and maintain a piece of equipment
• A scholarly article or books which analyzes a topic in great depth and carefully supporting its arguments using a large number of other sources

One problem we constantly run into when dealing with secondary sources is evaluating source credibility/authoritativeness .

In theory, the category of secondary sources could include all kinds of sources that comment on a topic secondhand, including social media, blog posts, newspapers, and Youtube videos.

However, many college instructors when assigning papers will use the term secondary sources as a shorthand for authoritative sources , or--in higher level college classes especially--assume a shared understanding that the only sources that satisfy a requirement for "10 secondary sources" are scholarly sources .

(It is always best to seek clarification from the instructor if you are unclear about an assignment's requirements.)

The authority of a given secondary source (as the ACRL's Framework for Information Literacy for Higher Education reminds us) is always going to be Constructed and Contextual .

In the context of academic writing (or writing for a scholarly audience), it is however possible to create a general ranking/hierarchy of secondary source types based on how authoritative they are considered to be.

Tertiary sources: dictionaries, reference books, and introductory textbooks

Tertiary books are the best kind of book to consult if you are entering into a topic for the first time.

Reference works such as encyclopedias, dictionaries, and bibliographies can offer a brief overview of a wide variety of topics you may be interested in researching, quickly bringing you up-to-speed on the history of research (or historiography) of your chosen topic, pointing the way to other important primary and secondary sources, and allowing you engage in the broader conversation about that topic among scholars.

At the same time, instructors are generally not looking for a citation to a tertiary source when they ask for "X number of scholarly articles." While many tertiary sources are produced by scholars (and so, in a technical sense, are scholarly ), their relationship to the knowledge created by academic scholarship is to compile and summarize that knowledge, rather than to create new knowledge and understanding (as is the expectation with secondary source scholarly articles and books.)

In academic writing, it is generally considered better to consult (and give credit to) the original source of the arguments and information we wish to engage with. This means (for example) consulting the original research article rather than a summary of it, or the actual book some information is discussed in rather than just a book review.

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What Is a Primary Source?

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In research and academics, a primary source refers to information collected from sources that witnessed or experienced an event firsthand. These can be historical documents , literary texts, artistic works, experiments, journal entries, surveys, and interviews. A primary source, which is very different from a secondary source , is also called primary data.

The Library of Congress defines primary sources as "the raw materials of history—original documents and objects which were created at the time under study," in contrast to secondary sources , which are "accounts or interpretations of events created by someone without firsthand experience," ("Using Primary Sources").

Secondary sources are often meant to describe or analyze a primary source and do not give firsthand accounts; primary sources tend to provide more accurate depictions of history but are much harder to come by.

Characteristics of Primary Sources

There are a couple of factors that can qualify an artifact as a primary source. The chief characteristics of a primary source, according to Natalie Sproull, are: "(1) [B]eing present during the experience, event or time and (2) consequently being close in time with the data. This does not mean that data from primary sources are always the best data."

Sproull then goes on to remind readers that primary sources are not always more reliable than secondary sources. "Data from human sources are subject to many types of distortion because of such factors as selective recall, selective perceptions, and purposeful or nonpurposeful omission or addition of information. Thus data from primary sources are not necessarily accurate data even though they come from firsthand sources," (Sproull 1988).

Original Sources

Primary sources are often called original sources, but this is not the most accurate description because you're not always going to be dealing with original copies of primary artifacts. For this reason, "primary sources" and "original sources" should be considered separate. Here's what the authors of "Undertaking Historical Research in Literacy," from Handbook of Reading Research , have to say about this:

"The distinction also needs to be made between primary and original sources . It is by no means always necessary, and all too often it is not possible, to deal only with original sources. Printed copies of original sources, provided they have been undertaken with scrupulous care (such as the published letters of the Founding Fathers), are usually an acceptable substitute for their handwritten originals." (E. J. Monaghan and D. K. Hartman, "Undertaking Historical Research in Literacy," in Handbook of Reading Research , ed. by P. D. Pearson et al. Erlbaum, 2000)

When to Use Primary Sources

Primary sources tend to be most useful toward the beginning of your research into a topic and at the end of a claim as evidence, as Wayne Booth et al. explain in the following passage. "[Primary sources] provide the 'raw data' that you use first to test the working hypothesis and then as evidence to support your claim . In history, for example, primary sources include documents from the period or person you are studying, objects, maps, even clothing; in literature or philosophy, your main primary source is usually the text you are studying, and your data are the words on the page. In such fields, you can rarely write a research paper  without using primary sources," (Booth et al. 2008).

When to Use Secondary Sources

There is certainly a time and place for secondary sources and many situations in which these point to relevant primary sources. Secondary sources are an excellent place to start. Alison Hoagland and Gray Fitzsimmons write: "By identifying basic facts, such as year of construction, secondary sources can point the researcher to the best primary sources , such as the right tax books. In addition, a careful reading of the bibliography in a secondary source can reveal important sources the researcher might otherwise have missed," (Hoagland and Fitzsimmons 2004).

Finding and Accessing Primary Sources

As you might expect, primary sources can prove difficult to find. To find the best ones, take advantage of resources such as libraries and historical societies. "This one is entirely dependent on the assignment given and your local resources; but when included, always emphasize quality. ... Keep in mind that there are many institutions such as the Library of Congress that make primary source material freely available on the Web," (Kitchens 2012).

Methods of Collecting Primary Data

Sometimes in your research, you'll run into the problem of not being able to track down primary sources at all. When this happens, you'll want to know how to collect your own primary data; Dan O'Hair et all tell you how: "If the information you need is unavailable or hasn't yet been gathered, you'll have to gather it yourself. Four basic methods of collecting primary data are field research, content analysis, survey research, and experiments. Other methods of gathering primary data include historical research, analysis of existing statistics, ... and various forms of direct observation," (O'Hair et al. 2001).

• Booth, Wayne C., et al. The Craft of Research . 3rd ed., University of Chicago Press, 2008.
• Hoagland, Alison, and Gray Fitzsimmons. "History."  Recording Historic Structures. 2nd. ed., John Wiley & Sons, 2004.
• Kitchens, Joel D. Librarians, Historians, and New Opportunities for Discourse: A Guide for Clio's Helpers . ABC-CLIO, 2012.
• Monaghan, E. Jennifer, and Douglas K. Hartman. "Undertaking Historical Research in Literacy." Handbook of Reading Research. Lawrence Erlbaum Associates, 2002.
• O'Hair, Dan, et al. Business Communication: A Framework for Success . South-Western College Pub., 2001.
• Sproull, Natalie L. Handbook of Research Methods: A Guide for Practitioners and Students in the Social Sciences. 2nd ed. Scarecrow Press, 1988.
• "Using Primary Sources." Library of Congress .
• Secondary Sources in Research
• Primary and Secondary Sources in History
• How to Prove Your Family Tree Connections
• Research in Essays and Reports
• Five Steps to Verifying Online Genealogy Sources
• Pros and Cons of Secondary Data Analysis
• Understanding Secondary Data and How to Use It in Research
• Documentation in Reports and Research Papers
• What Is a Research Paper?
• How to Use Libraries and Archives for Research
• 6 Skills Students Need to Succeed in Social Studies Classes
• How to Cite Genealogy Sources
• Definition and Examples of Quotation in English Grammar
• Glossary of Historical Terms
• How to Determine a Reliable Source on the Internet
• Fashion Throughout History

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I have to write a research paper using primary sources. where do i start.

• What is the difference between Primary and Secondary sources?
• How do I cite primary source materials?
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Primary sources are created by individuals who participated in or witnessed an event and recorded that event during or immediately after the event.

Explanation:

A student activist during the war writing about protest activities has created a memoir. This would be a primary source because the information is based on her own involvement in the events she describes. Similarly, an antiwar speech is a primary source. So is the arrest record of student protesters. A newspaper editorial or article, reporting on a student demonstration is also a primary source.

Deeds, wills, court documents, military records, tax records, census records, diaries, journals, letters, account books, advertisements, newspapers, photographs, and maps are primary sources.

Secondary sources are created by someone who was either not present when the event occurred or removed from it in time. We use secondary sources for overview information, and to help familiarize ourselves with a topic and compare that topic with other events in history.

History books, encyclopedias, historical dictionaries, and academic articles are secondary sources.

If you've never written a research paper using primary sources, it is important to understand that the process is different from using only secondary sources. Many students discover that finding and gaining access to primary source documents can be difficult. The Library website has a valuable guide to locating primary source documents. Follow the link below to be redirected to that guide:

https://libguides.furman.edu/resources/primary-sources

• Students are encouraged to seek help from the Special Collections Librarian or Research Librarians to aid in their research projects. Librarians will be able to aid students in a variety of ways including helping to locate primary source materials.

After locating appropriate primary sources, it is necessary for students to analyze and interpret them. To many students, this task can seem arduous, if not overwhelming. There are many resources available in the library as well as online, which are helpful. The National Archives website has very useful analysis worksheets that can help students to determine the significance of primary source documents. Links to PDF files of these worksheets are listed below:

Written Document | Artifact | Cartoon | Map | Motion Picture | Photograph | Poster | Sound Recording

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Applying phenomenography in textbook research

• Original Article
• Published: 22 May 2024

Cite this article

• Lam Ho Cheong   ORCID: orcid.org/0000-0001-7242-3342 1  

Education research for practice is in need of textbook studies, especially those having well-defined theoretical framework. This paper is an attempt to apply phenomenography in textbook research. It begins with a review of four existing types of textbook studies found in the literature. Next, the main features of phenomenography (qualitative difference, inductive approach, non-dualistic nature, and enacted object of learning) are discussed conceptually in comparison with the research approaches adopted in the existing textbook studies. Then, for more concrete illustration, we deliberate on our own phenomenographic study that investigated the qualitatively different ways of seeing Chinese word learning as reflected in Hong Kong textbooks. In this study, six learning packages at Kindergarten 3 level and six Chinese Language textbook sets at Primary 1 level were examined. Chinese word learning was found to be seen as: (A) getting by without understanding the words, (B) understanding the words, (C) categorizing the words, and (D) using one’s own words. Finally, the paper is concluded with a discussion of its contribution to improving textbook research with the theoretical framework of phenomenography as well as enhancing phenomenography with the use of textbook data.

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Data availability

Due to the nature of this textbook research, the collected data cannot be shared publicly. Supporting data are not available.

Code availability

No specific software application code is available.

To the best of our knowledge, Rezat ( 2006 ) is one exception, in which the activity theory in cultural-historical psychology was adopted to investigate the activity of ‘textbook use.’

Although the case mentioned in the paper is about learning Chinese words, there is no expectation for readers to have any knowledge of Chinese. Learning Chinese words only serves as an example.

Although the figures in this paper are made up for illustrative purpose due to copyright issues, their designs strictly adhere to the original exercises in the textbooks. Besides, English translation has been added for readers who are not familiar with Chinese.

Ahmed, J. U. (2010). Documentary research method: New dimensions. Indus Journal of Management & Social Sciences, 4 (1), 1–14.

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Åkerlind, G. S. (2005). Variation and commonality in phenomenographic research methods. Higher Education Research & Development, 24 (4), 321–334. https://doi.org/10.1080/07294360500284672

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Ashworth, P., & Lucas, U. (1998). What is the ‘world’ of phenomenography? Scandinavian Journal of Educational Research, 42 (4), 415–431. https://doi.org/10.1080/0031383980420407

Atkinson, P., & Coffey, A. (1997). Analysing documentary realities. In D. Silverman (Ed.), Qualitative research: Theory, method and practice (pp. 45–62). SAGE.

Bowden, J. (2005). Reflections on the phenomenographic team research process. In J. A. Bowden & P. Green (Eds.), Doing developmental phenomenography (pp. 11–31). RMIT University Press.

Bowden, J., & Marton, F. (1998). The university of learning: beyond quality and competence . Kogan Page.

Bowden, J. A., & Walsh, E. (Eds.). (2000). Phenomenography . RMIT University Press.

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‘Atawhai’: a primary care provider-led response to family violence in Aotearoa New Zealand

• Claire Gear   ORCID: orcid.org/0000-0002-1310-0188 1 ,
• Jane Koziol-McLain   ORCID: orcid.org/0000-0003-3453-023X 1 ,
• Elizabeth Eppel   ORCID: orcid.org/0000-0001-5331-2911 2 ,
• Anna Rolleston   ORCID: orcid.org/0000-0002-4804-8869 3 ,
• Ngareta Timutimu 4 ,
• Hori Ahomiro 5 ,
• Eunice Kelly 6 ,
• Clare Healy 7 &
• Claire Isham 8  

Archives of Public Health volume  82 , Article number:  74 ( 2024 ) Cite this article

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As a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, ‘Atawhai’ aims to make it easier for primary care professionals to respond to family violence.

Underpinned by indigenous Māori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wānanga and observation methods. Methods used to capture change will be reported separately.

Atawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings.

Conclusions

Atawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.

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Ehara taku toa i te toa takitahi, engari he toa takitini. My success is not mine alone, it is the success of the collective (Māori, indigenous people of Aotearoa New Zealand (NZ) whakataukī or proverb, articulated by an Atawhai participant).

Family violence (FV) is a key determinant of ill-health that significantly impacts the health and wellbeing of all family members, past, present and future [ 1 ]. Yet internationally, evidencing the effectiveness and sustainability of health care responses to FV has proven challenging, and service provider responses often remain individualistic and transactional [ 2 , 3 ]. Without adequate system support, health professionals can often be unsure of what to do, or how to help, missing opportunities to provide support [ 4 ]. In Aotearoa NZ, there is limited policy, resources, and funding to support the primary care sector to respond to FV [ 5 ]. Recognising this gap, this study aimed to identify and develop health system pathways and tools that made it easier for primary care professionals to respond to FV in practice.

This study produced ‘Atawhai’ (to move cautiously with kindness; www.atawhaitia.co.nz ), a relational response to FV, focused on building quality network relationships to support the delivery of safe, effective, and sustainable responses to those accessing health care. Developed and led by health care professionals working within primary care settings the ‘Atawhai Kōrero’ (conversations) underpins the response, recognising conversations about FV can occur in many shared moments in time, or wā, within a relationship, underpinned by tika (honesty), pono (truth), and aroha (empathy). Atawhai realises health professionals do not have to ‘fix the problem’ but be someone families and whānau can trust to walk alongside supporting opportunities for change. Care is taken so any kōrero is responsive to, and safe for, families and whānau. This paper reports on the findings of the Atawhai study, answering the research questions (1) What does an effective and sustainable response to family violence look like for primary care, and (2) What influences change in primary care family violence responsiveness? This study provides an example of practical application of complexity theory, where literature remains largely theoretical [ 6 ].

Family violence responsiveness in health care

Health systems have a critical role in FV service delivery, particularly in the primary care setting [ 7 ]. Given the consequences of FV on health, it is not surprising that the prevalence of FV among those seeking health care is higher than in the general population [ 7 , 8 , 9 ]. While intervention models exist internationally (e.g., RADAR [ 10 ], LIVES [ 11 ]), there is increasing recognition that standard prescriptive interventions do not reflect the complexity of the problem and are unlikely to generate sustainable solutions [ 2 , 4 , 12 ]. Understanding the relationships between context, violence and ill-health is critical for responding to the needs of those accessing care safely, supporting restoration and healing [ 13 , 14 , 15 ].

In Aotearoa NZ, FV is defined as ‘a pattern of behaviour that coerces, controls or harms within the context of a close personal relationship’ [ 16 ] (p.10) and is recognised as gender-based, disproportionately affecting women and children [ 16 , 17 ]. Population-based data estimates nearly two in three Aotearoa NZ women, over two in three Indigenous Māori women, two in five Pacific women and one in three Asian women will experience a form of physical, sexual, psychological, controlling, or economic violence by an intimate partner in their lifetime [ 18 ]. Yet, FV is non-discriminatory, also impacting men, older people, disabled, indigenous, migrant and LGBTQIA + communities [ 16 ].

Deeply rooted in societal trauma, FV continues to be perpetuated by systems and practices affected by dominant culture and colonial history, with devastating and intergenerational impacts, particularly for Māori [ 14 , 19 , 20 ]. The Waitangi Tribunal [ 21 ] has found significant breaches of Te Tiriti o Waitangi (the Māori language version of the written agreement between the British Crown and more than 500 Māori chiefs signed in 1840), which, historically and today, have resulted in broad inequities in Māori health outcomes, reinforced by chronic underfunding of Māori health services [ 22 , 23 ]. Understanding how colonialist and other system structures shape health care responses to FV, and therefore the agency and choices whānau and families have, is critical to disrupting patterns of violence for Māori and all populations in Aotearoa NZ [ 19 , 24 ].

Primary care is consistently identified in health strategies and policy as a priority setting where disproportionate numbers of people impacted by FV present [ 5 , 7 , 25 ]. Yet in Aotearoa NZ, the sector continues to be underutilised in the cross-government work to reduce FV with limited guidance and resourcing, generating ad hoc practice [ 4 , 5 ]. Launched in December 2021, Te Aorerekura is the National Strategy and Action Plan to eliminate family and sexual violence [ 16 , 26 ]. Capability frameworks were launched in May 2022 to build government and non-government workforce capability in responding to FV [ 27 , 28 ]. Health care is considered a ‘generalist workforce’, who must know how to respond safely and effectively to FV [ 29 ]. The strategy includes the existing Te Whatu Ora (Health New Zealand) Violence Intervention Programme (VIP), and primary care clinician workforce training for recognising and responding to sexual assault and/or non-fatal strangulation provided by Medical Sexual Assault Clinicians Aotearoa (MEDSAC) as work already under way in the health care sector. Beginning in 2004, VIP has established significant system infrastructure within hospitals and selected community settings over time to support intimate partner violence and child abuse and neglect identification, assessment, and referral. However, longitudinal evaluation data evidences low assessment and disclosure rates [ 30 ]. Primary care professionals argue the VIP intervention guidelines are inappropriate for the primary care setting and consider response autonomy important, highly valuing a local response, for the local context, supported by local relationships [ 31 , 32 , 33 ]. It is therefore critical to engage and empower primary care professionals in developing a response to FV that aligns with the motivations and concerns of their settings and contexts [ 34 ]. This study convened a series of whakawhitiwhiti kōrero wānanga (meetings for deliberate dialogue), to work with primary care professionals in the development of a FV response suited to such diverse contexts.

Methodology

Grounded in tikanga Māori (indigenous ways of being, relating and doing), this study combined complexity theory [ 35 ] and participatory research [ 36 , 37 ] methodologies to create a theoretical lens guiding study development, conduct, analysis, and impact. Methods included ten participant one-day whakawhitiwhiti kōrero wānanga (meetings for deliberative dialogue), Kaihopu Kōrero observation (conversation catchers), social network analysis (SNA) and pre/post readiness surveys. This paper focuses on the development of Atawhai through whakawhitiwhiti kōrero wānanga and Kaihopu Kōrero methods and discusses implications for policy and practice. SNA and readiness survey findings are reported separately.

Reflexivity

The premise of this study originates from over a decade of research seeking to improve responsiveness to FV within the Aotearoa NZ primary care sector [ 5 , 31 , 38 , 39 , 40 ]. Guided by our theoretical lens, we hypothesise effective and sustainable responses to FV are emergent from the interaction between the health professional and person(s) accessing care [ 38 ], leading to our focus on working with primary care professionals in understanding one part of this system interaction. The study is evidenced on the understanding that FV is (a) a key determinant of ill-health, (2) a complex problem, (3) a profound system gap, (4) an urgent issue, and that (5) primary care is a window of opportunity to make a difference [ 3 , 7 , 25 ]. The development and conduct of this study is grounded in research team relationships which have developed over long periods of time. Given the importance of this research to Māori, our team is privileged to be guided by two kaitiaki (protector) who protect the mātauranga (knowledge) and tikanga Māori involved in the research. Additionally, five investigators hold whakapapa (tribal relationships) to the research location. Our team includes highly skilled researchers and leaders in the fields of qualitative research methods, violence against women, primary care, Māori health research, complexity theory and specialist community FV services. Four investigators work within primary care service delivery settings.

This study was conducted in the Bay of Plenty (BOP), a region in the North Island of Aotearoa NZ. Prior to health reforms in 2023, capitation funding was distributed via District Health Boards (DHBs), responsible for planning and delivering health care services for their regional population. DHBs contracted primary care via service agreements with Primary Health Organisations (PHOs), responsible for contracting service delivery providers, largely general practices [ 23 ]. The BOP DHB served a population of approximately 225 thousand people; had a higher proportion of Māori compared to the national average (25% vs. 16%); and included three PHOs [ 41 ].

This study was approved by the Auckland University of Technology Ethics Committee (21/31). Fourteen participants (ten women, four men) were recruited via word of mouth (facilitated by research network relationships), a study website ( www.atawhaitia.co.nz ) and advertisements within local health care newsletters. The lead researcher met (online or in person) with potential participants to discuss study aims and expectations and answer queries or concerns. Following this discussion, a formal invitation with information sheet and consent form were emailed. Information sheets were also made available via the study website. We invited participant organisations to endorse their participation in the study via informed consent. Facilitated by participants, organisational consent (provided by senior management) aimed to provide managerial support for participants to attend wānanga and recognition as a participating organisation in project communications and publications. Organisations and/or participants were offered reimbursement of costs incurred by participating including time, travel, accommodation, and sundry costs.

Recruited participants included five tauiwi (non-Māori) and nine Māori, including general practitioners (two), a nurse practitioner (one) and a practice nurse (one), social workers (seven) and managers (three). Four participants were employed within general practice clinical settings and ten within Māori health organisations. Retention fluctuated over the study period, with participants navigating shifting employment, roles, managers, and capacity. Two participants withdrew following the first wānanga due to conflict in worldviews. One participant withdrew following the seventh wānanga due to a process issue preventing reimbursement for participation time. Role reassignment meant three participants were not supported by organisation management to continue to attend wānanga, though they remained connected to the study via communications. A core group of eight remained active participants throughout the study. Manaakitanga (the process of showing respect, generosity, and care for others), and the developing shared sense of commitment, connection and learning amongst the participants and research team was key to retention. The COVID-19 pandemic significantly impacted health care service provision, with many participants reporting their availability and capacity to participate in the project was stretched. During the data collection period there were two periods in which the whole country was mandated to isolate at home (25 March 2020–27 April 2020; 17 August 2021–31 August 2021) [ 42 ]. The COVID-19 Protection Framework (Traffic Lights) was in effect from 2 December 2021 to 12 September 2022 [ 43 ].

Data collection

Whakawhitiwhiti kōrero wānanga, deliberative dialogue workshops.

Atawhai emerged from ten, one-day, in person whakawhitiwhiti kōrero wānanga over 22-months (4 August 2021–29 June 2023). Aligned with deliberative dialogue methods [ 44 , 45 , 46 ], wānanga bring people together to kōrero about a common kaupapa (topic) and learn from one another, advancing knowledge [ 44 , 45 , 46 ]. The Atawhai wānanga supported participants to draw on their contextual knowledge and practice to critically reflect on what information is required for responsiveness to FV in primary care and how it may be integrated into practice. Each wānanga was planned and conducted by facilitators, Kaihopu Kōrero (see below) and kaitiaki, responsive to participant needs. Additional research team members attended wānanga as needed (e.g., for knowledge translation). The agenda for each wānanga included karakia (prayer), mihi whakatau (welcome), whakawhanaungatanga (relating to others), and innovative activities to build upon what participants identified as needed. Activity highlights included being welcomed to a local marae (meeting house) by iwi (tribe), being gifted our own waiata (song) by kuia (elder), producing video vignettes on the value of the research, and the Minister for the Elimination of Family Violence and Sexual Violence attending Wānanga Six [ 47 ]. Table  1 lists the general topics discussed at each wānanga.

Participant connection and learning occurred both inside and outside of the wānanga. For example, regular opportunities to connect online or in-person were facilitated to nurture relationships amongst the participants and research team. Participants also held conversations with colleagues about Atawhai, analysing what was learnt and bringing that learning back to wānanga. Data saturation was considered achieved at Wānanga Seven where participants agreed on what they had identified and developed, and discussions turned to advocacy, influence, and implementation. Participant attendance at wānanga fluctuated depending on participant availability, capacity, illness, tangihanga (funeral) etc. The facilitated opportunities to connect in between wānanga were key to keeping participants and the research team connected. On average, six participants attended each wānanga, eight or more participants attended in wānanga one and two. Wānanga Eight, Nine and Ten included new interested people (Atawhai Network members) in addition to participants. All people who engaged in the research were provided a list of FV and mental health service providers options as well an offer to debrief with research team members at any time.

Kaihopu Kōrero

During the wānanga, two senior research team members served as Kaihopu Kōrero (conversation catchers), modifying the UN Special Rapporteur role [ 39 , 48 ]. Kaihopu Kōrero were responsible for (1) ensuring discussions were of value in addressing our research aims informed by complexity theory and tikanga Māori, (2) capturing participant interactions and decisions and challenging thinking, (3) reporting observations and decisions to participants for validation, and (4) informing subsequent directions and diffusion strategies. Utilising Kaihopu Kōrero reflections, facilitators presented previous learning and decisions to participants for feedback at strategic points during the wānanga. Participants were encouraged to share their reflections on the previous wānanga during the whakawhanaungatanga phase. Following each wānanga, the research team debriefed and reviewed the Kaihopu Korero notes to create a one-page summary that was provided to participants. Designed as an internal knowledge translation mechanism to keep participants and the research team connected, each summary included key themes discussed at the wānanga, participant quotes and photos, knowledge needs and next steps. Learning and next steps were discussed with the wider research team at monthly meetings.

Our theoretical lens calls attention to how knowledge is emergent from continuous negotiation between multiple ways of knowing, inclusive of the practices, cultures and contexts involved in health care provision [ 49 ]. For example, understanding ‘what is the problem’ evolves in response to new knowledge. As such, analysis was adaptive and responsive to real-time findings as participants and the research team interacted and learned from one another. Utilising Kaihopu Kōrero data, real-time analysis involved mapping patterns of interaction and co-created pathways to responsiveness as they emerged during learning. It was a process of weaving together many data elements over time, allowing for new understanding to emerge for consideration by participants at subsequent wānanga. For example, the Atawhai Common Language (see findings) is a weave of the collective understanding of the problem of FV developed at wānanga two and the fundamental principles and values for connecting and communicating with whānau and families identified at wānanga three. Similarly, initial discussions with participants on growing meaningful relationships to support practice led to exploration of what an informal alliance could look like, that led to the realisation of the Atawhai Network (see findings).

Our primary research question asked, ‘What does an effective and sustainable response to family violence look like for primary care?’ This study found it is “having a network of trusted relationships between clinicians and kaimahi (community service providers) who share skillsets and information to support safe, relational responses to whānau and families, responsive to complex needs over time.”

Participants trusted in their mana (leadership), rangatiratanga (collective self-determination) and expertise, to deliver and advocate for safe FV support and interventions for whānau and families within their respective communities. What this looks like in practice is demonstrated by the Atawhai Kōrero (conversation), Atawhai Network , and Atawhai Common Language . This is supported by four Pathways to Responsiveness. To view these resources, visit www.atawhaitia.co.nz .

The Atawhai response to FV is encapsulated within the Atawhai Kōrero. It recognises that:

Kōrero [conversations] about family violence can be many shared moments in time, or wā (time), within a relationship, underpinned by tika (honesty), pono (truth), and aroha (empathy). Atawhai realises that as practitioners, we do not have to ‘fix the problem’ but be someone whānau and families can trust to walk alongside supporting opportunities for change. Care is always taken so any kōrero is responsive to, and safe for, whānau and families.

Responsive to participant learning, the Atawhai Network was developed to bring together primary care professionals who are dedicated to preventing FV. Underpinned by the Atawhai Tikanga , this health-sector-led network connects health care professionals and organisations with other providers, information, and tools to safely journey with whānau and families in their experience of FV. Atawhai relies on developing relationships across settings to share and learn from one another and translate knowledge between different health care disciplines and contexts. Members of the Atawhai Network gain confidence in knowing what to do and how to help, develop trusted relationships with local referral services and can share challenges with like-minded people. As described by a participant, the Network provides a supportive environment to build confidence and assist with the uncertainty involved in responding to complex care needs. The Atawhai Kōrero works not as a ‘tick-box’, but a ‘touchstone’ to refer to when working in an isolated consultation. Although not a quick fix, the Atawhai Network is a long-term health care response to FV that continually evolves in response to need.

Guided by Thomas and McDonagh [ 50 ] and developed from the collective understanding developed between Wānanga Two and Three, the Atawhai Common Language (Table  2 ) was validated by participants at Wānanga Five. The Atawhai Common Language articulates a shared language and behaviour for an effective network response, including a shared understanding of the value of participating. As described by a participant, Atawhai presents an opportunity for practitioners and organisations to recognise the responsibility primary care has to respond to FV as a key determinant of ill-health and realise the unique value of the consultation space for safe kōrero about FV. The Atawhai Pathways to Responsiveness recognise that many small changes in patterns of interaction over time will lead to system change. When enacted, these four health care system pathways will support sustainable responsiveness to FV: (1) Establishing FV as a key determinant of ill-health, (2) Connecting medical and community service provision, (3) Advocating for clinical and cultural supervision for practitioners, and (4) Tuituia: Connecting to information and support.

Our secondary research question asked, ‘What influences change in primary care family violence responsiveness?’ This study found two key influences: (a) relationships and (b) critical reflection. Within primary care, relationships between professionals, and between a professional and person(s) accessing care, are key to influencing change. We encouraged trusted relationships to occur through regular in-person whakawhanaungatanga (relating to others), kai (food) and kōrero (conversation). Across the wānanga, Atawhai generated trusted relationships between practitioners enabling a safe space for difficult, sensitive, inspiring, and hopeful conversations about FV to occur. Participants noted opportunities for learning from diverse relationships, including whānau, families, other colleagues, and their own experience. Over time, the research team, and participants (both collectively and separately) were able to generate ‘Āhuru Mōwai’, safe spaces for conversations about FV. Uniquely, Atawhai was also able to develop trusted relationships between the often-conflicting worldviews of western clinical practice and Māori health. As captured by Kaihopu Kōrero, participants said:

“[There is a] great sense of possibility and openness and potential. A re-engagement of medicine with te ao Māori. The big thing is about trust. To regain trust where trust has been lost. To use the wairua [spirit] of Atawhai to build and regain trust. Honours both sides, Māori and medical. A dignified way of entering into a relationship” (Participant, wānanga seven). “At the beginning [I was] feeling disheartened and at a loss to know how to help, [I] came to the first wānanga looking for solutions. [I’m] not feeling so powerless now, knowing there are other people who strongly feel this is something important. We don’t need to fix it, but we are all here to support each other” (Participant, wānanga seven). “After the first wānanga I was scared and reluctant to come back because I thought all of you are doing such good work – but now having shared that kōrero with you about what we are trying to do in Atawhai and how you are approaching the challenges, I feel so good and I know that I could call on you for help” (Participant, wānanga two).

The second key influence for change was generating opportunities for primary care professionals to have time and space to critically reflect on how personal, organisational, political, and societal system structures shape responses to FV. Participant diversity allowed learning from different perspectives, and these reflections often initiated a transformation in how participants thought about a FV response that then influenced how they practiced. As captured by Kaihopu Kōrero, participants expressed the following:

“You come in [to the wānanga] with one intent and come out with something different and it is evolving all the time” (Participant, wānanga five). “[We’ve] built up a lot of shared knowledge that has been distilled into many different resources. New knowledge grounded in practice that can inform policy […] I feel that is what a lot of practitioners are hungry for” (Participant, wānanga seven).

In another example, community service providers became aware that clinical providers did not routinely receive formal supervision, which was viewed as a serious lack of practice support. “Supervision” in this context, refers to a process of professional learning and development that enables individuals to reflect on and develop their knowledge, skills, and competence, through agreed and regular support with another professional. In lieu of this support, a peer support group in one primary care clinic setting was set up to provide a safe space for clinical providers to share the challenges they face in practice. As captured by Kaihopu Kōrero, participants reflected:

“Kaimahi [workers] on the ground need to be well to do this job, therefore manaaki in the form of supervision and peer support is necessary” (Participant, wānanga eight). “Young doctors […] were really shell-shocked by managing FV. There is nothing in the curriculum about violence, so they are feeling not prepared to manage [FV] especially because it is confronting. There’s a discrepancy between the view of students that it’s not in the curriculum and the university who say it is. But it’s not enough to help young docs feel comfortable. It’s not landing for students” (Participant, wānanga seven).

Participants strongly argued that to effectively address FV one had to “Know first who you are and where you come from” to “Be authentic” in the relationship with someone accessing care. These values were articulated within Atawhai ‘Gems’, personal maxims that helped practitioners converse about FV in practice (see Table  3 and visit www.atawhaitia.co.nz ).

Family violence is a key determinant of ill-health inadequately responded to within health systems internationally [ 3 , 51 ]. The World Health Organisation advises health systems to establish comprehensive system infrastructure that supports a ‘ women-centred, first-line’ response to intimate partner violence [ 7 ]. There is also growing recognition that standard prescriptive interventions do not reflect the complexity of the problem generating design of more adaptive and diverse methodological frameworks [ 38 ]. The innovative research design of this study pushes against methodological boundaries, operating as a complex adaptive system itself [ 52 ], shifting and changing in response to what is observed and learned during the research. This study developed ‘Atawhai’, a unique relational response that aims to make it easier for the primary care sector to respond to FV in Aotearoa NZ. We discuss two key learnings from this study that influence change (1) providing opportunity for critical reflection on the systems and structures shaping policy and practice, and (2) valuing trusted relationships for practitioners and those accessing care.

Critical reflection: why do we respond the way we do?

The UK Kings Fund describes transformational change in health care as requiring “a fundamental rethink to find new and better solutions. It requires a shift in the power balance within relationships, in mindsets and in ways of working, at every level of a system” [ 53 ] (p.84). Our findings show to generating change in responsiveness to FV requires greater attention to the initial conditions of complex adaptive systems (CAS). Within FV, there is a myriad of personal, organisational, political, and societal elements constantly interacting and shaping how the ‘problem’ is viewed (epistemology), and consequently, how we design interventions (methodology). The intervention design has implications for how responsiveness to FV is articulated within policy and demonstrated in practice (methods). However, what is often lacking is critical reflection on the systems and structures underpinning individual and collective stances on the problem (e.g., biomedicine, gender, equity, racism). These influences shape how we design responses to FV and therefore how responsive we are to FV in practice [ 51 , 54 , 55 , 56 ]. Atawhai found providing health professionals the opportunity to critically reflect on assumptions underpinning personal and organisational service delivery can initiate transformative change in the way a response is thought about. This finding builds on the ‘Triple R Pathway’ [ 4 ], our CAS approach demonstrating the self-organisation of FV responsiveness within health care. Having space and time to think and engage in conversation with peers influences the ‘Respond stance’, altering the pathway toward ‘Responsiveness’ in practice [ 4 , 34 ].

Complexity theory helps to see that interventions do not exist in isolation and are dependent on the context they occur within [ 34 , 57 ]. System and structural elements that exacerbate FV and shape the choices people have for change (such as housing, poverty, patriarchy, colonialism) are well known and addressed with approaches such as trauma and violence-informed care [ 13 ], or ecological models [ 1 ] that call attention to relationships with social determinants of health. Similarly, indigenous-centred approaches to FV service delivery recognise the impacts of colonisation, racism, and collective trauma over time [ 14 , 19 , 58 ]. The importance of critical reflection was made apparent as participants made sense of the patterns of interaction between systems and structures and how these were shaping their practice. Further, through conversation, participants could understand and empathise with others’ motivations and perspectives as well as the contextual constraints, expectations, pressures and uncertainties they faced, providing a wider view of the complex systems they each operated within [ 34 ]. This learning generated a humility amongst the participants and insights, recognising they are one part of a much larger system.

Critical reflection adds to the concept of being ‘ready’ to respond [ 59 ], requiring deep self-exploration of personal motivations to address FV. This learning could also take place within a collective (e.g., primary health care organisation), reflecting on organisational identity, values, and principles in relation to responding to FV and congruence with current practice. At a health system level, critical reflection on how the current public health approach to FV influences the development of interventions and resources is needed [ 55 ]. For example, screening, or routine enquiry, can obscure patterns of interaction with the systems and structures that exacerbate FV and entrapment, reducing understanding of the complexity involved [ 33 ]. The Atawhai complex adaptive system approach to FV connects problem to context, prompting reflection on why we respond the way we do. Our findings align with ‘simple rules’ for translating evidence in complex systems; ‘acting scientifically and pragmatically’, ‘embracing complexity’, and ‘engaging and empowering’ those affected by the desired change [ 34 ].

Relationships: creating safe spaces for conversation and learning

Utilising complexity theory, Atawhai was premised on the hypothesis that sustainable responses to FV are emergent from the interaction between the clinician and person accessing care [ 38 ]. Understanding sustainability as an emergent phenomenon means the quality of relationships between system agents is critical to success [ 60 , 61 ]. Atawhai demonstrates the critical importance of trusted relationships for addressing FV, which is often taken for granted, or undervalued. The Atawhai Kōrero guides developing genuine connection and understanding through unstructured conversation with those accessing care. Following the hypothesis, a mutual understanding of circumstances and a way forward emerges through conversation. Each person (professional and care-seeker) in the relationship learns from the kōrero which changes the way they act. Through these interactions, change occurs. However, given the non-linear nature of conversation and learning, there is uncertainty about whether change will be considered positive or negative. From this CAS perspective, as Jordan, Lanham et al. [ 61 ], say, “It is not possible to first learn about an intervention, then plan the intervention, and then implement the plan. Rather, individuals and collectives must learn as they act, and they must act in order to learn” (p.6). This approach is substantially different from the current public health method of identifying, assessing, and referring FV, which is often transactional, in response to a single event, and delivered at a single point in time [ 30 , 33 ]. Atawhai allows for kōrero as often as needed, aligning with primary care aims of long-term relationships with families and whānau.

Atawhai also highlights the critical importance of building trusted relationships amongst diverse primary care professionals to address FV. Building trusted relationships amongst professionals is often cited as necessary for better FV service provision, yet how to do so is often unclear. Getting to ‘Āhuru Mōwai’, our safe space as a group, was a journey that took time for trust to be established. Trust emerged from participants and the research team learning about one another (whakawhanaungatanga), describing their role, constraints, access to resources, and worldviews. Once trust was established, participants felt safe to engage in critical reflection, learning and sensemaking with one another [ 60 ]. Time is often cited as a barrier to delivering services or attending training within general practice due to the increasing complexity of care, workload expectations and administrative burden [ 62 ]. Trust takes time to occur and is mediated by many systemic influences, such as an expectation to achieve a trusted relationship within a 10–15-minute consultation. The Atawhai Kōrero advocates for many shared moments in time to occur, for the primary care profession to be someone that will walk alongside them in their journey. Having effective system supports such as referral relationships can work toward clinician capability in addressing concerns [ 63 ].

From a CAS perspective, FV interventions that focus on increasing the quality of relationships amongst diverse primary care professionals are likely to see the emergence of sustainability [ 60 ]. Based on relationships, Atawhai is an adaptive and reflexive approach, responsive to the uniqueness of local systems. It acts as a ‘boundary vehicle’ [ 64 ], providing a set of principles and values that can be reinterpreted over time by individuals and collectives based on their critical reflection and learning. We hypothesise Atawhai will generate synergies within existing systems, rather than acting as a standalone intervention, for example, building capability through supervision for general practitioners. Our learning offers three empirical rules to improve responsiveness to FV in primary care: (1) know yourself and the world in which you usually operate to realise and understand the system boundaries you reinforce every day through language and behaviours, (2) create, learn and adopt a common language that can work across worlds and continue to grow and enrich that language through conversation and use, and (3) create ‘boundary vehicles’ that work to bridge the boundaries of different worlds.

Strengths and limitations

This study demonstrates a complex adaptive system approach to translating evidence within health systems. It successfully weaves together indigenous and western science methodologies and methods to produce the equitable outcomes of Atawhai. The clear theoretical position directed our attention to patterns of relationships from both Te Ao Māori and complexity theory worldviews. Findings highlighted a need to critically reflect on the underpinning systems and structures that shape the design of responses to FV. Early in the study, we presented participants with an evidence base of FV as (1) a key determinant of ill-health, (2) a complex problem, (3) a profound system gap, (4) an urgent issue, and (5) primary care as a window of opportunity to make a difference. While participants critiqued this evidence themselves, on reflection we understand this to have underpinned the development of Atawhai. Participant recruitment was directed toward those associated with a general practice or Māori health organisation which limited engagement with other primary care settings such as those providing physiotherapy or midwifery services. Recruitment was limited to one geographical region of Aotearoa NZ and subject to selection bias (i.e., those interested in FV agreed to participate and more participants were recruited from Māori health organisations than clinical practices). A key limitation to the scale-up and spread of Atawhai was the engagement of the decision makers within participant organisations. While participants saw the value and benefit of Atawhai, it was more difficult to communicate this to those ‘outside’ of the study. Engaging decision-makers along the way is critical to response development, a key insight for future participatory research. The sustainability of the Network will depend on leadership and funding post-research. Finally, we focused on making it easier for primary care professionals to respond to FV. Future research will engage with whānau and families to explore what matters to them when accessing services, capture evidence of service delivery change (positive and negative), and monitor for unintended consequences over time.

Atawhai is a unique health care response to FV evidenced on empirical knowledge of primary care professionals. It advances current thinking on health system responses to FV by calling attention to two system parts (relationships and critical reflection) often not considered in current responses. Transformative change relies on the critical need to reflect on the systems and structures that shape responses to FV. Sustainability relies on the quality of system relationships in creating safe spaces to talk about FV. Generating change in complex systems takes time. Not a ‘quick fix’, Atawhai presents a grassroots approach to developing a sustainable long-term response to FV that evolves in response to needs. Most importantly, Atawhai aims to prioritise developing trust, so that whānau and families feel comfortable and heard amidst a plethora of complex and multiple traumatic experiences and needs.

Data availability

Study website (www.atawhaitia.co.nz) provides anonymised collective findings.

Abbreviations

Family Violence

New Zealand

Violence Intervention Programme

• Complex adaptive system

Bay of Plenty

District Health Board

Primary Health Organisation

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Acknowledgements

Ngā mihi nui ki a koutou te whānau Atawhai. Thank you to all participants, organisations, National Advisory Group, and network members who made this study possible and continue to be committed to the development of Atawhai in Aotearoa New Zealand. Ngā mihi nui Hazel Hape for grounding the research team in practice-based realities, Lisa Mullions for project coordination and manaakitanga, Professor Kelsey Hegarty for international advocacy and support of Atawhai, and Stacey Mareroa for contribution of Māori Mātauranga and knowledge translation. Ngā mihi nui ki a kōrua kaumatua Tamati Tata and Joanne Gear for their early support of project development.

This study was funded by the Health Research Council of New Zealand (20/732).

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CG led the study. CG, JKM, EE, AR, CH, CI, NT, HA contributed to the design, conduct and analysis of the study. HA, NT, and AR led indigenous methods and analysis. CG, JKM & EE led western methods and analysis. CI, CH, and EK led clinical data interpretation. All authors contributed to manuscript writing.

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Gear, C., Koziol-McLain, J., Eppel, E. et al. ‘Atawhai’: a primary care provider-led response to family violence in Aotearoa New Zealand. Arch Public Health 82 , 74 (2024). https://doi.org/10.1186/s13690-024-01309-1

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Tell us a bit about yourself.

I am a senior, a History major, graduating a year early. I brought in a few credits from high school, did summer school a couple of times, and suddenly had the choice to either accelerate my graduation date or slow things down. Since I want to go to law school, which is another three years of school, I figured I might as well speed things up. It has been the best decision for me.

I chose History because I just love history. I came in wanting to be an Accounting major. Most of my family are CPAs. But during orientation, I felt unsure about that decision. I spoke with my family who told me to major in something I love, so I decided to switch to history. And I've loved it ever since. It has been the best. I love all my classes, all the professors. I just cannot recommend it enough. I did end up minoring in business which involved taking a class in financial accounting, and I was correct, accounting is not for me. However, I have loved all my business classes.

What got you interested in history?

In middle school, I hated history. The teacher just read out the text of the slides he showed. It was boring, and I dreaded going to class. Then I hit ninth grade, and we got Mr. Burmeister. He was the best teacher ever. He stood up and taught history like it was a collection of stories, he made history fun. I took more classes with him throughout high school, and I came to really like history and the law. Now I am a History major applying to law school.

Why did you choose this senior seminar class? 

My soon-to-be sister-in-law, also a History major, did her senior seminar with Dr. Frank on FSU and the Seminole tribe and loved it. She suggested that I take something similar, so when I looked at the fall list of senior seminars, Dr. Conti’s stood out as being on American architecture. I looked her up to see what work she had done, and it was really interesting on plantations and public history. Her work was cool, so I thought the class was going to be cool. I like American history, and architecture is a huge part of it.

What project did you work on?

My senior seminar project was on Doak Campbell Stadium. I started off wanting to do a local history of Madison, FL, because of family connections. But I quickly realized that there were not enough sources. Dr. Conti helped me change to working on how going to a game at FSU’s football stadium produces an experience for the fans. That meant also at looking at how FSU became the football school it is today.

The main focus of my paper was on the period from the 1950s to the 1990s. FSU did not have a football team while it was a college for women, but it did have one at the beginning of the 20th century. Football came back when the college became FSU in 1947. The stadium was not built until 1950, and it has been renovated and expanded multiple times. The first stadium had 15,000 seats.

What really fascinated me was the relationship between academics and athletics. Money received from athletics was used to fund both faculty and students. Both the Eminent Scholars Program, which allowed FSU to hire notable academics and other scholarship programs to attract gifted undergraduates came from proceeds of football games.

Was it easy to get started with a project like this?

Every week, Dr. Conti assigned us some articles to read and a podcast episode to listen to. We would discuss this in class. The episodes linked directly to the stage we were in with our project, from how to find a topic, how to research it, how to write etc. We discussed the material in class, and it helped me think about the doing or making of history more broadly.

When I started working on the history of the stadium, I saw that there were so many sources, it was overwhelming. I contacted Special Collections, and they provided me with eight boxes of primary sources all to do with the stadium! I went to the Pepper Center to look through the material. I took a lot of pictures, and I had to be careful to keep track of what image came from what file. I took a picture of the box, then a picture of the folder, and then pictures of the documents inside it. In the main, I looked at correspondence and minutes of meetings, but I also found old homecoming programs and tickets. At the end of that day, I had collected about 90% of the material that I needed to write my paper.

Was it hard to write such a long paper?

When I got in the classroom on the first day, Dr. Conti asked: How are y'all feeling? What are your thoughts on writing a paper this long? And everybody in the class looked overwhelmed.

I had never written a paper this long before, and I did not know how to tackle it. I ended up planning it like a normal paper, just with the sections being longer, with a lot of paragraphs. I let the different things I wanted to write about lead me from topic to topic. From fans to tickets, from academics to scholarships, from Doak Campbell in the 1950s to the stadium today. And when I stopped writing, I had got to about 5,500 words, and there was still a lot that I could have mentioned but I had no more space.

Normally, I do all my research first, and then I sit down to write. But with this paper I could not do that. I remember being in Dr. Conti’s office the day before a draft section was due and telling her that this was not how I write my papers. But she said that I needed to start writing, and that I would not be able to do all my research in advance. And she was right. I began jotting down my ideas, then adding in sources. I would write a paragraph, then skip others. I left blank spaces with notes on what to add in later. And in the end, I came to 5,500 words and I was astounded.

This is how I will be writing my papers from here on out, it was so foreign to me in the beginning, but it now makes complete sense.

What advice would you give to students who are about to take the senior seminar?

I would say it is not as scary as it seems, and it is actually very interesting and fun. It will occupy a lot of your time. But it is worth it.  I had never taken a class before where you spend an entire semester working on one topic.  That is a really different experience.

You have to pick a topic that you love. But also, a topic that has a lot of good information. As I discovered with my first topic that I really wanted to do – I could not because of the absence of sources.  This is not a paper where the professor provides you with the research material. They will guide you, but you have to find the material by yourself.

If you could go back to the beginning of the semester, what would you do differently?

There is the classic advice: Do not wait so close to the deadlines before getting started with your work. I was guilty of this at the start of the class, but, thankfully, success was still possible, good luck to my fellow procrastinators.

The second thing I would tell myself is to go for the stadium as a topic straight away. I just did not even think about it. Yes, I knew it was there, but I did not look at it from an architectural point of view. It was football, not a senior seminar topic.

Any final thoughts?

I ended up loving the senior seminar more than I thought I would. I knew it was going to be a lot of work and having spoken to friends that had taken it, they said it was a lot too.  Yet, they always felt very accomplished that they had produced this long paper, especially since it usually was on some cool topic that they kept talking about.

I never stuck with a topic for that long. The whole experience of going to the archives, looking at all these documents, taking pictures … it was really fun. And I shared my findings with my grandfather who went to FSU and loves all things FSU football.

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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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)

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New Collections: Felix Gonzalez-Torres letters to María Martínez-Cañas

This entry is part of an ongoing series highlighting new collections. The Archives of American Art collects primary source materials—original letters, writings, preliminary sketches, scrapbooks, photographs, financial records, and the like—that have significant research value for the study of art in the United States. The following essay was originally published in the Spring 2024 issue (vol. 63, no. 1) of the Archives of American Art Journal. More information about the journal can be found at  https://www.journals.uchicago.edu/toc/aaa/current .

“It was a real pleasure to meet you. I miss Miami Beach, miss the light, the ocean, the blue skies & all the palm trees.” So opens a circa 1988–89 postcard from Felix Gonzalez-Torres (1957–1996) to fellow artist María Martínez-Cañas (b. 1960). Accompanying the postcard in this collection is a handwritten letter on lined notebook paper and a snapshot picturing three cats cuddling on a seat cushion that has fallen from its perch to a white tile floor. Dating from 1988–1992, this three-item collection is the first donation made in response to the call for submissions to the Felix Gonzalez-Torres Correspondence Archive , a unique partnership between the Archives and the Felix Gonzalez-Torres Foundation that was launched in 2020.

Gonzalez-Torres had an ongoing practice of sending correspondence to a range of people, including friends, individuals from the art world (such as collectors and curators) with whom he both intimately and casually engaged, and family. The first donation to the Correspondence Archive comes from not only an artist peer, but one who, like Gonzalez-Torres, was born in Cuba and raised in Puerto Rico. The families of both Gonzalez-Torres and Martínez-Cañas eventually settled in Miami, and the artists shared a love of the city’s topography and culture. Gonzalez-Torres writes in the letter on notebook paper that is part of this collection, “Extraño la luz de Miami Beach, el olor a platano maduro frito, y el azul de la playa.” [“I miss the light of Miami Beach, the smell of fried ripe plantain, and the blue of the beach.”] The practice of listing is prevalent throughout Gonzalez-Torres’s letters, as well as his artwork. The artists’ correspondence thus presents an opportunity to engage with the idea of multiple simultaneous possibilities, which was intrinsic to Gonzalez-Torres’s thinking.

Other facets of Gonzalez-Torres’s character and practice emerge in this collection, including his thoughtful regard for fellow artists and his participation in the New York-based art collective Group Material (which the artist considered separate from his practice). On the reverse of the snapshot of cats, for example, he notifies Martínez-Cañas that Group Material is going on sabbatical. From 1987 to 1994 Gonzalez-Torres was a core member of the group, which often invited contributions from contemporaries, such as Martínez-Cañas. She had apparently sent some slides for Group Material’s consideration (the specific project is unspecified), and Gonzalez-Torres was kindly returning them so they could be reused. This gesture evokes a pre-digital world and the once common practice of distributing 35mm slides as work samples. It also prompts us to imagine how Martínez-Cañas’s art might have been incorporated into one of Group Material’s politically charged installations.

Though his life was cut short by AIDS-related causes, Gonzalez-Torres remains a powerful presence in the contemporary art world, where his work continues to be shown widely. As well as attesting to the wide network of friends, family, and colleagues he maintained in his lifetime, Gonzalez-Torres’s correspondence material is relevant in how it may add perspective to the artist’s work. This inaugural gift from Martínez-Cañas suggests a future where Gonzalez-Torres’s presence is equally ensured in the Archives.

Josh T. Franco is the head of collecting at the Archives of American Art.

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