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How to Write a Conclusion for Research Papers (with Examples)

The conclusion of a research paper is a crucial section that plays a significant role in the overall impact and effectiveness of your research paper. However, this is also the section that typically receives less attention compared to the introduction and the body of the paper. The conclusion serves to provide a concise summary of the key findings, their significance, their implications, and a sense of closure to the study. Discussing how can the findings be applied in real-world scenarios or inform policy, practice, or decision-making is especially valuable to practitioners and policymakers. The research paper conclusion also provides researchers with clear insights and valuable information for their own work, which they can then build on and contribute to the advancement of knowledge in the field.

The research paper conclusion should explain the significance of your findings within the broader context of your field. It restates how your results contribute to the existing body of knowledge and whether they confirm or challenge existing theories or hypotheses. Also, by identifying unanswered questions or areas requiring further investigation, your awareness of the broader research landscape can be demonstrated.

Remember to tailor the research paper conclusion to the specific needs and interests of your intended audience, which may include researchers, practitioners, policymakers, or a combination of these.

Table of Contents

What is a conclusion in a research paper, summarizing conclusion, editorial conclusion, externalizing conclusion, importance of a good research paper conclusion, how to write a conclusion for your research paper, research paper conclusion examples.

• How to write a research paper conclusion with Paperpal? 

Frequently Asked Questions

A conclusion in a research paper is the final section where you summarize and wrap up your research, presenting the key findings and insights derived from your study. The research paper conclusion is not the place to introduce new information or data that was not discussed in the main body of the paper. When working on how to conclude a research paper, remember to stick to summarizing and interpreting existing content. The research paper conclusion serves the following purposes: 1

• Warn readers of the possible consequences of not attending to the problem.
• Recommend specific course(s) of action.
• Restate key ideas to drive home the ultimate point of your research paper.
• Provide a “take-home” message that you want the readers to remember about your study.

Types of conclusions for research papers

In research papers, the conclusion provides closure to the reader. The type of research paper conclusion you choose depends on the nature of your study, your goals, and your target audience. I provide you with three common types of conclusions:

A summarizing conclusion is the most common type of conclusion in research papers. It involves summarizing the main points, reiterating the research question, and restating the significance of the findings. This common type of research paper conclusion is used across different disciplines.

An editorial conclusion is less common but can be used in research papers that are focused on proposing or advocating for a particular viewpoint or policy. It involves presenting a strong editorial or opinion based on the research findings and offering recommendations or calls to action.

An externalizing conclusion is a type of conclusion that extends the research beyond the scope of the paper by suggesting potential future research directions or discussing the broader implications of the findings. This type of conclusion is often used in more theoretical or exploratory research papers.

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The conclusion in a research paper serves several important purposes:

• Offers Implications and Recommendations : Your research paper conclusion is an excellent place to discuss the broader implications of your research and suggest potential areas for further study. It’s also an opportunity to offer practical recommendations based on your findings.
• Provides Closure : A good research paper conclusion provides a sense of closure to your paper. It should leave the reader with a feeling that they have reached the end of a well-structured and thought-provoking research project.
• Leaves a Lasting Impression : Writing a well-crafted research paper conclusion leaves a lasting impression on your readers. It’s your final opportunity to leave them with a new idea, a call to action, or a memorable quote.

Writing a strong conclusion for your research paper is essential to leave a lasting impression on your readers. Here’s a step-by-step process to help you create and know what to put in the conclusion of a research paper: 2

• Research Statement : Begin your research paper conclusion by restating your research statement. This reminds the reader of the main point you’ve been trying to prove throughout your paper. Keep it concise and clear.
• Key Points : Summarize the main arguments and key points you’ve made in your paper. Avoid introducing new information in the research paper conclusion. Instead, provide a concise overview of what you’ve discussed in the body of your paper.
• Address the Research Questions : If your research paper is based on specific research questions or hypotheses, briefly address whether you’ve answered them or achieved your research goals. Discuss the significance of your findings in this context.
• Significance : Highlight the importance of your research and its relevance in the broader context. Explain why your findings matter and how they contribute to the existing knowledge in your field.
• Implications : Explore the practical or theoretical implications of your research. How might your findings impact future research, policy, or real-world applications? Consider the “so what?” question.
• Future Research : Offer suggestions for future research in your area. What questions or aspects remain unanswered or warrant further investigation? This shows that your work opens the door for future exploration.
• Closing Thought : Conclude your research paper conclusion with a thought-provoking or memorable statement. This can leave a lasting impression on your readers and wrap up your paper effectively. Avoid introducing new information or arguments here.
• Proofread and Revise : Carefully proofread your conclusion for grammar, spelling, and clarity. Ensure that your ideas flow smoothly and that your conclusion is coherent and well-structured.

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Remember that a well-crafted research paper conclusion is a reflection of the strength of your research and your ability to communicate its significance effectively. It should leave a lasting impression on your readers and tie together all the threads of your paper. Now you know how to start the conclusion of a research paper and what elements to include to make it impactful, let’s look at a research paper conclusion sample.

How to write a research paper conclusion with Paperpal?

A research paper conclusion is not just a summary of your study, but a synthesis of the key findings that ties the research together and places it in a broader context. A research paper conclusion should be concise, typically around one paragraph in length. However, some complex topics may require a longer conclusion to ensure the reader is left with a clear understanding of the study’s significance. Paperpal, an AI writing assistant trusted by over 800,000 academics globally, can help you write a well-structured conclusion for your research paper. 

• Sign Up or Log In: Create a new Paperpal account or login with your details.  
• Navigate to Features : Once logged in, head over to the features’ side navigation pane. Click on Templates and you’ll find a suite of generative AI features to help you write better, faster.  
• Generate an outline: Under Templates, select ‘Outlines’. Choose ‘Research article’ as your document type.  
• Select your section: Since you’re focusing on the conclusion, select this section when prompted.  
• Choose your field of study: Identifying your field of study allows Paperpal to provide more targeted suggestions, ensuring the relevance of your conclusion to your specific area of research. 
• Provide a brief description of your study: Enter details about your research topic and findings. This information helps Paperpal generate a tailored outline that aligns with your paper’s content. 
• Generate the conclusion outline: After entering all necessary details, click on ‘generate’. Paperpal will then create a structured outline for your conclusion, to help you start writing and build upon the outline.  
• Write your conclusion: Use the generated outline to build your conclusion. The outline serves as a guide, ensuring you cover all critical aspects of a strong conclusion, from summarizing key findings to highlighting the research’s implications. 
• Refine and enhance: Paperpal’s ‘Make Academic’ feature can be particularly useful in the final stages. Select any paragraph of your conclusion and use this feature to elevate the academic tone, ensuring your writing is aligned to the academic journal standards. 

By following these steps, Paperpal not only simplifies the process of writing a research paper conclusion but also ensures it is impactful, concise, and aligned with academic standards. Sign up with Paperpal today and write your research paper conclusion 2x faster .  

The research paper conclusion is a crucial part of your paper as it provides the final opportunity to leave a strong impression on your readers. In the research paper conclusion, summarize the main points of your research paper by restating your research statement, highlighting the most important findings, addressing the research questions or objectives, explaining the broader context of the study, discussing the significance of your findings, providing recommendations if applicable, and emphasizing the takeaway message. The main purpose of the conclusion is to remind the reader of the main point or argument of your paper and to provide a clear and concise summary of the key findings and their implications. All these elements should feature on your list of what to put in the conclusion of a research paper to create a strong final statement for your work.

A strong conclusion is a critical component of a research paper, as it provides an opportunity to wrap up your arguments, reiterate your main points, and leave a lasting impression on your readers. Here are the key elements of a strong research paper conclusion: 1. Conciseness : A research paper conclusion should be concise and to the point. It should not introduce new information or ideas that were not discussed in the body of the paper. 2. Summarization : The research paper conclusion should be comprehensive enough to give the reader a clear understanding of the research’s main contributions. 3 . Relevance : Ensure that the information included in the research paper conclusion is directly relevant to the research paper’s main topic and objectives; avoid unnecessary details. 4 . Connection to the Introduction : A well-structured research paper conclusion often revisits the key points made in the introduction and shows how the research has addressed the initial questions or objectives. 5. Emphasis : Highlight the significance and implications of your research. Why is your study important? What are the broader implications or applications of your findings? 6 . Call to Action : Include a call to action or a recommendation for future research or action based on your findings.

The length of a research paper conclusion can vary depending on several factors, including the overall length of the paper, the complexity of the research, and the specific journal requirements. While there is no strict rule for the length of a conclusion, but it’s generally advisable to keep it relatively short. A typical research paper conclusion might be around 5-10% of the paper’s total length. For example, if your paper is 10 pages long, the conclusion might be roughly half a page to one page in length.

In general, you do not need to include citations in the research paper conclusion. Citations are typically reserved for the body of the paper to support your arguments and provide evidence for your claims. However, there may be some exceptions to this rule: 1. If you are drawing a direct quote or paraphrasing a specific source in your research paper conclusion, you should include a citation to give proper credit to the original author. 2. If your conclusion refers to or discusses specific research, data, or sources that are crucial to the overall argument, citations can be included to reinforce your conclusion’s validity.

The conclusion of a research paper serves several important purposes: 1. Summarize the Key Points 2. Reinforce the Main Argument 3. Provide Closure 4. Offer Insights or Implications 5. Engage the Reader. 6. Reflect on Limitations

Remember that the primary purpose of the research paper conclusion is to leave a lasting impression on the reader, reinforcing the key points and providing closure to your research. It’s often the last part of the paper that the reader will see, so it should be strong and well-crafted.

• Makar, G., Foltz, C., Lendner, M., & Vaccaro, A. R. (2018). How to write effective discussion and conclusion sections. Clinical spine surgery, 31(8), 345-346.
• Bunton, D. (2005). The structure of PhD conclusion chapters.  Journal of English for academic purposes ,  4 (3), 207-224.

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Organizing Your Social Sciences Research Paper

• 9. The Conclusion
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The conclusion is intended to help the reader understand why your research should matter to them after they have finished reading the paper. A conclusion is not merely a summary of the main topics covered or a re-statement of your research problem, but a synthesis of key points derived from the findings of your study and, if applicable, where you recommend new areas for future research. For most college-level research papers, two or three well-developed paragraphs is sufficient for a conclusion, although in some cases, more paragraphs may be required in describing the key findings and their significance.

Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University.

Importance of a Good Conclusion

A well-written conclusion provides you with important opportunities to demonstrate to the reader your understanding of the research problem. These include:

• Presenting the last word on the issues you raised in your paper . Just as the introduction gives a first impression to your reader, the conclusion offers a chance to leave a lasting impression. Do this, for example, by highlighting key findings in your analysis that advance new understanding about the research problem, that are unusual or unexpected, or that have important implications applied to practice.
• Summarizing your thoughts and conveying the larger significance of your study . The conclusion is an opportunity to succinctly re-emphasize  your answer to the "So What?" question by placing the study within the context of how your research advances past research about the topic.
• Identifying how a gap in the literature has been addressed . The conclusion can be where you describe how a previously identified gap in the literature [first identified in your literature review section] has been addressed by your research and why this contribution is significant.
• Demonstrating the importance of your ideas . Don't be shy. The conclusion offers an opportunity to elaborate on the impact and significance of your findings. This is particularly important if your study approached examining the research problem from an unusual or innovative perspective.
• Introducing possible new or expanded ways of thinking about the research problem . This does not refer to introducing new information [which should be avoided], but to offer new insight and creative approaches for framing or contextualizing the research problem based on the results of your study.

Bunton, David. “The Structure of PhD Conclusion Chapters.” Journal of English for Academic Purposes 4 (July 2005): 207–224; Conclusions. The Writing Center. University of North Carolina; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Conclusions. The Writing Lab and The OWL. Purdue University; Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Structure and Writing Style

I.  General Rules

The general function of your paper's conclusion is to restate the main argument . It reminds the reader of the strengths of your main argument(s) and reiterates the most important evidence supporting those argument(s). Do this by clearly summarizing the context, background, and necessity of pursuing the research problem you investigated in relation to an issue, controversy, or a gap found in the literature. However, make sure that your conclusion is not simply a repetitive summary of the findings. This reduces the impact of the argument(s) you have developed in your paper.

When writing the conclusion to your paper, follow these general rules:

• Present your conclusions in clear, concise language. Re-state the purpose of your study, then describe how your findings differ or support those of other studies and why [i.e., what were the unique, new, or crucial contributions your study made to the overall research about your topic?].
• Do not simply reiterate your findings or the discussion of your results. Provide a synthesis of arguments presented in the paper to show how these converge to address the research problem and the overall objectives of your study.
• Indicate opportunities for future research if you haven't already done so in the discussion section of your paper. Highlighting the need for further research provides the reader with evidence that you have an in-depth awareness of the research problem but that further investigations should take place beyond the scope of your investigation.

Consider the following points to help ensure your conclusion is presented well:

• If the argument or purpose of your paper is complex, you may need to summarize the argument for your reader.
• If, prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction or within a new context that emerges from the data [this is opposite of the introduction, which begins with general discussion of the context and ends with a detailed description of the research problem]. 

The conclusion also provides a place for you to persuasively and succinctly restate the research problem, given that the reader has now been presented with all the information about the topic . Depending on the discipline you are writing in, the concluding paragraph may contain your reflections on the evidence presented. However, the nature of being introspective about the research you have conducted will depend on the topic and whether your professor wants you to express your observations in this way. If asked to think introspectively about the topics, do not delve into idle speculation. Being introspective means looking within yourself as an author to try and understand an issue more deeply, not to guess at possible outcomes or make up scenarios not supported by the evidence.

II.  Developing a Compelling Conclusion

Although an effective conclusion needs to be clear and succinct, it does not need to be written passively or lack a compelling narrative. Strategies to help you move beyond merely summarizing the key points of your research paper may include any of the following:

• If your essay deals with a critical, contemporary problem, warn readers of the possible consequences of not attending to the problem proactively.
• Recommend a specific course or courses of action that, if adopted, could address a specific problem in practice or in the development of new knowledge leading to positive change.
• Cite a relevant quotation or expert opinion already noted in your paper in order to lend authority and support to the conclusion(s) you have reached [a good source would be from your literature review].
• Explain the consequences of your research in a way that elicits action or demonstrates urgency in seeking change.
• Restate a key statistic, fact, or visual image to emphasize the most important finding of your paper.
• If your discipline encourages personal reflection, illustrate your concluding point by drawing from your own life experiences.
• Return to an anecdote, an example, or a quotation that you presented in your introduction, but add further insight derived from the findings of your study; use your interpretation of results from your study to recast it in new or important ways.
• Provide a "take-home" message in the form of a succinct, declarative statement that you want the reader to remember about your study.

III. Problems to Avoid

Failure to be concise Your conclusion section should be concise and to the point. Conclusions that are too lengthy often have unnecessary information in them. The conclusion is not the place for details about your methodology or results. Although you should give a summary of what was learned from your research, this summary should be relatively brief, since the emphasis in the conclusion is on the implications, evaluations, insights, and other forms of analysis that you make. Strategies for writing concisely can be found here .

Failure to comment on larger, more significant issues In the introduction, your task was to move from the general [the field of study] to the specific [the research problem]. However, in the conclusion, your task is to move from a specific discussion [your research problem] back to a general discussion framed around the implications and significance of your findings [i.e., how your research contributes new understanding or fills an important gap in the literature]. In short, the conclusion is where you should place your research within a larger context [visualize your paper as an hourglass--start with a broad introduction and review of the literature, move to the specific analysis and discussion, conclude with a broad summary of the study's implications and significance].

Failure to reveal problems and negative results Negative aspects of the research process should never be ignored. These are problems, deficiencies, or challenges encountered during your study. They should be summarized as a way of qualifying your overall conclusions. If you encountered negative or unintended results [i.e., findings that are validated outside the research context in which they were generated], you must report them in the results section and discuss their implications in the discussion section of your paper. In the conclusion, use negative results as an opportunity to explain their possible significance and/or how they may form the basis for future research.

Failure to provide a clear summary of what was learned In order to be able to discuss how your research fits within your field of study [and possibly the world at large], you need to summarize briefly and succinctly how it contributes to new knowledge or a new understanding about the research problem. This element of your conclusion may be only a few sentences long.

Failure to match the objectives of your research Often research objectives in the social and behavioral sciences change while the research is being carried out. This is not a problem unless you forget to go back and refine the original objectives in your introduction. As these changes emerge they must be documented so that they accurately reflect what you were trying to accomplish in your research [not what you thought you might accomplish when you began].

Resist the urge to apologize If you've immersed yourself in studying the research problem, you presumably should know a good deal about it [perhaps even more than your professor!]. Nevertheless, by the time you have finished writing, you may be having some doubts about what you have produced. Repress those doubts! Don't undermine your authority as a researcher by saying something like, "This is just one approach to examining this problem; there may be other, much better approaches that...." The overall tone of your conclusion should convey confidence to the reader about the study's validity and realiability.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Concluding Paragraphs. College Writing Center at Meramec. St. Louis Community College; Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University; Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions. The Lab Report. University College Writing Centre. University of Toronto; Leibensperger, Summer. Draft Your Conclusion. Academic Center, the University of Houston-Victoria, 2003; Make Your Last Words Count. The Writer’s Handbook. Writing Center. University of Wisconsin Madison; Miquel, Fuster-Marquez and Carmen Gregori-Signes. “Chapter Six: ‘Last but Not Least:’ Writing the Conclusion of Your Paper.” In Writing an Applied Linguistics Thesis or Dissertation: A Guide to Presenting Empirical Research . John Bitchener, editor. (Basingstoke,UK: Palgrave Macmillan, 2010), pp. 93-105; Tips for Writing a Good Conclusion. Writing@CSU. Colorado State University; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Writing Conclusions. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Writing: Considering Structure and Organization. Institute for Writing Rhetoric. Dartmouth College.

Writing Tip

Don't Belabor the Obvious!

Avoid phrases like "in conclusion...," "in summary...," or "in closing...." These phrases can be useful, even welcome, in oral presentations. But readers can see by the tell-tale section heading and number of pages remaining that they are reaching the end of your paper. You'll irritate your readers if you belabor the obvious.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Another Writing Tip

New Insight, Not New Information!

Don't surprise the reader with new information in your conclusion that was never referenced anywhere else in the paper. This why the conclusion rarely has citations to sources. If you have new information to present, add it to the discussion or other appropriate section of the paper. Note that, although no new information is introduced, the conclusion, along with the discussion section, is where you offer your most "original" contributions in the paper; the conclusion is where you describe the value of your research, demonstrate that you understand the material that you’ve presented, and position your findings within the larger context of scholarship on the topic, including describing how your research contributes new insights to that scholarship.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Conclusions. The Writing Center. University of North Carolina.

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Home » Research Paper Conclusion – Writing Guide and Examples

Research Paper Conclusion – Writing Guide and Examples

Table of Contents

Research Paper Conclusion

Definition:

A research paper conclusion is the final section of a research paper that summarizes the key findings, significance, and implications of the research. It is the writer’s opportunity to synthesize the information presented in the paper, draw conclusions, and make recommendations for future research or actions.

The conclusion should provide a clear and concise summary of the research paper, reiterating the research question or problem, the main results, and the significance of the findings. It should also discuss the limitations of the study and suggest areas for further research.

Parts of Research Paper Conclusion

The parts of a research paper conclusion typically include:

Restatement of the Thesis

The conclusion should begin by restating the thesis statement from the introduction in a different way. This helps to remind the reader of the main argument or purpose of the research.

Summary of Key Findings

The conclusion should summarize the main findings of the research, highlighting the most important results and conclusions. This section should be brief and to the point.

Implications and Significance

In this section, the researcher should explain the implications and significance of the research findings. This may include discussing the potential impact on the field or industry, highlighting new insights or knowledge gained, or pointing out areas for future research.

Limitations and Recommendations

It is important to acknowledge any limitations or weaknesses of the research and to make recommendations for how these could be addressed in future studies. This shows that the researcher is aware of the potential limitations of their work and is committed to improving the quality of research in their field.

Concluding Statement

The conclusion should end with a strong concluding statement that leaves a lasting impression on the reader. This could be a call to action, a recommendation for further research, or a final thought on the topic.

How to Write Research Paper Conclusion

Here are some steps you can follow to write an effective research paper conclusion:

• Restate the research problem or question: Begin by restating the research problem or question that you aimed to answer in your research. This will remind the reader of the purpose of your study.
• Summarize the main points: Summarize the key findings and results of your research. This can be done by highlighting the most important aspects of your research and the evidence that supports them.
• Discuss the implications: Discuss the implications of your findings for the research area and any potential applications of your research. You should also mention any limitations of your research that may affect the interpretation of your findings.
• Provide a conclusion : Provide a concise conclusion that summarizes the main points of your paper and emphasizes the significance of your research. This should be a strong and clear statement that leaves a lasting impression on the reader.
• Offer suggestions for future research: Lastly, offer suggestions for future research that could build on your findings and contribute to further advancements in the field.

Remember that the conclusion should be brief and to the point, while still effectively summarizing the key findings and implications of your research.

Example of Research Paper Conclusion

Here’s an example of a research paper conclusion:

Conclusion :

In conclusion, our study aimed to investigate the relationship between social media use and mental health among college students. Our findings suggest that there is a significant association between social media use and increased levels of anxiety and depression among college students. This highlights the need for increased awareness and education about the potential negative effects of social media use on mental health, particularly among college students.

Despite the limitations of our study, such as the small sample size and self-reported data, our findings have important implications for future research and practice. Future studies should aim to replicate our findings in larger, more diverse samples, and investigate the potential mechanisms underlying the association between social media use and mental health. In addition, interventions should be developed to promote healthy social media use among college students, such as mindfulness-based approaches and social media detox programs.

Overall, our study contributes to the growing body of research on the impact of social media on mental health, and highlights the importance of addressing this issue in the context of higher education. By raising awareness and promoting healthy social media use among college students, we can help to reduce the negative impact of social media on mental health and improve the well-being of young adults.

Purpose of Research Paper Conclusion

The purpose of a research paper conclusion is to provide a summary and synthesis of the key findings, significance, and implications of the research presented in the paper. The conclusion serves as the final opportunity for the writer to convey their message and leave a lasting impression on the reader.

The conclusion should restate the research problem or question, summarize the main results of the research, and explain their significance. It should also acknowledge the limitations of the study and suggest areas for future research or action.

Overall, the purpose of the conclusion is to provide a sense of closure to the research paper and to emphasize the importance of the research and its potential impact. It should leave the reader with a clear understanding of the main findings and why they matter. The conclusion serves as the writer’s opportunity to showcase their contribution to the field and to inspire further research and action.

When to Write Research Paper Conclusion

The conclusion of a research paper should be written after the body of the paper has been completed. It should not be written until the writer has thoroughly analyzed and interpreted their findings and has written a complete and cohesive discussion of the research.

Before writing the conclusion, the writer should review their research paper and consider the key points that they want to convey to the reader. They should also review the research question, hypotheses, and methodology to ensure that they have addressed all of the necessary components of the research.

Once the writer has a clear understanding of the main findings and their significance, they can begin writing the conclusion. The conclusion should be written in a clear and concise manner, and should reiterate the main points of the research while also providing insights and recommendations for future research or action.

Characteristics of Research Paper Conclusion

The characteristics of a research paper conclusion include:

• Clear and concise: The conclusion should be written in a clear and concise manner, summarizing the key findings and their significance.
• Comprehensive: The conclusion should address all of the main points of the research paper, including the research question or problem, the methodology, the main results, and their implications.
• Future-oriented : The conclusion should provide insights and recommendations for future research or action, based on the findings of the research.
• Impressive : The conclusion should leave a lasting impression on the reader, emphasizing the importance of the research and its potential impact.
• Objective : The conclusion should be based on the evidence presented in the research paper, and should avoid personal biases or opinions.
• Unique : The conclusion should be unique to the research paper and should not simply repeat information from the introduction or body of the paper.

Advantages of Research Paper Conclusion

The advantages of a research paper conclusion include:

• Summarizing the key findings : The conclusion provides a summary of the main findings of the research, making it easier for the reader to understand the key points of the study.
• Emphasizing the significance of the research: The conclusion emphasizes the importance of the research and its potential impact, making it more likely that readers will take the research seriously and consider its implications.
• Providing recommendations for future research or action : The conclusion suggests practical recommendations for future research or action, based on the findings of the study.
• Providing closure to the research paper : The conclusion provides a sense of closure to the research paper, tying together the different sections of the paper and leaving a lasting impression on the reader.
• Demonstrating the writer’s contribution to the field : The conclusion provides the writer with an opportunity to showcase their contribution to the field and to inspire further research and action.

Limitations of Research Paper Conclusion

While the conclusion of a research paper has many advantages, it also has some limitations that should be considered, including:

• I nability to address all aspects of the research: Due to the limited space available in the conclusion, it may not be possible to address all aspects of the research in detail.
• Subjectivity : While the conclusion should be objective, it may be influenced by the writer’s personal biases or opinions.
• Lack of new information: The conclusion should not introduce new information that has not been discussed in the body of the research paper.
• Lack of generalizability: The conclusions drawn from the research may not be applicable to other contexts or populations, limiting the generalizability of the study.
• Misinterpretation by the reader: The reader may misinterpret the conclusions drawn from the research, leading to a misunderstanding of the findings.

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How to Write a Conclusion for a Research Paper

3-minute read

• 29th August 2023

If you’re writing a research paper, the conclusion is your opportunity to summarize your findings and leave a lasting impression on your readers. In this post, we’ll take you through how to write an effective conclusion for a research paper and how you can:

·   Reword your thesis statement

·   Highlight the significance of your research

·   Discuss limitations

·   Connect to the introduction

·   End with a thought-provoking statement

Rewording Your Thesis Statement

Begin your conclusion by restating your thesis statement in a way that is slightly different from the wording used in the introduction. Avoid presenting new information or evidence in your conclusion. Just summarize the main points and arguments of your essay and keep this part as concise as possible. Remember that you’ve already covered the in-depth analyses and investigations in the main body paragraphs of your essay, so it’s not necessary to restate these details in the conclusion.

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Highlighting the Significance of Your Research

The conclusion is a good place to emphasize the implications of your research . Avoid ambiguous or vague language such as “I think” or “maybe,” which could weaken your position. Clearly explain why your research is significant and how it contributes to the broader field of study.

Here’s an example from a (fictional) study on the impact of social media on mental health:

Discussing Limitations

Although it’s important to emphasize the significance of your study, you can also use the conclusion to briefly address any limitations you discovered while conducting your research, such as time constraints or a shortage of resources. Doing this demonstrates a balanced and honest approach to your research.

Connecting to the Introduction

In your conclusion, you can circle back to your introduction , perhaps by referring to a quote or anecdote you discussed earlier. If you end your paper on a similar note to how you began it, you will create a sense of cohesion for the reader and remind them of the meaning and significance of your research.

Ending With a Thought-Provoking Statement

Consider ending your paper with a thought-provoking and memorable statement that relates to the impact of your research questions or hypothesis. This statement can be a call to action, a philosophical question, or a prediction for the future (positive or negative). Here’s an example that uses the same topic as above (social media and mental health):

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Conclusions

What this handout is about.

This handout will explain the functions of conclusions, offer strategies for writing effective ones, help you evaluate conclusions you’ve drafted, and suggest approaches to avoid.

About conclusions

Introductions and conclusions can be difficult to write, but they’re worth investing time in. They can have a significant influence on a reader’s experience of your paper.

Just as your introduction acts as a bridge that transports your readers from their own lives into the “place” of your analysis, your conclusion can provide a bridge to help your readers make the transition back to their daily lives. Such a conclusion will help them see why all your analysis and information should matter to them after they put the paper down.

Your conclusion is your chance to have the last word on the subject. The conclusion allows you to have the final say on the issues you have raised in your paper, to synthesize your thoughts, to demonstrate the importance of your ideas, and to propel your reader to a new view of the subject. It is also your opportunity to make a good final impression and to end on a positive note.

Your conclusion can go beyond the confines of the assignment. The conclusion pushes beyond the boundaries of the prompt and allows you to consider broader issues, make new connections, and elaborate on the significance of your findings.

Your conclusion should make your readers glad they read your paper. Your conclusion gives your reader something to take away that will help them see things differently or appreciate your topic in personally relevant ways. It can suggest broader implications that will not only interest your reader, but also enrich your reader’s life in some way. It is your gift to the reader.

Strategies for writing an effective conclusion

One or more of the following strategies may help you write an effective conclusion:

• Play the “So What” Game. If you’re stuck and feel like your conclusion isn’t saying anything new or interesting, ask a friend to read it with you. Whenever you make a statement from your conclusion, ask the friend to say, “So what?” or “Why should anybody care?” Then ponder that question and answer it. Here’s how it might go: You: Basically, I’m just saying that education was important to Douglass. Friend: So what? You: Well, it was important because it was a key to him feeling like a free and equal citizen. Friend: Why should anybody care? You: That’s important because plantation owners tried to keep slaves from being educated so that they could maintain control. When Douglass obtained an education, he undermined that control personally. You can also use this strategy on your own, asking yourself “So What?” as you develop your ideas or your draft.
• Return to the theme or themes in the introduction. This strategy brings the reader full circle. For example, if you begin by describing a scenario, you can end with the same scenario as proof that your essay is helpful in creating a new understanding. You may also refer to the introductory paragraph by using key words or parallel concepts and images that you also used in the introduction.
• Synthesize, don’t summarize. Include a brief summary of the paper’s main points, but don’t simply repeat things that were in your paper. Instead, show your reader how the points you made and the support and examples you used fit together. Pull it all together.
• Include a provocative insight or quotation from the research or reading you did for your paper.
• Propose a course of action, a solution to an issue, or questions for further study. This can redirect your reader’s thought process and help them to apply your info and ideas to their own life or to see the broader implications.
• Point to broader implications. For example, if your paper examines the Greensboro sit-ins or another event in the Civil Rights Movement, you could point out its impact on the Civil Rights Movement as a whole. A paper about the style of writer Virginia Woolf could point to her influence on other writers or on later feminists.

Strategies to avoid

• Beginning with an unnecessary, overused phrase such as “in conclusion,” “in summary,” or “in closing.” Although these phrases can work in speeches, they come across as wooden and trite in writing.
• Stating the thesis for the very first time in the conclusion.
• Introducing a new idea or subtopic in your conclusion.
• Ending with a rephrased thesis statement without any substantive changes.
• Making sentimental, emotional appeals that are out of character with the rest of an analytical paper.
• Including evidence (quotations, statistics, etc.) that should be in the body of the paper.

Four kinds of ineffective conclusions

• The “That’s My Story and I’m Sticking to It” Conclusion. This conclusion just restates the thesis and is usually painfully short. It does not push the ideas forward. People write this kind of conclusion when they can’t think of anything else to say. Example: In conclusion, Frederick Douglass was, as we have seen, a pioneer in American education, proving that education was a major force for social change with regard to slavery.
• The “Sherlock Holmes” Conclusion. Sometimes writers will state the thesis for the very first time in the conclusion. You might be tempted to use this strategy if you don’t want to give everything away too early in your paper. You may think it would be more dramatic to keep the reader in the dark until the end and then “wow” them with your main idea, as in a Sherlock Holmes mystery. The reader, however, does not expect a mystery, but an analytical discussion of your topic in an academic style, with the main argument (thesis) stated up front. Example: (After a paper that lists numerous incidents from the book but never says what these incidents reveal about Douglass and his views on education): So, as the evidence above demonstrates, Douglass saw education as a way to undermine the slaveholders’ power and also an important step toward freedom.
• The “America the Beautiful”/”I Am Woman”/”We Shall Overcome” Conclusion. This kind of conclusion usually draws on emotion to make its appeal, but while this emotion and even sentimentality may be very heartfelt, it is usually out of character with the rest of an analytical paper. A more sophisticated commentary, rather than emotional praise, would be a more fitting tribute to the topic. Example: Because of the efforts of fine Americans like Frederick Douglass, countless others have seen the shining beacon of light that is education. His example was a torch that lit the way for others. Frederick Douglass was truly an American hero.
• The “Grab Bag” Conclusion. This kind of conclusion includes extra information that the writer found or thought of but couldn’t integrate into the main paper. You may find it hard to leave out details that you discovered after hours of research and thought, but adding random facts and bits of evidence at the end of an otherwise-well-organized essay can just create confusion. Example: In addition to being an educational pioneer, Frederick Douglass provides an interesting case study for masculinity in the American South. He also offers historians an interesting glimpse into slave resistance when he confronts Covey, the overseer. His relationships with female relatives reveal the importance of family in the slave community.

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Douglass, Frederick. 1995. Narrative of the Life of Frederick Douglass, an American Slave, Written by Himself. New York: Dover.

Hamilton College. n.d. “Conclusions.” Writing Center. Accessed June 14, 2019. https://www.hamilton.edu//academics/centers/writing/writing-resources/conclusions .

Holewa, Randa. 2004. “Strategies for Writing a Conclusion.” LEO: Literacy Education Online. Last updated February 19, 2004. https://leo.stcloudstate.edu/acadwrite/conclude.html.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

Make a Gift

In a short paper—even a research paper—you don’t need to provide an exhaustive summary as part of your conclusion. But you do need to make some kind of transition between your final body paragraph and your concluding paragraph. This may come in the form of a few sentences of summary. Or it may come in the form of a sentence that brings your readers back to your thesis or main idea and reminds your readers where you began and how far you have traveled.

So, for example, in a paper about the relationship between ADHD and rejection sensitivity, Vanessa Roser begins by introducing readers to the fact that researchers have studied the relationship between the two conditions and then provides her explanation of that relationship. Here’s her thesis: “While socialization may indeed be an important factor in RS, I argue that individuals with ADHD may also possess a neurological predisposition to RS that is exacerbated by the differing executive and emotional regulation characteristic of ADHD.”

In her final paragraph, Roser reminds us of where she started by echoing her thesis: “This literature demonstrates that, as with many other conditions, ADHD and RS share a delicately intertwined pattern of neurological similarities that is rooted in the innate biology of an individual’s mind, a connection that cannot be explained in full by the behavioral mediation hypothesis.”  

Highlight the “so what”  

At the beginning of your paper, you explain to your readers what’s at stake—why they should care about the argument you’re making. In your conclusion, you can bring readers back to those stakes by reminding them why your argument is important in the first place. You can also draft a few sentences that put those stakes into a new or broader context.

In the conclusion to her paper about ADHD and RS, Roser echoes the stakes she established in her introduction—that research into connections between ADHD and RS has led to contradictory results, raising questions about the “behavioral mediation hypothesis.”

She writes, “as with many other conditions, ADHD and RS share a delicately intertwined pattern of neurological similarities that is rooted in the innate biology of an individual’s mind, a connection that cannot be explained in full by the behavioral mediation hypothesis.”  

Leave your readers with the “now what”  

After the “what” and the “so what,” you should leave your reader with some final thoughts. If you have written a strong introduction, your readers will know why you have been arguing what you have been arguing—and why they should care. And if you’ve made a good case for your thesis, then your readers should be in a position to see things in a new way, understand new questions, or be ready for something that they weren’t ready for before they read your paper.

In her conclusion, Roser offers two “now what” statements. First, she explains that it is important to recognize that the flawed behavioral mediation hypothesis “seems to place a degree of fault on the individual. It implies that individuals with ADHD must have elicited such frequent or intense rejection by virtue of their inadequate social skills, erasing the possibility that they may simply possess a natural sensitivity to emotion.” She then highlights the broader implications for treatment of people with ADHD, noting that recognizing the actual connection between rejection sensitivity and ADHD “has profound implications for understanding how individuals with ADHD might best be treated in educational settings, by counselors, family, peers, or even society as a whole.”

To find your own “now what” for your essay’s conclusion, try asking yourself these questions:

• What can my readers now understand, see in a new light, or grapple with that they would not have understood in the same way before reading my paper? Are we a step closer to understanding a larger phenomenon or to understanding why what was at stake is so important?  
• What questions can I now raise that would not have made sense at the beginning of my paper? Questions for further research? Other ways that this topic could be approached?  
• Are there other applications for my research? Could my questions be asked about different data in a different context? Could I use my methods to answer a different question?  
• What action should be taken in light of this argument? What action do I predict will be taken or could lead to a solution?  
• What larger context might my argument be a part of?  

What to avoid in your conclusion  

• a complete restatement of all that you have said in your paper.  
• a substantial counterargument that you do not have space to refute; you should introduce counterarguments before your conclusion.  
• an apology for what you have not said. If you need to explain the scope of your paper, you should do this sooner—but don’t apologize for what you have not discussed in your paper.  
• fake transitions like “in conclusion” that are followed by sentences that aren’t actually conclusions. (“In conclusion, I have now demonstrated that my thesis is correct.”)
• picture_as_pdf Conclusions

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How to Write a Conclusion for a Research Paper

Last Updated: May 8, 2024 Approved

This article was co-authored by Christopher Taylor, PhD . Christopher Taylor is an Adjunct Assistant Professor of English at Austin Community College in Texas. He received his PhD in English Literature and Medieval Studies from the University of Texas at Austin in 2014. wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 42 testimonials and 83% of readers who voted found it helpful, earning it our reader-approved status. This article has been viewed 2,259,454 times.

The conclusion of a research paper needs to summarize the content and purpose of the paper without seeming too wooden or dry. Every basic conclusion must share several key elements, but there are also several tactics you can play around with to craft a more effective conclusion and several you should avoid to prevent yourself from weakening your paper's conclusion. Here are some writing tips to keep in mind when creating a conclusion for your next research paper.

Sample Conclusions

Writing a basic conclusion.

• Do not spend a great amount of time or space restating your topic.
• A good research paper will make the importance of your topic apparent, so you do not need to write an elaborate defense of your topic in the conclusion.
• Usually a single sentence is all you need to restate your topic.
• An example would be if you were writing a paper on the epidemiology of infectious disease, you might say something like "Tuberculosis is a widespread infectious disease that affects millions of people worldwide every year."
• Yet another example from the humanities would be a paper about the Italian Renaissance: "The Italian Renaissance was an explosion of art and ideas centered around artists, writers, and thinkers in Florence."

• A thesis is a narrowed, focused view on the topic at hand.
• This statement should be rephrased from the thesis you included in your introduction. It should not be identical or too similar to the sentence you originally used.
• Try re-wording your thesis statement in a way that complements your summary of the topic of your paper in your first sentence of your conclusion.
• An example of a good thesis statement, going back to the paper on tuberculosis, would be "Tuberculosis is a widespread disease that affects millions of people worldwide every year. Due to the alarming rate of the spread of tuberculosis, particularly in poor countries, medical professionals are implementing new strategies for the diagnosis, treatment, and containment of this disease ."

• A good way to go about this is to re-read the topic sentence of each major paragraph or section in the body of your paper.
• Find a way to briefly restate each point mentioned in each topic sentence in your conclusion. Do not repeat any of the supporting details used within your body paragraphs.
• Under most circumstances, you should avoid writing new information in your conclusion. This is especially true if the information is vital to the argument or research presented in your paper.
• For example, in the TB paper you could summarize the information. "Tuberculosis is a widespread disease that affects millions of people worldwide. Due to the alarming rate of the spread of tuberculosis, particularly in poor countries, medical professionals are implementing new strategies for the diagnosis, treatment, and containment of this disease. In developing countries, such as those in Africa and Southeast Asia, the rate of TB infections is soaring. Crowded conditions, poor sanitation, and lack of access to medical care are all compounding factors in the spread of the disease. Medical experts, such as those from the World Health Organization are now starting campaigns to go into communities in developing countries and provide diagnostic testing and treatments. However, the treatments for TB are very harsh and have many side effects. This leads to patient non-compliance and spread of multi-drug resistant strains of the disease."

• Note that this is not needed for all research papers.
• If you already fully explained what the points in your paper mean or why they are significant, you do not need to go into them in much detail in your conclusion. Simply restating your thesis or the significance of your topic should suffice.
• It is always best practice to address important issues and fully explain your points in the body of your paper. The point of a conclusion to a research paper is to summarize your argument for the reader and, perhaps, to call the reader to action if needed.

• Note that a call for action is not essential to all conclusions. A research paper on literary criticism, for instance, is less likely to need a call for action than a paper on the effect that television has on toddlers and young children.
• A paper that is more likely to call readers to action is one that addresses a public or scientific need. Let's go back to our example of tuberculosis. This is a very serious disease that is spreading quickly and with antibiotic-resistant forms.
• A call to action in this research paper would be a follow-up statement that might be along the lines of "Despite new efforts to diagnose and contain the disease, more research is needed to develop new antibiotics that will treat the most resistant strains of tuberculosis and ease the side effects of current treatments."

• For example, if you are writing a history paper, then you might discuss how the historical topic you discussed matters today. If you are writing about a foreign country, then you might use the conclusion to discuss how the information you shared may help readers understand their own country.

Making Your Conclusion as Effective as Possible

• Since this sort of conclusion is so basic, you must aim to synthesize the information rather than merely summarizing it.
• Instead of merely repeating things you already said, rephrase your thesis and supporting points in a way that ties them all together.
• By doing so, you make your research paper seem like a "complete thought" rather than a collection of random and vaguely related ideas.

• Ask a question in your introduction. In your conclusion, restate the question and provide a direct answer.
• Write an anecdote or story in your introduction but do not share the ending. Instead, write the conclusion to the anecdote in the conclusion of your paper.
• For example, if you wanted to get more creative and put a more humanistic spin on a paper on tuberculosis, you might start your introduction with a story about a person with the disease, and refer to that story in your conclusion. For example, you could say something like this before you re-state your thesis in your conclusion: "Patient X was unable to complete the treatment for tuberculosis due to severe side effects and unfortunately succumbed to the disease."
• Use the same concepts and images introduced in your introduction in your conclusion. The images may or may not appear at other points throughout the research paper.

• Include enough information about your topic to back the statement up but do not get too carried away with excess detail.
• If your research did not provide you with a clear-cut answer to a question posed in your thesis, do not be afraid to indicate as much.
• Restate your initial hypothesis and indicate whether you still believe it or if the research you performed has begun swaying your opinion.
• Indicate that an answer may still exist and that further research could shed more light on the topic at hand.

• This may not be appropriate for all types of research papers. Most research papers, such as one on effective treatment for diseases, will have the information to make the case for a particular argument already in the paper.
• A good example of a paper that might ask a question of the reader in the ending is one about a social issue, such as poverty or government policy.
• Ask a question that will directly get at the heart or purpose of the paper. This question is often the same question, or some version of it, that you may have started with when you began your research.
• Make sure that the question can be answered by the evidence presented in your paper.
• If desired you can briefly summarize the answer after stating the question. You could also leave the question hanging for the reader to answer, though.

• Even without a call to action, you can still make a recommendation to your reader.
• For instance, if you are writing about a topic like third-world poverty, you can various ways for the reader to assist in the problem without necessarily calling for more research.
• Another example would be, in a paper about treatment for drug-resistant tuberculosis, you could suggest donating to the World Health Organization or research foundations that are developing new treatments for the disease.

Avoiding Common Pitfalls

• These sayings usually sound stiff, unnatural, or trite when used in writing.
• Moreover, using a phrase like "in conclusion" to begin your conclusion is a little too straightforward and tends to lead to a weak conclusion. A strong conclusion can stand on its own without being labeled as such.

• Always state the main argument or thesis in the introduction. A research paper is an analytical discussion of an academic topic, not a mystery novel.
• A good, effective research paper will allow your reader to follow your main argument from start to finish.
• This is why it is best practice to start your paper with an introduction that states your main argument and to end the paper with a conclusion that re-states your thesis for re-iteration.

• All significant information should be introduced in the body of the paper.
• Supporting evidence expands the topic of your paper by making it appear more detailed. A conclusion should narrow the topic to a more general point.
• A conclusion should only summarize what you have already stated in the body of your paper.
• You may suggest further research or a call to action, but you should not bring in any new evidence or facts in the conclusion.

• Most often, a shift in tone occurs when a research paper with an academic tone gives an emotional or sentimental conclusion.
• Even if the topic of the paper is of personal significance for you, you should not indicate as much in your paper.
• If you want to give your paper a more humanistic slant, you could start and end your paper with a story or anecdote that would give your topic more personal meaning to the reader.
• This tone should be consistent throughout the paper, however.

• Apologetic statements include phrases like "I may not be an expert" or "This is only my opinion."
• Statements like this can usually be avoided by refraining from writing in the first-person.
• Avoid any statements in the first-person. First-person is generally considered to be informal and does not fit with the formal tone of a research paper.

Community Q&A

You Might Also Like

• ↑ http://owl.english.purdue.edu/owl/resource/724/04/
• ↑ http://www.crlsresearchguide.org/18_Writing_Conclusion.asp
• ↑ http://writing.wisc.edu/Handbook/PlanResearchPaper.html#conclusion
• ↑ http://writingcenter.unc.edu/handouts/conclusions/
• ↑ http://writing2.richmond.edu/writing/wweb/conclude.html

About This Article

To write a conclusion for a research paper, start by restating your thesis statement to remind your readers what your main topic is and bring everything full circle. Then, briefly summarize all of the main points you made throughout your paper, which will help remind your readers of everything they learned. You might also want to include a call to action if you think more research or work needs to be done on your topic by writing something like, "Despite efforts to contain the disease, more research is needed to develop antibiotics." Finally, end your conclusion by explaining the broader context of your topic and why your readers should care about it, which will help them understand why your topic is relevant and important. For tips from our Academic co-author, like how to avoid common pitfalls when writing your conclusion, scroll down! Did this summary help you? Yes No

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• How to Write Discussions and Conclusions

The discussion section contains the results and outcomes of a study. An effective discussion informs readers what can be learned from your experiment and provides context for the results.

What makes an effective discussion?

When you’re ready to write your discussion, you’ve already introduced the purpose of your study and provided an in-depth description of the methodology. The discussion informs readers about the larger implications of your study based on the results. Highlighting these implications while not overstating the findings can be challenging, especially when you’re submitting to a journal that selects articles based on novelty or potential impact. Regardless of what journal you are submitting to, the discussion section always serves the same purpose: concluding what your study results actually mean.

A successful discussion section puts your findings in context. It should include:

• the results of your research,
• a discussion of related research, and
• a comparison between your results and initial hypothesis.

Tip: Not all journals share the same naming conventions.

You can apply the advice in this article to the conclusion, results or discussion sections of your manuscript.

Our Early Career Researcher community tells us that the conclusion is often considered the most difficult aspect of a manuscript to write. To help, this guide provides questions to ask yourself, a basic structure to model your discussion off of and examples from published manuscripts. 

Questions to ask yourself:

• Was my hypothesis correct?
• If my hypothesis is partially correct or entirely different, what can be learned from the results? 
• How do the conclusions reshape or add onto the existing knowledge in the field? What does previous research say about the topic? 
• Why are the results important or relevant to your audience? Do they add further evidence to a scientific consensus or disprove prior studies? 
• How can future research build on these observations? What are the key experiments that must be done? 
• What is the “take-home” message you want your reader to leave with?

How to structure a discussion

Trying to fit a complete discussion into a single paragraph can add unnecessary stress to the writing process. If possible, you’ll want to give yourself two or three paragraphs to give the reader a comprehensive understanding of your study as a whole. Here’s one way to structure an effective discussion:

Writing Tips

While the above sections can help you brainstorm and structure your discussion, there are many common mistakes that writers revert to when having difficulties with their paper. Writing a discussion can be a delicate balance between summarizing your results, providing proper context for your research and avoiding introducing new information. Remember that your paper should be both confident and honest about the results! 

• Read the journal’s guidelines on the discussion and conclusion sections. If possible, learn about the guidelines before writing the discussion to ensure you’re writing to meet their expectations. 
• Begin with a clear statement of the principal findings. This will reinforce the main take-away for the reader and set up the rest of the discussion. 
• Explain why the outcomes of your study are important to the reader. Discuss the implications of your findings realistically based on previous literature, highlighting both the strengths and limitations of the research. 
• State whether the results prove or disprove your hypothesis. If your hypothesis was disproved, what might be the reasons? 
• Introduce new or expanded ways to think about the research question. Indicate what next steps can be taken to further pursue any unresolved questions. 
• If dealing with a contemporary or ongoing problem, such as climate change, discuss possible consequences if the problem is avoided. 
• Be concise. Adding unnecessary detail can distract from the main findings. 

Don’t

• Rewrite your abstract. Statements with “we investigated” or “we studied” generally do not belong in the discussion. 
• Include new arguments or evidence not previously discussed. Necessary information and evidence should be introduced in the main body of the paper. 
• Apologize. Even if your research contains significant limitations, don’t undermine your authority by including statements that doubt your methodology or execution. 
• Shy away from speaking on limitations or negative results. Including limitations and negative results will give readers a complete understanding of the presented research. Potential limitations include sources of potential bias, threats to internal or external validity, barriers to implementing an intervention and other issues inherent to the study design. 
• Overstate the importance of your findings. Making grand statements about how a study will fully resolve large questions can lead readers to doubt the success of the research. 

Snippets of Effective Discussions:

Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach

Identifying reliable indicators of fitness in polar bears

• How to Write a Great Title
• How to Write an Abstract
• How to Write Your Methods
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Organizing Academic Research Papers: 9. The Conclusion

• Purpose of Guide
• Design Flaws to Avoid
• Glossary of Research Terms
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
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• About Informed Consent
• Writing Field Notes
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• Acknowledgements

The conclusion is intended to help the reader understand why your research should matter to them after they have finished reading the paper. A conclusion is not merely a summary of your points or a re-statement of your research problem but a synthesis of key points. For most essays, one well-developed paragraph is sufficient for a conclusion, although in some cases, a two-or-three paragraph conclusion may be required.

Importance of a Good Conclusion

A well-written conclusion provides you with several important opportunities to demonstrate your overall understanding of the research problem to the reader. These include:

• Presenting the last word on the issues you raised in your paper . Just as the introduction gives a first impression to your reader, the conclusion offers a chance to leave a lasting impression. Do this, for example, by highlighting key points in your analysis or findings.
• Summarizing your thoughts and conveying the larger implications of your study . The conclusion is an opportunity to succinctly answer the "so what?" question by placing the study within the context of past research about the topic you've investigated.
• Demonstrating the importance of your ideas . Don't be shy. The conclusion offers you a chance to elaborate on the significance of your findings.
• Introducing possible new or expanded ways of thinking about the research problem . This does not refer to introducing new information [which should be avoided], but to offer new insight and creative approaches for framing/contextualizing the research problem based on the results of your study.

Conclusions . The Writing Center. University of North Carolina; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion . San Francisco Edit, 2003-2008.

Structure and Writing Style

https://writing.wisc.edu/wp-content/uploads/sites/535/2018/07/conclusions_uwmadison_writingcenter_aug2012.pdf I.  General Rules

When writing the conclusion to your paper, follow these general rules:

• State your conclusions in clear, simple language.
• Do not simply reiterate your results or the discussion.
• Indicate opportunities for future research, as long as you haven't already done so in the discussion section of your paper.

The function of your paper's conclusion is to restate the main argument . It reminds the reader of the strengths of your main argument(s) and reiterates the most important evidence supporting those argument(s). Make sure, however, that your conclusion is not simply a repetitive summary of the findings because this reduces the impact of the argument(s) you have developed in your essay.

Consider the following points to help ensure your conclusion is appropriate:

• If the argument or point of your paper is complex, you may need to summarize the argument for your reader.
• If, prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction or within a new context that emerges from the data.

The conclusion also provides a place for you to persuasively and succinctly restate your research problem, given that the reader has now been presented with all the information about the topic . Depending on the discipline you are writing in, the concluding paragraph may contain your reflections on the evidence presented, or on the essay's central research problem. However, the nature of being introspective about the research you have done will depend on the topic and whether your professor wants you to express your observations in this way.

NOTE : Don't delve into idle speculation. Being introspective means looking within yourself as an author to try and understand an issue more deeply not to guess at possible outcomes.

II.  Developing a Compelling Conclusion

Strategies to help you move beyond merely summarizing the key points of your research paper may include any of the following.

• If your essay deals with a contemporary problem, warn readers of the possible consequences of not attending to the problem.
• Recommend a specific course or courses of action.
• Cite a relevant quotation or expert opinion to lend authority to the conclusion you have reached [a good place to look is research from your literature review].
• Restate a key statistic, fact, or visual image to drive home the ultimate point of your paper.
• If your discipline encourages personal reflection, illustrate your concluding point with a relevant narrative drawn from your own life experiences.
• Return to an anecdote, an example, or a quotation that you introduced in your introduction, but add further insight that is derived from the findings of your study; use your interpretation of results to reframe it in new ways.
• Provide a "take-home" message in the form of a strong, succient statement that you want the reader to remember about your study.

III. Problems to Avoid Failure to be concise The conclusion section should be concise and to the point. Conclusions that are too long often have unnecessary detail. The conclusion section is not the place for details about your methodology or results. Although you should give a summary of what was learned from your research, this summary should be relatively brief, since the emphasis in the conclusion is on the implications, evaluations, insights, etc. that you make. Failure to comment on larger, more significant issues In the introduction, your task was to move from general [the field of study] to specific [your research problem]. However, in the conclusion, your task is to move from specific [your research problem] back to general [your field, i.e., how your research contributes new understanding or fills an important gap in the literature]. In other words, the conclusion is where you place your research within a larger context. Failure to reveal problems and negative results Negative aspects of the research process should never be ignored. Problems, drawbacks, and challenges encountered during your study should be included as a way of qualifying your overall conclusions. If you encountered negative results [findings that are validated outside the research context in which they were generated], you must report them in the results section of your paper. In the conclusion, use the negative results as an opportunity to explain how they provide information on which future research can be based. Failure to provide a clear summary of what was learned In order to be able to discuss how your research fits back into your field of study [and possibly the world at large], you need to summarize it briefly and directly. Often this element of your conclusion is only a few sentences long. Failure to match the objectives of your research Often research objectives change while the research is being carried out. This is not a problem unless you forget to go back and refine your original objectives in your introduction, as these changes emerge they must be documented so that they accurately reflect what you were trying to accomplish in your research [not what you thought you might accomplish when you began].

Resist the urge to apologize If you've immersed yourself in studying the research problem, you now know a good deal about it, perhaps even more than your professor! Nevertheless, by the time you have finished writing, you may be having some doubts about what you have produced. Repress those doubts!  Don't undermine your authority by saying something like, "This is just one approach to examining this problem; there may be other, much better approaches...."

Concluding Paragraphs. College Writing Center at Meramec. St. Louis Community College; Conclusions . The Writing Center. University of North Carolina; Conclusions . The Writing Lab and The OWL. Purdue University; Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions . The Lab Report. University College Writing Centre. University of Toronto; Leibensperger, Summer. Draft Your Conclusion. Academic Center, the University of Houston-Victoria, 2003; Make Your Last Words Count . The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Tips for Writing a Good Conclusion . Writing@CSU. Colorado State University; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion . San Francisco Edit, 2003-2008; Writing Conclusions . Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Writing: Considering Structure and Organization . Institute for Writing Rhetoric. Dartmouth College.

Writing Tip

Don't Belabor the Obvious!

Avoid phrases like "in conclusion...," "in summary...," or "in closing...." These phrases can be useful, even welcome, in oral presentations. But readers can see by the tell-tale section heading and number of pages remaining to read, when an essay is about to end. You'll irritate your readers if you belabor the obvious.

Another Writing Tip

New Insight, Not New Information!

Don't surprise the reader with new information in your Conclusion that was never referenced anywhere else in the paper. If you have new information to present, add it to the Discussion or other appropriate section of the paper.  Note that, although no actual new information is introduced, the conclusion is where you offer your most "original" contributions in the paper; it's where you describe the value of your research, demonstrate your understanding of the material that you’ve presented, and locate your findings within the larger context of scholarship on the topic.

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Conclusions wrap up what you have been discussing in your paper. After moving from general to specific information in the introduction and body paragraphs, your conclusion should begin pulling back into more general information that restates the main points of your argument. Conclusions may also call for action or overview future possible research. The following outline may help you conclude your paper:

In a general way,

• Restate your topic and why it is important,
• Restate your thesis/claim,
• Address opposing viewpoints and explain why readers should align with your position,
• Call for action or overview future research possibilities.

Remember that once you accomplish these tasks, unless otherwise directed by your instructor, you are finished. Done. Complete. Don't try to bring in new points or end with a whiz bang(!) conclusion or try to solve world hunger in the final sentence of your conclusion. Simplicity is best for a clear, convincing message.

The preacher's maxim is one of the most effective formulas to follow for argument papers:

Tell what you're going to tell them (introduction).

Tell them (body).

Tell them what you told them (conclusion).

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Guide to Writing Introductions and Conclusions

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First and last impressions are important in any part of life, especially in writing. This is why the introduction and conclusion of any paper – whether it be a simple essay or a long research paper – are essential. Introductions and conclusions are just as important as the body of your paper. The introduction is what makes the reader want to continue reading your paper. The conclusion is what makes your paper stick in the reader’s mind.

Introductions

Your introductory paragraph should include:

1) Hook:  Description, illustration, narration or dialogue that pulls the reader into your paper topic. This should be interesting and specific.

2) Transition: Sentence that connects the hook with the thesis.

3) Thesis: Sentence (or two) that summarizes the overall main point of the paper. The thesis should answer the prompt question.

The examples below show are several ways to write a good introduction or opening to your paper. One example shows you how to paraphrase in your introduction. This will help you understand the idea of writing sequences using a hook, transition, and thesis statement.

» Thesis Statement Opening

This is the traditional style of opening a paper. This is a “mini-summary” of your paper.

For example:

» Opening with a Story (Anecdote)

A good way of catching your reader’s attention is by sharing a story that sets up your paper. Sharing a story gives a paper a more personal feel and helps make your reader comfortable.

This example was borrowed from Jack Gannon’s The Week the World Heard Gallaudet (1989):

Astrid Goodstein, a Gallaudet faculty member, entered the beauty salon for her regular appointment, proudly wearing her DPN button. (“I was married to that button that week!” she later confided.) When Sandy, her regular hairdresser, saw the button, he spoke and gestured, “Never! Never! Never!” Offended, Astrid turned around and headed for the door but stopped short of leaving. She decided to keep her appointment, confessing later that at that moment, her sense of principles had lost out to her vanity. Later she realized that her hairdresser had thought she was pushing for a deaf U.S. President. Hook: a specific example or story that interests the reader and introduces the topic.

Transition: connects the hook to the thesis statement

Thesis: summarizes the overall claim of the paper

» Specific Detail Opening

Giving specific details about your subject appeals to your reader’s curiosity and helps establish a visual picture of what your paper is about.

» Open with a Quotation

Another method of writing an introduction is to open with a quotation. This method makes your introduction more interactive and more appealing to your reader.

» Open with an Interesting Statistic

Statistics that grab the reader help to make an effective introduction.

» Question Openings

Possibly the easiest opening is one that presents one or more questions to be answered in the paper. This is effective because questions are usually what the reader has in mind when he or she sees your topic.

Source : *Writing an Introduction for a More Formal Essay. (2012). Retrieved April 25, 2012, from http://flightline.highline.edu/wswyt/Writing91/handouts/hook_trans_thesis.htm

Conclusions

The conclusion to any paper is the final impression that can be made. It is the last opportunity to get your point across to the reader and leave the reader feeling as if they learned something. Leaving a paper “dangling” without a proper conclusion can seriously devalue what was said in the body itself. Here are a few effective ways to conclude or close your paper. » Summary Closing Many times conclusions are simple re-statements of the thesis. Many times these conclusions are much like their introductions (see Thesis Statement Opening).

» Close with a Logical Conclusion

This is a good closing for argumentative or opinion papers that present two or more sides of an issue. The conclusion drawn as a result of the research is presented here in the final paragraphs.

» Real or Rhetorical Question Closings

This method of concluding a paper is one step short of giving a logical conclusion. Rather than handing the conclusion over, you can leave the reader with a question that causes him or her to draw his own conclusions.

» Close with a Speculation or Opinion This is a good style for instances when the writer was unable to come up with an answer or a clear decision about whatever it was he or she was researching. For example:

» Close with a Recommendation

A good conclusion is when the writer suggests that the reader do something in the way of support for a cause or a plea for them to take action.

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Traditional Academic Essays In Three Parts

Part i: the introduction.

An introduction is usually the first paragraph of your academic essay. If you’re writing a long essay, you might need 2 or 3 paragraphs to introduce your topic to your reader. A good introduction does 2 things:

• Gets the reader’s attention. You can get a reader’s attention by telling a story, providing a statistic, pointing out something strange or interesting, providing and discussing an interesting quote, etc. Be interesting and find some original angle via which to engage others in your topic.
• Provides a specific and debatable thesis statement. The thesis statement is usually just one sentence long, but it might be longer—even a whole paragraph—if the essay you’re writing is long. A good thesis statement makes a debatable point, meaning a point someone might disagree with and argue against. It also serves as a roadmap for what you argue in your paper.

Part II: The Body Paragraphs

Body paragraphs help you prove your thesis and move you along a compelling trajectory from your introduction to your conclusion. If your thesis is a simple one, you might not need a lot of body paragraphs to prove it. If it’s more complicated, you’ll need more body paragraphs. An easy way to remember the parts of a body paragraph is to think of them as the MEAT of your essay:

Main Idea. The part of a topic sentence that states the main idea of the body paragraph. All of the sentences in the paragraph connect to it. Keep in mind that main ideas are…

• like labels. They appear in the first sentence of the paragraph and tell your reader what’s inside the paragraph.
• arguable. They’re not statements of fact; they’re debatable points that you prove with evidence.
• focused. Make a specific point in each paragraph and then prove that point.

Evidence. The parts of a paragraph that prove the main idea. You might include different types of evidence in different sentences. Keep in mind that different disciplines have different ideas about what counts as evidence and they adhere to different citation styles. Examples of evidence include…

• quotations and/or paraphrases from sources.
• facts , e.g. statistics or findings from studies you’ve conducted.
• narratives and/or descriptions , e.g. of your own experiences.

Analysis. The parts of a paragraph that explain the evidence. Make sure you tie the evidence you provide back to the paragraph’s main idea. In other words, discuss the evidence.

Transition. The part of a paragraph that helps you move fluidly from the last paragraph. Transitions appear in topic sentences along with main ideas, and they look both backward and forward in order to help you connect your ideas for your reader. Don’t end paragraphs with transitions; start with them.

Keep in mind that MEAT does not occur in that order. The “ T ransition” and the “ M ain Idea” often combine to form the first sentence—the topic sentence—and then paragraphs contain multiple sentences of evidence and analysis. For example, a paragraph might look like this: TM. E. E. A. E. E. A. A.

Part III: The Conclusion

A conclusion is the last paragraph of your essay, or, if you’re writing a really long essay, you might need 2 or 3 paragraphs to conclude. A conclusion typically does one of two things—or, of course, it can do both:

• Summarizes the argument. Some instructors expect you not to say anything new in your conclusion. They just want you to restate your main points. Especially if you’ve made a long and complicated argument, it’s useful to restate your main points for your reader by the time you’ve gotten to your conclusion. If you opt to do so, keep in mind that you should use different language than you used in your introduction and your body paragraphs. The introduction and conclusion shouldn’t be the same.
• For example, your argument might be significant to studies of a certain time period .
• Alternately, it might be significant to a certain geographical region .
• Alternately still, it might influence how your readers think about the future . You might even opt to speculate about the future and/or call your readers to action in your conclusion.

Handout by Dr. Liliana Naydan. Do not reproduce without permission.

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Introductions and Conclusions

Have you ever read something that you couldn’t put down and then continued to think about it long after you finished? Good writing has that effect in general, but a strong introduction and conclusion are essential to engaging the reader from start to finish.

The introduction of a paper introduces the topic and scope of the discussion to prepare the reader for what follows, and the conclusion offers thoughtful analytic commentary or a synopsis that wraps up the discussion with final thoughts. In other words, the introduction and conclusion depend on everything that comes between them. With this in mind, an effective strategy for composing an introduction and a conclusion is to write everything that comes between them first. With the body of the paper drafted, you will know the topic well enough to introduce it effectively and you can also more readily determine where and how the discussion should end.

Consider the following characteristics of effective introductions and conclusions:

Characteristics of Effective Introductions

Provides relevant background information : Regardless of the topic, readers need a context to understand your remarks. A good introduction will include necessary background information about the topic that enables readers to understand the topic’s importance and why what you have to say about it matters. Providing context such as background information helps the reader feel grounded so that they can easily follow the development of the discussion.

Engages the reader : A good introduction will capture the attention of readers so that they want to read the paragraphs beyond the introduction. Enough specific information is presented so that readers are interested in the topic and what the writer plans to do with it. An engaging introduction invites readers into the world of the writing.

Sets the appropriate tone : The opening paragraph establishes the tone – the spirit and attitude behind the words – that the writer will use in a piece of writing. The tone should be a conscious choice as it reflects how the writer feels about the subject and about the audience, as well as the degree of formality of the writing. In most academic writing, the general tone is formal, but it may be more or less formal depending on the exact purpose of the writing. For example, a piece of writing with the purpose of introducing a new employee will probably be less formal and more personable than, say, a persuasive essay.

Establishes the focus and purpose : The introduction must make the focus and purpose of the paper clear to readers. Many writers include a thesis statement that establishes the focus and purpose and forecasts the main points. Even without an explicit thesis statement, the focus and purpose of the paper need to be just as clear. If readers do not understand the focus or what the writer hopes to accomplish, subsequent paragraphs may not make sense to readers.

Options for Introductions

The following is collection of some rhetorical strategies for writing introductions. Oftentimes an introduction will have characteristics of more than one strategy, so you should treat this list as a compilation of possibilities, not as a prescription of how certain types of beginnings must look. Try out a number of options to get a sense of the possibilities and then determine which would work best for your topic, purpose, and audience. The more you work on your introduction and think about what you are trying to say in your paper as a whole, the easier it will be to write an effective introduction.

Establish the Issue

Use the introduction to help make the case that the topic you are writing about is important and relevant and to provide context for your readers.

In the last decade or so, American culture has become increasingly tolerant of teenage sexuality. Many parents, too busy in their lives, are not proactive in educating their teens on issues related to sexuality. Educators are often left with the role of providing basic information about the subject even as more and more sexual education classes are cut from the curriculum. Where does this leave curious teens? Statistics show that 75 percent of teens have had sex by the time they are nineteen years old. The teenage birth rate continues to climb as do reported cases of sexually transmitted diseases (Healy, 2008). Cleary, it is imperative to develop intervention programs that teach adolescents the effective skills in delaying early sexual behaviors. Early education on delaying sexual activity for teens can drastically decrease teenage pregnancies, prevent the spread of STDs, and help teens to make the right choices that can impact the rest of their lives.

Asking relevant questions can be an excellent way to engage readers and get their attention. In the example below, the writer begins with a universal question that most readers can relate to.

Did you ever think that your life would change dramatically in a matter of twenty-four hours? One day you have a certain kind of life – a home, nearby schools for your kids, a wonderful neighborhood, good job, friends – and the next day it is all gone, irreversibly changed. As a resident of New Orleans, Louisiana, I had always known that a major hurricane could strike, but even knowing this fact could not prepare me for what happened in the wake of Hurricane Katrina. Hurricane Katrina demonstrated the need for residents to evacuate when mandated, for local and state authorities to work more efficiently together, and for the federal government to respond in a timely and responsible manner.

Use a narrative Most people enjoy reading a good story, so beginning with a narrative can be an effective way to connect with your readers.

It was a dark and stormy night. The wind whipped through the trees while lightening flashed and thunder boomed. Up ahead on a hill, a rickety old house stood. In an upstairs window, a single, solitary light shone, casting an eerie shadow across the yard. I was in Chattanooga, Tennessee, on business, and was driving to the outskirts of the city to visit my aunt, an old woman I hadn’t seen in nearly twenty years. According to my directions, that rickety old house was my aunt’s house, but I didn’t know if I had the nerve to knock on the door. In fact, I couldn’t remember a time I had been more scared. Everyone experiences fear just as everyone experiences happiness or sadness. Fear is a natural human emotion to the unknown and is characterized by physical changes to the body, an innate need to escape, and acute awareness of one’s surroundings.

Use an Attention Getter

Begin with a statement that will catch your readers’ attention and makes them want to continue reading.

Some children cannot sit still. They appear distracted by every little thing and do not seem to learn from their mistakes. These children disregard rules, even when they are punished repeatedly. It’s simple—their parents must not know how to control them. The truth is that attention-deficit hyperactivity disorder or ADHD is not understood appropriately. In fact, ADHD is a growing problem that requires more research to understand the issue, better intervention programs to help afflicted children, and improved training and support programs to help parents and educators.

Use an Extended Example or Series of Examples

Providing anecdotal examples can be a very effective way to capture your readers’ attention. Choose relevant, memorable examples.

According to the Federal Highway and Transportation Agency (2008), the majority of Americans, some 57%, do not regularly wear seat belts. Teddy Biro didn’t wear one when the car he was driving skidded on an icy road and hit a utility pole; Biro was catapulted through his front windshield and died of blood loss from a severed jugular vein. The coroner reported he had no other injuries besides minor abrasions. Bob Nettleblatt wasn’t wearing a seat belt when a car rear-ended him at a stop sign. Nettleblatt slammed his head into his front windshield and required 137 stitches to close up the laceration; investigators at the scene said if he had been wearing a seat belt, he would have been virtually unhurt from the 2 mph rear end collision (Fischer, 2007). Despite what is known about the safety of wearing seatbelts, too many Americans still do not buckle up, resulting in enormous emergency medical costs and fatalities that could be avoided. Despite what some people think, wearing a seatbelt is not a choice nor does it violate one’s personal rights. Wearing a seatbelt is the law and more needs to be done to enforce the law, punish those who break it, and educate young drivers to the dangers of not buckling up.

Define an Essential Term

To use this strategy, choose a term that is central to your paper and define it. This will help to engage your readers and make them want to continue reading. In the example below, the writer uses an extended example to define the term “collect.”

My friend George is a record fiend. Every room of his house contains floor-to-ceiling shelves filled entirely with record albums organized alphabetically regardless of genre. Stack after stack of record albums are piled high in the center of rooms, in corners, and in hallways. They are stacked under tables and in cupboards. One entire closet contains by George’s estimation over twenty-five hundred unsorted albums he purchased at flea markets, estate sales, and record shows. The parts of walls exposed contain framed original album covers—the Beatles’ Sgt. Pepper’s Lonely Hearts Club Band, Muddy Waters’ Electric Mud, John Coltrane’s Giant Steps. He owns commercially released albums, limited edition releases, reviewer copies, test pressings, and bootlegs. On most weekends, George travels to record shows and collectors conventions. He writes a weekly blog devoted to obscure records and another on the art of record collecting. His obsession with record collecting has cost him jobs, friends, and a wife. And still he collects.

Dramatize a Scene

Crafting a dramatic scene can go a long way toward making your readers want to read your work!

4 AM, March 28, 1979 and the floor of the control room at Three Mile Island nuclear power station jumps to life. The two control room operators are jolted from their mid-shift doldrums as alarms begin to sound, and the pounding in the auxiliary room is deafening. What those at the station did not know was that the “worst crisis yet experienced by the nation’s nuclear power industry” (Kemeny, 1979, p. 37) had just begun, and its impact wouldn’t be realized for years to come, if ever. Three Mile Island nuclear power station was located on an island in the middle of the Susquehanna River near Harrisburg, Pennsylvania. It contained two separate nuclear power plants, TMI 1 and TMI 2. TMI 1 had been shut down for maintenance, but TMI 2 was operating at 97% of rated power providing electricity to the area (Carraway, 2000). Within seconds of the first alarm, a chain of events would commence to destroy the nuclear reactor and with it, the future of the nuclear power industry in this country.

Use a Quote

Using a relevant quotation, whether it is direct or indirect, can also help engage your reader.

An observer once said that New Orleanians are either having a party, recuperating from a party, or planning a party. The biggest and best party of all and the city’s most famous celebration is Mardi Gras, the greatest free show on earth. Despite the image the popular media displays to outsiders, Mardi Gras is a yearly celebration that is much tamer than most realize, brings family and friends together, and promotes unity among diverse groups of people.

Shocking but true statements or statistics can help draw your readers in.

McDonald’s has sold over 100 billion burgers. One hundred billion burgers with bun, stacked on top of one another would extend over 2.9 million miles into space–twelve times as far as the moon (Grimes, 2007). What is the secret of McDonald’s incredible success? To use the words of Ray Kroc, McDonald’s founder, the secret to McDonald’s success is that the fast-food giant produces “consistently mediocre food” (as cited in Thomas, 2001). The McDonald’s corporation has become a model of success due to its understanding of its market niche, its ability to redefine its image over time, and its ability to remain stable and produce a profit even in difficult economic times.

Characteristics of an Effective Conclusion

Brings the writing to a logical close : A conclusion provides the necessary signal to readers that the business of the essay is winding down, and the reader is being returned to the world outside of the essay. This transition should be fluid and the parting content thoughtful so that readers are prepared for and satisfied with the ending.

Reinforces the main idea in an engaging manner : Just as the introduction provides a first impression, the conclusion provides the last impression. The conclusion should reinforce the main idea of the work in a way that is fresh and not merely a perfunctory rehashing of what the essay discussed. Use the ending as your last chance to reach your audience and make sure the main point, its significance and/or its larger implications, are understood.

Leaves readers with something to think about : Ideally, a conclusion will bring the world of the essay to a close in such a way that even though the business of reading has ended, the audience does not stop thinking about what the essay said – its ideas. You don’t want an audience to end reading an essay, thinking “So what?” Provide some content that engages readers with what is important about the topic and your discussion of it so that the meaning of the writing stays with readers.

Options for Conclusions

What follows is a list of possible ways to conclude your writing. Depending on the purpose of the writing, some endings are more appropriate than others, so give careful thought to these techniques and try out a number of appropriate possibilities. Please also keep in mind that these options, like the offerings for introductions, can be combined so that a conclusion may have characteristics of more than one type of ending.

Most of the options for introductions can also be used for conclusions as well. Recall the introduction in which the writer was telling the story of the dark and stormy night he went to visit an aunt he hadn’t seen in decades. The conclusion could pick up where the introduction left off, or it could tell the story of another fearful situation the writer experienced, but the same general technique, a narrative in this case, could be used.

What follows is a list of additional ways in which you can compose a conclusion for your writing.

The idea of the echo is to repeat key words or phrases to create an “echo” that gets at a particular meaning or emphasizes a certain idea important to the writing. In the example below, note how the repetition of “Too many drivers” emphasizes the idea and, in essence, creates an echo readers will hear.

Too many drivers act in inappropriate ways when they get behind the wheel of a motor vehicle. Too many drivers are unnecessarily aggressive, darting in and out of traffic, running stop lights, putting everyone else on the road in peril. Too many drivers are just plain inconsiderate as if they are the only ones on the road. And too many of those drivers are just like you and me – good, decent people until we get in our cars.

Audience Appeal

The writer shows or points out directly to the audience how things are or the likely consequences if certain conditions remain the same. The content is presented in such a way that the burden of responsibility lies with the audience. This approach is well suited for writing that has a persuasive purpose.

The current political culture allows for staggering sums of money to be spent on campaigns. The basic idea is not so much about content as it is about getting the word out and creating a buzz. The more one hears about a candidate, the greater the buzz. And, of course, creating a buzz costs money, but, as advertisers have known for a long time, it is money well spent. Getting elected is a lot like selling laundry detergent, and until American citizens let their governmental advertisers know that they’ve had enough, that spending millions of dollars – even if it’s a candidate’s own money – to hold an office is ludicrous, then they have no one but themselves to blame.

State the “So What?”

With this ending, the writer essentially states the deeper meaning of the piece of writing so that the idea is not only clear, but it is also emphasized.

Today, Maine is one of only ten states that has not passed public charter school legislation. Maine’s current public school choice offerings are slim at best. Current choices include only traditional public schools or private schools. Whether the reason for wanting other alternatives is personal or educational, Maine families should be afforded another choice in public education. It’s time for Maine to recognize that public charter schools are a valuable choice in free public education.

Clinching Statement

With this type of conclusion, the writer uses a thought-provoking final statement that communicates the essence of the piece of writing and stays with readers.

For most residents living in hurricane-prone New Orleans, the first of June simply marks the beginning of another local season—hurricane season. The media quickly saturate the airwaves with hurricane season predictions, hurricane preparedness reminders and checklists, evacuation routes and guidelines, mini-lessons on the benefits of super Doppler imagery, and, certainly up until Katrina, doomsday predictions of what could happen if a major hurricane hit New Orleans. The information delivered was such standard fare that few gave it much thought. Hurricane Katrina changed all that. Katrina taught New Orleanians to be mindful of hurricane season and to pay attention—really pay attention—to what was swirling out near or in the Gulf. And even though by meteorological standards, Katrina was not the Big One, the apocalyptic aftermath of the storm and the physical and psychological damage it caused added up to something far greater than anyone expected.

Back to the Beginning

This ending uses content that in some way refers back to the beginning of the essay, not in a redundant way but in a manner that makes an important connection.

While friends will drift in and out of our lives, disappearing and maybe reappearing, some will be as constant as the stars in the sky. These friends – the essence of true friends – we will keep forever. These few friends will always be around, will see us through thick and thin, good and bad, no matter what, because that is what true friends do.

While the tendency when writing a conclusion is to offer a summary of what came before, now you have options for a conclusion that will move beyond a mere summary and bring the writing to a thoughtful and graceful exit.

Ernest Hemingway, the great 20th century American writer, claimed to have written 256 different endings for his short novel The Old Man and the Sea . According to Hemingway, he needed to get it right. While you may not have the time to try so many different conclusions, do keep in mind what Hemingway clearly knew: For a conclusion to be successful, it needs to be satisfying. Good endings create a sense of closure, a sense that the business of the essay has come to a completion; the reader is not expecting more. Like an introduction that makes a good first impression, the conclusion makes the final impression, and you want it to be lasting.

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• Published: 08 May 2024

Exploring the dynamics of consumer engagement in social media influencer marketing: from the self-determination theory perspective

• Chenyu Gu   ORCID: orcid.org/0000-0001-6059-0573 1 &
• Qiuting Duan 2  

Humanities and Social Sciences Communications volume  11 , Article number:  587 ( 2024 ) Cite this article

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• Business and management
• Cultural and media studies

Influencer advertising has emerged as an integral part of social media marketing. Within this realm, consumer engagement is a critical indicator for gauging the impact of influencer advertisements, as it encompasses the proactive involvement of consumers in spreading advertisements and creating value. Therefore, investigating the mechanisms behind consumer engagement holds significant relevance for formulating effective influencer advertising strategies. The current study, grounded in self-determination theory and employing a stimulus-organism-response framework, constructs a general model to assess the impact of influencer factors, advertisement information, and social factors on consumer engagement. Analyzing data from 522 samples using structural equation modeling, the findings reveal: (1) Social media influencers are effective at generating initial online traffic but have limited influence on deeper levels of consumer engagement, cautioning advertisers against overestimating their impact; (2) The essence of higher-level engagement lies in the ad information factor, affirming that in the new media era, content remains ‘king’; (3) Interpersonal factors should also be given importance, as influencing the surrounding social groups of consumers is one of the effective ways to enhance the impact of advertising. Theoretically, current research broadens the scope of both social media and advertising effectiveness studies, forming a bridge between influencer marketing and consumer engagement. Practically, the findings offer macro-level strategic insights for influencer marketing.

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Introduction.

Recent studies have highlighted an escalating aversion among audiences towards traditional online ads, leading to a diminishing effectiveness of traditional online advertising methods (Lou et al., 2019 ). In an effort to overcome these challenges, an increasing number of brands are turning to influencers as their spokespersons for advertising. Utilizing influencers not only capitalizes on their significant influence over their fan base but also allows for the dissemination of advertising messages in a more native and organic manner. Consequently, influencer-endorsed advertising has become a pivotal component and a growing trend in social media advertising (Gräve & Bartsch, 2022 ). Although the topic of influencer-endorsed advertising has garnered increasing attention from scholars, the field is still in its infancy, offering ample opportunities for in-depth research and exploration (Barta et al., 2023 ).

Presently, social media influencers—individuals with substantial follower bases—have emerged as the new vanguard in advertising (Hudders & Lou, 2023 ). Their tweets and videos possess the remarkable potential to sway the purchasing decisions of thousands if not millions. This influence largely hinges on consumer engagement behaviors, implying that the impact of advertising can proliferate throughout a consumer’s entire social network (Abbasi et al., 2023 ). Consequently, exploring ways to enhance consumer engagement is of paramount theoretical and practical significance for advertising effectiveness research (Xiao et al., 2023 ). This necessitates researchers to delve deeper into the exploration of the stimulating factors and psychological mechanisms influencing consumer engagement behaviors (Vander Schee et al., 2020 ), which is the gap this study seeks to address.

The Stimulus-Organism-Response (S-O-R) framework has been extensively applied in the study of consumer engagement behaviors (Tak & Gupta, 2021 ) and has been shown to integrate effectively with self-determination theory (Yang et al., 2019 ). Therefore, employing the S-O-R framework to investigate consumer engagement behaviors in the context of influencer advertising is considered a rational approach. The current study embarks on an in-depth analysis of the transformation process from three distinct dimensions. In the Stimulus (S) phase, we focus on how influencer factors, advertising message factors, and social influence factors act as external stimuli. This phase scrutinizes the external environment’s role in triggering consumer reactions. During the Organism (O) phase, the research explores the intrinsic psychological motivations affecting individual behavior as posited in self-determination theory. This includes the willingness for self-disclosure, the desire for innovation, and trust in advertising messages. The investigation in this phase aims to understand how these internal motivations shape consumer attitudes and perceptions in the context of influencer marketing. Finally, in the Response (R) phase, the study examines how these psychological factors influence consumer engagement behavior. This part of the research seeks to understand the transition from internal psychological states to actual consumer behavior, particularly how these states drive the consumers’ deep integration and interaction with the influencer content.

Despite the inherent limitations of cross-sectional analysis in capturing the full temporal dynamics of consumer engagement, this study seeks to unveil the dynamic interplay between consumers’ psychological needs—autonomy, competence, and relatedness—and their varying engagement levels in social media influencer marketing, grounded in self-determination theory. Through this lens, by analyzing factors related to influencers, content, and social context, we aim to infer potential dynamic shifts in engagement behaviors as psychological needs evolve. This approach allows us to offer a snapshot of the complex, multi-dimensional nature of consumer engagement dynamics, providing valuable insights for both theoretical exploration and practical application in the constantly evolving domain of social media marketing. Moreover, the current study underscores the significance of adapting to the dynamic digital environment and highlights the evolving nature of consumer engagement in the realm of digital marketing.

Literature review

Stimulus-organism-response (s-o-r) model.

The Stimulus-Response (S-R) model, originating from behaviorist psychology and introduced by psychologist Watson ( 1917 ), posits that individual behaviors are directly induced by external environmental stimuli. However, this model overlooks internal personal factors, complicating the explanation of psychological states. Mehrabian and Russell ( 1974 ) expanded this by incorporating the individual’s cognitive component (organism) into the model, creating the Stimulus-Organism-Response (S-O-R) framework. This model has become a crucial theoretical framework in consumer psychology as it interprets internal psychological cognitions as mediators between stimuli and responses. Integrating with psychological theories, the S-O-R model effectively analyzes and explains the significant impact of internal psychological factors on behavior (Koay et al., 2020 ; Zhang et al., 2021 ), and is extensively applied in investigating user behavior on social media platforms (Hewei & Youngsook, 2022 ). This study combines the S-O-R framework with self-determination theory to examine consumer engagement behaviors in the context of social media influencer advertising, a logic also supported by some studies (Yang et al., 2021 ).

Self-determination theory

Self-determination theory, proposed by Richard and Edward (2000), is a theoretical framework exploring human behavioral motivation and personality. The theory emphasizes motivational processes, positing that individual behaviors are developed based on factors satisfying their psychological needs. It suggests that individual behavioral tendencies are influenced by the needs for competence, relatedness, and autonomy. Furthermore, self-determination theory, along with organic integration theory, indicates that individual behavioral tendencies are also affected by internal psychological motivations and external situational factors.

Self-determination theory has been validated by scholars in the study of online user behaviors. For example, Sweet applied the theory to the investigation of community building in online networks, analyzing knowledge-sharing behaviors among online community members (Sweet et al., 2020 ). Further literature review reveals the applicability of self-determination theory to consumer engagement behaviors, particularly in the context of influencer marketing advertisements. Firstly, self-determination theory is widely applied in studying the psychological motivations behind online behaviors, suggesting that the internal and external motivations outlined within the theory might also apply to exploring consumer behaviors in influencer marketing scenarios (Itani et al., 2022 ). Secondly, although research on consumer engagement in the social media influencer advertising context is still in its early stages, some studies have utilized SDT to explore behaviors such as information sharing and electronic word-of-mouth dissemination (Astuti & Hariyawan, 2021 ). These behaviors, which are part of the content contribution and creation dimensions of consumer engagement, may share similarities in the underlying psychological motivational mechanisms. Thus, this study will build upon these foundations to construct the Organism (O) component of the S-O-R model, integrating insights from SDT to further understand consumer engagement in influencer marketing.

Consumer engagement

Although scholars generally agree at a macro level to define consumer engagement as the creation of additional value by consumers or customers beyond purchasing products, the specific categorization of consumer engagement varies in different studies. For instance, Simon and Tossan interpret consumer engagement as a psychological willingness to interact with influencers (Simon & Tossan, 2018 ). However, such a broad definition lacks precision in describing various levels of engagement. Other scholars directly use tangible metrics on social media platforms, such as likes, saves, comments, and shares, to represent consumer engagement (Lee et al., 2018 ). While this quantitative approach is not flawed and can be highly effective in practical applications, it overlooks the content aspect of engagement, contradicting the “content is king” principle of advertising and marketing. We advocate for combining consumer engagement with the content aspect, as content engagement not only generates more traces of consumer online behavior (Oestreicher-Singer & Zalmanson, 2013 ) but, more importantly, content contribution and creation are central to social media advertising and marketing, going beyond mere content consumption (Qiu & Kumar, 2017 ). Meanwhile, we also need to emphasize that engagement is not a fixed state but a fluctuating process influenced by ongoing interactions between consumers and influencers, mediated by the evolving nature of social media platforms and the shifting sands of consumer preferences (Pradhan et al., 2023 ). Consumer engagement in digital environments undergoes continuous change, reflecting a journey rather than a destination (Viswanathan et al., 2017 ).

The current study adopts a widely accepted definition of consumer engagement from existing research, offering operational feasibility and aligning well with the research objectives of this paper. Consumer engagement behaviors in the context of this study encompass three dimensions: content consumption, content contribution, and content creation (Muntinga et al., 2011 ). These dimensions reflect a spectrum of digital engagement behaviors ranging from low to high levels (Schivinski et al., 2016 ). Specifically, content consumption on social media platforms represents a lower level of engagement, where consumers merely click and read the information but do not actively contribute or create user-generated content. Some studies consider this level of engagement as less significant for in-depth exploration because content consumption, compared to other forms, generates fewer visible traces of consumer behavior (Brodie et al., 2013 ). Even in a study by Qiu and Kumar, it was noted that the conversion rate of content consumption is low, contributing minimally to the success of social media marketing (Qiu & Kumar, 2017 ).

On the other hand, content contribution, especially content creation, is central to social media marketing. When consumers comment on influencer content or share information with their network nodes, it is termed content contribution, representing a medium level of online consumer engagement (Piehler et al., 2019 ). Furthermore, when consumers actively upload and post brand-related content on social media, this higher level of behavior is referred to as content creation. Content creation represents the highest level of consumer engagement (Cheung et al., 2021 ). Although medium and high levels of consumer engagement are more valuable for social media advertising and marketing, this exploratory study still retains the content consumption dimension of consumer engagement behaviors.

Theoretical framework

Internal organism factors: self-disclosure willingness, innovativeness, and information trust.

In existing research based on self-determination theory that focuses on online behavior, competence, relatedness, and autonomy are commonly considered as internal factors influencing users’ online behaviors. However, this approach sometimes strays from the context of online consumption. Therefore, in studies related to online consumption, scholars often use self-disclosure willingness as an overt representation of autonomy, innovativeness as a representation of competence, and trust as a representation of relatedness (Mahmood et al., 2019 ).

The use of these overt variables can be logically explained as follows: According to self-determination theory, individuals with a higher level of self-determination are more likely to adopt compensatory mechanisms to facilitate behavior compared to those with lower self-determination (Wehmeyer, 1999 ). Self-disclosure, a voluntary act of sharing personal information with others, is considered a key behavior in the development of interpersonal relationships. In social environments, self-disclosure can effectively alleviate stress and build social connections, while also seeking societal validation of personal ideas (Altman & Taylor, 1973 ). Social networks, as para-social entities, possess the interactive attributes of real societies and are likely to exhibit similar mechanisms. In consumer contexts, personal disclosures can include voluntary sharing of product interests, consumption experiences, and future purchase intentions (Robertshaw & Marr, 2006 ). While material incentives can prompt personal information disclosure, many consumers disclose personal information online voluntarily, which can be traced back to an intrinsic need for autonomy (Stutzman et al., 2011 ). Thus, in this study, we consider the self-disclosure willingness as a representation of high autonomy.

Innovativeness refers to an individual’s internal level of seeking novelty and represents their personality and tendency for novelty (Okazaki, 2009 ). Often used in consumer research, innovative consumers are inclined to try new technologies and possess an intrinsic motivation to use new products. Previous studies have shown that consumers with high innovativeness are more likely to search for information on new products and share their experiences and expertise with others, reflecting a recognition of their own competence (Kaushik & Rahman, 2014 ). Therefore, in consumer contexts, innovativeness is often regarded as the competence dimension within the intrinsic factors of self-determination (Wang et al., 2016 ), with external motivations like information novelty enhancing this intrinsic motivation (Lee et al., 2015 ).

Trust refers to an individual’s willingness to rely on the opinions of others they believe in. From a social psychological perspective, trust indicates the willingness to assume the risk of being harmed by another party (McAllister, 1995 ). Widely applied in social media contexts for relational marketing, information trust has been proven to positively influence the exchange and dissemination of consumer information, representing a close and advanced relationship between consumers and businesses, brands, or advertising endorsers (Steinhoff et al., 2019 ). Consumers who trust brands or social media influencers are more willing to share information without fear of exploitation (Pop et al., 2022 ), making trust a commonly used representation of the relatedness dimension in self-determination within consumer contexts.

Construction of the path from organism to response: self-determination internal factors and consumer engagement behavior

Following the logic outlined above, the current study represents the internal factors of self-determination theory through three variables: self-disclosure willingness, innovativeness, and information trust. Next, the study explores the association between these self-determination internal factors and consumer engagement behavior, thereby constructing the link between Organism (O) and Response (R).

Self-disclosure willingness and consumer engagement behavior

In the realm of social sciences, the concept of self-disclosure willingness has been thoroughly examined from diverse disciplinary perspectives, encompassing communication studies, sociology, and psychology. Viewing from the lens of social interaction dynamics, self-disclosure is acknowledged as a fundamental precondition for the initiation and development of online social relationships and interactive engagements (Luo & Hancock, 2020 ). It constitutes an indispensable component within the spectrum of interactive behaviors and the evolution of interpersonal connections. Voluntary self-disclosure is characterized by individuals divulging information about themselves, which typically remains unknown to others and is inaccessible through alternative sources. This concept aligns with the tenets of uncertainty reduction theory, which argues that during interpersonal engagements, individuals seek information about their counterparts as a means to mitigate uncertainties inherent in social interactions (Lee et al., 2008 ). Self-disclosure allows others to gain more personal information, thereby helping to reduce the uncertainty in interpersonal relationships. Such disclosure is voluntary rather than coerced, and this sharing of information can facilitate the development of relationships between individuals (Towner et al., 2022 ). Furthermore, individuals who actively engage in social media interactions (such as liking, sharing, and commenting on others’ content) often exhibit higher levels of self-disclosure (Chu et al., 2023 ); additional research indicates a positive correlation between self-disclosure and online engagement behaviors (Lee et al., 2023 ). Taking the context of the current study, the autonomous self-disclosure willingness can incline social media users to read advertising content more attentively and share information with others, and even create evaluative content. Therefore, this paper proposes the following research hypothesis:

H1a: The self-disclosure willingness is positively correlated with content consumption in consumer engagement behavior.

H1b: The self-disclosure willingness is positively correlated with content contribution in consumer engagement behavior.

H1c: The self-disclosure willingness is positively correlated with content creation in consumer engagement behavior.

Innovativeness and consumer engagement behavior

Innovativeness represents an individual’s propensity to favor new technologies and the motivation to use new products, associated with the cognitive perception of one’s self-competence. Individuals with a need for self-competence recognition often exhibit higher innovativeness (Kelley & Alden, 2016 ). Existing research indicates that users with higher levels of innovativeness are more inclined to accept new product information and share their experiences and discoveries with others in their social networks (Yusuf & Busalim, 2018 ). Similarly, in the context of this study, individuals, as followers of influencers, signify an endorsement of the influencer. Driven by innovativeness, they may be more eager to actively receive information from influencers. If they find the information valuable, they are likely to share it and even engage in active content re-creation to meet their expectations of self-image. Therefore, this paper proposes the following research hypotheses:

H2a: The innovativeness of social media users is positively correlated with content consumption in consumer engagement behavior.

H2b: The innovativeness of social media users is positively correlated with content contribution in consumer engagement behavior.

H2c: The innovativeness of social media users is positively correlated with content creation in consumer engagement behavior.

Information trust and consumer engagement

Trust refers to an individual’s willingness to rely on the statements and opinions of a target object (Moorman et al., 1993 ). Extensive research indicates that trust positively impacts information dissemination and content sharing in interpersonal communication environments (Majerczak & Strzelecki, 2022 ); when trust is established, individuals are more willing to share their resources and less suspicious of being exploited. Trust has also been shown to influence consumers’ participation in community building and content sharing on social media, demonstrating cross-cultural universality (Anaya-Sánchez et al., 2020 ).

Trust in influencer advertising information is also a key predictor of consumers’ information exchange online. With many social media users now operating under real-name policies, there is an increased inclination to trust information shared on social media over that posted by corporate accounts or anonymously. Additionally, as users’ social networks partially overlap with their real-life interpersonal networks, extensive research shows that more consumers increasingly rely on information posted and shared on social networks when making purchase decisions (Wang et al., 2016 ). This aligns with the effectiveness goals of influencer marketing advertisements and the characteristics of consumer engagement. Trust in the content posted by influencers is considered a manifestation of a strong relationship between fans and influencers, central to relationship marketing (Kim & Kim, 2021 ). Based on trust in the influencer, which then extends to trust in their content, people are more inclined to browse information posted by influencers, share this information with others, and even create their own content without fear of exploitation or negative consequences. Therefore, this paper proposes the following research hypotheses:

H3a: Information trust is positively correlated with content consumption in consumer engagement behavior.

H3b: Information trust is positively correlated with content contribution in consumer engagement behavior.

H3c: Information trust is positively correlated with content creation in consumer engagement behavior.

Construction of the path from stimulus to organism: influencer factors, advertising information factors, social factors, and self-determination internal factors

Having established the logical connection from Organism (O) to Response (R), we further construct the influence path from Stimulus (S) to Organism (O). Revisiting the definition of influencer advertising in social media, companies, and brands leverage influencers on social media platforms to disseminate advertising content, utilizing the influencers’ relationships and influence over consumers for marketing purposes. In addition to consumer’s internal factors, elements such as companies, brands, influencers, and the advertisements themselves also impact consumer behavior. Although factors like the brand image perception of companies may influence consumer behavior, considering that in influencer marketing, companies and brands do not directly interact with consumers, this study prioritizes the dimensions of influencers and advertisements. Furthermore, the impact of social factors on individual cognition and behavior is significant, thus, the current study integrates influencers, advertisements, and social dimensions as the Stimulus (S) component.

Influencer factors: parasocial identification

Self-determination theory posits that relationships are one of the key motivators influencing individual behavior. In the context of social media research, users anticipate establishing a parasocial relationship with influencers, resembling real-life relationships. Hence, we consider the parasocial identification arising from users’ parasocial interactions with influencers as the relational motivator. Parasocial interaction refers to the one-sided personal relationship that individuals develop with media characters (Donald & Richard, 1956 ). During this process, individuals believe that the media character is directly communicating with them, creating a sense of positive intimacy (Giles, 2002 ). Over time, through repeated unilateral interactions with media characters, individuals develop a parasocial relationship, leading to parasocial identification. However, parasocial identification should not be directly equated with the concept of social identification in social identity theory. Social identification occurs when individuals psychologically de-individualize themselves, perceiving the characteristics of their social group as their own, upon identifying themselves as part of that group. In contrast, parasocial identification refers to the one-sided interactional identification with media characters (such as celebrities or influencers) over time (Chen et al., 2021 ). Particularly when individuals’ needs for interpersonal interaction are not met in their daily lives, they turn to parasocial interactions to fulfill these needs (Shan et al., 2020 ). Especially on social media, which is characterized by its high visibility and interactivity, users can easily develop a strong parasocial identification with the influencers they follow (Wei et al., 2022 ).

Parasocial identification and self-disclosure willingness

Theories like uncertainty reduction, personal construct, and social exchange are often applied to explain the emergence of parasocial identification. Social media, with its convenient and interactive modes of information dissemination, enables consumers to easily follow influencers on media platforms. They can perceive the personality of influencers through their online content, viewing them as familiar individuals or even friends. Once parasocial identification develops, this pleasurable experience can significantly influence consumers’ cognitions and thus their behavioral responses. Research has explored the impact of parasocial identification on consumer behavior. For instance, Bond et al. found that on Twitter, the intensity of users’ parasocial identification with influencers positively correlates with their continuous monitoring of these influencers’ activities (Bond, 2016 ). Analogous to real life, where we tend to pay more attention to our friends in our social networks, a similar phenomenon occurs in the relationship between consumers and brands. This type of parasocial identification not only makes consumers willing to follow brand pages but also more inclined to voluntarily provide personal information (Chen et al., 2021 ). Based on this logic, we speculate that a similar relationship may exist between social media influencers and their fans. Fans develop parasocial identification with influencers through social media interactions, making them more willing to disclose their information, opinions, and views in the comment sections of the influencers they follow, engaging in more frequent social interactions (Chung & Cho, 2017 ), even if the content at times may be brand or company-embedded marketing advertisements. In other words, in the presence of influencers with whom they have established parasocial relationships, they are more inclined to disclose personal information, thereby promoting consumer engagement behavior. Therefore, we propose the following research hypotheses:

H4: Parasocial identification is positively correlated with consumer self-disclosure willingness.

H4a: Self-disclosure willingness mediates the impact of parasocial identification on content consumption in consumer engagement behavior.

H4b: Self-disclosure willingness mediates the impact of parasocial identification on content contribution in consumer engagement behavior.

H4c: Self-disclosure willingness mediates the impact of parasocial identification on content creation in consumer engagement behavior.

Parasocial identification and information trust

Information Trust refers to consumers’ willingness to trust the information contained in advertisements and to place themselves at risk. These risks include purchasing products inconsistent with the advertised information and the negative social consequences of erroneously spreading this information to others, leading to unpleasant consumption experiences (Minton, 2015 ). In advertising marketing, gaining consumers’ trust in advertising information is crucial. In the context of influencer marketing on social media, companies, and brands leverage the social connection between influencers and their fans. According to cognitive empathy theory, consumers project their trust in influencers onto the products endorsed, explaining the phenomenon of ‘loving the house for the crow on its roof.’ Research indicates that parasocial identification with influencers is a necessary condition for trust development. Consumers engage in parasocial interactions with influencers on social media, leading to parasocial identification (Jin et al., 2021 ). Consumers tend to reduce their cognitive load and simplify their decision-making processes, thus naturally adopting a positive attitude and trust towards advertising information disseminated by influencers with whom they have established parasocial identification. This forms the core logic behind the success of influencer marketing advertisements (Breves et al., 2021 ); furthermore, as mentioned earlier, because consumers trust these advertisements, they are also willing to share this information with friends and family and even engage in content re-creation. Therefore, we propose the following research hypotheses:

H5: Parasocial identification is positively correlated with information trust.

H5a: Information trust mediates the impact of parasocial identification on content consumption in consumer engagement behavior.

H5b: Information trust mediates the impact of parasocial identification on content contribution in consumer engagement behavior.

H5c: Information trust mediates the impact of parasocial identification on content creation in consumer engagement behavior.

Influencer factors: source credibility

Source credibility refers to the degree of trust consumers place in the influencer as a source, based on the influencer’s reliability and expertise. Numerous studies have validated the effectiveness of the endorsement effect in advertising (Schouten et al., 2021 ). The Source Credibility Model, proposed by the renowned American communication scholar Hovland and the “Yale School,” posits that in the process of information dissemination, the credibility of the source can influence the audience’s decision to accept the information. The credibility of the information is determined by two aspects of the source: reliability and expertise. Reliability refers to the audience’s trust in the “communicator’s objective and honest approach to providing information,” while expertise refers to the audience’s trust in the “communicator being perceived as an effective source of information” (Hovland et al., 1953 ). Hovland’s definitions reveal that the interpretation of source credibility is not about the inherent traits of the source itself but rather the audience’s perception of the source (Jang et al., 2021 ). This differs from trust and serves as a precursor to the development of trust. Specifically, reliability and expertise are based on the audience’s perception; thus, this aligns closely with the audience’s perception of influencers (Kim & Kim, 2021 ). This credibility is a cognitive statement about the source of information.

Source credibility and self-disclosure willingness

Some studies have confirmed the positive impact of an influencer’s self-disclosure on their credibility as a source (Leite & Baptista, 2022 ). However, few have explored the impact of an influencer’s credibility, as a source, on consumers’ self-disclosure willingness. Undoubtedly, an impact exists; self-disclosure is considered a method to attempt to increase intimacy with others (Leite et al., 2022 ). According to social exchange theory, people promote relationships through the exchange of information in interpersonal communication to gain benefits (Cropanzano & Mitchell, 2005 ). Credibility, deriving from an influencer’s expertise and reliability, means that a highly credible influencer may provide more valuable information to consumers. Therefore, based on the social exchange theory’s logic of reciprocal benefits, consumers might be more willing to disclose their information to trustworthy influencers, potentially even expanding social interactions through further consumer engagement behaviors. Thus, we propose the following research hypotheses:

H6: Source credibility is positively correlated with self-disclosure willingness.

H6a: Self-disclosure willingness mediates the impact of Source credibility on content consumption in consumer engagement behavior.

H6b: Self-disclosure willingness mediates the impact of Source credibility on content contribution in consumer engagement behavior.

H6c: Self-disclosure willingness mediates the impact of Source credibility on content creation in consumer engagement behavior.

Source credibility and information trust

Based on the Source Credibility Model, the credibility of an endorser as an information source can significantly influence consumers’ acceptance of the information (Shan et al., 2020 ). Existing research has demonstrated the positive impact of source credibility on consumers. Djafarova, in a study based on Instagram, noted through in-depth interviews with 18 users that an influencer’s credibility significantly affects respondents’ trust in the information they post. This credibility is composed of expertise and relevance to consumers, and influencers on social media are considered more trustworthy than traditional celebrities (Djafarova & Rushworth, 2017 ). Subsequently, Bao and colleagues validated in the Chinese consumer context, based on the ELM model and commitment-trust theory, that the credibility of brand pages on Weibo effectively fosters consumer trust in the brand, encouraging participation in marketing activities (Bao & Wang, 2021 ). Moreover, Hsieh et al. found that in e-commerce contexts, the credibility of the source is a significant factor influencing consumers’ trust in advertising information (Hsieh & Li, 2020 ). In summary, existing research has proven that the credibility of the source can promote consumer trust. Influencer credibility is a significant antecedent affecting consumers’ trust in the advertised content they publish. In brand communities, trust can foster consumer engagement behaviors (Habibi et al., 2014 ). Specifically, consumers are more likely to trust the advertising content published by influencers with higher credibility (more expertise and reliability), and as previously mentioned, consumer engagement behavior is more likely to occur. Based on this, the study proposes the following research hypotheses:

H7: Source credibility is positively correlated with information trust.

H7a: Information trust mediates the impact of source credibility on content consumption in consumer engagement behavior.

H7b: Information trust mediates the impact of source credibility on content contribution in consumer engagement behavior.

H7c: Information trust mediates the impact of source credibility on content creation in consumer engagement behavior.

Advertising information factors: informative value

Advertising value refers to “the relative utility value of advertising information to consumers and is a subjective evaluation by consumers.” In his research, Ducoffe pointed out that in the context of online advertising, the informative value of advertising is a significant component of advertising value (Ducoffe, 1995 ). Subsequent studies have proven that consumers’ perception of advertising value can effectively promote their behavioral response to advertisements (Van-Tien Dao et al., 2014 ). Informative value of advertising refers to “the information about products needed by consumers provided by the advertisement and its ability to enhance consumer purchase satisfaction.” From the perspective of information dissemination, valuable advertising information should help consumers make better purchasing decisions and reduce the effort spent searching for product information. The informational aspect of advertising has been proven to effectively influence consumers’ cognition and, in turn, their behavior (Haida & Rahim, 2015 ).

Informative value and innovativeness

As previously discussed, consumers’ innovativeness refers to their psychological trait of favoring new things. Studies have shown that consumers with high innovativeness prefer novel and valuable product information, as it satisfies their need for newness and information about new products, making it an important factor in social media advertising engagement (Shi, 2018 ). This paper also hypothesizes that advertisements with high informative value can activate consumers’ innovativeness, as the novelty of information is one of the measures of informative value (León et al., 2009 ). Acquiring valuable information can make individuals feel good about themselves and fulfill their perception of a “novel image.” According to social exchange theory, consumers can gain social capital in interpersonal interactions (such as social recognition) by sharing information about these new products they perceive as valuable. Therefore, the current study proposes the following research hypothesis:

H8: Informative value is positively correlated with innovativeness.

H8a: Innovativeness mediates the impact of informative value on content consumption in consumer engagement behavior.

H8b: Innovativeness mediates the impact of informative value on content contribution in consumer engagement behavior.

H8c: Innovativeness mediates the impact of informative value on content creation in consumer engagement behavior.

Informative value and information trust

Trust is a multi-layered concept explored across various disciplines, including communication, marketing, sociology, and psychology. For the purposes of this paper, a deep analysis of different levels of trust is not undertaken. Here, trust specifically refers to the trust in influencer advertising information within the context of social media marketing, denoting consumers’ belief in and reliance on the advertising information endorsed by influencers. Racherla et al. investigated the factors influencing consumers’ trust in online reviews, suggesting that information quality and value contribute to increasing trust (Racherla et al., 2012 ). Similarly, Luo and Yuan, in a study based on social media marketing, also confirmed that the value of advertising information posted on brand pages can foster consumer trust in the content (Lou & Yuan, 2019 ). Therefore, by analogy, this paper posits that the informative value of influencer-endorsed advertising can also promote consumer trust in that advertising information. The relationship between trust in advertising information and consumer engagement behavior has been discussed earlier. Thus, the current study proposes the following research hypotheses:

H9: Informative value is positively correlated with information trust.

H9a: Information trust mediates the impact of informative value on content consumption in consumer engagement behavior.

H9b: Information trust mediates the impact of informative value on content contribution in consumer engagement behavior.

H9c: Information trust mediates the impact of informative value on content creation in consumer engagement behavior.

Advertising information factors: ad targeting accuracy

Ad targeting accuracy refers to the degree of match between the substantive information contained in advertising content and consumer needs. Advertisements containing precise information often yield good advertising outcomes. In marketing practice, advertisers frequently use information technology to analyze the characteristics of different consumer groups in the target market and then target their advertisements accordingly to achieve precise dissemination and, consequently, effective advertising results. The utility of ad targeting accuracy has been confirmed by many studies. For instance, in the research by Qiu and Chen, using a modified UTAUT model, it was demonstrated that the accuracy of advertising effectively promotes consumer acceptance of advertisements in WeChat Moments (Qiu & Chen, 2018 ). Although some studies on targeted advertising also indicate that overly precise ads may raise concerns about personal privacy (Zhang et al., 2019 ), overall, the accuracy of advertising information is effective in enhancing advertising outcomes and is a key element in the success of targeted advertising.

Ad targeting accuracy and information trust

In influencer marketing advertisements, due to the special relationship recognition between consumers and influencers, the privacy concerns associated with ad targeting accuracy are alleviated (Vrontis et al., 2021 ). Meanwhile, the informative value brought by targeting accuracy is highlighted. More precise advertising content implies higher informative value and also signifies that the advertising content is more worthy of consumer trust (Della Vigna, Gentzkow, 2010 ). As previously discussed, people are more inclined to read and engage with advertising content they trust and recognize. Therefore, the current study proposes the following research hypotheses:

H10: Ad targeting accuracy is positively correlated with information trust.

H10a: Information trust mediates the impact of ad targeting accuracy on content consumption in consumer engagement behavior.

H10b: Information trust mediates the impact of ad targeting accuracy on content contribution in consumer engagement behavior.

H10c: Information trust mediates the impact of ad targeting accuracy on content creation in consumer engagement behavior.

Social factors: subjective norm

The Theory of Planned Behavior, proposed by Ajzen ( 1991 ), suggests that individuals’ actions are preceded by conscious choices and are underlain by plans. TPB has been widely used by scholars in studying personal online behaviors, these studies collectively validate the applicability of TPB in the context of social media for researching online behaviors (Huang, 2023 ). Additionally, the self-determination theory, which underpins this chapter’s research, also supports the notion that individuals’ behavioral decisions are based on internal cognitions, aligning with TPB’s assertions. Therefore, this paper intends to select subjective norms from TPB as a factor of social influence. Subjective norm refers to an individual’s perception of the expectations of significant others in their social relationships regarding their behavior. Empirical research in the consumption field has demonstrated the significant impact of subjective norms on individual psychological cognition (Yang & Jolly, 2009 ). A meta-analysis by Hagger, Chatzisarantis ( 2009 ) even highlighted the statistically significant association between subjective norms and self-determination factors. Consequently, this study further explores its application in the context of influencer marketing advertisements on social media.

Subjective norm and self-disclosure willingness

In numerous studies on social media privacy, subjective norms significantly influence an individual’s self-disclosure willingness. Wirth et al. ( 2019 ) based on the privacy calculus theory, surveyed 1,466 participants and found that personal self-disclosure on social media is influenced by the behavioral expectations of other significant reference groups around them. Their research confirmed that subjective norms positively influence self-disclosure of information and highlighted that individuals’ cognitions and behaviors cannot ignore social and environmental factors. Heirman et al. ( 2013 ) in an experiment with Instagram users, also noted that subjective norms could promote positive consumer behavioral responses. Specifically, when important family members and friends highly regard social media influencers as trustworthy, we may also be more inclined to disclose our information to influencers and share this information with our surrounding family and friends without fear of disapproval. In our subjective norms, this is considered a positive and valuable interactive behavior, leading us to exhibit engagement behaviors. Based on this logic, we propose the following research hypotheses:

H11: Subjective norms are positively correlated with self-disclosure willingness.

H11a: Self-disclosure willingness mediates the impact of subjective norms on content consumption in consumer engagement behavior.

H11b: Self-disclosure willingness mediates the impact of subjective norms on content contribution in consumer engagement behavior.

H11c: Self-disclosure willingness mediates the impact of subjective norms on content creation in consumer engagement behavior.

Subjective norm and information trust

Numerous studies have indicated that subjective norms significantly influence trust (Roh et al., 2022 ). This can be explained by reference group theory, suggesting people tend to minimize the effort expended in decision-making processes, often looking to the behaviors or attitudes of others as a point of reference; for instance, subjective norms can foster acceptance of technology by enhancing trust (Gupta et al., 2021 ). Analogously, if a consumer’s social network generally holds positive attitudes toward influencer advertising, they are also more likely to trust the endorsed advertisement information, as it conserves the extensive effort required in gathering product information (Chetioui et al., 2020 ). Therefore, this paper proposes the following research hypotheses:

H12: Subjective norms are positively correlated with information trust.

H12a: Information trust mediates the impact of subjective norms on content consumption in consumer engagement behavior.

H12b: Information trust mediates the impact of subjective norms on content contribution in consumer engagement behavior.

H12c: Information trust mediates the impact of subjective norms on content creation in consumer engagement behavior.

Conceptual model

In summary, based on the Stimulus (S)-Organism (O)-Response (R) framework, this study constructs the external stimulus factors (S) from three dimensions: influencer factors (parasocial identification, source credibility), advertising information factors (informative value, Ad targeting accuracy), and social influence factors (subjective norms). This is grounded in social capital theory and the theory of planned behavior. drawing on self-determination theory, the current study constructs the individual psychological factors (O) using self-disclosure willingness, innovativeness, and information trust. Finally, the behavioral response (R) is constructed using consumer engagement, which includes content consumption, content contribution, and content creation, as illustrated in Fig. 1 .

Consumer engagement behavior impact model based on SOR framework.

Materials and methods

Participants and procedures.

The current study conducted a survey through the Wenjuanxing platform to collect data. Participants were recruited through social media platforms such as WeChat, Douyin, Weibo et al., as samples drawn from social media users better align with the research purpose of our research and ensure the validity of the sample. Before the survey commenced, all participants were explicitly informed about the purpose of this study, and it was made clear that volunteers could withdraw from the survey at any time. Initially, 600 questionnaires were collected, with 78 invalid responses excluded. The criteria for valid questionnaires were as follows: (1) Respondents must have answered “Yes” to the question, “Do you follow any influencers (internet celebrities) on social media platforms?” as samples not using social media or not following influencers do not meet the study’s objective, making this question a prerequisite for continuing the survey; (2) Respondents had to correctly answer two hidden screening questions within the questionnaire to ensure that they did not randomly select scores; (3) The total time taken to complete the questionnaire had to exceed one minute, ensuring that respondents had sufficient time to understand and thoughtfully answer each question; (4) Respondents were not allowed to choose the same score for eight consecutive questions. Ultimately, 522 valid questionnaires were obtained, with an effective rate of 87.00%, meeting the basic sample size requirements for research models (Gefen et al., 2011 ). Detailed demographic information of the study participants is presented in Table 1 .

Measurements

To ensure the validity and reliability of the data analysis results in this study, the measurement tools and scales used in this chapter were designed with reference to existing established research. The main variables in the survey questionnaire include parasocial identification, source credibility, informative value, ad targeting accuracy, subjective norms, self-disclosure willingness, innovativeness, information trust, content consumption, content contribution, and content creation. The measurement scale for parasocial identification was adapted from the research of Schramm and Hartmann, comprising 6 items (Schramm & Hartmann, 2008 ). The source credibility scale was combined from the studies of Cheung et al. and Luo & Yuan’s research in the context of social media influencer marketing, including 4 items (Cheung et al., 2009 ; Lou & Yuan, 2019 ). The scale for informative value was modified based on Voss et al.‘s research, consisting of 4 items (Voss et al., 2003 ). The ad targeting accuracy scale was derived from the research by Qiu Aimei et al., 2018 ) including 3 items. The subjective norm scale was adapted from Ajzen’s original scale, comprising 3 items (Ajzen, 2002 ). The self-disclosure willingness scale was developed based on Chu and Kim’s research, including 3 items (Chu & Kim, 2011 ). The innovativeness scale was formulated following the study by Sun et al., comprising 4 items (Sun et al., 2006 ). The information trust scale was created in reference to Chu and Choi’s research, including 3 items (Chu & Choi, 2011 ). The scales for the three components of social media consumer engagement—content consumption, content contribution, and content creation—were sourced from the research by Buzeta et al., encompassing 8 items in total (Buzeta et al., 2020 ).

All scales were appropriately revised for the context of social media influencer marketing. To avoid issues with scoring neutral attitudes, a uniform Likert seven-point scale was used for each measurement item (ranging from 1 to 7, representing a spectrum from ‘strongly disagree’ to ‘strongly agree’). After the overall design of the questionnaire was completed, a pre-test was conducted with 30 social media users to ensure that potential respondents could clearly understand the meaning of each question and that there were no obstacles to answering. This pre-test aimed to prevent any difficulties or misunderstandings in the questionnaire items. The final version of the questionnaire is presented in Table 2 .

Data analysis

Since the model framework of the current study is derived from theoretical deductions of existing research and, while logically constructed, does not originate from an existing research model, this study still falls under the category of exploratory research. According to the analysis suggestions of Hair and other scholars, in cases of exploratory research model frameworks, it is more appropriate to choose Smart PLS for Partial Least Squares Path Analysis (PLS) to conduct data analysis and testing of the research model (Hair et al., 2012 ).

Measurement of model

In this study, careful data collection and management resulted in no missing values in the dataset. This ensured the integrity and reliability of the subsequent data analysis. As shown in Table 3 , after deleting measurement items with factor loadings below 0.5, the final factor loadings of the measurement items in this study range from 0.730 to 0.964. This indicates that all measurement items meet the retention criteria. Additionally, the Cronbach’s α values of the latent variables range from 0.805 to 0.924, and all latent variables have Composite Reliability (CR) values greater than the acceptable value of 0.7, demonstrating that the scales of this study have passed the reliability test requirements (Hair et al., 2019 ). All latent variables in this study have Average Variance Extracted (AVE) values greater than the standard acceptance value of 0.5, indicating that the convergent validity of the variables also meets the standard (Fornell & Larcker, 1981 ). Furthermore, the results show that the Variance Inflation Factor (VIF) values for each factor are below 10, indicating that there are no multicollinearity issues with the scales in this study (Hair, 2009 ).

The current study then further verified the discriminant validity of the variables, with specific results shown in Table 4 . The square roots of the average variance extracted (AVE) values for all variables (bolded on the diagonal) are greater than the Pearson correlation coefficients between the variables, indicating that the discriminant validity of the scales in this study meets the required standards (Fornell & Larcker, 1981 ). Additionally, a single-factor test method was employed to examine common method bias in the data. The first unrotated factor accounted for 29.71% of the variance, which is less than the critical threshold of 40%. Therefore, the study passed the test and did not exhibit serious common method bias (Podsakoff et al., 2003 ).

To ensure the robustness and appropriateness of our structural equation model, we also conducted a thorough evaluation of the model fit. Initially, through PLS Algorithm calculations, the R 2 values of each variable were greater than the standard acceptance value of 0.1, indicating good predictive accuracy of the model. Subsequently, Blindfolding calculations were performed, and the results showed that the Stone-Geisser Q 2 values of each variable were greater than 0, demonstrating that the model of this study effectively predicts the relationships between variables (Dijkstra & Henseler, 2015 ). In addition, through CFA, we also obtained some indicator values, specifically, χ 2 /df = 2.528 < 0.3, RMSEA = 0.059 < 0.06, SRMR = 0.055 < 0.08. Given its sensitivity to sample size, we primarily focused on the CFI, TLI, and NFI values, CFI = 0.953 > 0.9, TLI = 0.942 > 0.9, and NFI = 0.923 > 0.9 indicating a good fit. Additionally, RMSEA values below 0.06 and SRMR values below 0.08 were considered indicative of a good model fit. These indices collectively suggested that our model demonstrates a satisfactory fit with the data, thereby reinforcing the validity of our findings.

Research hypothesis testing

The current study employed a Bootstrapping test with a sample size of 5000 on the collected raw data to explore the coefficients and significance of the paths in the research model. The final test data results of this study’s model are presented in Table 5 .

The current study employs S-O-R model as the framework, grounded in theories such as self-determination theory and theory of planned behavior, to construct an influence model of consumer engagement behavior in the context of social media influencer marketing. It examines how influencer factors, advertisement information factors, and social influence factors affect consumer engagement behavior by impacting consumers’ psychological cognitions. Using structural equation modeling to analyze collected data ( N  = 522), it was found that self-disclosure willingness, innovativeness, and information trust positively influence consumer engagement behavior, with innovativeness having the largest impact on higher levels of engagement. Influencer factors, advertisement information factors, and social factors serve as effective external stimuli, influencing psychological motivators and, consequently, consumer engagement behavior. The specific research results are illustrated in Fig. 2 .

Tested structural model of consumer engagement behavior.

The impact of psychological motivators on different levels of consumer engagement: self-disclosure willingness, innovativeness, and information trust

The research analysis indicates that self-disclosure willingness and information trust are key drivers for content consumption (H1a, H2a validated). This aligns with previous findings that individuals with a higher willingness to disclose themselves show greater levels of engagement behavior (Chu et al., 2023 ); likewise, individuals who trust advertisement information are more inclined to engage with advertisement content (Kim, Kim, 2021 ). Moreover, our study finds that information trust has a stronger impact on content consumption, underscoring the importance of trust in the dissemination of advertisement information. However, no significant association was found between individual innovativeness and content consumption (H3a not validated).

Regarding the dimension of content contribution in consumer engagement, self-disclosure willingness, information trust, and innovativeness all positively impact it (H1b, H2b, and H3b all validated). This is consistent with earlier research findings that individuals with higher self-disclosure willingness are more likely to like, comment on, or share content posted by influencers on social media platforms (Towner et al., 2022 ); the conclusions of this paper also support that innovativeness is an important psychological driver for active participation in social media interactions (Kamboj & Sharma, 2023 ). However, at the level of consumer engagement in content contribution, while information trust also exerts a positive effect, its impact is the weakest, although information trust has the strongest impact on content consumption.

In social media advertising, the ideal outcome is the highest level of consumer engagement, i.e., content creation, meaning consumers actively join in brand content creation, seeing themselves as co-creators with the brand (Nadeem et al., 2021 ). Our findings reveal that self-disclosure willingness, innovativeness, and information trust all positively influence content creation (H1c, H2c, and H3c all validated). The analysis found that similar to the impact on content contribution, innovativeness has the most significant effect on encouraging individual content creation, followed by self-disclosure willingness, with information trust having the least impact.

In summary, while some previous studies have shown that self-disclosure willingness, innovativeness, and information trust are important factors in promoting consumer engagement (Chu et al., 2023 ; Nadeem et al., 2021 ; Geng et al., 2021 ), this study goes further by integrating and comparing all three within the same research framework. It was found that to trigger higher levels of consumer engagement behavior, trust is not the most crucial psychological motivator; rather, the most effective method is to stimulate consumers’ innovativeness, thus complementing previous research. Subsequently, this study further explores the impact of different stimulus factors on various psychological motivators.

The influence of external stimulus factors on psychological motivators: influencer factors, advertisement information factors, and social factors

The current findings indicate that influencer factors, such as parasocial identification and source credibility, effectively enhance consumer engagement by influencing self-disclosure willingness and information trust. This aligns with prior research highlighting the significance of parasocial identification (Shan et al., 2020 ). Studies suggest parasocial identification positively impacts consumer engagement by boosting self-disclosure willingness and information trust (validated H4a, H4b, H4c, and H5a), but not content contribution or creation through information trust (H5b, H5c not validated). Source credibility’s influence on self-disclosure willingness was not significant (H6 not validated), thus negating the mediating effect of self-disclosure willingness (H6a, H6b, H6c not validated). Influencer credibility mainly affects engagement through information trust (H7a, H7b, H7c validated), supporting previous findings (Shan et al., 2020 ).

Advertisement factors (informative value and ad targeting accuracy) promote engagement through innovativeness and information trust. Informative value significantly impacts higher-level content contribution and creation through innovativeness (H8b, H8c validated), while ad targeting accuracy influences consumer engagement at all levels mainly through information trust (H10a, H10b, H10c validated).

Social factors (subjective norms) enhance self-disclosure willingness and information trust, consistent with previous research (Wirth et al., 2019 ; Gupta et al., 2021 ), and further promote consumer engagement across all levels (H11a, H11b, H11c, H12a, H12b, and H12c all validated).

In summary, influencer, advertisement, and social factors impact consumer engagement behavior by influencing psychological motivators, with influencer factors having the greatest effect on content consumption, advertisement content factors significantly raising higher-level consumer engagement through innovativeness, and social factors also influencing engagement through self-disclosure willingness and information trust.

Implication

From a theoretical perspective, current research presents a comprehensive model of consumer engagement within the context of influencer advertising on social media. This model not only expands the research horizon in the fields of social media influencer advertising and consumer engagement but also serves as a bridge between two crucial themes in new media advertising studies. Influencer advertising has become an integral part of social media advertising, and the construction of a macro model aids researchers in understanding consumer psychological processes and behavioral patterns. It also assists advertisers in formulating more effective strategies. Consumer engagement, focusing on the active role of consumers in disseminating information and the long-term impact on advertising effectiveness, aligns more closely with the advertising effectiveness measures in the new media context than traditional advertising metrics. However, the intersection of these two vital themes lacks comprehensive research and a universal model. This study constructs a model that elucidates the effects of various stimuli on consumer psychology and engagement behaviors, exploring the connections and mechanisms through different mediating pathways. By differentiating levels of engagement, the study offers more nuanced conclusions for diverse advertising objectives. Furthermore, this research validates the applicability of self-determination theory in the context of influencer advertising effectiveness. While this psychological theory has been utilized in communication behavior research, its effectiveness in the field of advertising requires further exploration. The current study introduces self-determination theory into the realm of influencer advertising and consumer engagement, thereby expanding its application in the field of advertising communication. It also responds to the call from the advertising and marketing academic community to incorporate more psychological theories to explain the ‘black box’ of consumer psychology. The inclusion of this theory re-emphasizes the people-centric approach of this research and highlights the primary role of individuals in advertising communication studies.

From a practical perspective, this study provides significant insights for adapting marketing strategies to the evolving media landscape and the empowered role of audiences. Firstly, in the face of changes in the communication environment and the empowerment of audience communication capabilities, traditional marketing approaches are becoming inadequate for new media advertising needs. Traditional advertising focuses on direct, point-to-point effects, whereas social media advertising aims for broader, point-to-mass communication, leveraging audience proactivity to facilitate the viral spread of content across online social networks. Secondly, for brands, the general influence model proposed in this study offers guidance for influencer advertising strategy. If the goal is to maximize reach and brand recognition with a substantial advertising budget, partnering with top influencers who have a large following can be an effective strategy. However, if the objective is to maximize cost-effectiveness with a limited budget by leveraging consumer initiative for secondary spread, the focus should be on designing advertising content that stimulates consumer creativity and willingness to innovate. Thirdly, influencers are advised to remain true to their followers. In influencer marketing, influencers attract advertisers through their influence over followers, converting this influence into commercial gain. This influence stems from the trust followers place in the influencer, thus influencers should maintain professional integrity and prioritize the quality of information they share, even when presented with advertising opportunities. Lastly, influencers should assert more control over their relationships with advertisers. In traditional advertising, companies and brands often exert significant control over the content. However, in the social media era, influencers should negotiate more creative freedom in their advertising partnerships, asserting a more equal relationship with advertisers. This approach ensures that content quality remains high, maintaining the trust influencers have built with their followers.

Limitations and future directions

while this study offers valuable insights into the dynamics of influencer marketing and consumer engagement on social media, several limitations should be acknowledged: Firstly, constrained by the research objectives and scope, this study’s proposed general impact model covers three dimensions: influencers, advertisement information, and social factors. However, these dimensions are not limited to the five variables discussed in this paper. Therefore, we call for future research to supplement and explore more crucial factors. Secondly, in the actual communication environment, there may be differences in the impact of communication effectiveness across various social media platforms. Thus, future research could also involve comparative studies and explorations between different social media platforms. Thirdly, the current study primarily examines the direct effects of various factors on consumer engagement. However, the potential interaction effects between these variables (e.g., how influencers’ credibility might interact with advertisement information quality) are not extensively explored. Future research could investigate these complex interrelationships for a more holistic understanding. Lastly, our study, being cross-sectional, offers preliminary insights into the complex and dynamic nature of engagement between social media influencers and consumers, yet it does not incorporate the temporal dimension. The diverse impacts of psychological needs on engagement behaviors hint at an underlying dynamism that merits further investigation. Future research should consider employing longitudinal designs to directly observe how these dynamics evolve over time.

The findings of the current study not only theoretically validate the applicability of self-determination theory in the field of social media influencer marketing advertising research but also broaden the scope of advertising effectiveness research from the perspective of consumer engagement. Moreover, the research framework offers strategic guidance and reference for influencer marketing strategies. The main conclusions of this study can be summarized as follows.

Innovativeness is the key factor in high-level consumer engagement behavior. Content contribution represents a higher level of consumer engagement compared to content consumption, as it not only requires consumers to dedicate attention to viewing advertising content but also to share this information across adjacent nodes within their social networks. This dissemination of information is a pivotal factor in the success of influencer marketing advertisements. Hence, companies and brands prioritize consumers’ content contribution over mere viewing of advertising content (Qiu & Kumar, 2017 ). Compared to content consumption and contribution, content creation is considered the highest level of consumer engagement, where consumers actively create and upload brand-related content, and it represents the most advanced outcome sought by enterprises and brands in advertising campaigns (Cheung et al., 2021 ). The current study posits that to pursue better outcomes in social media influencer advertising marketing, enhancing consumers’ willingness for self-disclosure, innovativeness, and trust in advertising information are effective strategies. However, the crux lies in leveraging the consumer’s subjective initiative, particularly in boosting their innovativeness. If the goal is simply to achieve content consumption rather than higher levels of consumer engagement, the focus should be on fostering trust in advertising information. There is no hierarchy in the efficacy of different strategies; they should align with varying marketing contexts and advertising objectives.

The greatest role of social media influencers lies in attracting online traffic. information trust is the core element driving content consumption, and influencer factors mainly affect consumer engagement behaviors through information trust. Therefore, this study suggests that the primary role of influencers in social media advertising is to attract online traffic, i.e., increase consumer behavior regarding ad content consumption (reducing avoidance of ad content), and help brands achieve the initial goal of making consumers “see and complete ads.” However, their impact on further high-level consumer engagement behaviors is limited. This mechanism serves as a reminder to advertisers not to overestimate the effects of influencers in marketing. Currently, top influencers command a significant portion of the ad budget, which could squeeze the budget for other aspects of advertising, potentially affecting the overall effectiveness of the campaign. Businesses and brands should consider deeper strategic implications when planning their advertising campaigns.

Valuing Advertising Information Factors, Content Remains King. Our study posits that in the social media influencer marketing context, the key to enhancing consumer contribution and creation of advertising content lies primarily in the advertising information factors. In other words, while content consumption is important, advertisers should objectively assess the role influencers play in advertising. In the era of social media, content remains ‘king’ in advertising. This view indirectly echoes the points made in the previous paragraph: influencers effectively perform initial ‘online traffic generation’ tasks in social media, but this role should not be overly romanticized or exaggerated. Whether it’s companies, brands, or influencers, providing consumers with advertisements rich in informational value is crucial to achieving better advertising outcomes and potentially converting consumers into stakeholders.

Subjective norm is an unignorable social influence factor. Social media is characterized by its network structure of information dissemination, where a node’s information is visible to adjacent nodes. For instance, if user A likes a piece of content C from influencer I, A’s follower B, who may not follow influencer I, can still see content C via user A’s page. The aim of marketing in the social media era is to influence a node and then spread the information to adjacent nodes, either secondarily or multiple times (Kumar & Panda, 2020 ). According to the Theory of Planned Behavior, an individual’s actions are influenced by significant others in their lives, such as family and friends. Previous studies have proven the effectiveness of the Theory of Planned Behavior in influencing attitudes toward social media advertising (Ranjbarian et al., 2012 ). Current research further confirms that subjective norms also influence consumer engagement behaviors in influencer marketing on social media. Therefore, in advertising practice, brands should not only focus on individual consumers but also invest efforts in groups that can influence consumer decisions. Changing consumer behavior in the era of social media marketing doesn’t solely rely on the company’s efforts.

As communication technology advances, media platforms will further empower individual communicative capabilities, moving beyond the era of the “magic bullet” theory. The distinction between being a recipient and a transmitter of information is increasingly blurred. In an era where everyone is both an audience and an influencer, research confined to the role of the ‘recipient’ falls short of addressing the dynamics of ‘transmission’. Future research in marketing and advertising should thus focus more on the power of individual transmission. Furthermore, as Marshall McLuhan famously said, “the medium is the extension of man.” The evolution of media technology remains human-centric. Accordingly, future marketing research, while paying heed to media transformations, should emphasize the centrality of the ‘human’ element.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to privacy issues. Making the full data set publicly available could potentially breach the privacy that was promised to participants when they agreed to take part, and may breach the ethics approval for the study. The data are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank all the participants of this study. The participants were all informed about the purpose and content of the study and voluntarily agreed to participate. The participants were able to stop participating at any time without penalty. Funding for this study was provided by Minjiang University Research Start-up Funds (No. 324-32404314).

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Conceptualization: CG; methodology: CG and QD; software: CG and QD; validation: CG; formal analysis: CG and QD; investigation: CG and QD; resources: CG; data curation: CG and QD; writing—original draft preparation: CG; writing—review and editing: CG; visualization: CG; project administration: CG. All authors have read and agreed to the published version of the manuscript.

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Gu, C., Duan, Q. Exploring the dynamics of consumer engagement in social media influencer marketing: from the self-determination theory perspective. Humanit Soc Sci Commun 11 , 587 (2024). https://doi.org/10.1057/s41599-024-03127-w

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• Published: 13 May 2024

Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes

• Léa Solh Dost   ORCID: orcid.org/0000-0001-5767-1305 1 , 2 ,
• Giacomo Gastaldi   ORCID: orcid.org/0000-0001-6327-7451 3 &
• Marie P. Schneider   ORCID: orcid.org/0000-0002-7557-9278 1 , 2  

BMC Health Services Research volume  24 , Article number:  620 ( 2024 ) Cite this article

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Metrics details

Continuity of care is under great pressure during the transition from hospital to outpatient care. Medication changes during hospitalization may be poorly communicated and understood, compromising patient safety during the transition from hospital to home. The main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Patients with type 2 diabetes, with at least two comorbidities and who returned home after discharge, were recruited during their hospitalization. A descriptive qualitative longitudinal research approach was adopted, with four in-depth semi-structured interviews per participant over a period of two months after discharge. Interviews were based on semi-structured guides, transcribed verbatim, and a thematic analysis was conducted.

Twenty-one participants were included from October 2020 to July 2021. Seventy-five interviews were conducted. Three main themes were identified: (A) Medication management, (B) Medication understanding, and (C) Medication adherence, during three periods: (1) Hospitalization, (2) Care transition, and (3) Outpatient care. Participants had varying levels of need for medication information and involvement in medication management during hospitalization and in outpatient care. The transition from hospital to autonomous medication management was difficult for most participants, who quickly returned to their routines with some participants experiencing difficulties in medication adherence.

Conclusions

The transition from hospital to outpatient care is a challenging process during which discharged patients are vulnerable and are willing to take steps to better manage, understand, and adhere to their medications. The resulting tension between patients’ difficulties with their medications and lack of standardized healthcare support calls for interprofessional guidelines to better address patients’ needs, increase their safety, and standardize physicians’, pharmacists’, and nurses’ roles and responsibilities.

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Introduction

Continuity of patient care is characterized as the collaborative engagement between the patient and their physician-led care team in the ongoing management of healthcare, with the mutual objective of delivering high-quality and cost-effective medical care [ 1 ]. Continuity of care is under great pressure during the transition of care from hospital to outpatient care, with a risk of compromising patients’ safety [ 2 , 3 ]. The early post-discharge period is a high-risk and fragile transition: once discharged, one in five patients experience at least one adverse event during the first three weeks following discharge, and more than half of these adverse events are drug-related [ 4 , 5 ]. A retrospective study examining all discharged patients showed that adverse drug events (ADEs) account for up to 20% of 30-day hospital emergency readmissions [ 6 ]. During hospitalization, patients’ medications are generally modified, with an average of nearly four medication changes per patient [ 7 ]. Information regarding medications such as medication changes, the expected effect, side effects, and instructions for use are frequently poorly communicated to patients during hospitalization and at discharge [ 8 , 9 , 10 , 11 ]. Between 20 and 60% of discharged patients lack knowledge of their medications [ 12 , 13 ]. Consideration of patients’ needs and their active engagement in decision-making during hospitalization regarding their medications are often lacking [ 11 , 14 , 15 ]. This can lead to unsafe discharge and contribute to medication adherence difficulties, such as non-implementation of newly prescribed medications [ 16 , 17 ].

Patients with multiple comorbidities and polypharmacy are at higher risk of ADE [ 18 ]. Type 2 diabetes is one of the chronic health conditions most frequently associated with comorbidities and patients with type 2 diabetes often lack care continuum [ 19 , 20 , 21 ]. The prevalence of patients hospitalized with type 2 diabetes can exceed 40% [ 22 ] and these patients are at higher risk for readmission due to their comorbidities and their medications, such as insulin and oral hypoglycemic agents [ 23 , 24 , 25 ].

Interventions and strategies to improve patient care and safety at transition have shown mixed results worldwide in reducing cost, rehospitalization, ADE, and non-adherence [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. However, interventions that are patient-centered, with a patient follow-up and led by interprofessional healthcare teams showed promising results [ 34 , 35 , 36 ]. Most of these interventions have not been implemented routinely due to the extensive time to translate research into practice and the lack of hybrid implementation studies [ 37 , 38 , 39 , 40 , 41 ]. In addition, patient-reported outcomes and perspectives have rarely been considered, yet patients’ involvement is essential for seamless and integrated care [ 42 , 43 ]. Interprofessional collaboration in which patients are full members of the interprofessional team, is still in its infancy in outpatient care [ 44 ]. Barriers and facilitators regarding medications at the transition of care have been explored in multiple qualitative studies at one given time in a given setting (e.g., at discharge, one-month post-discharge) [ 8 , 45 , 46 , 47 , 48 ]. However, few studies have adopted a holistic methodology from the hospital to the outpatient setting to explore changes in patients’ perspectives over time [ 49 , 50 , 51 ]. Finally, little is known about whether, how, and when patients return to their daily routine following hospitalization and the impact of hospitalization weeks after discharge.

In Switzerland, continuity of care after hospital discharge is still poorly documented, both in terms of contextual analysis and interventional studies, and is mainly conducted in the hospital setting [ 31 , 35 , 52 , 53 , 54 , 55 , 56 ]. The first step of an implementation science approach is to perform a contextual analysis to set up effective interventions adapted to patients’ needs and aligned to healthcare professionals’ activities in a specific context [ 41 , 57 ]. Therefore, the main aims of this study were to investigate the perspectives of patients with type 2 diabetes and multimorbidities on their medications from hospital discharge to outpatient care, and on their healthcare journey through the outpatient healthcare system. In this article, we present the results focusing on patients’ perspectives of their medications from hospital to two months after discharge.

Study design

This qualitative longitudinal study, conducted from October 2020 to July 2021, used a qualitative descriptive methodology through four consecutive in-depth semi-structured interviews per participant at three, 10-, 30- and 60-days post-discharge, as illustrated in Fig.  1 . Longitudinal qualitative research is characterized by qualitative data collection at different points in time and focuses on temporality, such as time and change [ 58 , 59 ]. Qualitative descriptive studies aim to explore and describe the depth and complexity of human experiences or phenomena [ 60 , 61 , 62 ]. We focused our qualitative study on the 60 first days after discharge as this period is considered highly vulnerable and because studies often use 30- or 60-days readmission as an outcome measure [ 5 , 63 ].

This qualitative study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ). Ethics committee approval was sought and granted by the Cantonal Research Ethics Commission, Geneva (CCER) (2020 − 01779).

Recruitment took place during participants’ hospitalization in the general internal medicine divisions at the Geneva University Hospitals in the canton of Geneva (500 000 inhabitants), Switzerland. Interviews took place at participants’ homes, in a private office at the University of Geneva, by telephone or by secure video call, according to participants’ preference. Informal caregivers could also participate alongside the participants.

Study flowchart

Researcher characteristics

All the researchers were trained in qualitative studies. The diabetologist and researcher (GG) who enrolled the patients in the study was involved directly or indirectly (advice asked to the Geneva University Hospital diabetes team of which he was a part) for most participants’ care during hospitalization. LS (Ph.D. student and community pharmacist) was unknown to participants and presented herself during hospitalization as a “researcher” and not as a healthcare professional to avoid any risk of influencing participants’ answers. This study was not interventional, and the interviewer (LS) invited participants to contact a healthcare professional for any questions related to their medication or medical issues.

Population and sampling strategy

Patients with type 2 diabetes were chosen as an example population to describe polypharmacy patients as these patients usually have several health issues and polypharmacy [ 20 , 22 , 25 ]. Inclusions criteria for the study were: adult patients with type 2 diabetes, with at least two other comorbidities, hospitalized for at least three days in a general internal medicine ward, with a minimum of one medication change during hospital stay, and who self-managed their medications once discharged home. Exclusion criteria were patients not reachable by telephone following discharge, unable to give consent (patients with schizophrenia, dementia, brain damage, or drug/alcohol misuse), and who could not communicate in French. A purposive sampling methodology was applied aiming to include participants with different ages, genders, types, and numbers of health conditions by listing participants’ characteristics in a double-entry table, available in Supplementary Material 1 , until thematic saturation was reached. Thematic saturation was considered achieved when no new code or theme emerged and new data repeated previously coded information [ 64 ]. The participants were identified if they were hospitalized in the ward dedicated to diabetes care or when the diabetes team was contacted for advice. The senior ward physician (GG) screened eligible patients and the interviewer (LS) obtained written consent before hospital discharge.

Data collection and instruments

Sociodemographic (age, gender, educational level, living arrangement) and clinical characteristics (reason for hospitalization, date of admission, health conditions, diabetes diagnosis, medications before and during hospitalization) were collected by interviewing participants before their discharge and by extracting participants’ data from electronic hospital files by GG and LS. Participants’ pharmacies were contacted with the participant’s consent to obtain medication records from the last three months if information regarding medications before hospitalization was missing in the hospital files.

Semi-structured interview guides for each interview (at three, 10-, 30- and 60-days post-discharge) were developed based on different theories and components of health behavior and medication adherence: the World Health Organization’s (WHO) five dimensions for adherence, the Information-Motivation-Behavioral skills model and the Social Cognitive Theory [ 65 , 66 , 67 ]. Each interview explored participants’ itinerary in the healthcare system and their perspectives on their medications. Regarding medications, the following themes were mentioned at each interview: changes in medications, patients’ understanding and implication; information on their medications, self-management of their medications, and patients’ medication adherence. Other aspects were mentioned in specific interviews: patients’ hospitalization and experience on their return home (interview 1), motivation (interviews 2 and 4), and patient’s feedback on the past two months (interview 4). Interview guides translated from French are available in Supplementary Material 2 . The participants completed self-reported and self-administrated questionnaires at different interviews to obtain descriptive information on different factors that may affect medication management and adherence: self-report questionnaires on quality of life (EQ-5D-5 L) [ 68 ], literacy (Schooling-Opinion-Support questionnaire) [ 69 ], medication adherence (Adherence Visual Analogue Scale, A-VAS) [ 70 ] and Belief in Medication Questionnaire (BMQ) [ 71 ] were administered to each participant at the end of selected interviews to address the different factors that may affect medication management and adherence as well as to determine a trend of determinants over time. The BMQ contains two subscores: Specific-Necessity and Specific-Concerns, addressing respectively their perceived needs for their medications, and their concerns about adverse consequences associated with taking their medication [ 72 ].

Data management

Informed consent forms, including consent to obtain health data, were securely stored in a private office at the University of Geneva. The participants’ identification key was protected by a password known only by MS and LS. Confidentiality was guaranteed by pseudonymization of participants’ information and audio-recordings were destroyed once analyzed. Sociodemographic and clinical characteristics, medication changes, and answers to questionnaires were securely collected by electronic case report forms (eCRFs) on RedCap®. Interviews were double audio-recorded and field notes were taken during interviews. Recorded interviews were manually transcribed verbatim in MAXQDA® (2018.2) by research assistants and LS and transcripts were validated for accuracy by LS. A random sample of 20% of questionnaires was checked for accuracy for the transcription from the paper questionnaires to the eCRFs. Recorded sequences with no link to the discussed topics were not transcribed and this was noted in the transcripts.

Data analysis

A descriptive statistical analysis of sociodemographic, clinical characteristics and self-reported questionnaire data was carried out. A thematic analysis of transcripts was performed, as described by Braun and Clarke [ 73 ], by following six steps: raw data was read, text segments related to the study objectives were identified, text segments to create new categories were identified, similar or redundant categories were reduced and a model that integrated all significant categories was created. The analysis was conducted in parallel with patient enrolment to ensure data saturation. To ensure the validity of the coding method, transcripts were double coded independently and discussed by the research team until similar themes were obtained. The research group developed and validated an analysis grid, with which LS coded systematically the transcriptions and met regularly with the research team to discuss questions on data analysis and to ensure the quality of coding. The analysis was carried out in French, and the verbatims of interest cited in the manuscript were translated and validated by a native English-speaking researcher to preserve the meaning.

In this analysis, we used the term “healthcare professionals” when more than one profession could be involved in participants’ medication management. Otherwise, when a specific healthcare professional was involved, we used the designated profession (e.g. physicians, pharmacists).

Patient and public involvement

During the development phase of the study, interview guides and questionnaires were reviewed for clarity and validity and adapted by two patient partners, with multiple health conditions and who experienced previously a hospital discharge. They are part of the HUG Patients Partners + 3P platform for research and patient and public involvement.

Interviews and participants’ descriptions

A total of 75 interviews were conducted with 21 participants. In total, 31 patients were contacted, seven refused to participate (four at the project presentation and three at consent), two did not enter the selection criteria at discharge and one was unreachable after discharge. Among the 21 participants, 15 participated in all interviews, four in three interviews, one in two interviews, and one in one interview, due to scheduling constraints. Details regarding interviews and participants characteristics are presented in Tables  1 and 2 .

The median length of time between hospital discharge and interviews 1,2,3 and 4 was 5 (IQR: 4–7), 14 (13-20), 35 (22-38), and 63 days (61-68), respectively. On average, by comparing medications at hospital admission and discharge, a median of 7 medication changes (IQR: 6–9, range:2;17) occurred per participant during hospitalization and a median of 7 changes (5–12) during the two months following discharge. Details regarding participants’ medications are described in Table  3 .

Patient self-reported adherence over the past week for their three most challenging medications are available in Supplementary Material 3 .

Qualitative analysis

We defined care transition as the period from discharge until the first medical appointment post-discharge, and outpatient care as the period starting after the first medical appointment. Data was organized into three key themes (A. Medication management, B. Medication understanding, and C. Medication adherence) divided into subthemes at three time points (1. Hospitalization, 2. Care transition and 3. Outpatient care). Figure  2 summarizes and illustrates the themes and subthemes with their influencing factors as bullet points.

Participants’ medication management, understanding and adherence during hospitalization, care transition and outpatient care

A. Medication management

A.1 medication management during hospitalization: medication management by hospital staff.

Medications during hospitalization were mainly managed by hospital healthcare professionals (i.e. nurses and physicians) with varying degrees of patient involvement: “At the hospital, they prepared the medications for me. […] I didn’t even know what the packages looked like.” Participant 22; interview 1 (P22.1) Some participants reported having therapeutic education sessions with specialized nurses and physicians, such as the explanation and demonstration of insulin injection and glucose monitoring. A patient reported that he was given the choice of several treatments and was involved in shared decision-making. Other participants had an active role in managing and optimizing dosages, such as rapid insulin, due to prior knowledge and use of medications before hospitalization.

A.2 Medication management at transition: obtaining the medication and initiating self-management

Once discharged, some participants had difficulties obtaining their medications at the pharmacy because some medications were not stored and had to be ordered, delaying medication initiation. To counter this problem upstream, a few participants were provided a 24-to-48-hour supply of medications at discharge. It was sometimes requested by the patient or suggested by the healthcare professionals but was not systematic. The transition from medication management by hospital staff to self-management was exhausting for most participants who were faced with a large amount of new information and changes in their medications: “ When I was in the hospital, I didn’t even realize all the changes. When I came back home, I took away the old medication packages and got out the new ones. And then I thought : « my God, all this…I didn’t know I had all these changes » ” P2.1 Written documentation, such as the discharge prescription or dosage labels on medication packages, was helpful in managing their medication at home. Most participants used weekly pill organizers to manage their medications, which were either already used before hospitalization or were introduced post-discharge. The help of a family caregiver in managing and obtaining medications was reported as a facilitator.

A.3 Medication management in outpatient care: daily self-management and medication burden

A couple of days or weeks after discharge, most participants had acquired a routine so that medication management was less demanding, but the medication burden varied depending on the participants. For some, medication management became a simple action well implemented in their routine (“It has become automatic” , P23.4), while for others, the number of medications and the fact that the medications reminded them of the disease was a heavy burden to bear on a daily basis (“ During the first few days after getting out of the hospital, I thought I was going to do everything right. In the end, well [laughs] it’s complicated. I ended up not always taking the medication, not monitoring the blood sugar” P12.2) To support medication self-management, some participants had written documentation such as treatment plans, medication lists, and pictures of their medication packages on their phones. Some participants had difficulties obtaining medications weeks after discharge as discharge prescriptions were not renewable and participants did not see their physician in time. Others had to visit multiple physicians to have their prescriptions updated. A few participants were faced with prescription or dispensing errors, such as prescribing or dispensing the wrong dosage, which affected medication management and decreased trust in healthcare professionals. In most cases, according to participants, the pharmacy staff worked in an interprofessional collaboration with physicians to provide new and updated prescriptions.

B. Medication understanding

B.1 medication understanding during hospitalization: new information and instructions.

The amount of information received during hospitalization varied considerably among participants with some reporting having received too much, while others saying they received too little information regarding medication changes, the reason for changes, or for introducing new medications: “They told me I had to take this medication all my life, but they didn’t tell me what the effects were or why I was taking it.” P5.3

Hospitalization was seen by some participants as a vulnerable and tiring period during which they were less receptive to information. Information and explanations were generally given verbally, making it complicated for most participants to recall it. Some participants reported that hospital staff was attentive to their needs for information and used communication techniques such as teach-back (a way of checking understanding by asking participants to say in their own words what they need to know or do about their health or medications). Some participants were willing to be proactive in the understanding of their medications while others were more passive, had no specific needs for information, and did not see how they could be engaged more.

B.2 Medication understanding at transition: facing medication changes

At hospital discharge, the most challenging difficulty for participants was to understand the changes made regarding their medications. For newly diagnosed participants, the addition of new medications was more difficult to understand, whereas, for experienced participants, changes in known medications such as dosage modification, changes within a therapeutic class, and generic substitutions were the most difficult to understand. Not having been informed about changes caused confusion and misunderstanding. Therefore, medication reconciliation done by the patient was time-consuming, especially for participants with multiple medications: “ They didn’t tell me at all that they had changed my treatment completely. They just told me : « We’ve changed a few things. But it was the whole treatment ». ” P2.3 Written information, such as the discharge prescription, the discharge report (brief letter summarizing information about the hospitalization, given to the patient at discharge), or the label on the medication box (written by the pharmacist with instructions on dosage) helped them find or recall information about their medications and diagnoses. However, technical terms were used in hospital documentations and were not always understandable. For example, this participant said: “ On the prescription of valsartan, they wrote: ‘resume in the morning once profile…’[once hypertension profile allows]… I don’t know what that means.” P8.1 In addition, some documents were incomplete, as mentioned by a patient who did not have the insulin dosage mentioned on the hospital prescription. Some participants sought help from healthcare professionals, such as pharmacists, hospital physicians, or general practitioners a few days after discharge to review medications, answer questions, or obtain additional information.

B.3 Medication understanding in the outpatient care: concerns and knowledge

Weeks after discharge, most participants had concerns about the long-term use of their medications, their usefulness, and the possible risk of interactions or side effects. Some participants also reported having some lack of knowledge regarding indications, names, or how the medication worked: “I don’t even know what Brilique® [ticagrelor, antiplatelet agent] is for. It’s for blood pressure, isn’t it?. I don’t know.” P11.4 According to participants, the main reasons for the lack of understanding were the lack of information at the time of prescribing and the large number of medications, making it difficult to search for information and remember it. Participants sought information from different healthcare professionals or by themselves, on package inserts, through the internet, or from family and friends. Others reported having had all the information needed or were not interested in having more information. In addition, participants with low medication literacy, such as non-native speakers or elderly people, struggled more with medication understanding and sought help from family caregivers or healthcare professionals, even weeks after discharge: “ I don’t understand French very well […] [The doctor] explained it very quickly…[…] I didn’t understand everything he was saying” P16.2

C. Medication adherence

C.2 medication adherence at transition: adopting new behaviors.

Medication adherence was not mentioned as a concern during hospitalization and a few participants reported difficulties in medication initiation once back home: “I have an injection of Lantus® [insulin] in the morning, but obviously, the first day [after discharge], I forgot to do it because I was not used to it.” P23.1 Participants had to quickly adopt new behaviors in the first few days after discharge, especially for participants with few medications pre-hospitalization. The use of weekly pill organizers, alarms and specific storage space were reported as facilitators to support adherence. One patient did not initiate one of his medications because he did not understand the medication indication, and another patient took her old medications because she was used to them. Moreover, most participants experienced their hospitalization as a turning point, a time when they focused on their health, thought about the importance of their medications, and discussed any new lifestyle or dietary measures that might be implemented.

C.3 Medication adherence in outpatient care: ongoing medication adherence

More medication adherence difficulties appeared a few weeks after hospital discharge when most participants reported nonadherence behaviors, such as difficulties implementing the dosage regimen, or intentionally discontinuing the medication and modifying the medication regimen on their initiative. Determinants positively influencing medication adherence were the establishment of a routine; organizing medications in weekly pill-organizers; organizing pocket doses (medications for a short period that participants take with them when away from home); seeking support from family caregivers; using alarm clocks; and using specific storage places. Reasons for nonadherence were changes in daily routine; intake times that were not convenient for the patient; the large number of medications; and poor knowledge of the medication or side effects. Healthcare professionals’ assistance for medication management, such as the help of home nurses or pharmacists for the preparation of weekly pill-organizers, was requested by participants or offered by healthcare professionals to support medication adherence: “ I needed [a home nurse] to put my pills in the pillbox. […] I felt really weak […] and I was making mistakes. So, I’m very happy [the doctor] offered me [home care]. […] I have so many medications.” P22.3 Some participants who experienced prehospitalization non-adherence were more aware of their non-adherence and implemented strategies, such as modifying the timing of intake: “I said to my doctor : « I forget one time out of two […], can I take them in the morning? » We looked it up and yes, I can take it in the morning.” P11.2 In contrast, some participants were still struggling with adherence difficulties that they had before hospitalization. Motivations for taking medications two months after discharge were to improve health, avoid complications, reduce symptoms, reduce the number of medications in the future or out of obligation: “ I force myself to take them because I want to get to the end of my diabetes, I want to reduce the number of pills as much as possible.” P14.2 After a few weeks post-hospitalization, for some participants, health and illness were no longer the priority because of other life imperatives (e.g., family or financial situation).

This longitudinal study provided a multi-faceted representation of how patients manage, understand, and adhere to their medications from hospital discharge to two months after discharge. Our findings highlighted the varying degree of participants’ involvement in managing their medications during their hospitalization, the individualized needs for information during and after hospitalization, the complicated transition from hospital to autonomous medication management, the adaptation of daily routines around medication once back home, and the adherence difficulties that surfaced in the outpatient care, with nonadherence prior to hospitalization being an indicator of the behavior after discharge. Finally, our results confirmed the lack of continuity in care and showed the lack of patient care standardization experienced by the participants during the transition from hospital to outpatient care.

This in-depth analysis of patients’ experiences reinforces common challenges identified in the existing literature such as the lack of personalized information [ 9 , 10 , 11 ], loss of autonomy during hospitalization [ 14 , 74 , 75 ], difficulties in obtaining medication at discharge [ 11 , 45 , 76 ] and challenges in understanding treatment modifications and generics substitution [ 11 , 32 , 77 , 78 ]. Some of these studies were conducted during patients’ hospitalization [ 10 , 75 , 79 ] or up to 12 months after discharge [ 80 , 81 ], but most studies focused on the few days following hospital discharge [ 9 , 11 , 14 , 82 ]. Qualitative studies on medications at transition often focused on a specific topic, such as medication information, or a specific moment in time, and often included healthcare professionals, which muted patients’ voices [ 9 , 10 , 11 , 47 , 49 ]. Our qualitative longitudinal methodology was interested in capturing the temporal dynamics, in-depth narratives, and contextual nuances of patients’ medication experiences during transitions of care [ 59 , 83 ]. This approach provided a comprehensive understanding of how patients’ perspectives and behaviors evolved over time, offering insights into the complex interactions of medication management, understanding and adherence, and turning points within their medication journeys. A qualitative longitudinal design was used by Fylan et al. to underline patients’ resilience in medication management during and after discharge, by Brandberg et al. to show the dynamic process of self-management during the 4 weeks post-discharge and by Lawton et al. to examine how patients with type 2 diabetes perceived their care after discharge over a period of four years [ 49 , 50 , 51 ]. Our study focused on the first two months following hospitalization and future studies should focus on following discharged and at-risk patients over a longer period, as “transitions of care do not comprise linear trajectories of patients’ movements, with a starting and finishing point. Instead, they are endless loops of movements” [ 47 ].

Our results provide a particularly thorough description of how participants move from a state of total dependency during hospitalization regarding their medication management to a sudden and complete autonomy after hospital discharge impacting medication management, understanding, and adherence in the first days after discharge for some participants. Several qualitative studies have described the lack of shared decision-making and the loss of patient autonomy during hospitalization, which had an impact on self-management and created conflicts with healthcare professionals [ 75 , 81 , 84 ]. Our study also highlights nuanced patient experiences, including varying levels of patient needs, involvement, and proactivity during hospitalization and outpatient care, and our results contribute to capturing different perspectives that contrast with some literature that often portrays patients as more passive recipients of care [ 14 , 15 , 74 , 75 ]. Shared decision-making and proactive medication are key elements as they contribute to a smoother transition and better outcomes for patients post-discharge [ 85 , 86 , 87 ].

Consistent with the literature, the study identifies some challenges in medication initiation post-discharge [ 16 , 17 , 88 ] but our results also describe how daily routine rapidly takes over, either solidifying adherence behavior or generating barriers to medication adherence. Participants’ nonadherence prior to hospitalization was a factor influencing participants’ adherence post-hospitalization and this association should be further investigated, as literature showed that hospitalized patients have high scores of non-adherence [ 89 ]. Mortel et al. showed that more than 20% of discharged patients stopped their medications earlier than agreed with the physician and 25% adapted their medication intake [ 90 ]. Furthermore, patients who self-managed their medications had a lower perception of the necessity of their medication than patients who received help, which could negatively impact medication adherence [ 91 ]. Although participants in our study had high BMQ scores for necessity and lower scores for concerns, some participants expressed doubts about the need for their medications and a lack of motivation a few weeks after discharge. Targeted pharmacy interventions for newly prescribed medications have been shown to improve medication adherence, and hospital discharge is an opportune moment to implement this service [ 92 , 93 ].

Many medication changes were made during the transition of care (a median number of 7 changes during hospitalization and 7 changes during the two months after discharge), especially medication additions during hospitalization and interruptions after hospitalization. While medication changes during hospitalization are well described, the many changes following discharge are less discussed [ 7 , 94 ]. A Danish study showed that approximately 65% of changes made during hospitalization were accepted by primary healthcare professionals but only 43% of new medications initiated during hospitalization were continued after discharge [ 95 ]. The numerous changes after discharge may be caused by unnecessary intensification of medications during hospitalization, delayed discharge letters, lack of standardized procedures, miscommunication, patient self-management difficulties, or in response to an acute situation [ 96 , 97 , 98 ]. During the transition of care, in our study, both new and experienced participants were faced with difficulties in managing and understanding medication changes, either for newly prescribed medication or changes in previous medications. Such difficulties corroborate the findings of the literature [ 9 , 10 , 47 ] and our results showed that the lack of understanding during hospitalization led to participants having questions about their medications, even weeks after discharge. Particular attention should be given to patients’ understanding of medication changes jointly by physicians, nurses and pharmacists during the transition of care and in the months that follow as medications are likely to undergo as many changes as during hospitalization.

Implication for practice and future research

The patients’ perspectives in this study showed, at a system level, that there was a lack of standardization in healthcare professional practices regarding medication dispensing and follow-up. For now, in Switzerland, there are no official guidelines on medication prescription and dispensation during the transition of care although some international guidelines have been developed for outpatient healthcare professionals [ 3 , 99 , 100 , 101 , 102 ]. Here are some suggestions for improvement arising from our results. Patients should be included as partners and healthcare professionals should systematically assess (i) previous medication adherence, (ii) patients’ desired level of involvement and (iii) their needs for information during hospitalization. Hospital discharge processes should be routinely implemented to standardize hospital discharge preparation, medication prescribing, and dispensing. Discharge from the hospital should be planned with community pharmacies to ensure that all medications are available and, if necessary, doses of medications should be supplied by the hospital to bridge the gap. A partnership with outpatient healthcare professionals, such as general practitioners, community pharmacists, and homecare nurses, should be set up for effective asynchronous interprofessional collaboration to consolidate patients’ medication management, knowledge, and adherence, as well as to monitor signs of deterioration or adverse drug events.

Future research should consolidate our first attempt to develop a framework to better characterize medication at the transition of care, using Fig. 2   as a starting point. Contextualized interventions, co-designed by health professionals, patients and stakeholders, should be tested in a hybrid implementation study to test the implementation and effectiveness of the intervention for the health system [ 103 ].

Limitations

This study has some limitations. First, the transcripts were validated for accuracy by the interviewer but not by a third party, which could have increased the robustness of the transcription. Nevertheless, the interviewer followed all methodological recommendations for transcription. Second, patient inclusion took place during the COVID-19 pandemic, which may have had an impact on patient care and the availability of healthcare professionals. Third, we cannot guarantee the accuracy of some participants’ medication history before hospitalization, even though we contacted the participants’ main pharmacy, as participants could have gone to different pharmacies to obtain their medications. Fourth, our findings may not be generalizable to other populations and other healthcare systems because some issues may be specific to multimorbid patients with type 2 diabetes or to the Swiss healthcare setting. Nevertheless, issues encountered by our participants regarding their medications correlate with findings in the literature. Fifth, only 15 out of 21 participants took part in all the interviews, but most participants took part in at least three interviews and data saturation was reached. Lastly, by its qualitative and longitudinal design, it is possible that the discussion during interviews and participants’ reflections between interviews influenced participants’ management, knowledge, and adherence, even though this study was observational, and no advice or recommendations were given by the interviewer during interviews.

Discharged patients are willing to take steps to better manage, understand, and adhere to their medications, yet they are also faced with difficulties in the hospital and outpatient care. Furthermore, extensive changes in medications not only occur during hospitalization but also during the two months following hospital discharge, for which healthcare professionals should give particular attention. The different degrees of patients’ involvement, needs and resources should be carefully considered to enable them to better manage, understand and adhere to their medications. At a system level, patients’ experiences revealed a lack of standardization of medication practices during the transition of care. The healthcare system should provide the ecosystem needed for healthcare professionals responsible for or involved in the management of patients’ medications during the hospital stay, discharge, and outpatient care to standardize their practices while considering the patient as an active partner.

Data availability

The anonymized quantitative survey datasets and the qualitative codes are available in French from the corresponding author on reasonable request.

Abbreviations

adverse drug events

Adherence Visual Analogue Scale

Belief in Medication Questionnaire

Consolidated Criteria for Reporting Qualitative Research

case report form

standard deviation

World Health Organization

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Acknowledgements

The authors would like to thank all the patients who took part in this study. We would also like to thank the Geneva University Hospitals Patients Partners + 3P platform as well as Mrs. Tourane Corbière and Mr. Joël Mermoud, patient partners, who reviewed interview guides for clarity and significance. We would like to thank Samuel Fabbi, Vitcoryavarman Koh, and Pierre Repiton for the transcriptions of the audio recordings.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Open access funding provided by University of Geneva

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LS, GG, and MS conceptualized and designed the study. LS and GG screened and recruited participants. LS conducted the interviews. LS, GG, and MS performed data analysis and interpretation. LS drafted the manuscript and LS and MS worked on the different versions. MS and GG approved the final manuscript.

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Solh Dost, L., Gastaldi, G. & Schneider, M. Patient medication management, understanding and adherence during the transition from hospital to outpatient care - a qualitative longitudinal study in polymorbid patients with type 2 diabetes. BMC Health Serv Res 24 , 620 (2024). https://doi.org/10.1186/s12913-024-10784-9

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ORIGINAL RESEARCH article

The potential protective role of peripheral immunophenotypes in alzheimer's disease: a mendelian randomization study provisionally accepted.

• 1 Department of Neurology, First Affiliated Hospital of Zhengzhou University, China
• 2 Academy of Medical Sciences, Zhengzhou University, China
• 3 Department of Neurology, First Affiliated Hospital of Zhengzhou University, China

The final, formatted version of the article will be published soon.

Introduction: Alzheimer's disease (AD) is the most widespread neurodegenerative disease in the world. Previous studies have shown that peripheral immune dysregulation plays a paramount role in AD, but whether there is a protective causal relationship between peripheral immunophenotypes and AD risk remains ambiguous. Methods: Two-sample Mendelian randomization (MR) was performed using large genome-wide association study (GWAS) genetic data to assess causal effects between peripheral immunophenotypes and AD risk. Utilizing the genetic associations of 731 immune cell traits as exposures. We adopted the inverse variance weighted method as the primary approach. The Weighted median and MR-Egger regression methods were employed as supplements. Various sensitivity analyses were performed to assess the robustness of the outcomes. Results: Based on the IVW method, we identified 14 immune cell traits that significantly reduced the risk of AD, of which six demonstrated statistical significance in both IVW and Weighted median methods. Among the seven immune traits, four were related to regulatory T (Treg) cells : (1) CD25++ CD45RA- CD4 not regulatory T cell % T cell (odds ratio (OR) [95% confidence interval (CI)] = 0.96 [0.95,0.98], adjusted P = 1.17E-02), (2) CD25++ CD45RA- CD4 not regulatory T cell % CD4+ T cell (OR [95% CI] = 0.97 [0.96,0.99], adjusted P = 3.77E-02), (3) Secreting CD4 regulatory T cell % CD4 regulatory T cell (OR [95% CI] = 0.98 [0.97,0.99], adjusted P = 7.10E-03), (4) Activated & secreting CD4 regulatory T cell % CD4 regulatory T cell(OR [95% CI] = 0.98 [0.97,0.99], adjusted P = 7.10E-03). In addition, HLA DR++ monocyte % monocyte (OR [95% CI] = 0.93 [0.89, 0.98], adjusted P = 4.87E-02) was associated with monocytes, and HLA DR on myeloid Dendritic Cell (OR [95% CI] = 0.93 [0.89, 0.97], adjusted P = 1.17E-02) was related to dendritic cells (DCs). Conclusion: These findings enhance the comprehension of the protective role of peripheral immunity in AD and provide further support for Treg and monocyte as potential targets for immunotherapy in AD.

Keywords: peripheral immunity, peripheral blood immune cell phenotype, Alzheimer's disease, Mendelian randomization, Protective factor

Received: 18 Mar 2024; Accepted: 17 May 2024.

Copyright: © 2024 Zuo, Hu, Hao, Li, Shi, Guo, Ma, Li, Liang, Chan, Mao, Xu and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD, PhD. Changhe Shi, First Affiliated Hospital of Zhengzhou University, Department of Neurology, Zhengzhou, China

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Foxit PDF “Flawed Design” Exploitation

Research by: Antonis Terefos

Introduction

PDF (Portable Document Format) files have become an integral part of modern digital communication. Renowned for their universality and fidelity, PDFs offer a robust platform for sharing documents across diverse computing environments. PDFs have evolved into a standard format for presenting text, images, and multimedia content with consistent layout and formatting, irrespective of the software, hardware, or operating system used to view them. This versatility has made PDFs indispensable in fields ranging from business and academia to government and personal use, serving as a reliable means of exchanging information in a structured and accessible manner.

In the realm of PDF viewers, Adobe Acrobat Reader reigns supreme as the industry’s dominant player. However, while Adobe Acrobat Reader holds the biggest market share, notable contenders are vying for attention, with Foxit PDF Reader being a prominent alternative. With more than 700 million users located in more than 200 countries and significant customers in the government sector like the US Air Force, Army, Navy & Missile Defense Agency, as well as in the technological sector like Google, Microsoft, Intel & Dell.

Check Point Research has identified an unusual pattern of behavior involving PDF exploitation, mainly targeting users of Foxit Reader. This exploit triggers security warnings that could deceive unsuspecting users into executing harmful commands. Check Point Research has observed variants of this exploit being actively utilized in the wild. Its low detection rate is attributed to the prevalent use of Adobe Reader in most sandboxes or antivirus solutions, as Adobe Reader is not susceptible to this specific exploit. Additionally, Check Point Research has observed various exploit builders, ranging from those coded in .NET to those written in Python, being used to deploy this exploit.

This exploit has been used by multiple threat actors, from e-crime to espionage. The campaigns have taken advantage of the low detection rate and protection against this exploit where actors have been spotted sharing those malicious PDF files even using nontraditional means such as Facebook. Check Point Research isolated and investigated three in-depth cases, ranging from an espionage campaign with a military focus to e-crime with multiple links and tools, achieving impressive attack chains.

The “Flawed Design”

Check Point Research discovered that samples from  EXPMON  produced unusual behavior when executed with Foxit Reader compared to Adobe Reader. The exploitation of victims occurs through a flawed design in Foxit Reader, which shows as a default option the “OK,” which could lead the majority of the targets to ignore those messages and execute the malicious code. The malicious command is executed once the victim “Agrees” to the default options twice.

The victim scenario is shown below: when opening the file, we come across the first pop-up, the default option “Trust once,” which is the correct approach.

Once clicking “OK“, the target comes across a second pop-up. If there were any chance the targeted user would read the first message, the second would be “Agreed” without reading. This is the case that the Threat Actors are taking advantage of this flawed logic and common human behavior, which provides as the default choice the most “harmful” one.

Attaching a debugger, we can observe the executed command and, with the use of PowerShell, will download and execute a malicious file.

Executed Command:

Analyzing the PDF file statically, we can obtain the executed logic behind it.

The initial link, which references the root of the PDF, is shown using the key  /Root . In this case, points to object  1 . Following this object, we can observe the key  /OpenAction , which by itself doesn’t indicate malicious activity. This is a key in a PDF file’s catalog dictionary. It specifies an action to be performed automatically when the document is opened. The next keys are responsible for the execution of the command,  /S /Launch  indicating to the Foxit Reader to launch an external application and  /Win  providing the information needed for the launched application. Later, keys  /F  and  /P  provide the application to execute and its parameters.

This sequence of keys triggers the two previous warnings in Foxit Reader, and with the flawed design and careless users, it is able to execute malicious commands that appear highly leveraged by threat actors. Meanwhile, the key  /Launch  appears not to be triggered for Adobe Reader.

Campaigns utilizing PDF Exploit

Check Point Research collected a plethora of malicious PDF files, taking advantage of the specific exploit targeting Foxit Reader users. Despite the majority of sandboxes and VirusTotal failing to trigger the exploit, given Adobe’s prevalence as the primary PDF Reader, numerous files from previous campaigns remained unretrieved. Nonetheless, we acquired a sufficient amount of dropped payloads from various origins, revealing a diverse range of malicious tools within the infection chain and prominent malware families such as:

• Agent-Tesla
• NanoCore RAT

We meticulously isolated and conducted in-depth research on particular instances where the initial PDF samples resulted in interesting campaigns. Through the analysis, we aimed to uncover unique insights into the nature and mechanisms of these infections.

Case I. Windows & Android Botnets with a Scent of Espionage

While researching, we stumbled upon a malicious PDF file with a suspicious “military” related name, “ Regarding Invitation to attend defence services Asia 2024 and National Security Asia 2024.pdf ”. The PDF was possibly distributed via a link to download. The campaign’s attack chain is simple, with the PDF downloading and executing a downloader of two executables, which will later on collect and upload various files such as Documents, Images, Archives, and Databases.

Command & Control

The downloader provides no functionality other than downloading and executing the two payloads, and the information sent to the C&C, which registers the bot, only displays the victims that received the following stage payloads.

Based on the creation date of those “bot-registration” files, we obtained the campaign dates and number of Bots added to the Botnet per day. The primary campaign appears to have occurred on April 5, 2024, which is the day with the most registered bots.

The attack chain and the use of specific tools testify to a campaign focused on espionage, and further findings of android infections using Rafel RAT testify to this assumption even further. Based on the obtained victim data, the Threat Actor has the capability of performing hybrid campaigns, which also resulted in a Two Factor Authentication (2FA) bypass. Check Point Research considers these campaigns to have been performed by the  APT-C-35 / DoNot Team .

Windows Campaign Technical Analysis

The PDF document was still hosted on the C&C, suggesting it could be downloaded using a download link instead of being sent as a file to potential victims.

Check Point Research analyzed the specific PDF document and discovered it was built using an open-source  PDF Builder , released on February 13, 2024. The command used once the “exploit” is triggered downloads an executable file from a remote server and executes it.

Machine Information

The executed downloader collects machine Information and writes it into “ %Appdata%/TestLog/$PC_Name.txt ”:

• Computer name

String decryption

The malware contains strings important to its functionality and is encrypted with a custom algorithm.

Network communication

The downloader has an unusual approach to retrieving the data that will be sent. It enumerates the files inside the folder  %Appdata%/TestLog/  and uploads it to the C&C:  hxxps://mailservicess.com/ghijkl/ghijkl/index.php

After registering the bot to the C&C, it downloads two payloads and stores them as %Appdata%/Intel/index.exe and %Appdata%/Intel/upload.exe . Both are executed with parameters “ pp ” with a “big” time difference between each other.

Persistence

The malware copies itself at  %Appdata%/Intel/Mozila/Systems.exe  and sets a Run registry path “ SOFTWARE\\Microsoft\\Windows\\CurrentVersion\\Run ” named “ TailoredExperiencesWithDiagnosticDataEnabled ” and values the copied path.

Downloaded Payloads

The first payload, “ in.exe ”, stored as “ index.exe ”, does not contain any network-related functionality. It is used for listing files inside the specific root directories  C:\\ ,  D:\\ ,  E:\\ ,  F:\\ ,  G:\\ ,  H:\\ ,  I:\\  and  Z:\\  and copies files with the below extensions to folder  %AppData%/htdocs/ .

A text summary of all copied files will be created at  %AppData%/output.exe .

The second payload, “ up.exe ,” stored as “ upload.exe ,” is executed after some time from the first payload and uses a similar string decryption to the downloader.

The uploader enumerates the files from  %Appdata%/htdocs/  and uploads them to the C&C using the same network communication used for the downloader.

The group has used those two downloaded payloads, but through further research, we discovered another tool that could be dropped depending on the interests of the group. The internal tool names are:

• indexer , which copies and makes a summary of files of interest.
• upload , a tool that uploads previous files
• screen,  a tool making screenshots and saves them to the same folder to be picked up by  upload .

Based on analyzed tools, we believe that further undiscovered tools could exist that serve different needs, such as stealers, which would drop their results into the mentioned folder so the upload tool could send them to the C&C.

Check Point Research also observed evidence of other malware and tooling from directories discovered on the C&C, but we haven’t managed to obtain any samples that could further verify our findings. The folders we discovered were:

• /AhMyth/ , is an open-source Android RAT
• /sliver/ , an open-source cross-platform red team framework similar to Cobalt Strike.
• /Keres/,  is a PowerShell reverse-shell backdoor with persistence for Windows and Linux.

Case II. Chained-Campaign

During this campaign, the multiple links to follow, commands, and files executed in order to result in a stealer and two mines. The initial part of the infection chain was achieved with a malicious PDF document targeting Foxit PDF Reader users. The file’s name is “ swift v2.pdf ”, possibly mainly targeting users from the United States, among other countries.

To this day, the PDF file still has a low detection rate among antivirus solutions, posing an even bigger threat. In one of the campaigns, the Threat Actor distributed it also via Facebook, passing undetected by the Social Media’s malware detectors.

Campaign Technical Analysis

Analyzing statically, the command triggered is  cmd.exe , and the malicious BAT file is downloaded by executing  curl .

The malicious payload opens the browser on a Facebook page; we are not exactly sure what this action is done for, possibly to distract the user from the malicious activities to be performed or from the empty PDF page. We managed to obtain similar BAT payloads with different legitimate pages opened, such as Amazon. One hypothesis could be that the website opened could indicate the platform where the users were targeted.

The “First payload” will download a second BAT file and store it in the  %Startup%  folder as  WindowsUpdate.bat  to maintain persistence. On reboot, the machine will execute using PowerShell, a Python file.

The “First payload” once dropping the persistence BAT file downloads and “installs” Python 3.9 at  C:\\Users\\Public\\python . At this point, it is even clearer that the final payload will be a Python file, which will be downloaded again using  curl  and then executed.

This Python file is a Loader that executes dynamically downloaded code. The first  exec  call will download an obfuscated Python info stealer and Miner dropper and the second  exec  will execute it. This info stealer targets only Chrome and Edge browsers and steals user’s credentials and cookies. In order to retrieve the actual C&C, the malware makes a GET request and then a POST to  /up/cookie-password-all  with the user’s Personal Identifiable Information (PII).

For “closing”, the malware makes two last GET requests to retrieve the actual URL for the miners to drop. Using PowerShell commands, downloads unzips and executes the miners.

Both of the miners are stored in Gitlab ( @topworld20241 ), and both of the ZIP archives contain the file to be executed  config.vbs  with the instructions and configuration of each miner.

Case III. Python Stealer with Low Detection

Another way of delivering the malicious end file could be more direct, such as downloading the malicious file from DiscordApp and executing it. This was the case with the below PDF infection chain downloading a malicious Python file.

Python files are not the usual suspects, which is testified even by the low detection rate; even more shocking is that this Python stealer is an open-source project called  Blank-Grabber  and not a newly discovered malware.

The PDF executes PowerShell and downloads the malicious file from DiscordApp, resulting in a “legitimate” appearing network traffic. The Python malware is then downloaded as  lol.pyw  and executed on the victim’s machine.

The malware is functional and possesses many features, from a Graphical Builder to UAC Bypass, Anti VM, and stealing capabilities from various browsers and applications.

What is interesting to see is the  class VmProtect , which lists all the anti-VM techniques.

From identifying known:

• Computer names
• Users names
• Registry key & values
• killing running tasks related to Virtual machines or any other malware-reversing related tools.
• Making Internet-related checks regarding the emulation of the network and checking if the system is hosted online.

Another interesting part is the function, which results in UAC bypass,  def UACbypass .

Blank-Grabber appears to be a fully functional open-source infostealer, and its low detection rate makes it an even bigger threat for targeted users.

Case IV. From PDF to PDF to … Remcos

Another interesting case occurred when a malicious PDF included a hyperlink to an attachment hosted on  trello.com . Upon downloading, it revealed a secondary PDF file containing malicious code, which takes advantage of this “exploitation” of Foxit Reader users. The attack chain is once again impressive, with multiple files being dropped in order to infect the victim with the final payload. In total, more than 10 files were executed, with the final malware  Remcos  RAT being injected into memory using the  DynnamicWrapperX .

The Threat Actor performing this campaign,  @Silentkillertv , appears to be selling also malicious tools via Telegram. On the 27th of April, the Threat Actor published a PDF Exploit, which targets Foxit PDF Reader and has  “100% Bypass of Anti-Viruses”  as well as is able to bypass  “Gmail, Yahoo, Facebook, and Hotmail file sharing restrictions” .

The first PDF file contained a malicious hyperlink that downloaded a PDF file named “ Facebook_Adversting_project.pdf ”.

Once clicking the link, the victim receives the second PDF file, which is hosted on trello.com a legitimate website. Similar to Discord, Threat Actors have been taking advantage of legitimate websites in order to host and distribute malicious files.

The file was uploaded on the 27th of April by “ Bechtelar Libby @bechtelarlibby ”.

The user’s initial activity seems to date back to March 1st, 2024. Judging by the file and folder names generated by the suspicious account, it appears that the targeted countries included Vietnam and Korea, among others.

In the second PDF, the exploitation targeting Foxit users is executed through the following PowerShell command:

At this point, multiple “links”/files need to be followed in order to retrieve the final payload. The first payload is downloaded as  NCGHDFHGTDFJMDFGKJHFTYFUKFYU.LNK  and is a  .lnk . This file downloads using curl a  .hta  file from a remote server and executes it from this location  %AppData%\STARTGOVFFGHJFKJHFTFDGHJF.HTA .

The HTA file initiates two requests to the identical server, fetching two files. One is a VBScript file, while the other is a genuine image, utilized as a decoy. Notably, this HTA file contained comments written in Arabic.

The third payload is stored as  %temp%\FGHJFTFDHBJVJHGVHJKFVJGTFKHFJH.VBS  and is executed before the genuine image. This VBScript is straightforward, downloading additional VBScript code and executing the “response” accordingly.

The VBScript code executes the following command:

The fifth payload is yet another  .hta  file that communicates with the same endpoint. It downloads and executes another VBScript file (sixth), which in turn downloads yet another VBScript file (seventh).

At this stage, the attack chain employed two PDF files employing distinct methods of “exploitation” and entailed seven requests and executions of scripting language files. The seventh payload (VBS) contains embedded Base64 strings.

• DynamicWrapperX  Loader, dynwrapx.dll (stored as  AUTOUPDATESTART.dll )
• Shellcode, to be injected into the Loader

Once the injection process is completed, it proceeds to load and execute the Shellcode, which subsequently decrypts the malicious executable. The infection ultimately manifests as Remcos RAT with the command and control server located at  139.99.85[.]106:2404 , operating under the botnet name “ Telegram : @Silentkillertv ”. Another instance of Remcos, identified by the hash  2266f701f749d4f393b8a123bd7208ec7d5b18bbd22eb47853b906686327ad59 , also utilizes the same command and control server. However, in this case, the botnet name was “ RemoteHost ”.

Check Point managed to uncover various “online-fingerprints,” ranging from YouTube and TikTok accounts to Telegram accounts and channels established by the actor. These platforms were utilized to disseminate malicious tools and resources.

Telegram Message from the Threat Actor:

After comprehending the exploit and identifying its key components, we initiated a hunt for additional malicious samples. Among the pool of collected files, we discovered several .NET and Python files that triggered our detection rule. Upon closer examination, we determined that these files were, in fact, the builders responsible for generating malicious samples.

Regardless of the programming language, all builders exhibit a consistent structure. The PDF template utilized for the exploit includes placeholder text, which is intended to be substituted once the user provides input for the URL from which to download the malicious file.

Python Builders

Check Point obtained two Python Builders, which were developed by the same author as they feature identical Python code. The only variation lies in the PowerShell command embedded in the PDF exploit template.

Figure 23 – Python Builder Source Code.

The command employed in this builder initially utilizes CMD, which then triggers PowerShell.

In the other Python builder, instead of dropping the payload as a  .vbs  file, it is dropped as a  .exe  file.

Once the actor has successfully built the PDF exploit, the final message is written in Portuguese:  “Payload generated successfully .”

.NET Builders

For .NET, we obtained multiple Builders “Avict Softwares I Exploit PDF”, “PDF Exploit Builder 2023”, and “FuckCrypt.” All of those three builders have similar code, and we wouldn’t be surprised if actors stole each other’s code and made their own builders.

“FuckCrypt” comprises two functionalities: one is “Exe to VBS,” and the other is the PDF exploit.

All the builders have the “same” commands and flow. The only thing different between them is the filenames. Below is their generic command with $+STRING, which shows the differences between them.

The Python builders share similar names with the “PDF Exploit Builder” (supporting only EXE), implying either they were developed by the same individual or that one of the builders was “copied” and developed to another language. A scenario where the code was stolen from .NET and rewritten Python seems more plausible. The similarity in names between “Avict Software” (which supports only EXE) and “FuckCrypt” (VBS) indicates a similar situation of potential code stealing between developers or the same author, as seen in the previous scenario.

Builders Statistics

From the observed filenames in the commands, it appears that the most frequently used builder is the “PDF Exploit Builder” & Python variants. There’s also the possibility that manual commands were added or that additional builders exist beyond those obtained.

Except from the observed Builders, we also discovered a  GitHub  project created on February 13 providing another .NET builder with exactly the same “exploit” commands as the previously mentioned. This same Builder is used by the APT group  APT-C-35 / DoNot Team.

While this “exploit” doesn’t fit the classical definition of triggering malicious activities, it could be more accurately categorized as a form of “phishing” or manipulation aimed at Foxit PDF Reader users, coaxing them into habitually clicking “OK” without understanding the potential risks involved. Threat Actors vary from E-crime to APT groups, with the underground ecosystem taking advantage of this “exploit” for years, as it had been “rolling undetected” as most AV & Sandboxes utilize the major player in PDF Readers, Adobe. The infection success and the low detection rate allow PDFs to be distributed via many untraditional ways, such as Facebook, without being stopped by any detection rules. Check Point reported the issue to Foxit Reader, which acknowledged it and stated that it would be resolved in version 2024 3.

Recommendations

Until the software update is applied, Foxit users are advised to remain vigilant about potential exploitation and adhere to classic defense practices. To mitigate the risks of being affected by such threats, it is essential to:

• Keep operating systems and applications updated through timely patches and other means.
• Be cautious of unexpected emails with links, especially from unknown senders.
• Enhance cybersecurity awareness among employees.
• Consult security specialists for any doubts or uncertainties.

Check Point Threat Emulation, Harmony Endpoint, and Harmony Mobile Protect provide comprehensive coverage of attack tactics, file types, and operating systems and protect its customers against the type of attacks and the “exploit” described in this report.

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