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• Developing Your Research Topic
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The research process : a guide: strategy.

• Research Guides
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Comprehensive research using scholarly resources is essential when writing a research paper. The following key resources will be helpful in determining a research strategy for any topic.

Determine a topic.   If your topic is too broad, you may find too many sources.  If it is too narrow, you may find very little information. If at all possible, try to discuss your topic with your GSI or professor prior to beginning the research process.  When you have evaluated several of the basic sources recommended, it is always a good idea to REFINE YOUR TOPIC mid-way through the research process, by clarifying the scope or depth of the subject you are doing research on. See the section below for more information on refining your topic.

Standardize note-taking.   Most students who are doing research for a paper consult various sources and often, half-way through the research process, forget which sources they've used, or have forgotten to take down important information such as dates, pages, and are never able to locate the source again.  To save time, keep consistent notes about sources in one place.  Consider using bibliographic software such as  Endnote or Zotero. 

Examine standard historical texts.   General art historical texts can provide good overviews that cover many periods and artists.  Bibliographies are usually included at the end of each chapter.  Footnotes citing additional publications can also be useful.

Consult an encyclopedia.   A general  (Encyclopedia Britannica) or subject-specific (Grove Art Online) encyclopedia can provide an excellent overview of a topic, and often provide historical context.  Encyclopedia articles are authored by scholars in the field, and often contain excellent bibliographies which can lead to additional sources.

Refining Your Topic

How to narrow a topic.

How do you know if your topic is too broad and needs to be narrowed?

• You are finding too much information on the topic – more sources exist than you can reasonably go through.
• You feel you are attempting to cover more information than you have room for in your paper.

Example: I would like to research Surrealist art.

This is a very broad subject which needs to be narrowed. When considering the categories below, we can narrow our topic to a specific Surrealist artist and one aspect of their work: 'Science in the Art of Remedios Varo'.

How to Broaden a Topic

How do you know if your topic is too narrow and needs to be broadened?

• You are finding very little information on the topic – you can't find many sources.
• Your topic is too new and not much research has been published on the topic yet.

Example: I want to research Thomas Campbell, a contemporary Bay Area artist.

This artist may not yet have a lot of sources published about his work or life. You may need to broaden your research to include the context within which he has worked, such as the Bay Area art in the 1990s+ and the Mission School artists group, and then focus on a aspect or event from this broader context.

Source Types

Dictionaries  (general or subject-specific) can be useful for tracking down unknown or obscure words and terms, and for related terms. Examples include:  A Concise Dictionary of the Avant-gardes ;  The Edinburgh Dictionary of Modernism ;  Dictionary of Subjects and Symbols in Art .

Catalogues Raisonné   present the complete works of an artist, often accompanied by a comprehensive bibliography. Search of these in  UC Library Search  and include 'catalogue raisonne' as a keyword.

Books  Search by author, title, keyword, or subject in  UC Library Search .

Art-related periodical indexes  lead to both popular and scholarly articles in the journal literature. List of  Indexes.  

Reference Sources  are sources such as handbooks, dictionaries and encyclopedias. Examples include: the  Routledge Encyclopedia of Modernism ;  Bloomsbury International Encyclopedia of Surrealism ;  Oxford Art Online . See our  guide page on reference works  for more information.

Book Reviews  written by authorities in the field can help evaluate scholarship. Book reviews are often found in professional journals or a publication such as  BookForum . You can also search in  UC Library Search  and include the keyword 'book review'.

Dissertations  can be found in  UC Library Search  or  Dissertations & Theses.  

Exhibition catalogs  contain scholarly essays and high quality images. Search in  UC Library Search  and include 'exhibition catalog' as a keyword.

Newspaper Articles  can be useful when searching for current artists and exhibition reviews. Search in  News Databases.

Primary Sources  represent first-hand accounts, such as oral histories, personal interviews, an artist's archives, etc.  The Bancroft Library, and the Berkeley Art Museum are excellent sources for finding original source material.  Also see  Calisphere  for digitized collections from libraries and archives around California. See the  Digital Public Library of America  for digital collections from archives and libraries around the U.S. Also search  WorldCat  and limit to Archival Materials. You may also use an archive directory such as  Archive Finder  or  ArchiveGrid  to find archives with relevant holdings.

Videos/Film  can provide documentaries on artists or works by artists and can be viewed in the Media Resources Center, Moffitt Library or viewed online via one of our online streaming collections such as  Kanopy  or  Art and Architecture in Video . You may also search  UC Library Search  and limit 'material type' to 'video/film'. Also see our guide on  art film & video .

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Writing a Research Strategy

This page is focused on providing practical tips and suggestions for preparing The Research Strategy, the primary component of an application's Research Plan along with the Specific Aims. The guidance on this page is primarily geared towards an R01-style application, however, much of it is useful for other grant types as well.

Developing the Research Strategy

The primary audience for your application is your peer review group. When writing your Research Strategy, your goal is to present a well-organized, visually appealing, and readable description of your proposed project and the rationale for pursuing it. Your writing should be streamlined and organized so your reviewers can readily grasp the information. If it's a key point, repeat it, then repeat it again. Add more emphasis by putting the text in bold , or bold italics . If writing is not your forte, get help.  For more information, please visit  W riting For Reviewers .

How to Organize the Research Strategy Section

How to organize a Research Strategy is largely up to the applicant. Start by following the NIH application instructions and guidelines for formatting attachments such as the research plan section.

It is generally structured as follows:

Significance

For  Preliminary Studies (for new applications) or a Progress Report (for renewal and revision applications).

• You can either include preliminary studies or progress report information as a subsection of Approach or integrate it into any or all of the three main sections.
• If you do the latter, be sure to mark the information clearly, for example, with a bold subhead.

 Helpful tips to consider when formatting:

• Organize using bold headers or an outline or numbering system—or both—that are used consistently throughout.
• Start each section with the appropriate header: Significance, Innovation, or Approach.
• Organize the Approach section around the Specific Aims.

For most applications, you need to address Rigor ous Study Design  by describing the experimental design and methods you propose and how they will achieve robust and unbiased results. See the NIH guidance for elaboration on the 4 major areas of rigor and transparency emphasized in grant review.  These requirements apply to research grant, career development, fellowship, and training applications.

Tips for Drafting Sections of the Research Strategy

Although you will emphasize your project's significance throughout the application, the Significance section should give the most details. The farther removed your reviewers are from your field, the more information you'll need to provide on basic biology, importance of the area, research opportunities, and new findings. Reviewing the potentially relevant study section rosters may give you some ideas as to general reviewer expertise. You will also need to describe the prior and preliminary studies that provide a strong scientific rationale for pursuing the proposed studies, emphasizing the strengths and weaknesses in the rigor and transparency of these key studies.

This section gives you the chance to explain how your application is conceptually and/or technically innovative. Some examples as to how you might do this could include but not limited to:

• Demonstrate the proposed research is new and unique, e.g., explores new scientific avenues, has a novel hypothesis, will create new knowledge.
• Explain how the proposed work can refine, improve, or propose a new application of an existing concept or method.

If your proposal is paradigm-shifting or challenges commonly held beliefs, be sure that you include sufficient evidence in your preliminary data to convince reviewers, including strong rationale, data supporting the approach, and clear feasibility. Your job is to make the reviewers feel confident that the risk is worth taking.

For projects predominantly focused on innovation and outside-the-box research, investigators may wish to consider mechanisms other than R01s for example (e.g., exploratory/developmental research (R21) grants, NIH Director's Pioneer Award Program (DP1), and NIH Director's New Innovator Award Program (DP2).

The Approach section is where the experimental design is described. Expect your assigned reviewers to scrutinize your approach: they will want to know what you plan to do, how you plan to do it, and whether you can do it. NIH data show that of the peer review criteria, approach has the highest correlation with the overall impact score. Importantly, elements of rigorous study design should be addressed in this section, such as plans for minimization of bias (e.g. methods for blinding and treatment randomization) and consideration of relevant biological variables. Likewise, be sure to lay out a plan for alternative experiments and approaches in case you get uninterpretable or surprising results, and also consider limitations of the study and alternative interpretations. Point out any procedures, situations, or materials that may be hazardous to personnel and precautions to be exercised. A full discussion on the use of select agents should appear in the Select Agent Research attachment.  Consider including a timeline demonstrating anticipated completion of the Aims. 

Here are some pointers to consider when organizing your Approach section:

• Enter a bold header for each Specific Aim.
• Under each aim, describe the experiments.
• If you get result X, you will follow pathway X; if you get result Y, you will follow pathway Y.
• Consider illustrating this with a flowchart.

Preliminary Studies

If submitting a new application to a NOFO that allows preliminary data, it is strongly encouraged to include preliminary studies.  Preliminary studies demonstrate competency in the methods and interpretation. Well-designed and robust preliminary studies also serve to provide a strong scientific rationale for the proposed follow-up experiments. Reviewers also use preliminary studies together with the biosketches to assess the investigator review criterion, which reflects the competence of the research team. Provide alternative interpretations to your data to show reviewers you've thought through problems in-depth and are prepared to meet future challenges. As noted above, preliminary data can be put anywhere in the Research Strategy, but just make sure reviewers will be able to distinguish it from the proposed studies. Alternatively, it can be a separate section with its own header.

Progress Reports

If applying for a renewal or a revision (a competing supplement to an existing grant), include a progress report for reviewers.

Create a header so reviewers can easily find it and include the following information:

• Project period beginning and end dates.
• Summary of the importance and robustness of the completed findings in relation to the Specific Aims.
• Account of published and unpublished results, highlighting progress toward achieving your Specific Aims.

Other Helpful Tips

Referencing publications.

References show breadth of knowledge of the field and provide a scientific foundation for your application. If a critical work is omitted, reviewers may assume the applicant is not aware of it or deliberately ignoring it.

Throughout the application, reference all relevant publications for the concepts underlying your research and your methods. Remember the strengths and weaknesses in the rigor of the key studies you cite for justifying your proposal will need to be discussed in the Significance and/or Approach sections.

Read more about Bibliography and References Cited at Additional Application Elements .

Graphics can illustrate complex information in a small space and add visual interest to your application. Including schematics, tables, illustrations, graphs, and other types of graphics can enhance applications. Consider adding a timetable or flowchart to illustrate your experimental plan, including decision trees with alternative experimental pathways to help your reviewers understand your plans.

Video may enhance your application beyond what graphics alone can achieve. If you plan to send one or more videos, you'll need to meet certain requirements and include key information in your Research Strategy. State in your cover letter that a video will be included in your application (don't attach your files to the application). After you apply and get assignment information from the Commons, ask your assigned Scientific Review Officer (SRO) how your business official should send the files. Your video files are due at least one month before the peer review meeting.

However, you can't count on all reviewers being able to see or hear video, so you'll want to be strategic in how you incorporate it into your application by taking the following steps:

• Caption any narration in the video.
• Include key images from the video
• Write a description of the video, so the text would make sense even without the video.

Tracking for Your Budget

As you design your experiments, keep a running tab of the following essential data:

• Who. A list of people who will help (for the Key Personnel section later).
• What. A list of equipment and supplies for the experiments
• Time. Notes on how long each step takes. Timing directly affects the budget as well as how many Specific Aims can realistically be achieved.

Jotting this information down will help when Creating a Budget  and complete other sections later.

Review and Finalize Your Research Plan

Critically review the research plan through the lens of a reviewer to identify potential questions or weak spots.

Enlist others to review your application with a fresh eye. Include people who aren't familiar with the research to make sure the proposed work is clear to someone outside the field.

When finalizing the details of the Research Strategy, revisit and revise the Specific Aims as needed. Please see Writing Specific Aims . 

comments Want to contact NINDS staff? Please visit our Find Your NINDS Program Officer page to learn more about contacting Program Officer, Grants Management Specialists, Scientific Review Officers, and Health Program Specialists.

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• Knowledge Base
• Methodology

Research Design | Step-by-Step Guide with Examples

Published on 5 May 2022 by Shona McCombes . Revised on 20 March 2023.

A research design is a strategy for answering your research question  using empirical data. Creating a research design means making decisions about:

• Your overall aims and approach
• The type of research design you’ll use
• Your sampling methods or criteria for selecting subjects
• Your data collection methods
• The procedures you’ll follow to collect data
• Your data analysis methods

A well-planned research design helps ensure that your methods match your research aims and that you use the right kind of analysis for your data.

Table of contents

Step 1: consider your aims and approach, step 2: choose a type of research design, step 3: identify your population and sampling method, step 4: choose your data collection methods, step 5: plan your data collection procedures, step 6: decide on your data analysis strategies, frequently asked questions.

• Introduction

Before you can start designing your research, you should already have a clear idea of the research question you want to investigate.

There are many different ways you could go about answering this question. Your research design choices should be driven by your aims and priorities – start by thinking carefully about what you want to achieve.

The first choice you need to make is whether you’ll take a qualitative or quantitative approach.

Qualitative research designs tend to be more flexible and inductive , allowing you to adjust your approach based on what you find throughout the research process.

Quantitative research designs tend to be more fixed and deductive , with variables and hypotheses clearly defined in advance of data collection.

It’s also possible to use a mixed methods design that integrates aspects of both approaches. By combining qualitative and quantitative insights, you can gain a more complete picture of the problem you’re studying and strengthen the credibility of your conclusions.

Practical and ethical considerations when designing research

As well as scientific considerations, you need to think practically when designing your research. If your research involves people or animals, you also need to consider research ethics .

• How much time do you have to collect data and write up the research?
• Will you be able to gain access to the data you need (e.g., by travelling to a specific location or contacting specific people)?
• Do you have the necessary research skills (e.g., statistical analysis or interview techniques)?
• Will you need ethical approval ?

At each stage of the research design process, make sure that your choices are practically feasible.

Prevent plagiarism, run a free check.

Within both qualitative and quantitative approaches, there are several types of research design to choose from. Each type provides a framework for the overall shape of your research.

Types of quantitative research designs

Quantitative designs can be split into four main types. Experimental and   quasi-experimental designs allow you to test cause-and-effect relationships, while descriptive and correlational designs allow you to measure variables and describe relationships between them.

With descriptive and correlational designs, you can get a clear picture of characteristics, trends, and relationships as they exist in the real world. However, you can’t draw conclusions about cause and effect (because correlation doesn’t imply causation ).

Experiments are the strongest way to test cause-and-effect relationships without the risk of other variables influencing the results. However, their controlled conditions may not always reflect how things work in the real world. They’re often also more difficult and expensive to implement.

Types of qualitative research designs

Qualitative designs are less strictly defined. This approach is about gaining a rich, detailed understanding of a specific context or phenomenon, and you can often be more creative and flexible in designing your research.

The table below shows some common types of qualitative design. They often have similar approaches in terms of data collection, but focus on different aspects when analysing the data.

Your research design should clearly define who or what your research will focus on, and how you’ll go about choosing your participants or subjects.

In research, a population is the entire group that you want to draw conclusions about, while a sample is the smaller group of individuals you’ll actually collect data from.

Defining the population

A population can be made up of anything you want to study – plants, animals, organisations, texts, countries, etc. In the social sciences, it most often refers to a group of people.

For example, will you focus on people from a specific demographic, region, or background? Are you interested in people with a certain job or medical condition, or users of a particular product?

The more precisely you define your population, the easier it will be to gather a representative sample.

Sampling methods

Even with a narrowly defined population, it’s rarely possible to collect data from every individual. Instead, you’ll collect data from a sample.

To select a sample, there are two main approaches: probability sampling and non-probability sampling . The sampling method you use affects how confidently you can generalise your results to the population as a whole.

Probability sampling is the most statistically valid option, but it’s often difficult to achieve unless you’re dealing with a very small and accessible population.

For practical reasons, many studies use non-probability sampling, but it’s important to be aware of the limitations and carefully consider potential biases. You should always make an effort to gather a sample that’s as representative as possible of the population.

Case selection in qualitative research

In some types of qualitative designs, sampling may not be relevant.

For example, in an ethnography or a case study, your aim is to deeply understand a specific context, not to generalise to a population. Instead of sampling, you may simply aim to collect as much data as possible about the context you are studying.

In these types of design, you still have to carefully consider your choice of case or community. You should have a clear rationale for why this particular case is suitable for answering your research question.

For example, you might choose a case study that reveals an unusual or neglected aspect of your research problem, or you might choose several very similar or very different cases in order to compare them.

Data collection methods are ways of directly measuring variables and gathering information. They allow you to gain first-hand knowledge and original insights into your research problem.

You can choose just one data collection method, or use several methods in the same study.

Survey methods

Surveys allow you to collect data about opinions, behaviours, experiences, and characteristics by asking people directly. There are two main survey methods to choose from: questionnaires and interviews.

Observation methods

Observations allow you to collect data unobtrusively, observing characteristics, behaviours, or social interactions without relying on self-reporting.

Observations may be conducted in real time, taking notes as you observe, or you might make audiovisual recordings for later analysis. They can be qualitative or quantitative.

Other methods of data collection

There are many other ways you might collect data depending on your field and topic.

If you’re not sure which methods will work best for your research design, try reading some papers in your field to see what data collection methods they used.

Secondary data

If you don’t have the time or resources to collect data from the population you’re interested in, you can also choose to use secondary data that other researchers already collected – for example, datasets from government surveys or previous studies on your topic.

With this raw data, you can do your own analysis to answer new research questions that weren’t addressed by the original study.

Using secondary data can expand the scope of your research, as you may be able to access much larger and more varied samples than you could collect yourself.

However, it also means you don’t have any control over which variables to measure or how to measure them, so the conclusions you can draw may be limited.

As well as deciding on your methods, you need to plan exactly how you’ll use these methods to collect data that’s consistent, accurate, and unbiased.

Planning systematic procedures is especially important in quantitative research, where you need to precisely define your variables and ensure your measurements are reliable and valid.

Operationalisation

Some variables, like height or age, are easily measured. But often you’ll be dealing with more abstract concepts, like satisfaction, anxiety, or competence. Operationalisation means turning these fuzzy ideas into measurable indicators.

If you’re using observations , which events or actions will you count?

If you’re using surveys , which questions will you ask and what range of responses will be offered?

You may also choose to use or adapt existing materials designed to measure the concept you’re interested in – for example, questionnaires or inventories whose reliability and validity has already been established.

Reliability and validity

Reliability means your results can be consistently reproduced , while validity means that you’re actually measuring the concept you’re interested in.

For valid and reliable results, your measurement materials should be thoroughly researched and carefully designed. Plan your procedures to make sure you carry out the same steps in the same way for each participant.

If you’re developing a new questionnaire or other instrument to measure a specific concept, running a pilot study allows you to check its validity and reliability in advance.

Sampling procedures

As well as choosing an appropriate sampling method, you need a concrete plan for how you’ll actually contact and recruit your selected sample.

That means making decisions about things like:

• How many participants do you need for an adequate sample size?
• What inclusion and exclusion criteria will you use to identify eligible participants?
• How will you contact your sample – by mail, online, by phone, or in person?

If you’re using a probability sampling method, it’s important that everyone who is randomly selected actually participates in the study. How will you ensure a high response rate?

If you’re using a non-probability method, how will you avoid bias and ensure a representative sample?

Data management

It’s also important to create a data management plan for organising and storing your data.

Will you need to transcribe interviews or perform data entry for observations? You should anonymise and safeguard any sensitive data, and make sure it’s backed up regularly.

Keeping your data well organised will save time when it comes to analysing them. It can also help other researchers validate and add to your findings.

On their own, raw data can’t answer your research question. The last step of designing your research is planning how you’ll analyse the data.

Quantitative data analysis

In quantitative research, you’ll most likely use some form of statistical analysis . With statistics, you can summarise your sample data, make estimates, and test hypotheses.

Using descriptive statistics , you can summarise your sample data in terms of:

• The distribution of the data (e.g., the frequency of each score on a test)
• The central tendency of the data (e.g., the mean to describe the average score)
• The variability of the data (e.g., the standard deviation to describe how spread out the scores are)

The specific calculations you can do depend on the level of measurement of your variables.

Using inferential statistics , you can:

• Make estimates about the population based on your sample data.
• Test hypotheses about a relationship between variables.

Regression and correlation tests look for associations between two or more variables, while comparison tests (such as t tests and ANOVAs ) look for differences in the outcomes of different groups.

Your choice of statistical test depends on various aspects of your research design, including the types of variables you’re dealing with and the distribution of your data.

Qualitative data analysis

In qualitative research, your data will usually be very dense with information and ideas. Instead of summing it up in numbers, you’ll need to comb through the data in detail, interpret its meanings, identify patterns, and extract the parts that are most relevant to your research question.

Two of the most common approaches to doing this are thematic analysis and discourse analysis .

There are many other ways of analysing qualitative data depending on the aims of your research. To get a sense of potential approaches, try reading some qualitative research papers in your field.

A sample is a subset of individuals from a larger population. Sampling means selecting the group that you will actually collect data from in your research.

For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.

Statistical sampling allows you to test a hypothesis about the characteristics of a population. There are various sampling methods you can use to ensure that your sample is representative of the population as a whole.

Operationalisation means turning abstract conceptual ideas into measurable observations.

For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioural avoidance of crowded places, or physical anxiety symptoms in social situations.

Before collecting data , it’s important to consider how you will operationalise the variables that you want to measure.

The research methods you use depend on the type of data you need to answer your research question .

• If you want to measure something or test a hypothesis , use quantitative methods . If you want to explore ideas, thoughts, and meanings, use qualitative methods .
• If you want to analyse a large amount of readily available data, use secondary data. If you want data specific to your purposes with control over how they are generated, collect primary data.
• If you want to establish cause-and-effect relationships between variables , use experimental methods. If you want to understand the characteristics of a research subject, use descriptive methods.

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VII. Researched Writing

7.3 Developing a Research Strategy

Deborah Bernnard; Greg Bobish; Jenna Hecker; Irina Holden; Allison Hosier; Trudi Jacobson; Tor Loney; Daryl Bullis; and Sarah LeMire

Sarah’s art history professor just assigned the course project and Sarah is delighted that it isn’t the typical research paper. Rather, it involves putting together a website to help readers understand a topic. It will certainly help Sarah get a grasp on the topic herself. Learning by attempting to teach others, she agrees, might be a good idea. The professor wants the website to be written for people who are interested in the topic and with backgrounds similar to the students in the course. Sarah likes that a target audience is defined, and since she has a good idea of what her friends might understand and what they would need more help with, she thinks it will be easier to know what to include in her site…well, at least easier than writing a paper for an expert like her professor.

An interesting feature of this course is that the professor has formed the students into teams. Sarah wasn’t sure she liked this idea at the beginning, but it seems to be working out okay. Sarah’s team has decided that their topic for this website will be 19 th century women painters. Her teammate Chris seems concerned: “Isn’t that an awfully big topic?” The team checks with the professor who agrees they would be taking on far more than they could successfully explain on their website. He suggests they develop a draft thesis statement to help them focus, and after several false starts, they come up with:

The involvement of women painters in the Impressionist movement had an effect upon the subjects portrayed.

They decide this sounds more manageable. Because Sarah doesn’t feel comfortable on the technical aspects of setting up the website, she offers to start locating resources that will help them to develop the site’s content. The next time the class meets, Sarah tells her teammates what she has done so far:

“I thought I’d start with some scholarly sources, since they should be helpful, right? I put a search into the online catalog for the library, but nothing came up! The library should have books on this topic, shouldn’t it? I typed the search in exactly as we have it in our thesis statement. That was so frustrating. Since that didn’t work, I tried Google, and put in the search. I got over 8 million results, but when I looked over the ones on the first page, they didn’t seem very useful. One was about the feminist art movement in the 1960s, not during the Impressionist period. The results all seemed to have the words I typed highlighted, but most really weren’t useful. I am sorry I don’t have much to show you. Do you think we should change our topic?”

Alisha suggests that Sarah talk with a reference librarian . She mentions that a librarian came to talk to one of her other classes about doing research, and it was really helpful. Alisha thinks that maybe Sarah shouldn’t have entered the entire thesis statement as the search, and maybe she should have tried databases to find articles. The team decides to brainstorm all the search tools and resources they can think of.

Here’s what they came up with:

Brainstormed List of Search Tools and Resources

Based on your experience, do you see anything you would add?

Sarah and her team think that their list is pretty good. They decide to take it further and list the advantages and limitations of each search tool, at least as far as they can determine.

Brainstormed Advantages and Disadvantages of Search Tools and Resources

Alisha suggests that Sarah should show the worksheet to a librarian and volunteers to go with her. The librarian, Mr. Harrison, says they have made a really good start, but he can fill them in on some other search strategies that will help them to focus on their topic. He asks if Sarah and Alisha would like to learn more.

Let’s step back from this case study and think about the elements that someone doing research should plan before starting to enter search terms in Google, Wikipedia, or even a scholarly database. There is some preparation you can do to make things go much more smoothly than they have for Sarah.

Self-Reflection

As you work through your own research quests, it is very important to be self-reflective. Consider:

• What do you really need to find?
• Do you need to learn more about the general subject before you can identify the focus of your search?
• How thoroughly did you develop your search strategy?
• Did you spend enough time finding the best tools to search?
• What is going really well, so well that you’ll want to remember to do it in the future?

Another term for what you are doing is metacognition, or thinking about your thinking. Reflect on what Sarah is going through. Does some of it sound familiar based on your own experiences? You may already know some of the strategies presented here. Do you do them the same way? How does it work? What pieces are new to you? When might you follow this advice? Don’t just let the words flow over you; rather, think carefully about the explanation of the process. You may disagree with some of what you read. If you do, follow through and test both methods to see which provides better results.

Selecting Search Tools

After you have thought the planning process through more thoroughly, think about the best place to find information for your topic and for the type of paper. Part of planning to do research is determining which search tools will be the best ones to use. This applies whether you are doing scholarly research or trying to answer a question in your everyday life, such as what would be the best place to go on vacation. “Search tools” might be a bit misleading since a person might be the source of the information you need. Or it might be a web search engine , a specialized database , an association—the possibilities are endless. Often people automatically search Google first, regardless of what they are looking for. Choosing the wrong search tool may just waste your time and provide only mediocre information, whereas other sources might provide really spot-on information and quickly, too. In some cases, a carefully constructed search on Google, particularly using the advanced search option, will provide the necessary information, but other times it won’t. This is true of all sources: make an informed choice about which ones to use for a specific need.

So, how do you identify search tools? Let’s begin with a first-rate method. For academic research, talking with a librarian or your professor is a great start. They will direct you to those specialized tools that will provide access to what you need. If you ask a librarian for help, they may also show you some tips about searching in the resources. This section will cover some of the generic strategies that will work in many search tools, but a librarian can show you very specific ways to focus your search and retrieve the most useful items.

If neither your professor nor a librarian is available when you need help, take a look at the TAMU Libraries website . There is a Help button in the top right corner of the website that will direct you to assistance via phone, chat, text, and email. Under the Guides button, you’ll find class- and subject-related guides that list useful databases and other resources for particular classes and majors to assist researchers. There is also a directory of the databases the library subscribes to and the subjects they cover. Take advantage of the expertise of librarians by using such guides. Novice researchers usually don’t think of looking for this type of help and, as a consequence, often waste time.

When you are looking for non-academic material, consider who cares about this type of information. Who works with it? Who produces it or the help guides for it? Some sources are really obvious and you are already using them—for example, if you need information about the weather in London three days from now, you might check Weather.com for London’s forecast. You don’t go to a library (in person or online), and you don’t do a research database search. For other information you need, think the same way. Are you looking for anecdotal information on old railroads? Find out if there is an organization of railroad buffs. You can search on the web for this kind of information or, if you know about and have access to it, you could check the Encyclopedia of Associations. This source provides entries for all U.S. membership organizations which can quickly lead you to a potentially wonderful source of information. Librarians can point you to tools like these.

Consider Asking an Expert

Have you thought about using people, not just inanimate sources, as a way to obtain information? This might be particularly appropriate if you are working on an emerging topic or a topic with local connections. There are a variety of reasons that talking with someone will add to your research.

For personal interactions, there are other specific things you can do to obtain better results. Do some background work on the topic before contacting the person you hope to interview. The more familiarity you have with your topic and its terminology, the easier it will be to ask focused questions. Focused questions are important if you want to get into the meat of what you need. Asking general questions because you think the specifics might be too detailed rarely leads to the best information. Acknowledge the time and effort someone is taking to answer your questions, but also realize that people who are passionate about subjects enjoy sharing what they know. Take the opportunity to ask experts about sources they would recommend. One good place to start is with the librarians at the Texas A&M University Libraries. Visit the library information page for details on how to contact a librarian. [1]

Determining Search Concepts and Keywords

Once you’ve selected some good resources for your topic, and possibly talked with an expert, it is time to move on to identify words you will use to search for information on your topic in various databases and search engines. This is sometimes referred to as building a search query . When deciding what terms to use in a search, break down your topic into its main concepts. Don’t enter an entire sentence or a full question. Different databases and search engines process such queries in different ways, but many look for the entire phrase you enter as a complete unit rather than the component words. While some will focus on just the important words, such as Sarah’s Google search that you read about earlier in this chapter, the results are often still unsatisfactory. The best thing to do is to use the key concepts involved with your topic. In addition, think of synonyms or related terms for each concept. If you do this, you will have more flexibility when searching in case your first search term doesn’t produce any or enough results. This may sound strange since, if you are looking for information using a Web search engine, you almost always get too many results. Databases, however, contain fewer items, and having alternative search terms may lead you to useful sources. Even in a search engine like Google, having terms you can combine thoughtfully will yield better results.

The worksheet in Figure 7.3.1 [2] is an example of a process you can use to come up with search terms. It illustrates how you might think about the topic of violence in high schools. Notice that this exact phrase is not what will be used for the search. Rather, it is a starting point for identifying the terms that will eventually be used.

Example Search Term Brainstorming Worksheet

Now, use a clean copy of the same worksheet (Figure 7.3.2) [3] to think about the topic Sarah’s team is working on. How might you divide their topic into concepts and then search terms? Keep in mind that the number of concepts will depend on what you are searching for and that the search terms may be synonyms or narrower terms. Occasionally, you may be searching for something very specific, and in those cases, you may need to use broader terms as well. Jot down your ideas, then compare what you have written to the information on the second, completed worksheet (Figure 7.3.3) [4] and identify three differences.

Boolean Operators

Once you have the concepts you want to search, you need to think about how you will enter them into the search box. Often, but not always, Boolean operators will help you. You may be familiar with Boolean operators as they provide a way to link terms. There are three Boolean operators: AND , OR , and NOT . (Note: Some databases require Boolean operators to be in all caps while others will accept the terms in either upper or lower case.

We will start by capturing the ideas of the women creating the art. We will use women painters and women artists as the first step in our sample search. You could do two separate searches by typing one or the other of the terms into the search box of whatever tool you are using:

women painters women artists

You would end up with two separate results lists and have the added headache of trying to identify unique items from the lists. You could also search on the phrase:

women painters AND women artists

But once you understand Boolean operators, that last strategy won’t make as much sense as it seems to. The first Boolean operator is AND. AND is used to get the intersection of all the terms you wish to include in your search. With this example,

you are asking that the items you retrieve have both of those terms. If an item only has one term, it won’t show up in the results. This is not what the searcher had in mind—she is interested in both artists and painters because she doesn’t know which term might be used. She doesn’t intend that both terms have to be used. Let’s go on to the next Boolean operator, which will help us out with this problem.

OR is used when you want at least one of the terms to show up in the search results. If both do, that’s fine, but it isn’t a condition of the search. So OR makes a lot more sense for this search:

women painters OR women artists

Now, if you want to get fancy with this search, you could use both AND as well as OR :

women AND (painters OR artists)

The parentheses mean that these two concepts, painters and artists, should be searched as a unit, and the search results should include all items that use one word or the other. The results will then be limited to those items that contain the word women . If you decide to use parentheses for appropriate searches, make sure that the items contained within them are related in some way. With OR , as in our example, it means either of the terms will work. With AND , it means that both terms will appear in the document.

Type both of the searches above in Google Scholar (scholar.google.com) and compare the results.

• Were they the same?
• If not, can you determine what happened?
• Which results list looked better?

Here is another example of a search string using both parentheses and two Boolean operators:

entrepreneurship AND (adolescents OR teens)

In this search, you are looking for entrepreneurial initiatives connected with people in their teens. Because there are so many ways to categorize this age group, it makes sense to indicate that either of these terms should appear in the results along with entrepreneurship.

The search string above isn’t perfect. Can you pick out two problems with the search terms?

The third Boolean operator, NOT , can be problematic. NOT is used to exclude items from your search. If you have decided, based on the scope of the results you are getting, to focus only on a specific aspect of a topic, use NOT , but be aware that items are being lost in this search.

For example, if you entered

entrepreneurship AND (adolescents OR teens) NOT adults

you might lose some good results.

Why might you lose some good results using the search above?

Other Helpful Search Techniques

Using Boolean operators isn’t the only way you can create more useful searches. In this section, we will review several others.

In this search:

entrepreneurs AND (adolescents OR teens)

you might think that the items that are retrieved from the search can refer to entrepreneurs and to terms from the same root, like entrepreneurship. But because computers are very literal, they usually look for the exact terms you enter. While some search engines like Google are moving beyond this model, library databases tend to require more precision. Truncation, or searching on the root of a word and whatever follows, is how you can tell the database to do this type of search.

So, if you search on:

entrepreneur * AND (adolescents OR teens)

You will get items that refer to entrepreneur , but also entrepreneurship .

Look at these examples:

adolescen * educat *

Think of two or three words you might retrieve when searching on these roots. It is important to consider the results you might get and alter the root if need be. An example of this is polic * . Would it be a good idea to use this root if you wanted to search on policy or policies ? Why or why not?

In some cases, a symbol other than an asterisk is used. To determine what symbol to use, check the help section in whatever resource you are using. The topic should show up under the truncation or stemming headings.

Phrase Searches

Phrase searches are particularly useful when searching the web. If you put the exact phrase you want to search in quotation marks, you will only get items with those words as a phrase and not items where the words appear separately in a document, website, or other resource. Your results will usually be fewer, although surprisingly, this is not always the case.

Try these two searches in the search engine of your choice:

• “ essay exam” 

Was there a difference in the quality and quantity of results?

If you would like to find out if the database or search engine you are using allows phrase searching and the conventions for doing so, search the help section. These help tools can be very, well, helpful!

Advanced Searches

Advanced searching allows you to refine your search query and prompts you for ways to do this. Consider the basic Google search box. It is very minimalistic, but that minimalism is deceptive. It gives the impression that searching is easy and encourages you to just enter your topic without much thought to get results. You certainly do get many results, but are they really good results? Simple search boxes do many searchers a disfavor. There is a better way to enter searches.

Advanced search screens show you many of the options available to you to refine your search and, therefore, get more manageable numbers of better items. Many web search engines include advanced search screens, as do databases for searching research materials. Advanced search screens will vary from resource to resource and from web search engine to research database, but they often let you search using:

• Implied Boolean operators (for example, the “all the words” option is the same as using the Boolean AND );
• Limiters for date, domain (.edu, for example), type of resource (articles, book reviews, patents);
• Field (a field is a standard element, such as title of publication or author’s name);
• Phrase (rather than entering quote marks) Let’s see how this works in practice.

Practical Application: Google Searches

Go to the advanced search option in Google. You can find it at http://www.google.com/advanced_search

Take a look at the options Google provides to refine your search. Compare this to the basic Google search box. One of the best ways you can become a better searcher for information is to use the power of advanced searches, either by using these more complex search screens or by remembering to use Boolean operators, phrase searches, truncation, and other options available to you in most search engines and databases.

While many of the text boxes at the top of the Google Advanced Search page mirror concepts already covered in this section (for example, “this exact word or phrase” allows you to omit the quotes in a phrase search), the options for narrowing your results can be powerful. You can limit your search to a particular domain (such as .edu for items from educational institutions) or you can search for items you can reuse legally (with attribution, of course!) by making use of the “usage rights” option. However, be careful with some of the options as they may excessively limit your results. If you aren’t certain about a particular option, try your search with and without using it and compare the results. If you use a search engine other than Google, check to see if it offers an advanced search option: many do.

Subject Headings

In the section on advanced searches, you read about field searching. To explain further, if you know that the last name of the author whose work you are seeking is Wood, and that he worked on forestry-related topics, you can do a far better search using the author field. Just think what you would get in the way of results if you entered a basic search such as forestry AND wood . It is great to use the appropriate Boolean operator, but oh, the results you will get! But what if you specified that wood had to show up as part of the author’s name? This would limit your results quite a bit.

So what about forestry ? Is there a way to handle that using a field search? The answer is yes. Subject headings are terms that are assigned to items to group them. An example is cars—you could also call them autos, automobiles, or even more specific labels like SUVs or vans. You might use the Boolean operator OR and string these all together. But if you found out that the sources you are searching use automobiles as the subject heading, you wouldn’t have to worry about all these related terms, and could confidently use their subject heading and get all the results, even if the author of the piece uses cars and not automobiles .

How does this work? In many databases, a person called an indexer or cataloger scrutinizes and enters each item. This person performs helpful, behind-the-scenes tasks such as assigning subject headings, age levels, or other indicators that make it easier to search very precisely. An analogy is tagging, although indexing is more structured than tagging. If you have tagged items online, you know that you can use any terms you like and that they may be very different from someone else’s tags. With indexing, the indexer chooses from a set group of terms. Obviously, this precise indexing isn’t available for web search engines—it would be impossible to index everything on the web. But if you are searching in a database, make sure you use these features to make your searches more precise and your results lists more relevant. You also will definitely save time.

You may be thinking that this sounds good. Saving time when doing research is a great idea. But how will you know what subject headings exist so you can use them? Here is a trick that librarians use. Even librarians don’t know what terms are used in all the databases or online catalogs that they use, so a librarian’s starting point isn’t very far from yours. But they do know to use whatever features a database provides to do an effective search. They find out about them by acting like a detective.

You’ve already thought about the possible search terms for your information needs. Enter the best search strategy you developed which might use Boolean operators or truncation. Scan the results to see if they seem to be on topic. If they aren’t, figure out what results you are getting that just aren’t right and revise your search. Terms you have searched on often show up in bold face type so they are easy to pick out. Besides checking the titles of the results, read the abstracts (or summaries), if there are any. You may get some ideas for other terms to use. But if your results are fairly good, scan them with the intent to find one or two items that seem to be precisely what you need. Get to the full record (or entry), where you can see all the details entered by the indexers. Figure 7.3.4 [5]  is an example from the Texas A&M University Libraries’ Quick Search, but keep in mind that the catalog or database you are using may have entries that look very different.

Once you have the “full” record (which does not refer to the full text of the item, but rather the full descriptive details about the book, including author, subjects, date, and place of publication, and so on), look at the subject headings and see what words are used. They may be called descriptors or some other term, but they should be recognizable as subjects. They may be identical to the terms you entered but if not, revise your search using the subject heading words. The result list should now contain items that are relevant for your needs.

It is tempting to think that once you have gone through all the processes around the circle, as seen in the diagram in Figure 7.3.5 [6] , your information search is done and you can start writing. However, research is a recursive process. You don’t start at the beginning and continue straight through until you end at the end. Once you have followed this planning model, you will often find that you need to alter or refine your topic and start the process again, as seen here:

This revision process may happen at any time before or during the preparation of your paper or other final product. The researchers who are most successful do this, so don’t ignore opportunities to revise.

So let’s return to Sarah and her search for information to help her team’s project. Sarah realized she needed to make a number of changes in the search strategy she was using. She had several insights that definitely led her to some good sources of information for this particular research topic. Can you identify the good ideas she implemented?

This section contains material from:

Bernnard, Deborah, Greg Bobish, Jenna Hecker, Irina Holden, Allison Hosier, Trudi Jacobson, Tor Loney, and Daryl Bullis. The Information Literacy User’s Guide: An Open, Online Textbook , edited by Greg Bobish and Trudi Jacobson. Geneseo, NY: Open SUNY Textbooks, Milne Library, 2014. http://textbooks.opensuny.org/the-information-literacy-users-guide-an-open-online-textbook/ . Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License .

• https://library.tamu.edu ↵
• “Concept Brainstorming,” derived in 2019 from: Deborah Bernnard et al., The Information Literacy User’s Guide: An Open, Online Textbook , eds. Greg Bobish and Trudi Jacobson (Geneseo, NY: Open SUNY Textbooks, Milne Library, 2014), https://textbooks.opensuny.org/the-information-literacy-users-guide-an-open-online-textbook/ . Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License . ↵
• “Blank Concept Brainstorming Worksheet,” derived in 2019 from: Deborah Bernnard et al., The Information Literacy User’s Guide: An Open, Online Textbook , eds. Greg Bobish and Trudi Jacobson (Geneseo, NY: Open SUNY Textbooks, Milne Library, 2014), https://textbooks.opensuny.org/the-information-literacy-users-guide-an-open-online-textbook/ . Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License . ↵
• “Completed Concept Brainstorming Worksheet” derived in 2019 from: Deborah Bernnard et al., The Information Literacy User’s Guide: An Open, Online Textbook , eds. Greg Bobish and Trudi Jacobson (Geneseo, NY: Open SUNY Textbooks, Milne Library, 2014), https://textbooks.opensuny.org/the-information-literacy-users-guide-an-open-online-textbook/ . Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License . ↵
• “Full Record Entry for a Book” is a reproduction from July 2019 of a Texas A&M University Libraries catalog entry from the Texas A&M University Libraries Quick Search. https://libcat.tamu.edu/vwebv/searchBasic. ↵
• “Planning Model” derived in 2019 from: Deborah Bernnard et al., The Information Literacy User’s Guide: An Open, Online Textbook , eds. Greg Bobish and Trudi Jacobson (Geneseo, NY: Open SUNY Textbooks, Milne Library, 2014), https://textbooks.opensuny.org/the-information-literacy-users-guide-an-open-online-textbook/ . Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License . ↵

A statement, usually one sentence, that summarizes an argument that will later be explained, expanded upon, and developed in a longer essay or research paper. In undergraduate writing, a thesis statement is often found in the introductory paragraph of an essay. The plural of thesis is theses .

When something is described as scholarly, that means that has been written by and for the academic community. The term scholarly is commonly used as shorthand to indicate that information that has been peer reviewed  or examined by other experts of the same academic field or discipline. Sometimes, the terms academic, scholarly, and peer reviewed are confused as synonyms; peer reviewed is a narrower term referring to an item that has been reviewed by experts in the field prior to publication, while academic is a broader term that also includes works that are written by and for academics, but that have not been peer reviewed.

A library catalog is a database of records for the items a library holds and/or to which it has access. Searching a library catalog is not the same as searching the web, even though you may see a similar search box for both tools. Library catalog searches can return information that you would not find on the open web, and the searching process will likely take longer to refine.

A librarian who specializes in helping the public find information. In academic librarians, reference librarians often have subject specialties.

A database is an organized collection of data in a digital format. Library research databases are often composed of academic publications like journal articles and book chapters, although there are also specialty databases that have data like engineering specifications or world news articles.

An online software tool used to find information on the web. Many popular online search engines return query results by using algorithms to return probable desired information.

A short account or telling of an incident or story, either personal or historical; anecdotal evidence is frequently found in the form of a personal experience rather than objective data or widespread occurrence.

Query: to ask a question or make an inquiry, often with some amount of skepticism involved.

With relation to a database, a query is a call for results. Most times a query is a search term entered into a search box.

A full record for a library item is all of the bibliographic information entered into the catalog for that particular work. Common entries in a full record will include the name of the work, the author, the publisher, the place of publication, the number of pages, the format, subject terms, and sometimes chapter titles.

A form of returning back to or reoccurrence, usually as a procedure or practice that can be repeated.

7.3 Developing a Research Strategy Copyright © 2022 by Deborah Bernnard; Greg Bobish; Jenna Hecker; Irina Holden; Allison Hosier; Trudi Jacobson; Tor Loney; Daryl Bullis; and Sarah LeMire is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

• Cookies & Privacy
• GETTING STARTED
• Introduction
• FUNDAMENTALS

Getting to the main article

Choosing your route

Setting research questions/ hypotheses

Assessment point

Building the theoretical case

Setting your research strategy

Data collection

Data analysis

Once you have a good understanding of the theoretical components involved in your main journal article , your choice of route , and the approach within that route, it is time to set the research strategy you will use in your dissertation.

Your dissertation guidelines may refer to this stage of your dissertation as setting the research design , research methodology , or even research methods , but these are just three of the components that can make up a research strategy . We prefer to refer to your setting a research strategy because all the choices you make concerning how you implement (i.e., operationalize ) your dissertation should be strategic . This is because the research strategy you implement in your dissertation consists of a number of components , and these components are all interrelated; that is, the choice of one component (e.g., your research design ) influences the next (e.g., your research methods ).

Whilst it is best to consult your dissertation guidelines to see which components you are required to include, your research strategy generally requires that you are able to describe , explain and justify :

the research paradigm that you are following;

the quantitative research design that guides how you have set up your research;

the quantitative research method(s) that determine how you went about collecting your data;

the sampling strategy you used to guide what data you collected;

the data analysis techniques that you used to answer your research questions/hypotheses;

how you ensured the research quality of your findings; and

your approach towards research ethics .

The extent to which the nature of these components (e.g., the different types of research method available) will vary between the main journal article and your dissertation will depend on the route you are following, and the approach within that route.

Broadly speaking, you will be able to rely more heavily on the research strategy used in the main journal article when setting your research strategy if you have taken on Route A: Duplication compared with Route B: Generalisation , and certainly, Route C: Extension , which typically requires more independent thought and planning. However, there are certain expectations, usually set out in dissertation guidelines, which require certain components of research strategy to be discussed, even when these were not addressed in your main journal article. Therefore, you need to understand (a) what these components mean, and (b) not only the explicitly mentioned components in your main journal article, but also those that are implicit, but not mentioned, and those that may have been intentionally left out.

In order to set your research strategy, you will need to (a) consider the route you are following, and the approach within that route, (b) research relevant theory about the various components of research strategy, (c) devise your research strategy, and (d) address practical requirements associated with this research strategy. When you work through this STAGE SIX , bear in mind that it can be one of the easiest places within the dissertation process to gain or lose marks. It can also be challenging, and you may need to spend time reading through relevant theory. However, we have many articles within the Research Strategy section of the Fundamentals part of Lærd Dissertation to help you. To start the process, work through the following seven steps , each of which address a different component involved in setting your research strategy:

• STEP ONE: Research paradigm
• STEP TWO: Research design
• STEP THREE: Research methods
• STEP FOUR: Sampling strategy
• STEP FIVE: Research quality
• STEP SIX: Research ethics
• STEP SEVEN: Data analysis techniques

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Expert Commentary

Research strategy guide for finding quality, credible sources

Strategies for finding academic studies and other information you need to give your stories authority and depth

Republish this article

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

by Keely Wilczek, The Journalist's Resource May 20, 2011

This <a target="_blank" href="https://journalistsresource.org/home/research-strategy-guide/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

Knowing how to conduct deeper research efficiently and effectively is a critical skill for journalists — especially in the information age. It is, like other facets of the profession such as interviewing, a matter of practice and establishing good habits. And once you find a successful routine for information-gathering, it will pay dividends time and again.

Journalists need to be able to do many kinds of research. This article focuses on creating a research strategy that will help you find academic studies and related scholarly information. These sources can, among other things, give your stories extra authority and depth — and thereby distinguish your work. You can see examples of such studies — and find many relevant ones for your stories — by searching the Journalist’s Resource database . But that is just a representative sample of what exists in the research world.

The first step is to create a plan for seeking the information you need. This requires you to take time initially and to proceed with care, but it will ultimately pay off in better results. The research strategy covered in this article involves the following steps:

Get organized

Articulate your topic, locate background information.

• Identify your information needs

List keywords and concepts for search engines and databases

Consider the scope of your topic, conduct your searches, evaluate the information sources you found, analyze and adjust your research strategy.

Being organized is an essential part of effective research strategy. You should create a record of your strategy and your searches. This will prevent you from repeating searches in the same resources and from continuing to use ineffective terms. It will also help you assess the success or failure of your research strategy as you go through the process. You also may want to consider tracking and organizing citations and links in bibliographic software such as Zotero . (See this helpful resource guide about using Zotero.)

Next, write out your topic in a clear and concise manner. Good research starts with a specific focus.

For example, let’s say you are writing a story about the long-range health effects of the explosion at the Chernobyl Nuclear Power Plant based on a study published in Environmental Health Perspectives titled, “The Chernobyl Accident 20 Years On: An Assessment of the Health Consequences and the International Response.” (The study is summarized in Journalist’s Resource here .)

A statement of your topic might be, “Twenty years after the Chernobyl disaster, scientists are still learning the affects of the accident on the health of those who lived in the surrounding area and their descendants.”

If you have a good understanding of the Chernobyl disaster, proceed to the next step, “Identify the information you need.” If not, it’s time to gather background information. This will supply you with the whos and the whens of the topic. It will also provide you with a broader context as well as the important terminology.

Excellent sources of background information are subject-specific encyclopedias and dictionaries, books, and scholarly articles, and organizations’ websites. You should always consult more than one source so you can compare for accuracy and bias.

For your story about Chernobyl, you might want to consult some of the following sources:

• Frequently Asked Chernobyl Questions , International Atomic Agency
• Chernobyl Accident 1986 , World Nuclear Association
• Chernobyl: Consequences of the Catastrophe for People and the Environment , New York Academy of Sciences, 2009.
• “Chernobyl Disaster,” Encyclopedia Britannica, last updated 2013.

Identify the information you need

What information do you need to write your story? One way to determine this is to turn your overall topic into a list of questions to be answered. This will help you identify the type and level of information you need. Some possible questions on consequences of the Chernobyl accident are:

• What are the proven health effects?
• What are some theorized health effects?
• Is there controversy about any of these studies?
• What geographic area is being studied?
• What are the demographic characteristics of the population being studied?
• Was there anything that could have been done at the time to mitigate these effects?

Looking at these questions, it appears that scientific studies and scholarly articles about those studies, demographic data, disaster response analysis, and government documents and publications from the Soviet Union and Ukraine would be needed.

Now you need to determine what words you will use to enter in the search boxes within resources. One way to begin is to extract the most important words and phrases from the questions produced in the previous step. Next, think about alternative words and phrases that you might use. Always keep in mind that different people may write or talk about the same topic in different ways. Important concepts can referred to differently or be spelled differently depending on country of origin or field of study.

For the Chernobyl health story, some search keyword options are: “Chernobyl,” “Chornobyl”; “disaster,” “catastrophe,” “explosion”; “health,” “disease,” “illness,” “medical conditions”; “genetic mutation,” “gene mutation,” “germ-line mutation,” “hereditary disease.” Used in different combinations, these can unearth a wide variety of resources.

Next you should identify the scope of your topic and any limitations it puts on your searches. Some examples of limitations are language, publication date, and publication type. Every database and search engine will have its own rules so you may need to click on an advanced search option in order to input these limitations.

It is finally time to start looking for information but identifying which resources to use is not always easy to do. First, if you are part of an organization, find out what, if any, resources you have access to through a subscription. Examples of subscription resources are LexisNexis and JSTOR. If your organization does not provide subscription resources, find out if you can get access to these sources through your local library. Should you not have access to any subscription resources appropriate for your topic, look at some of the many useful free resources on the internet.

Here are some examples of sources for free information:

• PLoS , Public Library of Science
• Google Scholar
• SSRN , Social Science Research Network
• FDsys , U.S. Government documents and publications
• World Development Indicators , World Bank
• Pubmed , service of the U.S. National Library of Medicine

More quality sites, and search tips, are here among the other research articles at Journalist’s Resource.

As you only want information from the most reliable and suitable sources, you should always evaluate your results. In doing this, you can apply journalism’s Five W’s (and One H):

• Who : Who is the author and what are his/her credentials in this topic?
• What: Is the material primary or secondary in nature?
• Where: Is the publisher or organization behind the source considered reputable? Does the website appear legitimate?
• When: Is the source current or does it cover the right time period for your topic?
• Why: Is the opinion or bias of the author apparent and can it be taken into account?
• How: Is the source written at the right level for your needs? Is the research well-documented?

Were you able to locate the information you needed? If not, now it is time to analyze why that happened. Perhaps there are better resources or different keywords and concepts you could have tried. Additional background information might supply you with other terminology to use. It is also possible that the information you need is just not available in the way you need it and it may be necessary to consult others for assistance like an expert in the topic or a professional librarian.

Keely Wilczek is a research librarian at the Harvard Kennedy School. Tags: training

About The Author

Keely Wilczek

• Open access
• Published: 09 May 2024

A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol

• Edward Riley-Gibson   ORCID: orcid.org/0000-0003-0829-7913 1 , 2 , 3 , 4 ,
• Alix Hall 1 , 2 , 3 , 4 ,
• Adam Shoesmith 1 , 2 , 3 , 4 ,
• Luke Wolfenden 1 , 2 , 3 , 4 ,
• Rachel C. Shelton 5 ,
• Emma Doherty 1 , 2 , 3 , 4 ,
• Emma Pollock 1 , 2 , 3 , 4 ,
• Debbie Booth 1 , 2 , 3 , 4 ,
• Ramzi G. Salloum 7 ,
• Celia Laur 8 , 9 ,
• Byron J. Powell 10 , 11 , 12 ,
• Melanie Kingsland 1 , 2 , 3 , 4 ,
• Cassandra Lane 1 , 2 , 3 , 4 ,
• Maji Hailemariam 6 ,
• Rachel Sutherland 1 , 2 , 3 , 4 &
• Nicole Nathan 1 , 2 , 3 , 4  

Systematic Reviews volume  13 , Article number:  129 ( 2024 ) Cite this article

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The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research.

This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared.

Discussion/conclusion

This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners.

Systematic review registration

PROSPERO CRD42022352333.

Peer Review reports

Global burden of chronic disease

Preventable chronic diseases such as heart disease, diabetes, and respiratory disease account for a significant proportion of morbidity and mortality, attributing to 70% of all deaths internationally [ 1 , 2 ]. There are several key behavioural risk factors associated with the development of chronic diseases across the life course including the following: physical inactivity, poor diet, harmful alcohol use, and tobacco smoking [ 3 , 4 ]. Each of these behavioural risk factors is responsible for a considerable proportion (2.78–9.24%) of the total disease burden globally [ 5 ].

The World Health Organization (WHO) recommends the implementation of evidence-based interventions (EBIs) in clinical (e.g. hospitals, general practitioner (GP) surgeries, dental practices, community health centres, and charity-based health programmes or initiatives) and community settings (e.g. schools, early childcare services, sporting clubs/organisations, and community centres) to target and reduce the prevalence and severity of these behavioural risk factors [ 4 ]. The routine and widespread implementation of EBIs (e.g. targeting physical activity [ 6 ] and alcohol reduction [ 7 ]) to address the prevention of chronic disease in these settings is important, as they provide centralised points of access to reach a large proportion of the population, and they have existing infrastructure to support intervention delivery [ 8 ]. Consequently, there have been substantial investments made by governments internationally in the development and implementation of EBIs to address behavioural risk factors for chronic disease in these settings [ 9 , 10 , 11 ].

There are two distinct outcomes within the field of sustainability: ‘sustainability’ and ‘sustainment’. There are several definitions in the literature for both sustainment and sustainability [ 12 , 13 , 14 ]. For this review, we make a clear distinction between sustainment and sustainability. We view sustainment as an outcome, defined by Damschroder et al. (2022) as ‘the extent the innovation is in place or being delivered long-term’ [ 15 ]. Sustainability is defined by Moore et al. (2017) as ‘after a defined period of time, the program, clinical intervention, and/or implementation strategies continue to be delivered and/or individual behaviour change (i.e., clinician, patient) is maintained; the programme and individual behaviour change may evolve or adapt while continuing to produce benefits for individuals/systems’ [ 13 ]. Recent research argues that sustainability should be viewed as a dynamic process with interventions updated according to new evidence and adapted to meet the changing needs of the context and population in which it is being delivered [ 12 , 16 ].

Although many EBIs provide significant benefits when initially implemented, the effects of these interventions often diminish once initial implementation support or resources are withdrawn, and consequently, the quality of intervention delivery decreases or is discontinued entirely [ 17 ]. Therefore, long-term positive health impacts are often not realised [ 17 , 18 , 19 , 20 ] or are not achieved equitably across a range of settings and populations [ 21 ]. Further, discontinuation of programmes may also have important implications for wasted investments in time and resources, as well as community member and practitioner mistrust and wariness to engage in future implementation efforts [ 21 ]. Even with multi-level implementation support and significant financial investment, ‘initiative decay’ is common [ 10 ]. For example, a systematic review by Wiltsey Stirman and Kimberly [ 17 ], focusing on the sustainment of public health and clinical interventions, found that out of 125 studies included in the review, the majority of interventions were only partially sustained (i.e. continuation of some, but not all elements of the intervention), following full initial implementation. Overall, less than half of the interventions included in this review were sustained to high levels of fidelity. Another recent systematic review by Herlitz and MacIntyre [ 20 ], which aimed to determine the sustainment of school-based public health interventions, found that of the 18 included interventions, none continued to be delivered in their entirety (i.e. all components) once initial implementation support (start-up funding and/or other resources) had been withdrawn.

Accordingly, policymakers are increasingly concerned with the sustainability of EBIs and highlight the importance of ensuring the sustained delivery of such interventions long term. To ensure that the positive effects of EBIs continue and health impact is realised, the public health investment in initial implementation is not wasted, and that community support, trust, and engagement with such interventions are not lost; it is vital that the implementation of these EBIs be sustained [ 21 ].

What impacts on sustaining EBIs

Understanding the determinants of sustainment is essential to successfully design effective sustainment support strategies and reduce implementation decline [ 22 ]. Theoretical frameworks, such as the Dynamic Sustainability Framework [ 12 ], the Program Sustainability Assessment Tool [ 23 ], and the Integrated Sustainability Framework [ 16 ], identify and categorise a range of factors that may impact the sustainment of EBIs. In general, most frameworks identify sustainability determinants at multiple levels, that is, the salient outer contextual factors (e.g. external funding environment), inner contextual factors (e.g. programme champions in the organisation), processes (e.g. strategic planning), intervention characteristics (e.g. fit with context and population), and implementer characteristics (e.g. staff attitude, motivation, and skills). Further, systematic reviews of determinants to sustaining EBIs in specific clinical and community settings have identified a number of factors perceived by stakeholders. The most frequently identified being as follows: the availability of equipment, resources and facilities, continued executive or leadership support, and staff turnover [ 17 , 19 , 20 , 22 ]. Moreover, there are commonalities in factors that commonly impact sustainability across both clinical and community settings such as funding and external partnerships, organisational factors (e.g. alignment with values, needs, resources, and priorities of the organisation) and support (e.g. the presence of programme champions, leadership support), and practitioner/workforce characteristics (e.g. staff motivation and attitudes [ 16 ]. The information gathered from these reviews can be utilised to determine which factors to prioritise when developing strategies to sustain EBI delivery.

The need for effective strategies to support sustainment

If policymakers and practitioners are to address determinants of sustaining EBIs, it is important to determine which strategies are most effective in supporting sustainment. It is also important to note that strategies designed to support sustainment may overlap with strategies designed to support initial implementation. While there is a growing body of evidence regarding the effectiveness of strategies to support the initial implementation of EBIs [ 24 , 25 , 26 ], to our knowledge, only one review has aimed to collate strategies designed specifically to support sustainment [ 27 ].This review of strategies used within community-based settings found only six studies that reported the use of nine types of strategies designed to support sustainment. The most commonly reported strategies were funding and/or contracting for EBIs, continued use, and maintenance of workforce skills through continued training, booster training sessions, supervision, and feedback. However, the review was descriptive and, given the low number of studies conducted to date, did not synthesise any data relating to the effectiveness or impact of the strategies designed to support sustainment. Additionally, as this review only focused on community settings, there is a current gap which presents a need to synthesise strategies designed to support sustainment in a broader range of settings. Consequently, the field is bereft of an evidence base of effective strategies for sustainment. Research within sustainability science is rapidly increasing. Consequently, there are likely to be numerous new studies that may provide evidence of effective strategies designed to support sustainment. Therefore, the primary aim of this review is to determine the effect of strategies aiming to sustain the chronic disease prevention initiatives targeting key health behaviours (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings.

The secondary aims of this review are as follows:

Examine the effectiveness of strategies designed to support sustainment on relevant health outcomes (including physical activity, healthy eating, obesity prevention, smoking cessation, or harmful alcohol use).

Describe the cost implications of strategies designed to support sustainment.

Identify if there are any unintended/adverse effects of strategies designed to support sustainment on end users.

This systematic review protocol was registered with PROSPERO on 20 August 2022 (Registration ID: CRD42022352333) and is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist (PRISMA-P) [ 28 ].

Eligibility criteria

Types of studies.

We will include any randomised study with a control group that aims to assess the effect of a strategy or group of strategies to sustain the implementation of a chronic disease prevention EBI in a clinical or community setting. We will include the following types of studies:

Randomised controlled trial (RCT) (with a parallel control group)

Cluster randomised controlled trial (C-RCT) (with a parallel control group and at least two clusters randomised to each group)

Stepped-wedge trial

Cross over (only data prior to crossover will be used in the analysis)

We will restrict the review to this set of designs for pragmatic reasons due to the size of this review. Further, these designs are considered as gold standard for assessing casual effects, so are most appropriate for addressing the research questions. We will only include studies that compare a strategy or group of strategies to improve sustainment of a physical activity, healthy eating, obesity prevention, smoking cessation, or harmful alcohol use EBI (also termed as policy, practice, or program) with no sustainment intervention or ‘usual practice’. There will be no restriction on the length of the study follow-up period due to the varied definitions of sustainment within the literature. There will also be no restriction on country of origin or language. However, we will exclude studies that are not focused on assessing the effect of a sustainment strategy on the sustained implementation of a policy, practice, or programme as a specific aim.

Types of participants

We will include managers, policy makers, staff, clinicians, or volunteers delivering, or supporting the delivery of, EBIs to patients in clinical settings including hospitals, GP surgeries, community health centres, and charity-based health programmes or initiatives (e.g. charity-run smoking cessation and healthy eating interventions in low socioeconomic countries/areas).

We will also include managers, policy makers, staff, or volunteers delivering, or supporting the delivery of, EBIs to end users in community settings including educational settings (i.e. primary and secondary schools, colleges, and universities), childcare services (long day care, family day care, preschools, and nurseries), elite or nonelite sports organisations and clubs (professional and amateur sports clubs, sporting governing bodies), and community centres (youth centres, community outreach centres).

Types of interventions

We will include any study that employs a strategy or group of strategies with the explicit aim of sustaining the implementation of a smoking cessation, healthy eating, physical activity, alcohol or obesity prevention policy, practice, or programme by usual staff, clinicians, or volunteers within the setting, for example managers, policy makers, nurses, doctors, teachers, and carers. Studies embedding principles of sustainability into strategies that have a primary aim of increasing adoption or implementation of EBIs will be excluded. Strategies designed to support sustainment will be classified based on the sustainability-explicit expert recommendations for implementing change (ERIC) glossary [ 29 ]. To be eligible, strategies designed to support sustainment must be distinct from continuous quality improvement (CQI). Distinctions will be made between sustainment and CQI by recognising CQI as studies focused on making immediate improvements to an individual organisation [ 30 ]. This is compared to sustainability trials which are typically designed based on theoretical frameworks or models and focused on making generalisable improvements, rather than being restricted on one individual organisation.

Types of outcome measures

Primary outcome measures.

Studies that report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. This may include the ongoing delivery of physical activity, dietary, alcohol, or smoking cessation interventions in line with public health or clinical guidelines.

Sustained implementation must be a measure of usual staff or volunteer delivery of the policy, practice, or programme and not be externally supported by research personnel, except for the purposes of data collection. Individual outcomes such as sustained effects of patient’s participation in a programme (e.g. their participation in a healthy eating programme) are not considered sustainment outcomes.

Secondary outcome measures

Data on secondary outcomes will only be extracted for those studies that first meet the eligibility criteria for the primary review outcomes. For example, if a study aims to sustain the implementation of a physical activity policy practice, but reports on dietary outcomes and physical activity practices, only data regarding physical activity practices will the extracted.

Secondary outcomes include the following:

Health outcomes where an EBI or initiative is used to target modifiable health behaviour risks related to chronic disease. I.e. any objective or subjective measure of diet (e.g. fruit/vegetable intake), physical activity (e.g. minutes of physical activity during the school day), sedentary behaviour (e.g. daily minutes of sedentary time), weight status (e.g. BMI (body mass index)), alcohol consumption (e.g. number of standard drinks consumed on a typical drinking day), and smoking cessation (e.g. weekly number of cigarettes smoked). A hierarchy will be used to prioritise multiple measures of the same health outcome.

Cost outcomes relating to estimates of absolute costs, the assessment of the cost-effectiveness, or budget impact of strategies designed to support sustainment.

Any reported adverse effects of strategies designed to support sustainment. This may include negative impact on health outcomes (e.g. an increase in injury rates following physical activity initiatives), disruption to service operation or staff attitudes (e.g. negative impact on staff motivation or cohesion), or negative consequences to other key programmes or practices (e.g. lack of funding for other vital programmes due to reallocation of funding).

Search methods for identification of studies

We will conduct searches for peer-reviewed articles in relevant electronic databases.

Electronic searches

We will conduct searches in the following electronic databases: the Cochrane Central Register of Controlled trials (CENTRAL) (2022) via Cochrane Library; MEDLINE (1946 to November, 2022), PsycINFO (1950 to November, 2022), and Embase (1947 to November, 2022) via OVID; CINAHL (November, 2022) via EBSCO; and SCOPUS (November, 2022) and Education Research Complete (November, 2022) via EBSCO.

Search strategy/search terms

Search terms will be developed based on reviews conducted by Shelton et al. [ 16 ] (maintenance/sustainability) and Wolfenden et al. [ 9 , 10 , 11 ] (physical activity, nutrition, and obesity, implementation, and setting) and will cover the following four concepts:

Sustainability (other terms include maintenance, durability, continuation, institutionalisation, routinization, normalisation, integration, adherence)

Heath behaviours (e.g. physical activity, healthy eating, smoking cessation)

Clinical settings (e.g. hospitals, general practice)

Community settings (e.g. schools, workplaces, community centres)

Data collection and analysis

Selection criteria.

The search results from the electronic databases will be managed and duplicates identified using EndNote. The de-duplicated library will be imported into Covidence software, where article screening will occur. Both title and abstract and full-text screening will be conducted independently by two members of the research team, who will assess study eligibility according to the inclusion criteria. Any conflicts will be resolved by consensus. In instances where the study eligibility cannot be resolved via consensus, a third review author will make the final decision.

Data extraction and management

Two review authors unblinded to author and journal information will independently extract information from the included studies. We will record the information extracted from the included studies in a data extraction form, developed based on the recommendations of the Cochrane Public Health Group Guide for Developing a Cochrane Protocol [ 31 ]. The data extraction form will be piloted before the initiation of the review. Data extraction discrepancies between review authors will be resolved by consensus or by a third review author if required.

We will extract the following information:

Study eligibility as well as the study design, date of publication, EBI, country, the demographic/socioeconomic characteristics of the programme and participants, the number of experimental conditions, setting, overall study duration, and time points measured.

Characteristics of the strategy designed to support sustainment, including strategy description and duration of initial implementation support and length of time since withdrawn (if noted), duration of strategies (i.e. duration for which the sustainment strategy was in place), description of strategies, the theoretical underpinning of the strategy (if noted in the study), process evaluation measures (e.g. acceptability and appropriateness), and information to allow classification against the sustainability-explicit ERIC glossary [ 29 ]. Strategies will be described in line with the sustainability-explicit ERIC glossary [ 29 ].

Primary and secondary outcomes within each study, including the data collection method, validity of measures used, effect size, and measures of outcome variability

Source(s) of research funding and potential conflicts of interest

Assessment of risk of bias in included studies

Overall risk of bias.

Two review authors will assess risk of bias independently for each review outcome using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) described by Sterne et al. [ 32 ]. Signalling questions will be used for the following domains: Bias arising from the randomisation process, bias due to deviations from intended interventions, bias due to missing outcome data, bias in measurement of the outcome, bias in the selection of the reported result, and overall bias. The response options to the signalling questions will be as follows: ‘yes’, ‘probably yes’, ‘probably no’, ‘no’, and ‘no information’. Once the signalling questions are answered, a risk-of-bias judgement and one of three levels (low risk of bias, some concerns, or high risk of bias) will be assigned to each domain. Stepped wedge trials will be assessed for risk of bias using RoB 2, with consideration given to time confounding. Crossover trials will be assessed using the RoB 2 extension for crossover designs, and only the initial segment prior to crossover will be used in the analysis. We will use the ROB2 extension for cluster trials for the assessment of the risk of bias for cluster RCTs, which includes consideration of the following additional domains: recruitment bias, baseline imbalances, loss of clusters, incorrect analysis, contamination, and compatibility with individually randomised trials. An overall risk of bias will be assigned to each study outcome giving consideration to all of the above domains. Overall risk of bias for study outcomes will be assessed against set criteria and judged as follows: ‘low risk of bias’ (‘the trial is judged to be at low risk of bias for all domains’), ‘some concerns’ (the trial is judged to raise some concerns in at least one domain, but not be at high risk of bias for any domain), and high risk of bias (the trial is judged to be at high risk of bias in at least on domain OR the trial is judged to have some concerns for multiple domains in a way that substantially lowers confidence in the result) (Higgins et al., 2022). The risk of bias of the included studies will be documented in a ‘risk-of-bias’ table.

Synthesis methods

Study characteristics will be grouped as types of studies, participants (i.e. clinical or community), and strategies designed to support sustainment. Strategies designed to support sustainment will be classified using the sustainability-explicit ERIC glossary [ 29 ]. The sustainability-explicit ERIC glossary is a taxonomy which categorises and defines strategies designed to support sustainment. It is an adapted version of the original ERIC [ 33 ], which has been extended with a specific focus on sustainability. The sustainability-explicit ERIC glossary will allow us to code the strategies in this review based on the standardised definitions included in the glossary. Deductive and inductive coding approaches will be used, and any strategies that do not fit within the sustainability-explicit ERIC glossary will be added. The effect of interest will be intention to treat, and we will prioritise differences between groups at follow-up, rather than differences between groups in the change from baseline. Primary outcomes will be reported using odds ratios, and any primary outcomes measured as means and standard deviations will be transformed into odds ratios (Higgins, et al., 2022). For secondary outcomes, the most appropriate effect type will be used, which will include odds ratios for dichotomous outcomes and means for continuous outcomes. Random-effects meta-analyses will be undertaken to estimate a pooled treatment effect overall for the primary outcome and by health behaviour for secondary outcomes (i.e. physical activity, alcohol consumption, dietary outcomes, and tobacco use). If we are unable to conduct a meta-analysis due to insufficient or incomplete data (e.g. missing standard deviations) that cannot be estimated from the data reported by authors, we will synthesise results using vote counting based on the direction of effect [ 31 ], with such methods reporting in compliance with the synthesis without meta-analysis (SWIM) guidelines [ 34 ]. For trials with multiple follow-up periods, we will use data from the final follow-up period reported. For studies that report multiple results for primary and secondary outcomes, we will prioritise the most objectively measured. Results from cluster- and individual-level RCTs will be combined. The standard error from cluster trials that do not adjust for clustering will be adjusted for unit of analysis errors following recommended procedures outlined by the Cochrane Handbook [ 31 ]. Trials reporting multiple, relevant intervention arms will be combined into a single group following methods outlined in the Cochrane Handbook [ 31 ].

Sensitivity analyses

Where there are sufficient studies, a sensitivity analyses removing studies with high risk of bias will be undertaken. If imputation of intra-class correlation coefficient (ICC) values to adjust for clustered trials is required, a sensitivity analysis assessing different ICC values will also be conducted.

Assessing heterogeneity and subgroup analyses

Statistical heterogeneity will be assessed by reviewing the distribution of studies on the forest plots and assessing the I 2 statistic. Pre-specified sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and will include time period classified as sustainability and type of setting (i.e. clinical or community). Differences between sub-groups will be statistically compared following procedures recommended by the Cochrane Handbook; within subgroup differences will not be interpreted.

This systematic review will synthesise current evidence on the effect of strategies designed to support sustainment of chronic disease prevention policies, practices, and programmes. This will be the first systematic review to determine the effect of strategies designed to support the sustainment of EBIs in both clinical and community settings. The findings of this review will directly inform the design of future sustainability and implementation trials. Further, these findings will help inform the development of a sustainability practice guide for public health practitioners. The main limitation of this review protocol is our restriction to only RCTs. In focusing exclusively on RCTs, we may overlook valuable insights from alternative study designs, such as quasi-experimental and qualitative methods, which offer a more nuanced understanding of real-world constraints and pressures. Future reviews may wish to broaden the included study types which could capture important information on the effect of sustainment strategies. Further, while our review will use data from included studies final follow-up period, the inclusion of longitudinal data could offer valuable insights into the temporal dynamics of sustainment strategy effectiveness and provide a more nuanced understanding of how interventions unfold over time. Therefore, we recommend that future reviews consider incorporating multiple follow-up times.

Availability of data and materials

Data and materials relating to this review are available from the corresponding author on reasonable request.

Abbreviations

Evidenced-based interventions

Preferred Reporting Items for Systematic review and Meta-Analysis

Continuous quality improvement

Body mass index

Randomised controlled trial

Cluster randomised controlled trial

Intra-class correlation coefficient

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Acknowledgements

Not applicable.

This project is funded through the National Health and Medical Research Council (NHMRC) as part of Dr. Nicole Nathan’s Medical Research Future Fund (MRFF) Investigator Grant (APP1194785) and was supported by work undertaken as part of an NHMRC Centre for Research Excellence National Centre of Implementation Science (NCOIS) grant (APP1153479). Dr. Nicole Nathan is supported by a MRFF Investigator Grant (APP1194785); LW is supported by an NHMRC Investigator Grant (G1901360). Edward Riley-Gibson is supported by a University of Newcastle PhD scholarship. Adam Shoesmith is supported by a University of Newcastle PhD scholarship (ref. 3145402). Byron Powell is supported in part through grants from the Agency for Healthcare Research and Quality (R13HS025632) and the US National Institutes of Health (R01CA262325, P50CA19006, and R25MH080916). Ramzi G. Salloum is supported by the University of Florida Clinical and Translational Science Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences (UL1TR001427). The funders had no role in the study design, conduct of the study, analysis, or dissemination of findings.

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Edward Riley-Gibson, Alix Hall, Adam Shoesmith, Luke Wolfenden, Emma Doherty, Emma Pollock, Debbie Booth, Melanie Kingsland, Cassandra Lane, Rachel Sutherland & Nicole Nathan

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ERG led the development of this protocol. NN, AH, and LW led the initial conceptual planning of the review and made significant contributions to the methodology included in this protocol. AS RCS, ED, EP, RGS, CL, BP, MK, CL, MH, and RS provided extensive guidance and input into the background, structure, and methodology of this protocol. DB conducted the database searches, and ERG, LW, NN, AH made significant contributions to the search strategy.

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Riley-Gibson, E., Hall, A., Shoesmith, A. et al. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Syst Rev 13 , 129 (2024). https://doi.org/10.1186/s13643-024-02541-0

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• Antimicrobial Resistance
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About Microbial Ecology

• Germs, or microbes, are found everywhere, including on and in people, animals and the environment, where they exist in communities called microbiomes.
• CDC invests in research around microbial ecology.
• Research has shown that treatments focused on microbial ecology and protecting a person's microbiome can protect people from infections, including healthcare-associated and antimicrobial-resistant infections, so that people live longer, healthier lives.

Germs, or microbes , are found everywhere, including on and in people, animals and the environment, where they exist in communities called microbiomes. People have their own microbiomes (e.g., on their skin, in the gut) that help maintain good health and protect people from infections.

CDC invests in research around microbial ecology, which looks at the relationships within and across these microbial communities to determine how germs interact with one another and their environment. Microbial ecology includes interactions of individuals and their microbiomes with other people, animals, plants, food and surfaces (e.g., healthcare bed rails or counter tops), all of which can serve as sources, or reservoirs, of pathogens (harmful germs) that can lead to infection. This innovative work helps scientists better understand the role of microbial ecology in human health and how to leverage its role to develop and implement life-saving tools.

Sometimes a microbiome can become unbalanced. For example, when a person takes antibiotics or antifungals, the drugs kill both pathogens (harmful germs) that cause infections and beneficial germs that protect our body from infection. This results in an unbalanced microbiome.

Research has shown that therapeutics (treatments) focused on microbial ecology and protecting a person's microbiome can protect people from infections, including healthcare-associated and antimicrobial-resistant infections, so that people live longer, healthier lives.

Although scientists know that microbial ecology plays important roles in maintaining human health, there are unanswered scientific questions. It is critical to understand the relationships and interactions within microbial communities to prevent infections and their spread, improve antibiotic and antifungal use and slow the spread of antimicrobial resistance. Continued research will help public health scientists better understand microbial ecology treatment options to save lives.

Terms to know

• Colonization: When a germ or microbe is found on or in the body but does not cause symptoms or disease. Finding the microbe multiple times over time could represent persistent colonization.
• Diversity: The variety and composition of microbes present in a microbial community. Diversity can be evaluated at different levels (e.g., genus, species, strain, operational taxonomic units). Diversity can be measured using an index, such as alpha (within a community) or beta (among two or more communities) diversity.
• Dominance: When a particular microbe makes up a large portion of a microbial community (e.g., >30%). An increased portion of a particular microbe may be associated with development of infection, sepsis, or other adverse outcomes.
• Ecological pressure: Any force(s) that impact living organisms (i.e., microbes) and/or their environment.
• Endogenous infection : When a person gets an infection caused by a pathogen that is already colonizing a part of their body (e.g., S. aureus in their nose).
• Exogenous infection : When a person gets an infection from a pathogen that recently spread to them from another person or from a contaminated surface.
• Fitness: Any trait that allows a microbe at any taxonomic level (e.g., genus, species, strain) or a community of microbes to thrive in the environment.
• Infection: When a microbe (e.g., bacteria, fungi) causes disease in a living organism (e.g., person, animal).
• Microbes: Tiny living organisms, including bacteria and fungi, that can mostly only be seen with a microscope. Often referred to as germs.
• Microbial ecology: The study of the relationships and interactions within microbial communities (e.g., environment-host-microbe) within a defined space.
• Microbiome: A community of naturally occurring germs within a defined space, such as in and on our bodies. Microbial communities are found on our skin, and in our mouth, respiratory tract, urinary tract, and gut.
• Microbiota: Microbes living in a microbiome. Microbiota in our bodies can work together to help keep us from getting sick.
• Microbial strain: Germs with very similar genetics and one or more genetic traits that makes them different from other strains. These different genetic traits can sometimes help the germ survive and multiply in certain environments (i.e., fitness).
• Strain selection: External pressure (e.g., antibiotic) applied to microbes. Microbes that withstand the pressure survive.
• Virulence: A measure of the ability or likelihood to cause disease.
• Virulence factor: A trait that allows a microbe to grow, multiply, and cause disease in a host (e.g., person, animal).

How colonization can cause infections

Harmful germs (pathogens) can cause an infection by entering the body through various body sites and via medical devices. Additionally, when a microbiome is disrupted, pathogens, including antimicrobial-resistant pathogens, can take over, or dominate.

Dominance of one or several pathogens puts people at increased risk for infection, including recurring C. difficile infection, antimicrobial-resistant infections, skin infections or sepsis . This is especially true for vulnerable people and critically ill patients, such as surgical patients and newborns in the intensive care unit. For example, a 2019 CDC-funded study found that patients who had a high number of antimicrobial-resistant Klebsiella pneumoniae (K. pneumoniae) in their microbiomes were at higher risk for K. pneumoniae bloodstream infections, which can be life-threatening.

When a person is colonized and it leads to infection, it often happens like this:

1. Lucy is colonized with antimicrobial-resistant Pathogen A.

Lucy goes to the hospital for surgery. Lucy is either already colonized with antimicrobial-resistant Pathogen A, which is not causing an infection, or she becomes colonized with Pathogen A soon after admission. This could happen by person-to-person spread or from contaminated surfaces. Lucy and her healthcare providers do not know that Lucy is colonized.

Lucy is at higher risk for an infection following her procedure and can spread Pathogen A to others. Because Pathogen A is antimicrobial-resistant, it may cause an infection that is difficult or impossible to treat.

2. Lucy's microbiome becomes disrupted, allowing Pathogen A to dominate her microbiome.

Lucy is given antibiotics through an IV to help prevent infections that could happen following her surgery. Her gut's beneficial germs are wiped out by the antibiotics in addition to some pathogens, resulting in an unbalanced microbiome.

However, because Pathogen A is antimicrobial-resistant, it is not killed and remains. It now outcompetes and outnumbers the beneficial germs, becoming dominant in Lucy's microbiome.

3. Pathogen A starts to invade the body, causing an infection.

An unbalanced microbiome puts Lucy at higher risk for infection because her body's defense is low. Pathogen A starts to spread onto the skin causing an infection at the IV site. Pathogen A also continues to spread to the surrounding environment and to other people.

How pathogen reduction and decolonization works

Increased risk of infection.

People receiving medical care in healthcare facilities , like hospitals and nursing homes, can get healthcare-associated infections. This often happens during or after procedures like surgery, or from devices like catheters or ventilators. Sometimes healthcare-associated infections (HAIs) are caused by antimicrobial-resistant pathogens, making them difficult to treat.

People can be colonized with pathogens without symptoms of an infection, and this increases their risk for infection. They can spread these pathogens to others through person-to-person contact or contaminated surfaces. When people are critically ill, have recently undergone surgery, received transplants or are in intensive care units or have compromised immune systems, they are at even higher risk for infection when they are also colonized with pathogens.

Colonization screenings

When a healthcare facility identifies certain antimicrobial-resistant pathogens within their facility, CDC recommends colonization screening . Colonization screening is an infection prevention method using laboratory testing to identify patients who are colonized with resistant pathogens. Checking patients who are at risk for colonization helps guide infection control to prevent spread.

Types of intervention strategies

Healthy microbial communities with beneficial bacteria help our body protect against pathogen colonization, dominance and infection. Healthcare providers and infection preventionists can use intervention strategies to reduce or eliminate colonized pathogens in people to protect them from infection and prevent the spread of the colonizing pathogens. These strategies include:

• Pathogen reduction , a strategy that decreases the number of bacterial or fungal pathogens that might lead to infection.
• Decolonization , a type of pathogen reduction that eliminates the colonizing pathogens. A primary goal of decolonization is to remove pathogens from specific places on our body, such as skin (e.g., surgery sites) and mucosal surfaces (e.g., nose, gastrointestinal tract). These specific body sites (skin, mouth, respiratory tract, urinary tract, gut) are home to microbiomes, communities of naturally occurring germs.

Pathogen reduction and decolonization strategies

Traditional therapeutic strategies or medical interventions to reduce colonizing pathogens or decolonize people include:

• Topical treatments , such as antiseptic agents like chlorhexidine gluconate used for bathing .
• Antibiotic prophylaxis , such as antibiotics like neomycin or aminoglycosides.
• Nasal ointment for the nose , such as mupirocin or povidone-iodine.

These traditional strategies or interventions help avoid the loss of beneficial germs and disrupting microbiomes by:

• Limiting application to a certain body site/individual microbiome (e.g., in the gut or the nasopharynx, the top part of throat) or targeting specific pathogens.
• Decreasing the use of antibiotics and antifungals needed to treat infections, which can help slow antimicrobial resistance.
• Specifically targeting those at highest risk for becoming infected - due to identified risk factors or those already found to be colonized with the pathogen using a lab test.

Emerging pathogen reduction/decolonization strategies

While not yet approved by the U.S. Food and Drug Administration (FDA) specifically for this purpose, certain microbiome therapeutics for the treatment of recurrent Clostridioides difficile infection, such as fecal microbiota transplantation (used under enforcement discretion) and two approved live biotherapeutic products (i.e. Rebiota and VOWST), are known to reduce the number of antimicrobial-resistant pathogens in treated patients. Pathogen reduction and decolonization in the future may involve the use of bacteriophages (phages) which are viruses that only infect bacteria, along with other live biotherapeutic products (e.g., ingesting beneficial germs). Phage products have not been approved for this use by the U.S. Food and Drug Administration (FDA). As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria , CDC and FDA are working together to discuss approaches to evaluate the safety and efficacy of these products.

What CDC is doing

Pathogen reduction and decolonization strategies can prevent infections and stop the spread of pathogens and their genes. CDC invests in innovative research projects to identify and implement new ways to respond to antimicrobial resistance. CDC funds research on pathogen reduction and decolonization, but more research is needed to develop new therapeutic strategies to address colonization, microbiomes, and healthcare-associated and antimicrobial-resistant infections.

Examples of CDC research include:

• Identifying and sharing effective public health approaches to protect people's microbiomes. CDC and NIH co-edited a supplement issue in the Journal of Infectious Diseases (JID) titled The State of Microbiome Science at the Intersection of Infectious Diseases and Antimicrobial Resistance .
• Studying the connection between antibiotics and microbiomes , including new ways to protect and restore the microbiome.
• Studying non-traditional treatment strategies for the remediation of antimicrobial-resistant pathogens in contaminated handwashing sinks and plumbing systems in healthcare facilities involving use of lytic bacteriophages (bacterial viruses).

Data from these projects help CDC better protect people by, for example, uncovering places antimicrobial-resistant germs live and spread, improving outbreak response, and strengthening infection prevention practices.

Antimicrobial resistance happens when germs like bacteria and fungi can defeat the drugs designed to kill them.

For Everyone

Public health.

Bias Busters: Motivations under the microscope

Despite their best intentions, executives fall prey to cognitive and organizational biases that get in the way of good decision making. In this series, we highlight some of them and offer a few effective ways to address them.

Our topic this time?

Motivations under the microscope

The dilemma.

The CFO at a chemical company is launching a new resource allocation process. Under it, the finance and strategy teams would no longer review requests business unit by business unit. Instead, they would consider proposals in the aggregate, rank them, and funnel resources to the most promising opportunities. It’s a nimbler way to manage resources, the CFO tells senior management—“and, really, the only way we can continue to keep up with the market.” Leaders in the life sciences and advanced-materials businesses are on board with the plan. They can easily point to strong sales growth and recent product innovations to support their resource requests. But other leaders are balking. The head of petrochemicals tells the CFO, “We’re not growing as fast or as much as everyone else, but the revenue from our polymers keeps the lights on around here. Under this new plan, our proposals are never going to get a fair shot.” They and some of the other business unit leaders have already started appealing to the finance and strategy teams for process exceptions, which would essentially defeat the purpose of the new approach.

How can the CFO make the new resource allocation plan work for everyone?

Bias Busters Collection

The research.

The CFO needs to recognize the dynamic at play here, which is a form of the collective action problem—a bias that has vexed business, social science, and political leaders since the dawn of organizations. 1 Todd Sandler, “Collective action: Fifty years later,” Public Choice , September 2015, Volume 164, Number 3/4. It reflects situations in which individuals or teams would be better off in the long term by cooperating with others but fail to do so because of conflicting interests, prompting tensions to rise. The dynamic has also been described as the principal–agent problem, where an agent (an individual or group) acts on behalf of a principal (another individual or group), and if their motivations aren’t in sync, outcomes for both may be suboptimal. 2 Michael C. Jensen and William H. Meckling, “Theory of the firm: Managerial behavior, agency costs and ownership structure,” Journal of Financial Economics , October 1976, Volume 3, Number 4. In the case of the chemical company, business unit leaders are being asked to cooperate with a new process that would have them “compete” with colleagues for access to limited corporate resources. The motivation here is for the different teams to act in their own best interests, which may lead to decreased growth and value to shareholders over time.

How to put your money where your strategy is

One way to counter the collective action problem is for the CFO and executive-leadership team to draw what we call a motivation map. The map could be a literal outline, captured in a spreadsheet or slideshow, or a one-time discussion. Either way, it’s a tool that the CFO and executive-leadership team can use to better understand how business unit leaders would be affected by the new allocation process. Through the mapping exercise, they would first take inventory of each leader’s primary motivations and priorities, looking at factors such as financial incentives, personal goals, and professional status. They could then consider how the status quo supports those motivations and priorities and plan for how to appeal to business unit leaders in a way that would help shift their thinking in a different direction.

In the case of the chemical company, such an exercise could be particularly useful for bringing the head of petrochemicals into the fold. For instance, the CFO and team could ask, “Is this leader’s compensation tied to the size of the business unit’s P&L? Are they currently in a position of influence within the organization—and looking for more?” Based on the answers, the CFO and team could tailor their messaging on the process change accordingly. For instance, if loss of status is a concern, they might offer the petrochemicals head an advisory role on the new resource allocation board. If compensation is the issue, the CFO and team can help redefine financial incentives to reflect the change in the company’s approach to resource management. A formalized mapping exercise can give the CFO and team more information than surface-level statements might.

It can be hard to convince individuals and teams to let go of long-established processes, rituals, and rewards. A motivation map can help senior management determine how best to bring together leaders with different priorities and perspectives, align their incentives, and ultimately move everyone toward a better, more productive place.

Eileen Kelly Rinaudo is McKinsey’s global director of advancing women executives and is based in McKinsey’s New York office, Tim Koller is a partner in the Denver office, and Derek Schatz is a consultant in the Chicago office.

This article was edited by Roberta Fusaro, an editorial director based in the Waltham, Massachusetts, office.

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• Sex differences in risk of incident microvascular and macrovascular complications: a population-based data-linkage study among 25 713 people with diabetes
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• http://orcid.org/0000-0001-8750-9720 Alice A Gibson 1 , 2 ,
• Emma Cox 1 , 2 ,
• Francisco J Schneuer 1 , 2 , 3 ,
• Jacob Humphries 4 ,
• Crystal MY Lee 5 ,
• Joanne Gale 1 ,
• Steven Chadban 2 , 6 ,
• Mark Gillies 7 ,
• Clara K Chow 2 , 8 , 9 ,
• Stephen Colagiuri 2 , 4 ,
• Natasha Nassar 1 , 2 , 3
• 1 Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health , The University of Sydney , Sydney , New South Wales , Australia
• 2 Charles Perkins Centre , The University of Sydney , Sydney , New South Wales , Australia
• 3 Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health , The University of Sydney , Sydney , New South Wales , Australia
• 4 Faculty of Medicine and Health , The University of Sydney , Sydney , New South Wales , Australia
• 5 School of Population Health , Curtin University , Perth , Western Australia , Australia
• 6 Department of Renal Medicine, Kidney Centre , Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
• 7 Discipline of Ophthalmology and Eye Health, Save Sight Institute, Faculty of Medicine and Health , The University of Sydney , Sydney , New South Wales , Australia
• 8 Westmead Applied Research Centre, Faculty of Medicine and Health , The University of Sydney , Sydney , New South Wales , Australia
• 9 Department of Cardiology , Westmead Hospital , Westmead , New South Wales , Australia
• Correspondence to Dr Alice A Gibson, Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; alice.gibson{at}sydney.edu.au

Background The global prevalence of diabetes is similar in men and women; however, there is conflicting evidence regarding sex differences in diabetes-related complications. The aim of this study was to investigate sex differences in incident microvascular and macrovascular complications among adults with diabetes.

Methods This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The study sample included 25 713 individuals (57% men), aged ≥45 years, with diabetes at baseline. Incident cardiovascular disease (CVD), eye, lower limb, and kidney complications were determined using hospitalisation data and claims for medical services. Multivariable Cox proportional hazards models were used to assess the association between sex and incident complications.

Results Age-adjusted incidence rates per 1000 person years for CVD, eye, lower limb, and kidney complications were 37, 52, 21, and 32, respectively. Men had a greater risk of CVD (adjusted hazard ratio (aHR) 1.51, 95% CI 1.43 to 1.59), lower limb (aHR 1.47, 95% CI 1.38 to 1.57), and kidney complications (aHR 1.55, 95% CI 1.47 to 1.64) than women, and a greater risk of diabetic retinopathy (aHR 1.14, 95% CI 1.03 to 1.26). Over 10 years, 44%, 57%, 25%, and 35% of men experienced a CVD, eye, lower limb, or kidney complication, respectively, compared with 31%, 61%, 18%, and 25% of women. Diabetes duration (<10 years vs ≥10 years) had no substantial effect on sex differences in complications.

Conclusions Men with diabetes are at greater risk of complications, irrespective of diabetes duration. High rates of complications in both sexes highlight the importance of targeted complication screening and prevention strategies from diagnosis.

• EPIDEMIOLOGY
• DIABETES MELLITUS
• CARDIOVASCULAR DISEASES
• COHORT STUDIES
• RECORD LINKAGE

Data availability statement

Data may be obtained from a third party and are not publicly available. This research was completed using data collected from the Sax Institute’s 45 and Up Study. Requests for access to data should be addressed to the corresponding author or the Sax Institute ( http://www.saxinstitute.org.au/ ).

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/jech-2023-221759

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WHAT IS ALREADY KNOWN ON THIS TOPIC

The absolute risk of cardiovascular disease appears to be higher in men with diabetes compared with women with diabetes. However, the evidence for sex differences in microvascular complications is limited and conflicting.

Further, there is little understanding of the potential impact of diabetes duration on sex differences in micro- and macrovascular complications.

WHAT THIS STUDY ADDS

Compared with women, men were at greater risk of incident cardiovascular disease, lower limb and kidney complications, and diabetic retinopathy.

Sex differences in rate of complications were similar for those with diabetes duration <10 years and ≥10 years.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICY

Given the high rates of complication in both sexes, this study highlights the importance of targeted complication screening and prevention strategies from the time of diagnosis.

Introduction

Diabetes leads to numerous microvascular and macrovascular complications such as loss of vision, amputation, kidney failure, myocardial infarction and stroke, placing an enormous burden on individuals and their families, healthcare systems and society in general. Globally, the prevalence of diabetes continues to escalate. An estimated 537 million people aged 20–79 years were living with diabetes in 2021, which is projected to rise to a staggering 783 million by 2045. 1 In Australia, the prevalence of diabetes has tripled over the past three decades, affecting an estimated 1.3 million (5.1%) Australians in 2018–2021. 2

Although the prevalence of diabetes is similar in men and women (worldwide prevalence of 8.9% and 8.4%, respectively), 3 the incidence and progression of diabetes-related complications appears to be more sex-specific. It is well established that the absolute risk of cardiovascular disease (CVD) is higher in men with diabetes than women with diabetes. 4 However, the evidence for sex differences in microvascular complications such as retinopathy, neuropathy and nephropathy is limited and conflicting. For instance, in the UK Prospective Diabetes Study, the incidence of retinopathy was similar in men and women; however, women had a lower relative risk of retinopathy progression (RR 0.54, 95% CI 0.37 to 0.80). 5 In the prospective DiaGene cohort study of diabetes complications, the incidence of microalbuminuria (a biomarker of nephropathy) was higher in men, and men were more likely to develop two or three microvascular complications compared with women (OR 2.42, 95% CI 1.69 to 3.45). 6

Ample duration of follow-up is required to assess long-term diabetes-related complications. Multiple studies have provided strong evidence that individuals with longer diabetes duration are at greater risk of complications 7 8 ; however, there is little understanding of the potential impact of diabetes duration on sex differences in diabetes-related complications. The aim of this study was to investigate sex differences in incident micro- and macrovascular complications among a large population-based sample of people with diabetes. We also investigated whether sex differences were modified by duration of diabetes.

Study population and data sources

We used data from The Sax Institute’s 45 and Up Study, a large prospective cohort of 267 357 men and women aged over 45 years residing in the state of New South Wales (NSW), Australia. This cohort represents approximately 11% of the NSW population aged over 45. The cohort profile and research protocol have been published in detail previously. 9 Briefly, participants of the 45 and Up Study were randomly sampled from Services Australia Medicare enrolment database, between 2005 and 2009. Participants were invited by mail and agreed to participate by completing a sex-specific self-administered questionnaire and providing written consent for linkage of their survey responses to administrative health data collections. The estimated response rate was 19%. The full baseline survey questionnaires are available at https://www.saxinstitute.org.au/our-work/45-up-study/questionnaires/ .

For this study we used data from participants’ baseline questionnaires that were linked to their corresponding medical services claims (Medicare Benefits Schedule, MBS), prescription medication (Pharmaceutical Benefits Scheme, PBS), hospital admission (Admitted Patient Data Collection, APDC) and death registry data collections (Registry of Births Deaths and Marriages). Detailed information about the datasets and linkage process is provided in the online supplemental file 1 . The 45 and Up Study was approved by the University of NSW Human Research Ethics Committee, and use of linked data for this study was approved by the NSW Population and Health Services Research Ethics Committee (Cancer Institute NSW reference: 2017/HRE0206).

Supplemental material

Study sample.

The present study includes all participants in the 45 and Up Study identified with diabetes at baseline. The online supplemental file 1 provides a detailed overview of diabetes case ascertainment. In brief, we used a combination of self-report and the multiple linked administrative data sources (MBS, PBS, APDC) to ascertain diabetes status.

Study exposures

The main exposures of interest were sex and diabetes duration at baseline. Diabetes duration at baseline was calculated using the age at first diabetes diagnosis identified from the baseline survey and categorised into <10 years or ≥10 years.

Study outcomes

Study outcomes were determined following literature review and consultation with clinical experts and defined as incident hospitalisation or treatment for the following four major groups and subgroups of diabetes-related micro- and macrovascular complications 10 :

Cardiovascular complications: ischaemic heart disease, transient ischaemic attack (TIA), stroke, heart failure, diabetic cardiomyopathy

Eye complications: diabetes with ‘any ophthalmic complication’, cataract, diabetic retinopathy

Lower limb complications: peripheral neuropathy, ulcers, cellulitis, Charcot foot, osteomyelitis, peripheral vascular disease, and minor or major amputation

Kidney complications: ‘diabetes with kidney complication’, acute kidney failure, chronic kidney disease, unspecified kidney failure, dialysis, and kidney transplant.

Diabetes-related complications were primarily ascertained from hospital admission records (APDC) using principal and additional International Statistical Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM) diagnosis or Australian Classification of Healthcare Interventions (ACHI) procedure codes. As not all diabetes-related complications included in this analysis require hospital admission, we also included out-of-hospital treatment for complications such as home dialysis for chronic kidney disease, or retinal laser. This was identified using relevant MBS treatment items. A complete list of outcomes and associated diagnosis, procedure and treatment codes are presented in online supplemental table 1 .

Self-reported sociodemographic, lifestyle and health characteristics were identified from the baseline survey. All questions, response options and categories are provided in online supplemental table 2 . Sociodemographic characteristics included age group, socioeconomic background (Index of Relative Socioeconomic Disadvantage (IRSD) quintile), household income, highest level of education, language other than English spoken at home, country of birth, and private health insurance. The IRSD is derived from income, education, unemployment, and other census data. 11

Lifestyle and health factors included body mass index (BMI), smoking status, physical activity, fruit and vegetable consumption, family history of diabetes, and previous history of CVD (including heart disease and stroke), history of high blood pressure and blood pressure treatment, and treatment for high cholesterol. Of note, previous history of CVD was not included in the CVD complications analysis, as individuals with a prior history were excluded from this analysis.

Statistical analysis

Contingency tables were used to describe the baseline characteristics of participants, grouped by sex. For all major groups and subgroups of diabetes complications, we calculated age-adjusted incidence rates of complications per 1000 person-years, based on the subpopulation at risk (time to first event, death or end of follow-up time). We used Kaplan-Meier estimators to compare age-standardised cumulative complication rates for major outcome groups stratified by sex and duration of diabetes.

Cox proportional hazards models were used to estimate crude and adjusted hazard ratios (aHR) to assess associations between sex and incident CVD, lower limb, eye, and kidney complications. For analysing each group of complications (ie, CVD, lower limb, eye, and kidney), we excluded those with a prior history of that group of complications (ie, between January 2001 and their baseline survey date). The models for each outcome were conducted adjusting for other factors in a sequential process: (1) unadjusted, (2) adjusted for age and sex, (3) adjusted for age, sex, sociodemographics, and lifestyle, and (4) adjusted for all sociodemographic, lifestyle, and health-related factors. Person-years were calculated from the date of recruitment until incident treatment or hospitalisation, death, or end of follow-up (ie, December 2019). All models account for the competing risk of death before complication. Proportionality assumptions were verified based on the methods of Lin et al . 12

Multiple imputation was performed using full conditional specification and incorporating sociodemographic, lifestyle and health factors described above. Thirty imputations were conducted and estimates from the imputed datasets were combined by calculating the mean of the parameter of interest and standard errors adjusted for the uncertainty produced by the imputation process. The missing at random (MAR) assumption required for imputation was considered reasonable based on the missingness patterns in the data ( table 1 ) and the large number of variables included in the imputation process. 13 All analyses were performed using SAS software version 9.4 (SAS Institute Inc, Cary, NC, USA).

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Baseline sociodemographic, lifestyle and health characteristics of the cohort of participants with diabetes by sex (n=25 713).

Sample characteristics

The full baseline 45 and Up sample included 267 357 participants. There were 266 471 active participants available for this analysis. We excluded participants if they did not have diabetes at baseline (n=232 535), their diabetes status was uncertain (n=8166), or there were inconsistencies in their age, death, or baseline data (n=57). Our final sample included 25 713 participants ( online supplemental figure 1 ).

Table 1 presents the baseline characteristics of the cohort by sex, with almost half of the cohort aged 60–74 years and a slightly higher proportion of females aged 45–59 years with diabetes. A higher proportion of men were overweight (38.7% in men vs 27.8% in women), had higher educational attainment, held private health insurance, and had a history of heart disease. In terms of smoking status, although a similar proportion of men and women were current smokers, a higher proportion of men were ex-smokers (51% compared with only 29% women). Of the 19 277 (75%) people with diabetes who had an age of diagnosis, 58% had a duration of diabetes <10 years and 42% had a duration of diabetes ≥10 years at baseline. There were no meaningful differences in baseline characteristics between those with and without an age of diagnosis ( online supplemental table 3 ).

Incident CVD complications

During 177 851 person-years of follow-up, the overall incidence rate of CVD complications was 37 per 1000 person-years, which was higher among men than women (43 vs 30 per 1000) ( figure 1A ). After adjustment of covariates, compared with women, the aHR for any incident CVD complication in men was 1.51 (95% CI 1.43 to 1.59) ( figure 1B ). Among the CVD complication subgroups, associations were similar to the overall result for heart failure and stroke and stronger for myocardial infarction and other coronary heart disease ( online supplemental figure 2 ). These associations are reflected in the cumulative hazard curves which show that at 10 years’ follow-up, 44.4% (95% CI 43.0% to 45.9%) of men and 30.9% (95% CI 29.7% to 32.2%) of women with diabetes experienced a CVD complication (p<0.001) ( figure 2A ). The sex difference in rate of CVD complications at 10 years was similar, although slightly greater, for those with diabetes <10 years compared with ≥10 years’ duration ( online supplemental figure 6 , online supplemental table 4 ).

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(A) Age-adjusted incidence rates per 1000 person-years of incident diabetes-related complications by sex and (B) adjusted hazards ratio (aHR) (95% CI) for association between sex and incident diabetes-related complications. Hazards ratios are calculated from Cox proportional hazard models based on multiple imputed data adjusted for age, sociodemographics (education, SEIFA, income, language, country of birth, private insurance), lifestyle (BMI, smoking, diet and physical activity) and health history (family history of diabetes, cardiovascular disease, blood pressure and treatment for high cholesterol). BMI, body mass index; SEIFA, Socio-Economic Indexes for Areas.

Cumulative incidence of macrovascular and microvascular complications by sex: (A) CVD complications; (B) eye complications; (C) lower limb complications; (D) kidney complications. Hazard function survival curves using Kaplan-Meier methods. P values in the figures represent the results for the log-rank test. CVD, cardiovascular disease.

Incident eye complications

The incidence rate of eye complications was 52 per 1000 person years and was similar for men and women (52 vs 53 per 1000) ( figure 1A ). Compared with women, men had a lower risk of any eye complication (aHR 0.94, 95% CI 0.89 to 0.98) ( figure 1B ), with results largely influenced by the lower risk of cataract surgery among men (aHR 0.90, 95% CI 0.86 to 0.95) ( online supplemental figure 3 ). In contrast, men had a slightly greater rate and risk of diabetic retinopathy (10 vs 9 per 1000 person years; aHR 1.14, 95% CI 1.03 to 1.26) ( online supplemental figure 3 ). At 10 years’ follow-up, the cumulative incidence of eye complications was 57.0% (95% CI 55.3% to 58.8%) in men and 60.9% (95% CI 58.9% to 62.9%) in women (p<0.001) ( figure 2B ); for diabetic retinopathy these rates were 9.8% (95% CI 9.2% to 10.4%) in men and 8.9% (95% CI 8.2% to 9.5%) in women. When stratified by duration of diabetes, there was no statistical sex difference in risk of diabetic retinopathy for those with diabetes <10 years (aHR 1.12, 95% CI 0.95 to 1.31) at baseline and ≥10 years’ duration (aHR 1.16, 95% CI 0.99 to 1.36) at baseline ( online supplemental figure 6 , online supplemental table 4 ).

Incident lower limb complications

The incidence rate of lower limb complications was 21 per 1000 person years and was higher among men than women (25 vs 18 per 1000) ( figure 1A ). The risk of any lower limb complication was 1.5 times higher in men than women (aHR 1.47, 95% CI 1.38 to 1.57) ( figure 1B ), and the risks of peripheral neuropathy, ulcer and cellulitis were similar. The difference was stronger for peripheral vascular disease, with the risk of complications over two times higher for men. While the incidence was low, the risk of osteomyelitis and amputation was over 2.5-fold higher in men than in women ( online supplemental figure 4 ). The cumulative incidence of lower limb complications at 10 years was higher among men at 24.6% (95% CI 23.7% to 25.5%) versus 17.8% (95% CI 16.9% to 18.7%) in women ( figure 2C ), and this pattern was relatively similar irrespective of diabetes duration ( online supplemental figure 6 , online supplemental table 4 ).

Incident kidney complications

The incidence rate of kidney complications was 32 per 1000 person years and was higher among men than women (36 vs 26 per 1000) ( figure 1A ). The risk of any kidney complication was 1.6 times higher in men than in women (aHR 1.55, 95% CI 1.47 to 1.64) ( figure 1B ), with similar risk estimates for specific subgroups, including kidney failure, chronic kidney disease and dialysis ( online supplemental figure 5 ). This pattern of a higher risk of kidney complications in men is reflected in the cumulative incidence at 10 years, which was higher among men at 35.2% (95% CI 34.0% to 36.3%) versus 25.3% (95% CI 24.3% to 26.3%) in women ( figure 2D ). The sex difference in rate of kidney complications at 10 years was similar, although slightly greater, for those with diabetes ≥10 years compared with <10 years’ duration ( online supplemental figure 6 , online supplemental table 4 ).

Our study demonstrates that men with diabetes have a higher rate and greater risk of most diabetes-related complications compared with women, and this difference remained consistent irrespective of the duration of diabetes. For every 1000 people with diabetes, our findings suggest that an average of 37, 52, 21, and 32 people will develop CVD, eye, lower limb, and kidney complications every year. Men had a 1.5-fold increased risk of CVD, lower limb, and kidney complications, and risk of diabetic retinopathy was 14% greater in men than in women. These findings are reflected in the ~1.4 times higher 10-year rates for CVD, lower limb, and kidney complications in men compared with women.

The greater risk of CVD complications observed for men in our study is consistent with other large population-based studies in France 14 and Denmark. 15 These studies reported a higher incidence of major adverse cardiovascular events including heart failure in men with diabetes compared with women with diabetes (incidence rate (IR) 96 vs 66/1000 person-years, 14 and IR 24.9 vs 19.9/1000 person-years 15 ). Men, irrespective of diabetes status, have been shown to have a greater CVD risk factor burden than women. 16–18 A recent study using nationally representative survey data from Australians aged 45–74 years showed men had a higher average BMI, waist circumference, systolic and diastolic blood pressure, total: high density lipoprotein (HDL) cholesterol ratio, triglycerides and glycated haemoglobin (HbA1c) compared with women, and a higher proportion of men were also current or ex-smokers. 17 Our study observed similar differences in baseline characteristics, with men more likely to be overweight, have a history of heart disease or stroke, and be previous smokers. Men may also be less likely to adopt primary prevention strategies, such as healthy lifestyle change and medication use, 16 19 and to engage in health seeking behaviours, such as preventative health checks. 20 21 Further, women are known to be at lower risk of CVD complications compared with men due to the protective effects of reproductive factors such as breastfeeding and the use of hormone replacement therapy within 10 years of menopause. 22 There are important age-specific sex differences in CVD complications. Women have an older age of CVD onset compared with men, 23 and experience lower rates of CVD up until the age of 80 years. 18 It is possible that the sex differences in CVD complications observed in our study may resolve if the cohort were to be followed for a longer time.

Evidence for sex differences in microvascular diabetes complications is less conclusive than for macrovascular complications. A meta-analysis of 10 studies (nine cohort) reported an elevated, but non-significant, increase in incident chronic kidney disease among women compared with men (adjusted women-to-men relative risk ratio (WMR) 1.14, 95% CI 0.97 to 1.34), with risk particularly higher for end stage renal disease (adjusted WMR 1.38, 95% CI 1.22 to 1.55). 24 In contrast, studies from the Netherlands and UK found a higher baseline prevalence and risk of incident microalbuminuria in men. 6 25 Although no studies have examined overall lower limb complications, the risk of amputation has been shown to be greater in men than in women. 26 27 Similarly, a meta-analysis of 20 studies found that men with diabetic foot have an approximate 50% increased amputation risk compared with women. 28 In contrast to the results for CVD, kidney and lower limb complications, our study found that women with diabetes were at greater risk of eye complications. This appeared to be largely driven by the inclusion of cataracts as a sub-group, which are more prevalent in women compared with men. 29 30 Considering diabetic retinopathy specifically, our results indicate a 14% greater risk of incident retinopathy in men which is consistent with a study from Italy which showed the incidence of diabetic retinopathy to be associated with the male sex (HR 1.31, 95% CI 1.05 to 1.63). 31 The mechanisms for sex differences in microvascular complications remains under-researched, 32 but possible factors include worse glycaemic and blood pressure control and treatment, 18 and an underutilisation of medical care for microvascular complications 28 in men compared with women. Large-scale studies examining sex differences in adherence to guideline-recommended processes of care, including medication adherence and healthy lifestyle behaviours, are needed to understand these findings better.

It is well understood that individuals with longer diabetes duration are at greater risk of complications. The UK Biobank study showed that with each 5 year increase in diabetes duration, there was a 20% increase in excess risk of CVD complications for both men and women. 7 Despite the greater complication-risk with longer disease duration, we observed a similar sex difference in risk of complications for those with diabetes duration <10 years compared with those with diabetes duration ≥10 years. Few studies have examined the effect of diabetes duration on sex differences in risk of complications; however, Duarte et al found that the magnitude of the association between duration of diabetes and glycaemic control was stronger for women compared with men. 33 Only individuals with age of diagnosis reported in the baseline survey could be included in our analysis stratified by disease duration (approximately two-thirds of the full sample), which may have influenced our findings.

The strengths of this study include the large population-based sample, the long follow-up time, and use of objective linked data to identify incident diabetes-related complications, avoiding issues of loss to follow-up and self-report. The data in our study did not include diabetes complications not requiring hospitalisation, with the exception of diabetic retinopathy and home dialysis. While our analyses took into account competing risk of CVD-related death before hospitalisation, these numbers were small (n=163), with no meaningful sex differences that might have had an impact on our results ( online supplemental table 5 ). Given that diabetic kidney disease is frequently asymptomatic, unknown to patients, 34 and requires laboratory testing for detection, it is likely that the incidence of early-stage chronic kidney disease was underestimated in our study. On the other hand, as we excluded those with a prior history of complications to capture incident complications, this may have not allowed enough time for the development of end stage complications, such as limb amputations or requirement for kidney replacement therapy with dialysis or transplantation. As such, the absolute rates of complications should be interpreted with caution. The 45 and Up Study provides detailed information on sociodemographic, health and lifestyle covariates which we were able to adjust for in the analysis. However, we did not take into account all potential confounding/effect-modifying factors including glycaemic, lipid and blood pressure control, medication use 35 and adherence which may have impacted the strength of the association between sex and risk of complications. We were also not able to differentiate between type 1 and type 2 diabetes in our study, precluding an analysis by type of diabetes. Although the 45 and Up cohort are broadly representative of the Australian population aged ≥45 years, the sample does overrepresent higher income earners, people aged 80 and over, and residents of rural and remote areas, 36 which may limit the generalisability of the results. Although men have a higher absolute risk of CVD complications, studies in patients with diabetes compared to those without diabetes have shown that the relative CVD risk conferred by diabetes is greater in women. 37–39 Sex differences in relative risk of diabetes complications was not assessed in our study.

In conclusion, although men with diabetes are at greater risk of developing complications, in particular CVD, kidney and lower-limb complications, the rates of complications are high in both sexes. The similar sex difference for those with shorter compared with longer diabetes duration highlights the need for targeted complication screening and prevention strategies from the time of diabetes diagnosis. Further investigation into the underlying mechanisms for the observed sex differences in diabetes complications are needed to inform targeted interventions.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants. The 45 and Up Study was approved by the University of NSW Human Research Ethics Committee, and use of linked data for this study was approved by the NSW Population and Health Services Research Ethics Committee (Cancer Institute NSW reference: 2017/HRE0206). Participants gave informed consent to participate in the study before taking part.

Acknowledgments

This research was completed using data collected through the 45 and Up Study (www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW and partners the Heart Foundation and the NSW Ministry of Health. We thank the many thousands of people participating in the 45 and Up Study. We also acknowledge the support of the NSW Centre for Health Record Linkage (CHeReL; http://www.cherel.org.au ).

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Supplementary materials

Supplementary data.

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

• Data supplement 1

Contributors AAG, NN and SC conceived the idea for the study. All authors contributed intellectual content to the study design and interpretation of the findings. FS, JH, and JG conducted the analysis. AAG, EC, NN and JG drafted the manuscript and all authors provided edits and comments. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. All authors have approved the final article. AAG is the guarantor of this work.

Funding This work was supported by an Australian Diabetes Society Servier Research Grant, an Australian Diabetes Research Trust Grant and a NSW Health EMCR CVD Capacity Grant. AAG is supported by an Australian National Health and Medical Research Council Emerging Leader 1 Investigator Grant (APP1173784). AAG is also grateful to the NSW Cardiovascular Research Network for a Professional Development Award. NN is supported by Financial Markets Foundation for Children and by an Australian National Health and Medical Research Council Leadership 2 Investigator Grant (APP1197940). Mark Gillies is supported by an NHMRC Level 3 Investigator grant. Clara K Chow is supported by an NHMRC Leadership Investigator grant (APP1195326). Funding bodies were not involved in the study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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

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Exploring the significant problems confronting secondary schools history education: a baseline study

• Open access
• Published: 14 May 2024
• Volume 3 , article number  52 , ( 2024 )

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• Fekede Sileshi Fufa   ORCID: orcid.org/0000-0001-6035-8205 1 ,
• Abera Husen Tulu   ORCID: orcid.org/0000-0002-0408-9028 2 &
• Ketebo Abdiyo Ensene   ORCID: orcid.org/0000-0001-8492-9340 1  

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The purpose of this baseline study is to determine the significant problems confronting history education in secondary school. The researchers employed qualitative research methods and case study design. The techniques that were employed to acquire credible data were document analysis, interviews, and classroom observation. Six experienced history education teachers and eight top-ten students from Sebeta town public secondary school were interviewed, and academic achievement statistics of 174 students in history education were analyzed. In addition eight lesson observations were carried out to validate the information gleaned from the interviews and document analysis. The study's findings show that the primary challenges influencing history education in Sebeta town public secondary schools were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time. The findings also indicate the significance of training history education teachers to use participatory teaching tactics, as well as the need for curriculum experts to better coordinate the range of history education content and teaching strategies. The findings of this study will help teachers, practitioners, scholars, policymakers, and educational professionals find solutions to significant problems in secondary school history education, as well as develop effective techniques for teaching history education in secondary schools that involve twenty-first century skills and abilities.

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1 Introduction

History education as an academic discipline has a long history in the world. In the nineteenth century a German historian Leopold von Ranke an indispensable contribution to modernizing history writing [ 1 , p. 2, 2 , p. 171]. Ranke (1795–1886) not only established history as a major discipline, but he also established the idea that all accurate history must be based on primary sources and rigorous methodology [ 1 , p.13, 3 ]. As a result, he is regarded as the father of modern historiography [ 1 , p. 2]. Since the nineteenth century, history education has developed as an independent discipline across the world.

In terms of teaching strategies, evidence shows that teaching approaches play an important role in any subject of study in enhancing students' academic achievements [ 4 , p. 601, 5 ]. Many research findings demonstrate that the approach employed to develop any operation significantly determines the end product [ 6 , p. 7]. Several factors influence students' academic achievement; evidence suggests that teachers are the most essential ones in terms of students’ education and achievements [ 7 , pp. 2633–34]. According to the research findings conducted on student learning, the way teachers engage their pupils is crucial in the teaching and learning process [ 8 , p. 39]. The approaches used by the teacher should be matched to the demands of the students [ 6 , p.7]. Students’ motivation and achievement are mostly dependent on the teachers’ activities [ 9 , p. 15). Several researches have indicated that among the subjects offered in schools, students do have not much interest in history education [ 10 , p. 45]. According to a study conducted on secondary schools, history education has been taught through lectures rather than participatory and student- centred strategies [ 11 , p. 1). According to Kiio [ 11 , pp. 1–2], effective implementation of participatory teaching and learning methodologies can increase students' interest in history education. Issar [ 10 , p. 49] also emphasized the significance of learning history education, stating that learning history education should help students understand the complexities of human lives, the diversity and relationships between different groups, the changes and continuities and connect the past, present, and future events.

Scholars confirm that constructive learning approaches allow students to participate actively in the lessons [ 12 , p. 35]. Since 1980, the theory of social constructivism has been advocated as an effective way of learning and teaching [ 12 , pp. 35–36]. It is a theory developed by Russian psychologist Lev Vygotsky (1896–1934), which holds that individuals are active participants in the creation of their knowledge [ 13 , p.783]. Vygotsky’s social constructivism focuses on pedagogies that encourage active learning, effective and meaningful learning, constructive learning, and learning by doing [ 13 , p.783]. Current research in the field of history education supports the notion that participatory approaches to teaching the subject at the secondary school level are the preferred method for developing the skills required to handle the world's future historiographical needs [ 14 , p. 81]. In several works of literature, interactive teaching approaches are vital in increasing student academic achievement. The purpose of this baseline study is to investigate the significant problems confronting history education in Sebeta government secondary schools.

2 Statement of the problem

History education is frequently a source of public debate, a source of unrest, and a site of struggle over what and how should be taught in schools in Ethiopia [ 15 , p. 2]. National history is taught as a compulsory subject in different countries. Several countries believe that knowing the country’s history is a requirement for all citizens [ 16 , pp. 1–2]. In the case of history education teaching in Ethiopia, for the first time, a history syllabus was included in the education curriculum after 1943 [ 17 , p.87]. However, no specific research on significant problems confronting history education in Ethiopian secondary schools has been conducted. Researchers who have studied the problem of education in Ethiopia have directly and indirectly addressed the issue of history education [ 18 , pp.18–19].

According to research conducted by Resource and Guide [ 19 , p. 8], teaching is important by incorporating 21st-century skills such as critical thinking skills, problem-solving, language proficiency, communication and collaborative skills, cognitive skills, adaptability skills and the ability to make decisions. Furthermore, student-centred teaching method fosters students' comprehension, deep learning, problem-solving, critical thinking, and communication [ 20 , p. 4]. Research conducted on history education has discovered a link between teaching approaches and students' attitudes towards history education [ 21 , p. 3]. A scant study has been conducted on significant problems confronting history education in Ethiopian secondary schools and on approaches more appropriate for teaching history.

This motivated the researchers to conduct research on major problems confronting history education in Ethiopian secondary schools in Sebeta town. To fill this gap, the researchers used a variety of tools to analyze significant problems confront history education in Ethiopian secondary schools in general, and Sebeta town public Secondary School in particular.

Thus, this study attempts to answer the following questions:

What are the most significant problems facing history education at Sebeta town public secondary school?

What are the most common teaching strategies employed at Sebeta town government secondary school?

How is the student’s academic achievement in history at Sebeta public secondary school?

3 Objectives of the study

To find out the most significant problems facing history education at Sebeta Town Government Secondary School.

To identify the most common teaching strategies employed at Sebeta town government secondary school.

To determine a student’s academic achievement in history at Sebeta government secondary school.

4 Literature review

Any research project needs theory to provide direction and help on how things are implemented. Theoretical foundation aids in deciphering the way phenomena happen and the basis of specific actions [ 22 , p. 75]. This research is founded on Vygotsky’s social constructivist learning theory, which supports historical thinking. According to a social learning theory developed by Russian psychologist Lev Vygotsky (1896–1934), individuals are active participants in the development of their knowledge [ 23 , p. 395]. This social constructivism approach places a strong emphasis on pairs and small groups [ 24 , pp.13–15]. According to this theory, students learn primarily through interactions with their classmates, instructors, and parents, whereas teachers are expected to facilitate dialogue in the classroom [ 25 , p. 243]. According to Richard [ 26 , p. 380], good teaching and learning are strongly reliant on interpersonal interaction and conversation, with the primary focus on the student’s understanding of the topic.

Scholarly works reveal that there is very little study on the significant problems confronting history education. The existing scholarly works on teaching approach and students’ learning, on the other hand, demonstrate that there are strong relationships between the effects of teaching strategies and students’ achievement. Sugano and Mamolo [ 27 , p. 827] conducted a study on the “Effects of Teaching Methodologies on Students’ Attitude and Motivation,’’ found that teaching methods had an enormous positive impact (Cohen’s d = 0.379) on student attitude. The study also found that cooperative learning had a greater power than traditional teaching methods in improving students’ positive attitudes, motivation and interest.

History teaching should not only be mastery of the basic content (substantive knowledge) but also enhance the acquisition of subject skills and competencies that will make students learn on their own and manage their own lives and carry it through the adversities of life in society [ 26 , 28 ]. Luka [ 14 , p. VII] discovered in his study, “The Impact of Teaching Methods on Attitudes of Secondary School Students Towards Learning of History in Malawi,” that students in secondary schools have negative attitudes towards learning history. One of the reasons he highlighted is that student-centred techniques of teaching are not regularly used in the subject of history education ( Ibid , [ 29 ]).

Moreover, Mazibuko [ 30 , p. 142] revealed that teaching methods in history education greatly contributed to students' negative perceptions of the subject. He discovered that traditional methods of teaching history utilized by teachers contributed to students decreasing interest in the subject ( Ibid ). Besides, Zhu and Kaiser [ 31 , p. 191] discovered that teaching methods influence students’ motivation, attitudes towards school, willingness to do homework, and confidence in their learning.

In his study on effective teaching in history, Boadu [ 8 , p. 39] discovered that effective teaching of history should bring the subject closer to students’ lives, hearts, and minds. He argued that effective teaching cannot emerge from traditional history teaching, because the teacher lectures on the subject intensely, and students are forced to take and memorize notes.

Silver and Perini [ 32 , p. 16) argued that teachers who use a variety of teaching techniques have well-behaved and motivated students, resulting in high student academic achievement.

Adding to this, according to [ 33 , p. 74], the quality of teaching strategies influences student learning and contributes to a 15 to 20 times improvement in student achievement. These researches highlighted that effective teaching strategies played a crucial influence on student motivation, developing students’ positive attitudes, and improving students’ academic achievement more than traditional teacher-centred approaches. There has been no research undertaken in Ethiopian secondary schools to determine which methodologies could be better appropriate for teaching history. Using the designed study instruments, the researchers examine and determine the significant problems confronting history education in Sebeta government secondary schools.

5 Research methodology

The study was conducted using the constructivist paradigm view with the qualitative research approach. In this study, the researchers utilized a qualitative research approach. The qualitative research approach allows the researchers to conduct an in-depth investigation of the problem under study [ 34 , pp. 177–179, 35 , p. 12]. The qualitative research approach has different specific designs. These are Phenomenology, Ethnography, Narrative inquiry, Case study, Grounded theory and Historical research [ 36 , p. 49]. In this study, the qualitative case study design was used. Case studies are ways to explain, describe, or explore phenomena. According to Hatch [ 37 , p. 37], case studies are the type of qualitative work that investigates a contextualized contemporary phenomenon within specific boundaries. This study was carried out using document analysis, interviews, and classroom observation techniques.

The researchers received the accreditation letter from their institution and submitted it to the relevant authorities to confirm the legality of the research. The letter was then submitted to the Sebeta town’s education office and Sebeta secondary schools to acquire authorization to collect primary data from sampled respondents. The data collection process was started after getting all relevant permits from the authorities. Before interviews with respondents, the researchers described the goal of the study to the participants to acquire their permission. The researchers told participants that the study's primary aim was to collect data for the research titled "The significant problems confronting history education in history education in Sebeta town public secondary schools, Ethiopia." After extensive verbal discussions with the respondents, interviews were conducted with those who expressed full interest in participating in the study.

5.1 Sampling procedure

This study employed a purposive sampling technique. In the first stage, the study site was chosen purposively, which is Sebeta town. In the following step, this baseline study was confined to two out of four government secondary schools in Sebeta town with similar standards, a higher number of students and staff than the others. The schools that were purposely selected for the study are those that have been in existence for a long time, have more experienced staff than others, and are expected to provide firsthand information. Purposive sampling was used to select knowledgeable research participants [ 38 , pp. 512–513]. Because it allows the researcher to select the research participants who were believed informed sources of information, thoughtful, informative, articulate, and experienced with the problem under the study [ 35 , p.142, 39 , pp. 100–114]. The researchers selected individuals who have a good source of information about the issue under study (history education teachers and students [ 39 , p. 100]. In the selected two secondary schools, there are six history education teachers, five males and one female. These teachers were purposefully included in the study. The researchers believed that the experienced teachers who were chosen were useful as a primary source of data because they were familiar with the subject's contents, as well as its problems. Eight top-ten grade ten students from the two schools also took part in the study directly. The researchers believed the top-ten students were able to explain the area of study more accurately than the others. Grade ten students were purposefully chosen for the study. The following are the grounds for choosing grade ten students: First history education in Ethiopia begins in grade nine. Students began studying history education grade nine onwards. Because it is assumed that grade ten students know more about history education contents than grade nine students. Second, it is assumed that grade ten comprises all types of students (higher achievers, moderate, and slow learners), as well as grade 10 students who will choose a major (social sciences and natural sciences) in their future grade eleven. As a result, the researchers opted to gather the finest information from grade ten students to establish their perspectives toward history.

6 Results and discussions

6.1 what are the significant problems facing history education in sebeta town government secondary school, 6.1.1 interviews analysis.

For explanation, the abbreviation SSST stands for “Sebeta Secondary School Teacher”, similarly, BSSST stands for “Burka Sebeta Secondary School Teacher” and the numbers denote the order. As shown in Table  1 , six history education teachers were interviewed for this study. Of the six teachers interviewed, five had more than 15 years of teaching experience. Five of these teachers hold a bachelor's degree and one has an MA in history. Five of the teachers interviewed were male and one was female. During the interviews, the teachers revealed to the researchers that three of the six teachers had an MA in another academic discipline (Table 2 ).

For clarification, the abbreviation SSSS stands for, “Sebeta Secondary School Student”, BSSS, “Burka Sebeta Secondary School Student” and the numbers represent the order. Eight students’ four males and four females from both schools were chosen for the interview of this study.

An interview is one of the data collection instruments that were used to explore the significant problems confronting history education in government secondary schools. An interview allows the researchers to gather information that is directly related to the research objectives [ 40 , p. 411]. It is typically conducted one-on-one with informants who have firsthand experience with the research topic [ 25 , p. 144]. An interview was conducted with six experienced history education teachers, and eight secondary school students to gather adequate data about the topic under investigation.

The researchers began their interview with teachers by asking, “What are the significant problems facing history education in Sebeta town government secondary school?” The researchers interviewed teachers concerning the organization of the history education curriculum. Teacher SSST1’s response to this question is as follows: “I have been teaching history education for 18 years but I have never seen or read the curriculum of history education until today.’’ Furthermore, BSSST1 shared the same point of view saying: “So far, I have not read any history education syllabus or seen what it contains except students’ textbook. There is no available history education syllabus in secondary school for teachers. ” Teacher SSST2 also made a similar note: “We do not have a history syllabus, and the teaching materials that we use to teach students are only students’ textbooks.”

All of the teachers interviewed stated that they did not have a history curriculum and had never utilized it. The researchers found that teachers do not see contents, structures, recommended teaching aids, and methodologies in the history education syllabus and teachers’ guide.

Teachers explained that the history education textbook is divided into three parts: world history, African history, and Ethiopian history. According to the teachers interviewed, the history of the Ethiopian peoples are not written inclusively in students’ textbooks, and Ethiopian history education does not adequately addressed the political, social, and economic history of the Ethiopian people (BSSST1, BSSST2, SSST1, SSSS2, SSST3). However, research work suggests that in multi-ethnic countries, all students should be able to learn about themselves and their culture from the books they learn from Hodkinson et al. [ 41 , p. 3] stated that “all learners must be able to find themselves and their world represented in the books from which they learn.”.

In addition, teachers were asked as history education teaching materials in the same way as other Subjects. To this question, all of the teachers interviewed consistently said no. Teachers claim that “since our country’s political changes, textbooks for all disciplines have been updated three to four times, but history education has not been updated in the same way” (BSSST1, BSSST2, SSST1, SSSS2, SSST3, SSSST4). They demonstrated this to the researchers by referring to the textbook they were using. In this instance, a history grade 10 students’ textbook was published in 2002 GC/1994, reprinted in 2005/1997 and renewed in 2023 after 18 years. According to the teachers interviewed, there has been no detailed reform of history education in terms of adding or removing content, implementing new teaching strategies, or keeping up with the 21st-century world. One interviewed teacher said, ‘’I have been teaching history for 18 years and have not observed any changes in history education contents since I started teaching history education.’’ (SSST1).

The researchers continued their interview with teachers by asking, is the content of the history education curriculum appropriate for the student's abilities? This question is to gather evidence to understand that the content of the history curriculum is appropriate for the student's abilities. Teachers and students were asked this question. When asked about the content of history education in grade ten, teachers made two comments:

Students who did not study history as a subject in elementary school (1st grade to grade eight) may find it more difficult when they begin studying history education as a subject in grade nine (SSST1 and SSST2).

They have been studying in their mother tongue in primary school (grades 1 to 8) and studying in English from grade 9 onwards will make it difficult for students to understand the contents (SSST1 and SSST2). The students interviewed strongly agree with the latter. According to the students, “the content of history is very difficult to understand, history is not like other subjects, it requires proper knowledge of English” SSSS1, SSSS2, BSSSS1 and BSSS2).

Follow-up questions were also raised for teachers, to determine the teaching methods included in the history education curriculum. However, teachers were unable to respond to this question because they were not implementing the teaching practices outlined in the history education curriculum due to a lack of a history syllabus. A well-designed teaching strategy has a crucial role in improving students' academic achievement [ 42 , p. 51–64]. Therefore, teachers teach history using their own teaching and learning methods. When asked what teaching method they used, the teachers stated that they used the lecture teaching method (SSSS1, SSSS2, BSSSS1 and BSSS2). The reason they use lecture methods more than other teaching and learning methods is that the content of history lessons is extensive and the time allocated for history lessons is 80 min per week (SSSS1, SSSS2, BSSSS1 and BSSS2).

6.1.2 Classroom observation analysis

The researchers used lesson observations to obtain firsthand and ‘real' facts and data about the significant problems confronting history education in Sebeta government secondary schools. This is because many people do not want to discuss all topics during an interview [ 43 , p. 117]. The researchers employed the lesson observation checklist, which included activities such as the teacher's teaching strategies, teacher and student activities throughout the session, teacher-student interaction during the lesson, student seating arrangements, and teaching aids used. Using this checklist, the researchers observed the teacher’s teaching practice during the lesson. The researchers observed four different classrooms. The primary aim of this observation was to strengthen the data obtained from teachers and students during an interview. The teachers in all of the classrooms first ask students what they learned in their last class. Aside from that, they only used to give notes and lectures to the students in every class.

Another point that the researchers visited in the classroom was the teachers’ and students’ activities during the lesson. The teachers gave notes, and lectures and many students were busy writing notes. When the teachers lecture the content some students do not pay attention and instead take notes. Some students do not take notes, do not listen and look elsewhere. As observed by the researchers, teacher-student interaction during the lesson is very weak. Based on the observation students' seating arrangements were traditional in that three students' seats occur on a wave which is not convenient for group discussion, group work and collaborative learning.

During classroom observation, there are no teaching aids used in all classrooms visited by the teachers to make the lessons practical.

Finally, based on the findings of the study through classroom observation, traditional methods of teaching and learning in history classrooms are still the dominant teaching strategies in the twenty-first century. Researchers who research teaching strategies confirm that participatory teaching is an effective way to improve students’ academic achievement. Madar and Baban [ 42 , pp. 51–64] also discovered that participatory teaching is a good strategy to develop students’ skills and increase their academic achievements. They added that participatory teaching strategies put students at the centre of the teaching and learning process (p. 51). However, through interviews with teachers, students, and lesson observation, the researchers discovered that teachers are not employing student-centred approaches that are fitting for students' learning and achievement.

The responses of teachers and students are consistent with the literature on strategies for teaching. Researchers who conducted studies on teaching strategies found that the teacher- centred method is a traditional strategy that is not very effective in enhancing student achievement. The findings of this study also agree with Mohammed [ 44 , p. 11] who conducted a study on, “strategies in the teaching of geography …” , and stated that the lecture method of teaching has a negative effect on students’ creativity, critical thinking, ability to produce new ideas, and academic achievement of students. Similarly, this study’s findings also concur with Ezurike [ 45 , pp. 1120–124] conducted a study on, “The Influence of Teacher-Centered and Student-Centered Teaching Methods on Academic Achievement of Students,” which discovered that poor methods, mostly teacher-centred and conventional teaching methods used by teachers, are one of the major factors contributing to students’ poor achievement.

Finally, it is better to conclude that teaching strategies can positively and negatively influence students' academic achievement. If teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

6.2 How do teaching strategies influence students' academic achievement in Sebeta secondary schools?

To answer this question, the researchers conducted interviews with teachers and students, as well as document reviews and classroom observations. This issue was addressed by both teachers and students. Methods of teaching have a wide range of effects on the academic success of learners. When asked this question, they all had similar answers. According to teachers, good teaching strategies play a significant role in improving students’ academic achievement. They state this as follows:

Using collaborative teaching practices can significantly improve students' academic achievement. Because collaborative instruction is a teaching technique in which students learn together by assisting one another. Higher achiever students support the low achiever learner in this instructional learning process. However, if teachers utilize traditional teaching methods without involving students in the teaching-learning process, students' academic achievement may suffer (BSSST1, SSST2, and SSST3).

However, for a variety of reasons, teachers do not use collaborative teaching strategies to improve the academic achievement of their students. Rather than focusing on improving the academic achievements of students’ teachers are only concerned with completing their content. Furthermore, the student stated that teaching strategy can positively and negatively influence students' academic achievement. According to students:

…if teachers employ interactive teaching strategies during teaching lessons, students can understand the main point of the lesson and profit much from it. In contrast, if teachers exclusively employ the lecture approach without involving students in the lesson, it may result in low student achievement in the subject. Furthermore, students responded with two statements: excellent teaching strategies encourage students’ interest in the subject and are also, critical for improving students' academic achievement (BSSSS1, BSSSS2, SSSS1, SSSS3, and SSSS6).

The teachers were interviewed about teaching methods they implement when teaching a history education lesson. The teachers were asked to mention teaching methods that they always use in teaching history. The majority of the teachers claimed to use lecture approaches when teaching history education lessons. Teachers noted: “huge class sizes and low time allotted to history subjects, making it difficult to apply participator/student-centred methods (BSSST3, SSST, and SSST2). Furthermore, when asked about their teachers’ teaching methods in history class, students stated that “teachers only use teacher-centred strategies (lecture, dictation, note-giving and reading notes on the blackboard)” (BSSSS3, SSSS1, SSSS2).

During the interview all interviewed teachers acknowledged the use of the lecture method in their teaching. The justifications provided for the use of the lecture method include saving time, the convenience of covering content on time and the nature of students. Teachers said, “A lecture method helps the teacher to cover a lot of content in a short period” (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). The findings of this study are consistent with the findings of a study conducted by Luka [ 14 , p. 30] on the topic of “the impact of teaching methods on attitudes of secondary school students towards learning of history in Malawi,” which discovered that teachers use boring lecture methods to complete their courses rather than focusing on students' results.

History teachers' perceptions of the use of the participatory approach were very low. Based on the interview conducted with history education teachers they were not interested in using student-center teaching strategies (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSSST4). Teachers claimed that participatory teaching strategies were time-consuming and unsuitable for large-class settings ( Ibid ). Instead of using participatory teaching strategies teachers choose teacher-centred methods to cover a large portion within a given time.

The researchers interviewed history teachers at Sebeta secondary schools about the challenges that they confront when implementing the participatory approach. The interviewed teachers stated that the time allotted for history education did not correspond to the content (BSSST1, BSSST2, SSST1, SSST2, SSST3, and SSST4). They were unwilling to utilize student-centred teaching methodologies because they believed it would be time-consuming and difficult to cover the contents of the student’s textbooks within the academic year. According to the teachers, the time allotted to history education every week was only two periods (80 min), although history education included more than 246 pages ( Ibid ). Students also stated that teachers frequently employ lecture methods when teaching history lessons. Both teachers and students agree that collaborative learning methods are more beneficial than traditional teaching methods in improving students’ academic achievement (SSST1, SSST2, SSST3, SSST4, BSST1, and BSST2). Teachers claim that "due to the wide range of topics covered in history education, we use lecture methods of teaching rather than participatory approaches" (SSST1, SSST3, BSST1, and BSST2).

6.3 How is the student's academic achievement in history at Sebeta government secondary school? To answer this question, the researchers used document review

6.3.1 document analysis.

Document analysis is part of the qualitative data collection strategy that every researcher engages in throughout the research period. In this research researchers reviewed, history education students’ textbooks, published articles and roasters of students (students’ mark list). The history education achievement of 174 Sebeta government secondary school students scored in grade 9 in 2020/2021 was compared to look at their achievement in grade 10 in 2021/2022. As a result, one student achieved less than 50% out of 100%, 39 students’ scores ranged from 50 to 60 out of 100%, 98 students scored from 61 to 70 out of 100%, 27 students scored between 71 and 80 out of 100%, 8 students scored between 81 and 90 out of 100%, and 1 student scored between 91 and 100, in grade nine. In grade 10, 11 students scored below 50, 103 students scored between 50 and 60, 45 students scored between 61 and 70, 9 students scored between 71 and 80, 4 students scored between 81 and 90, and 2 students scored between 91 and 100 out of 100%.

Based on this analysis, we can witness students’ achievement in two ways. The first is that in grade 9, 138 out of 174 students scored less than 70% out of 100% and the results of students scoring from 70 to 100% declined significantly. The second point to mention is that student achievement in history education has been highly declining at the subsequent grade level. In Grade 10, the number of students scoring less than 50% grew, and 159 out of 174 students scored less than 70% in history education. This indicates students' achievement in history in grade 9 decreased in grade 10. This suggests that students' achievement in history education was inadequate. Following the analysis of student achievement, interviews were conducted with students and teachers to identify why students' achievement in history education was so low.

7 Conclusion and recommendations

Research shows that teaching strategies are a crucial aspect in successful learning because they enable learners to learn, create, and take a proactive attitude towards learning. The significant issues confronting history education have been identified were teaching strategy, a lack of awareness about implementing participatory teaching methods, a lack of comprehensiveness of the contents of history education teaching materials, and the issue of the bulkiness and scope of history education texts being covered on time and Lack of teachers’ understanding of employing creative teaching strategies to improve students’ academic progress. Despite this, the study found that teachers in Sebeta government secondary schools use the teacher-centered lecture approach rather than interactive or student-centered strategies, which are recommended for students' learning. Teachers were cognizant of student-center teaching and learning improved student achievement. Conversely, teachers are hesitant to adopt participatory teaching methodologies due to the vastness of history textbooks and the lack of time provided to history education to cover bulky texts. As a result, they employ teaching approaches that they believe will allow them to complete the history education contents in the allocated time rather than focusing on enhancing students' academic achievement.

Furthermore, the study also found out that teachers are reluctant to use participatory student-centred learning methods because the two periods per week allocated (80 min) to teaching history education are not enough to cover a wide range of history education content. They believe participatory student-center teaching is ineffective in large classrooms and takes more time than the lecture method. Such thinking stems from a lack of understanding (imparting knowledge) on the use of innovative teaching strategies. The researchers examined the lecture teaching approach that students had learned as well as their results. Several students' achievement in history education shows below 70% out of 100% at Sebeta government secondary schools. The main reason for this low achievement is the teachers’ teaching strategies (the use of teacher-centred approach) to teaching history education to complete a wide content within the allotted time. Teachers do not consider which strategies could improve students’ achievement rather than focus on completing their content. This has also resulted in students’ negative attitudes towards the subject.

The outcomes of this study can serve as the foundation for future research in academic and professional studies. This discovery is notable for the fact that teaching and learning approaches influence students' academic achievement in both directions. Accordingly, if teachers only employ the lecture approach without involving students in the lesson, it may result in low student academic achievement in contrast if teachers employ student-centred strategies students can understand the main point of the lesson and enhance the academic achievement of students.

Thus, for future studies intervention exprimental research in history education is required to measure the extent to which participatory methods of instruction increase the academic achievement of students over teacher-centred strategies. More research, according to the researchers, should be conducted using participatory teaching methods in one classroom and lecture methods in others to determine to what extent participatory teaching methods improve the academic achievement of students when compared to teacher-centred strategies. Following the findings, researchers provided the following recommendations: national and regional education experts should collaborate closely in making history education content inclusive, as well as training history education teachers in the use of participatory teaching approaches. Curriculum experts should effectively organize the breadth of history education contents. To ensure that students learn successfully, the relevant authorities should rigorously monitor the state of the teaching and learning processes in general and history education in particular.

Data availability

The data of this study is the primary source, which is the roster of students' results and education policies. The student results/ marks analyzed for this study are from two Sebeta town public secondary schools: Sebeta secondary school and Burka Sebeta secondary school and Ethiopian education policies. So, the data are available from the corresponding author upon reasonable request from anyone.

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Fufa, F.S., Tulu, A.H. & Ensene, K.A. Exploring the significant problems confronting secondary schools history education: a baseline study. Discov Educ 3 , 52 (2024). https://doi.org/10.1007/s44217-024-00132-8

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