chapter 5 research content

Research Guide

Chapter 5 sections of a paper.

Now that you have identified your research question, have compiled the data you need, and have a clear argument and roadmap, it is time for you to write. In this Module, I will briefly explain how to develop different sections of your research paper. I devote a different chapter to the empirical section. Please take into account that these are guidelines to follow in the different section, but you need to adapt them to the specific context of your paper.

5.1 The Abstract

The abstract of a research paper contains the most critical aspects of the paper: your research question, the context (country/population/subjects and period) analyzed, the findings, and the main conclusion. You have about 250 characters to attract the attention of the readers. Many times (in fact, most of the time), readers will only read the abstract. You need to “sell” your argument and entice them to continue reading. Thus, abstracts require good and direct writing. Use journalistic style. Go straight to the point.

There are two ways in which an abstract can start:

By introducing what motivates the research question. This is relevant when some context may be needed. When there is ‘something superior’ motivating your project. Use this strategy with care, as you may confuse the reader who may have a hard time understanding your research question.

By introducing your research question. This is the best way to attract the attention of your readers, as they can understand the main objective of the paper from the beginning. When the question is clear and straightforward this is the best method to follow.

Regardless of the path you follow, make sure that the abstract only includes short sentences written in active voice and present tense. Remember: Readers are very impatient. They will only skim the papers. You should make it simple for readers to find all the necessary information.

5.2 The Introduction

The introduction represents the most important section of your research paper. Whereas your title and abstract guide the readers towards the paper, the introduction should convince them to stay and read the rest of it. This section represents your opportunity to state your research question and link it to the bigger issue (why does your research matter?), how will you respond it (your empirical methods and the theory behind), your findings, and your contribution to the literature on that issue.

I reviewed the “Introduction Formulas” guidelines by Keith Head , David Evans and Jessica B. Hoel and compiled their ideas in this document, based on what my I have seen is used in papers in political economy, and development economics.

This is not a set of rules, as papers may differ depending on the methods and specific characteristics of the field, but it can work as a guideline. An important takeaway is that the introduction will be the section that deserves most of the attention in your paper. You can write it first, but you need to go back to it as you make progress in the rest of teh paper. Keith Head puts it excellent by saying that this exercise (going back and forth) is mostly useful to remind you what are you doing in the paper and why.

5.2.1 Outline

What are the sections generally included in well-written introductions? According to the analysis of what different authors suggest, a well-written introduction includes the following sections:

• Hook: Motivation, puzzle. (1-2 paragraphs)
• Research Question: What is the paper doing? (1 paragraph)
• Antecedents: (optional) How your paper is linked to the bigger issue. Theory. (1-2 paragraphs)
• Empirical approach: Method X, country Y, dataset Z. (1-2 paragraphs)
• Detailed results: Don’t make the readers wait. (2-3 paragraphs)
• Mechanisms, robustness and limitations: (optional) Your results are valid and important (1 paragraph)
• Value added: Why is your paper important? How is it contributing to the field? (1-3 paragraphs)
• Roadmap A convention (1 paragraph)

Now, let’s describe the different sections with more detail.

5.2.1.1 1. The Hook

Your first paragraph(s) should attract the attention of the readers, showing them why your research topic is important. Some attributes here are:

• Big issue, specific angle: This is the big problem, here is this aspect of the problem (that your research tackles)
• Big puzzle: There is no single explanation of the problem (you will address that)
• Major policy implemented: Here is the issue and the policy implemented (you will test if if worked)
• Controversial debate: some argue X, others argue Y

5.2.1.2 2. Research Question

After the issue has been introduced, you need to clearly state your research question; tell the reader what does the paper researches. Some words that may work here are:

• I (We) focus on
• This paper asks whether
• In this paper,
• Given the gaps in knoweldge, this paper
• This paper investigates

5.2.1.3 3. Antecedents (Optional section)

I included this section as optional as it is not always included, but it may help to center the paper in the literature on the field.

However, an important warning needs to be placed here. Remember that the introduction is limited and you need to use it to highlight your work and not someone else’s. So, when the section is included, it is important to:

• Avoid discussing paper that are not part of the larger narrative that surrounds your work
• Use it to notice the gaps that exist in the current literature and that your paper is covering

In this section, you may also want to include a description of theoretical framework of your paper and/or a short description of a story example that frames your work.

5.2.1.4 4. Empirical Approach

One of the most important sections of the paper, particularly if you are trying to infer causality. Here, you need to explain how you are going to answer the research question you introduced earlier. This section of the introduction needs to be succint but clear and indicate your methodology, case selection, and the data used.

5.2.1.5 5. Overview of the Results

Let’s be honest. A large proportion of the readers will not go over the whole article. Readers need to understand what you’re doing, how and what did you obtain in the (brief) time they will allocate to read your paper (some eager readers may go back to some sections of the paper). So, you want to introduce your results early on (another reason you may want to go back to the introduction multiple times). Highlight the results that are more interesting and link them to the context.

According to David Evans , some authors prefer to alternate between the introduction of one of the empirical strategies, to those results, and then they introduce another empirical strategy and the results. This strategy may be useful if different empirical methodologies are used.

5.2.1.6 6. Mechanisms, Robustness and Limitations (Optional Section)

If you have some ideas about what drives your results (the mechanisms involved), you may want to indicate that here. Some of the current critiques towards economics (and probably social sciences in general) has been the strong focus on establishing causation, with little regard to the context surrounding this (if you want to hear more, there is this thread from Dani Rodrick ). Agency matters and if the paper can say something about this (sometimes this goes beyond our research), you should indicate it in the introduction.

You may also want to briefly indicate how your results are valid after trying different specifications or sources of data (this is called Robustness checks). But you also want to be honest about the limitations of your research. But here, do not diminish the importance of your project. After you indicate the limitations, finish the paragraph restating the importance of your findings.

5.2.1.7 7. Value Added

A very important section in the introduction, these paragraphs help readers (and reviewers) to show why is your work important. What are the specific contributions of your paper?

This section is different from section 3 in that it points out the detailed additions you are making to the field with your research. Both sections can be connected if that fits your paper, but it is quite important that you keep the focus on the contributions of your paper, even if you discuss some literature connected to it, but always with the focus of showing what your paper adds. References (literature review) should come after in the paper.

5.2.1.8 8. Roadmap

A convention for the papers, this section needs to be kept short and outline the organization of the paper. To make it more useful, you can highlight some details that might be important in certain sections. But you want to keep this section succint (most readers skip this paragraph altogether).

5.2.2 In summary

The introduction of your paper will play a huge role in defining the future of your paper. Do not waste this opportunity and use it as well as your North Star guiding your path throughout the rest of the paper.

5.3 Context (Literature Review)

Do you need a literature review section?

5.4 Conclusion

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Chapter 5 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

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Thesis Writing: What to Write in Chapter 5

Table of contents, introduction.

This article tells what a budding researcher must include in Chapter 5-the Summary. It also includes the tense of the verb and the semantic markers, which are predominantly used in writing the summary, conclusions, and recommendations.

For others, writing Chapter 5 is the easiest part of thesis writing, but there are groups of students who would like to know more about it. If you are one of them, this article on how to write chapter 5 of your thesis is purposely written for you.

What to Write in Chapter 5

1. write the summary.

Your summary in Chapter 5 may include:

• objectives of the study.
• statement of the problem.
• respondents.
• sampling procedures.
• method/s of research employed.
• statistical treatment/s applied, or hypotheses tested, if there is any; and

If you notice, all the parts mentioned above are already included in your Chapters 1- 4. So, the challenge is on how you are going to write and present it in Chapter 5 briefly.

First, you must go directly to the point of highlighting the main points. There is no need to explain the details thoroughly. You must avoid copying and pasting what you have written in the previous chapters. Just KISS (keep it short and simple)!

Then, write sentences in  simple past  and always use  passive voice  construction rather than the active voice. You must also be familiar with the different semantic markers.

When I was enrolled in Academic Writing in my master’s degree, I learned that there are semantic markers which can be used in order not to repeat the same words or phrases such as  additionally, also, further, in addition to, moreover, contrary to, with regard to, as regards, however, finally, during the past ___ years, from 1996 to 2006, after 10 years, as shown in, as presented in, consequently, nevertheless, in fact, on the other hand, subsequently and nonetheless.

Next, you may use the following guide questions to check that you have not missed anything in writing the summary:

• What is the objective of the study?;
• Who/what is the focus of the study?;
• Where and when was the investigation conducted?;
• What method of research was used?;
• How were the research data gathered?;
• How were the respondents chosen?;
• What were the statistical tools applied to treat the collected data?; and
• Based on the data presented and analyzed, what findings can you summarize?

Finally, organize the summary of the results of your study according to the way the questions are sequenced in the statement of the problem.

2. Write the Conclusion or Conclusions

Once you have written the summary in Chapter 5, draw out a conclusion from each finding or result. It can be done per question, or you may arrange the questions per topic or sub-topic if there is any. But if your research is quantitative, answer the research question directly and tell if the hypothesis is rejected or accepted based on the findings.

As to grammar, make sure that you use the  present tense of the verb  because it comprises a general statement of the theory or the principle newly derived from the present study. So, don’t be confused because, in your summary, you use past tense, while in conclusion; you use the present tense.

3. Write the Recommendations

The recommendations must contain practical suggestions that will improve the situation or solve the problem investigated in the study.

First, it must be logical, specific, attainable, and relevant. Second, it should be addressed to persons, organizations, or agencies directly concerned with the issues or to those who can immediately implement the recommended solutions. Third, present another topic which is very relevant to the present study that can be further investigated by future researchers.

But never recommend anything that is not part of your study or not being mentioned in your findings.

First, it must be logical, specific, attainable, and relevant. Second, it should be addressed to persons, organizations, or agencies directly concerned with the issues or to those who can immediately implement the recommended solutions. Third, present another topic that is very relevant to the present study that can be further investigated by future researchers.

Recommend nothing that is not part of your research or not being mentioned in your findings.

However, there are universities, especially in the Philippines, that require a specific thesis format to be followed by students. Thus, as a student, you must conform to the prescribed form of your college or university.

Nordquist, R. n.d. Imperative Mood. Retrieved July 29, 2014, from https://www.thoughtco.com/imperative-mood-grammar-1691151

© 2014 July 29 M. G. Alvior | Updated 2024 January 10

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About the author, mary g. alvior, phd.

Dr. Mary Gillesania Alvior has PhD in Curriculum Development from West Visayas State University. She earned her Master of Arts in Teaching English from De La Salle University, Manila as Commission on Higher Education (CHED) scholar. As academic advisor, she helps learners succeed in their academic careers by providing them the necessary skills and tips in order to survive in this wobbling financial environment. In 2014, she got involved in the establishment of a language institute in the Middle East, particularly in the use of Common European Framework of Reference for Languages (CEFR). Then she went to Thailand and became a lecturer in the international college and handled English and Graduate Education courses. From 2017 to 2021, she became the Focal Person for the Establishment of a Medical School, Director of Curriculum and Instructional Materials Development Office (CIMDO), Head of BAC Secretariat, Quality Management System (QMS) Leader, and TWG member of the Procurement for Medical Equipment. Currently, she is the coordinator of the Project Management Committee for the Establishment of the Medical School. In spite of numerous tasks, she is into data privacy, quality management system, and space industry.

100 Comments

can you please make a summary about “Centella Asiatica with virgin Coconut Oil as Ointment”?

I am still having problem in organizing my summary and conclusion (my topic is dress code in public schools. to be more specific, at the Voinjama Public School. Can you help me with a sample?

This is very helpful especially the grammar part. It really jumped start my writing effort… really want to finish my study with style.

I just pray you are okay. Thanks for responding to the questions, I have also learnt a lot.

Hello, Daryl. Thank you so much. About your request, I will find time to write about it. I got so busy the past months.

Precise and direct to the point ,, Thanks maam Mary.

Thanks very much for this all importing information on how to write chapter five in thesis writing. It gives me more insight as to how to develop the chapter five perfectly.

Hello maam my PhD research purely a qualitative study on community based organization of slum ..i used 3 tool case study , participant observation and FGDs to analyse role, impact, challenge and aspiration of CBOs . i used tabular form (matrix to analyse ) did not use any software..

PLEASE HELP/GUIDE ME WHAT SHOULD I WRITE in my Chapter 5 .. your help is very much crucial as i have to submit thesis this weekend KULDEEP

I’m so sorry, Kuldeep. I wish you are done with your doctorate research. It is been a year then. I got sick and had a lot of work to do. God bless!

Hello ma’am, can I ask about in what part the recommendation in chapter 1 reflect the recommendation in chapter5? Thanks.

Sorry, Aly. This is very late. Take your statement of the problem. the results for the statement of the problem will be the basis for your recommendation.

You are welcome, Prince. God bless to your research endeavor.

Thank you very much very insightful.

Eric, you are welcome. I wish you are able to finish your work.

how to write a recommendation, my title is common causes of financial problem. Hope you can help me…

Hello, Jolven. Your recommendation must be based on your findings. So, if that is your title, and you found that the common causes are the ——-, then write a recommendation based on the causes.

Thanks a lot, Mimimi.

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Chapter 5: Conclusion, Interpretation and Discussion

Introduction.

The following chapter concludes this report. A summary of the research is presented, and findings of the study are discussed and interpreted. The significance of this research in the immediate context of El Gallo and in the field of low-income housing is examined. Recommendations for further research end the chapter.

The scope of the following conclusions is limited to the context and historical characteristics of El Gallo. Thus, applied to other situations, these conclusions may yield incorrect assumptions. Still, these conclusions are relevant to the process of dwelling evolution in progressive development projects.

5.1 Summary of Research

This study observed the process of dwelling evolution in progressive development projects. The literature review was concentrated on the process of progressive development occurring in planned sponsored projects. It was found that, based on observations of the informal settlement process, progressive development under different contextual conditions was not questioned, and its benefits were taken for granted. Studies in the area were reduced to the period of improvement up to the time when the dwelling was physically consolidated. Longer term evaluation of progressive development projects were not found.

Research was undertaken on a 27-year-old progressive development project in Venezuela. The intention was to observe the process of dwelling evolution and the kind of housing that was being produced under progressive urban development projects on a long-term basis. The case study showed dwellings built with different initial levels of user-participation. Dwelling evolution was observed in a survey sample using parameters relevant to the case study (i.e., area increase, dwelling spatial growth and plot occupation, and changes in the functional structure).

Survey dwellings followed identifiable patterns of evolution in size, spatial structure and use-layout. Patterns were affected by aspects of the surrounding context and by aspects inherent to characteristics of the initial dwelling. Consequently, different dwelling groups showed different processes of progressive development.

5.2 Discussion and Interpretation of Findings.

As progressive developments, dwellings at El Gallo were able to adopt new and diverse roles along their whole process of evolution. In this section, relevant issues of the process of dwelling evolution observed at El Gallo are discussed. The first concerns the role of the non-permanent structure in the context of El Gallo as a sponsored progressive development project. The second comments on the process of dwelling evolution that followed the construction of the permanent structure.

In principle, non-permanent structures at El Gallo were similar to ranchos built in informal settlements. Ranchos at El Gallo served as primary shelters while more basic household priorities were met (i.e., services and infrastructure were provided, sources of income were found and generated, and even a favourable social environment was developed among neighbours). However, the majority of tin shacks were neither considerably increased nor upgraded with better materials even when they were used for long periods of time. This fact, together with the sudden change in the pace of development caused by the construction of a very complete permanent dwelling and subsequent removal of the rancho, had no connection with the gradual process of shack replacement observed in invasion settlements of Ciudad Guayana during this study (Portela, M. 1992). Neither did this process have a relationship with the system of "piecemeal construction" described by several housing researchers as characteristic of low-income dwellers.

The shanties were... housing in process of improvement. In particular the piecemeal system of building afforded great advantages to those who, like most of the poor in developing societies, have great variations in income from month to month (Peattie L. 1982:132).

Under El Gallo conditions of land security, ranchos did not show consolidation, and revealed their transient character because they were eventually substituted by permanent structures. The non-permanent structure revealed the primary household's aspiration for a minimum satisfactory habitable area. However, besides basic shelter during the initial stage, ranchos served to the purposes of capital accumulation that eventually allowed households to buy a basic unit according to official standards, or building a bigger, more complete first permanent structure. The size of ranchos reflected households' aspirations for the permanent dwelling, that is,smaller ranchos were substituted by basic units of the housing programs. Instead larger ranchos were substituted by large self-produced dwellings.

It is difficult to ascertain why ranchos were removed when they could have been kept as part of the dwelling, as in fact did a minority of households (2 cases). Is a fact that the temporary materials of ranchos contributed to their deterioration that ended with the total removal of the rancho. However, an idea that may have contributed to the demolition of the rancho was the household's adoption of the planner's belief that ranchos were a bad but necessary step on the way to obtaining permanent housing. Thus, once the permanent dwelling was built, the price households paid to gain credibility (i.e., that this stage was reached) was the demolition of the rancho itself. This interpretation can be specially true for Ciudad Guayana, where dwellings of certain quality such as those of El Gallo were seen as "casas" or houses. Instead, structures of similar quality in the hills of cities such as Caracas were still considered ranchos. In the long run, informal settlements obtained the largest benefits from this process because they gained far more official tolerance and social credibility (i.e., that shacks were actually temporary means of residence towards good-quality housing).

Those who lived in smaller ranchos improved their spatial conditions by moving to the small basic dwellings. Those who occupied bigger ranchos built bigger dwellings by themselves. Still, some households built their dwellings without going through the rancho stage. Self-produced dwellings followed the formal models either to gain the government's credibility of user commitment to build "good" government-like housing, or because households believed so. Imitation of the formal models, however, varied according to the builder's interpretation. For instance, the pattern of the detached dwelling was adopted, but often one of the side yards was reduced to a physical separation between the dwelling and the plot separation wall. More effective interpretations involved enlarging the front porch or using the central circulation axis to allow easy extension in the future.

The building approach of the permanent structure influenced the process of evolution that followed. Basic units built by the housing agencies had a compact, complete layout with higher standards of construction; however, aspects of the design, such as internal dimensions, were inadequate for household criteria, and the layout was not well adapted. Dwellings built according to provided plans and specificationshad similar problems, but households enlarged spaces and modified layouts when they were building the units. The level of construction standards was also reduced since the lateral façades of some dwellings were unfinished. Dwellings built totally by self-help means were the largest permanent structures. Aspects of the design of the first permanent structure allowed easy extension of the dwelling towards open areas of the plot. More user participation was reflected in straight-forward processes of evolution without internal modifications, and fewer stages to reach the current houseform.

5.3 Significance of the Study

While this study acknowledges again the effectiveness of progressive development in the housing system, it shows how dwelling evolution in progressive development projects can have different characteristics produced by internal and external interventions. Usually, projects are designed and launched to reproduce certain desirable outcomes and meet specific expectations. However, conditions prevailing in these projects and sometimes strategies that are introduced to "improve," "speed up" or make more "efficient" the process of evolution can affect the outcome in many different ways. This study showed how contextual characteristics of El Gallo, as well as the design and level of user participation in the initial permanent dwelling, affected successive stages of progressive development. However, it is important to recognize that are other issues beyond the spatial aspects that are intrinsically related with the evolution of the dwellings and that were not included within the scope of these particular research (i.e., household's changes in income, size, and age or gender structure).

The findings at El Gallo add modestly to the body of knowledge of literature on progressive development. Progressive Urban Development Units, UMUPs , have been the main housing strategy in Ciudad Guayana these last years, and they are likely to keep being used. Simple facts such as knowing the characteristics of the additions and modifications that households make to their dwellings over time can be the basis for more assertive actions supporting or enforcing progressive development activities. Understanding the process of dwelling evolution in low-income developments would be an effective way to help the process that, in the case of Ciudad Guayana, zonings and bylaws have been unable to regulate.

5.4 Recommendations for Further Research

Long term assessments are particularly constrained by the availability and reliability of recorded data. The frequency, and often the methodology, in which censuses and surveys are made do not always suit the purposes of this kind of research. Household interviews are very important, but they may become troubled by informant's limited memories and the continuity of the household in the dwelling. Aerial documentation, if available, represents one of the most reliable sources to observe physical change. Nevertheless, a careful and detailed process of observation of aerial data becomes very time consuming. For similar studies, a first phase in which the housing diversity is identified in the aerial data according to the selected criteria, would allow to reduce the number of detailed survey samples needed, thus considerably reducing the time of data collection.

In the context of Ciudad Guayana, further studies of the non-permanent dwelling in recent UMUPs would reveal new insights into the function of these structures in progressive development projects. This would be essential especially if any kind of initial aid is to be provided. On the other hand, following the growth of progressive developments is necessary if services and infrastructure are, as they are now, the responsibility of the local government. Identifying the producers of physical evolution -- i.e., the drivers and catalysts of change -- would be an important step for further research. An interesting step within this trend could be to ascertain the extent in which other household processes -- family growth, income increase and economic stability, household aging, changes in the household composition (single- to multi- family), etc., affect the process of dwelling evolution.

In the context of low-income housing, the process of progressive development needs further understanding. As in Ciudad Guayana, progressive development is likely to be the main housing strategy for other developing countries in the near future. Local authorities would do well to follow the evolution of settlements and to identify real household needs, and the consequences of public and/or private interventions in low-income settlements. Perhaps the most important learning of this study is that the experience of El Gallo acknowledges again the dynamic participation of the low-income households under different conditions, and still leaves wide room for a positive participation for the many other actors in the evolving urban entity.

. Notes for Chapter V

1 Dodge reports that some settlers of Ciudad Guayana kept the rancho and rented it to poorer families (Dodge,C. 1968:220). This attitude has been more common in other progressive development projects. The Dandora site and services also encouraged the construction of temporary shacks while the permanent dwelling was built. However, non-permanent structures remained to be rented or used as storage areas even after the permanent dwelling was built (McCarney, P.L. 1987:90).

Department and University Information

Minimum cost housing group.

Conclusion: The Practice of Longitudinal Research

• First Online: 30 May 2024

Cite this chapter

• Julia Cook 7  

Part of the book series: Perspectives on Children and Young People ((PCYP,volume 15))

In their germinal work on Researching Social Change McLeod and Thomson (Researching social change: Qualitative approaches. Sage, 2009) conceptualise the longitudinal researcher as a time traveller who works across multiple timescapes and with interwoven memories and hopes—both their own and those of their participants. While considering the practice of longitudinal research the three authors in this section have, in essence, reflected on their own experiences as time travellers, and the temporal work that they have performed alongside their research participants. The chapters in this section present perspectives on the history of longitudinal research in the field of youth studies, and how it has been shaped into the present-day field; the affordances that longitudinal research presents to researchers; and the way in which longitudinal research methods can be used to create meaning in both prospective and retrospective work. In considering these topics the authors highlight insights that are specific to the locale in which their studies were conducted, and yet have resonances that extend beyond these contexts to provide inspiration and instruction for other longitudinal youth researchers.

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France, A. (2008). Risk factor analysis and the youth question. Journal of Youth Studies, 11 (1), 1–15.

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Cook, J. (2024). Conclusion: The Practice of Longitudinal Research. In: Cook, J., Maire, Q., Wyn, J. (eds) Longitudinal Methods in Youth Research. Perspectives on Children and Young People, vol 15. Springer, Singapore. https://doi.org/10.1007/978-981-97-2332-4_5

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• Volume 14, Issue 5
• Childbirth Acquired Perineal Trauma study (CHAPTER): a UK prospective cohort study protocol
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Victoria Hodgetts Morton 1 , 2 ,
• http://orcid.org/0000-0002-0983-7590 Rebecca Man 2 ,
• Rita Perry 2 ,
• Terry Hughes 2 ,
• Susan Tohill 2 ,
• Christine MacArthur 2 ,
• Laura Magill 2 ,
• R Katie Morris 1 , 2
• CHAPTER Group
• 1 Birmingham Women's Hospital , Birmingham , UK
• 2 Institute of Applied Health Research , University of Birmingham , Birmingham , UK
• Correspondence to Dr Rebecca Man; r.man{at}bham.ac.uk

Introduction Childbirth-related perineal trauma (CRPT) is the most common complication of childbirth affecting 80% of women overall after vaginal birth. There remains a lack of comprehensive evidence relating to the prevalence of subsequent health problems. Current evidence is related to short-term outcomes, for example, pain, but there is less known about longer-term outcomes such as infection, wound dehiscence, pelvic floor function and psychological outcomes. This is a protocol for a cohort study assessing outcomes of women after CRPT.

Methods and analysis A multicentre, prospective UK cohort study aiming to include 1000 women. All women who have sustained CRPT will be eligible for inclusion and will be followed-up for 12 months after childbirth. The primary outcome will be perineal infection at 6 weeks post-birth. Secondary outcomes will include antibiotic use for perineal infection, wound breakdown, use of analgesia, the requirement for admission or surgical intervention, urinary and faecal incontinence, anxiety and depressive symptoms, sexual function and impact on daily activities. Outcomes will be measured at 6 weeks, 6 months and 12 months post partum, with some outcomes being measured at all time points and others at selected most appropriate time points only. Outcome data will be obtained from a review of clinical notes and from patient questionnaires. Simple descriptive statistics will be used to summarise characteristics and outcomes, with categorical variables expressed as percentages and continuous variables as mean averages, alongside the corresponding standard deviatons.

Ethics and dissemination Ethical approval has been granted by the Research Ethics Council with reference 23/WA/0169. Data collected from the Childbirth Acquired Perineal Trauma (CHAPTER) cohort study will highlight the prevalence and type of complications after CRPT and which women are more at risk. After the conclusion of this study, findings will be used to work with governmental organisations and Royal Colleges to target resources and ultimately improve care.

• Postpartum Period
• Natural Childbirth
• Postpartum Women
• WOUND MANAGEMENT

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjopen-2024-086724

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Strengths and limitations of this study

This study aims to incorporate a diverse range of women with childbirth-related perineal trauma (CRPT) from across the UK, with the goal of producing representative and up-to-date information on complications after CRPT.

Follow-up questionnaires are comprehensive and holistic with a range of potential physical and psychological complications after CRPT being assessed.

Follow-up for the year after childbirth is integral to this study and we will need to consider the potential for non-response to the questionnaires, particularly at the later data collection points.

Questionnaires will need to be completed and returned within the specified time frame in relation to the follow-up points. Where responses occur outside these time windows we will need to consider the impact of this on response.

Introduction

In the UK every year, 80% of women who have a vaginal birth (approximately 450 000 women), experience childbirth-related perineal trauma (CRPT). 1 2 CRPT affects 91% of women in a first birth and 70% in successive births and is therefore the most common complication after childbirth. 2 Despite CRPT affecting the vast majority of women who give birth, the prevalence and severity of resulting health complications remain unclear. There is some evidence relating to initial outcomes, for example, pain, but less is known about longer-term complications, including; wound dehiscence, infection, psychological or social issues, sexual dysfunction and incontinence. 3–6

Complications from CRPT can be multifaceted and long-lasting, with some women suffering wound-related complications for many years and ultimately requiring complex reconstructive surgery, or developing long-term psychological problems. 7 8 There is currently very little research exploring the prevalence of severe CRPT, its risk factors, management or its short or long-term complications. 9 Information to tell us how serious these complications are or how often they occur, is not routinely collected. There is very little research to indicate which women might be more likely to suffer complications from CRPT or experience longer-term health problems. 3–6 The Childbirth Acquired Perineal Trauma (CHAPTER) cohort study is designed to address this substantial evidence gap.

This multicentre, prospective, UK-based cohort study will follow a diverse group of UK women who have sustained CRPT. We will determine the current assessment and management of CRPT immediately after it is sustained, in addition to the prevalence and type of short-term and long-term complications in women who have CRPT. Risk factors for developing CRPT complications and current practice of assessment and management of CRPT complications will be ascertained.

Methods and analysis

To describe the current assessment and management of CRPT at the time it is sustained.

To determine the prevalence of short-term and long-term complications or health problems in women who have CRPT.

To describe the management of subsequent complications in women with CRPT.

To describe the risk factors associated with the development of CRPT-associated complications or longer-term sequelae.

Study design

A UK multicentre prospective cohort study.

Study setting

CHAPTER is open to any type of unit in the UK which offers maternity care. This includes obstetrical-led, alongside midwifery units and freestanding midwifery units.

Sample size calculations

We will aim to recruit a minimum of 1000 women. 300 participants will allow us to determine a CRPT complication prevalence rate of 10% with a 95% CI of 6.8% to 14.0%. A sample size of 900 will allow rarer outcomes to be estimated with precision, for example, a 95% CI for an estimate of 5% would range from 3.7% to 6.6%. We anticipate the sample will include approximately 450 women in the minor trauma group and 450 women in the second, third and fourth degree tear group. We have in excess of 99% power to detect the difference in pain relief previously seen and with the anticipated sample we would be able to detect a difference of less than 10% points between groups (25% vs 35%).

Approximately 70% of women have a vaginal delivery (55–60% unassisted; 10–15% assisted) and there are 73 889 live births per 6-week period, thus 51 722 with a vaginal delivery of which 39 723 will sustain non-obstetric anal sphincter injury (non-OASI) CPRT and 2068 OASI CRPT. 1 10 Based on 20 maternity sites participating (n=9930) and 80% of those being suitable to be approached (eligible, baby or mother not too unwell to be approached—7944), if 50% of those eligible are successfully approached with 50% consenting (1986) and 50% completing all follow-up gives a potential sample of n=993 for all outcomes. For those outcomes that can be determined by routine data collection, this gives a potential sample of n=1986. 11 12

Inclusion criteria

To include women who fit any of the following criteria:

Women (≥16 years) who have given birth either spontaneously or operatively and sustained CRPT (including OASI) who are able and willing to give informed consent.

To include women who have failed instrumental delivery who ultimately give birth via caesarean section provided they have sustained CRPT.

To include women with multiple births who give birth vaginally and via caesarean section provided they have sustained CRPT.

Exclusion criteria

Outcomes to be measured.

Primary outcome: perineal infection within 6 weeks post-birth.

Secondary outcomes:

Clinical outcomes from medical records check

Antibiotic use for perineal infection.

Wound breakdown.

Urinary and faecal incontinence.

Readmission or triage visit for CRPT-related complications.

Requiring referral or review within a specialist perineal clinic.

Requiring minor or major corrective perineal surgery.

Patient-reported outcomes as obtained from questionnaires

At 6 weeks, 6 and 12 months post partum:

Urinary incontinence via the Revised Urinary Incontinence Scale. 13

Faecal incontinence via the Revised Faecal Incontinence Scale. 14

Anxiety and depression via the Edinburgh Postnatal Depression Scale. 15

General health-related quality of life measured using the EQ-5D-5L tool (EuroQol 5 dimension, 5 level). 16

Post-traumatic stress disorder (PTSD) via selected domains from the City Birth Trauma Scale 17

Measures of pain.

Readmissions.

At 6 and 12 months post partum only:

Sexual function via the Bespoke CHAPTER Questionnaire.

Physical activity via the Pelvic Floor Impact Questionnaire. 18

Pelvic organ prolapse symptoms via selected domains from the Revised Postpartum Pelvic Floor and Birth Questionnaire. 19

Maternal satisfaction.

Ability to feed baby according to mother’s preference.

Ability to care for baby.

Social isolation

Ability to care for older children.

Impact on seeking healthcare.

Future pregnancy and subsequent mode of birth preference.

Identification of participants and recruitment

Potentially eligible participants will be identified by members of the clinical care or research team at the relevant site. This will include midwives and obstetricians (consultants and trainees), research midwives and nurses in maternity units in secondary and tertiary care NHS Trusts. All participants screened for inclusion in the CHAPTER study will be recorded on the online CHAPTER screening log. No identifiable information will be included on the screening log. This log will be prospectively maintained at each site using either the hospital birth register or the postnatal ward-specific list of births. The CHAPTER screening log will be held on the Research Electronic Data Capture (REDCap) system.

There will be a maximum of three defined 14-day data collection periods. We shall review demographics and type of CRPT after each 14-day data collection period to ensure that we are achieving representation related to non-OASI and our aim for inclusivity. This will allow us to purposively recruit in subsequent rounds if required.

Consent process

Within the CHAPTER cohort study, two different methods can be used to obtain informed consent for the study:

In-person written informed consent.

Remote consent.

Irrespective of the type of consent to be used, the first approach to potential participants for possible inclusion in the study must be made by a member of the clinical care team at the site (eg, midwife or obstetrician).

The initial approach to potential participants will, in most cases, take place while women are still an inpatient and can be in one of two settings:

On the labour ward/birthing unit for those women anticipating an early discharge but at least 6 hours after birth.

On the postnatal ward.

For those women who have a home birth or who are discharged before they have been approached for inclusion, they will be asked to participate when they are seen by a community midwife usually on day 1 post partum.

Women will be provided with background information about the study, including the premise and what their participation would involve. The women will have an opportunity to ask questions and a written CHAPTER study patient information sheet (PIS) will be provided as an adjunct to this conversation.

Those for whom English is not their first spoken language will also be supported by standard Trust interpretation services, for example, Trust interpreters or LanguageLine (a UK language translation service agency that provides interpreting and translation services in over 200 languages, including British Sign Language). Women who understand spoken English will be able to participate in the study. They will be contacted via telephone and asked to complete the follow-up questionnaires over the telephone with a translator should they choose to. A record of the discussion with the women will be kept in their medical notes.

Remote consent process

Remote documented consent is an option within the CHAPTER study. Remote consent may be undertaken if in-person consent is not feasible, for example, in areas where participants are likely to have a home birth due to the geographical area. In these instances, the woman will be provided with the PIS and consent form by the community midwife or by post. The informed consent discussions will proceed as detailed, but by telephone or video-conference and the details will be recorded in the patient’s medical notes.

There are then two options that may be used to document informed consent. The choice of which method is the decision of the research team at the site:

Scanned/photograph of consent form:

The patient will be asked to initial the boxes on the consent form, and sign and date the form while on the call. If the consent form was sent to the patient by post the patient will be asked to take a photo or scan of the signed form, and email it to the site staff, who will print it off and counter-sign. If the consent form was sent to the patient electronically, and they have access to a printer, they can print a hard copy, take a photo or scan of the signed form and email it to the site staff, who will print it off and counter-sign. The original signed and counter-signed consent form will be placed in the Investigator Site File (ISF), a copy will be sent to the participant (electronically or by post) and a copy will be filed in the patient’s medical notes.

Postal consent:

The patient will be asked to initial the boxes on the consent form, and sign and date the form while on the call. The patient should then post the signed consent form to the site staff, who will counter-sign it on receipt. The original-signed and counter-signed consent form will be placed in the ISF, a copy will be posted to the participant and a copy will be filed in the patient’s medical notes.

Withdrawal of consent

Participants will be made aware from the beginning of their involvement in the study that they can freely withdraw at any time. Continued consent will be assumed by the completion and return of the questionnaires at each time point. Participants will be given details on how to withdraw from the study at any point in the PIS. Reasons for withdrawal must be recorded on the CHAPTER REDCap database.

If a participant decides that they do not wish to continue their participation in the CHAPTER study, they may withdraw in one of two ways:

No study-related follow-up: The participant does not wish to complete patient-reported study-specific follow-up (ie, patient-reported outcomes and quality of life measures at 6 weeks, 6 and 12 months post partum) but is willing for routinely collected data to be used for inclusion in the study.

No further data collection: The participant is not willing to be followed-up in any way for the purposes of the study AND does not wish for any further data to be collected (ie, only data collected prior to withdrawal can be used in the study analysis).

If a participant withdraws from the CHAPTER study, their study record on the CHAPTER REDCap database will be closed and no further data will be collected, as per the participant’s request. All data collected until that time point, will be retained and included in the analysis.

Participant registration

Registration will be via a secure online system hosted by the University of Birmingham Centre for Prospective and Observational Studies (BiCOPS); www.CHAPTER-bicops.bham.ac.uk . Unique log-in usernames will be provided to those who wish to use the online system and who have been delegated the role of registering participants in the study.

After eligibility for registration has been confirmed and informed consent has been taken and documented, the participant can be registered to the study using the CHAPTER online system. During the online registration process, eligibility must be confirmed and participant contact details for follow-up must be entered. A registration number will be given once all questions have been answered. Following registration, a confirmatory email will be sent to the responsible clinician, midwife and local principle investigator (PI). The local research team should add the participant to the CHAPTER participant recruitment and identification log which links participants with their CHAPTER study number. PIs must maintain this document securely and it must not be submitted to the study office. The CHAPTER participant recruitment and identification log should be held in strict confidence.

Once the patient has consented to entry into CHAPTER, their General Practitioner should be notified that they are in the CHAPTER study, using the CHAPTER study GP letter. No other parties outside of the study team will be informed of the participant’s entry into the study.

Baseline data collection

After the woman has consented and they are registered on to the CHAPTER study, baseline information will be collected (outline of information collected in table 1 ). Information will be collected from the maternity record related to demographics (eg, age, ethnicity), maternal characteristics (eg, body mass index, obstetrical history, medical conditions) and delivery characteristics (eg, mode of delivery, CRPT type and details of repair). There are no additional study-specific follow-up hospital visits once the participant is entered into the CHAPTER study.

• View inline

A summary of baseline study participant characteristics

Data collection time points

All follow-up will be conducted remotely. At the time of study entry, participants will be asked to specify their preferred method of contact. Participants will be contacted at the follow-up time points, using their preferred method of communication where possible to request completion of the CHAPTER study questionnaire ( online supplemental appendix S1 —6-week questionnaire). There are three follow-up time points at 6 weeks, 6 months and 12 months post partum.

Supplemental material

At 6 weeks post partum: A clinical note review of electronic secondary care records will be undertaken. This combined with the questionnaire data at this time point, will be used to determine whether the primary outcome of perineal infection within 6 weeks post partum has been met.

At all time points, participants will be asked to complete questionnaire items relating to: Urinary incontinence, flatus incontinence, faecal incontinence, anxiety and depressive symptoms, general health-related quality of life, PTSD symptoms (please see outcomes section for specific questionnaires used).

At 6 and 12 months post partum only: participants will be asked questions relating to sexual function, physical activity, pelvic organ prolapse, maternal satisfaction, ability to feed the baby according to mother’s preference, ability to care for baby, social isolation, ability to care for older children (if relevant), impact on seeking healthcare, future pregnancy and mode of birth preference.

Where questionnaires indicate that a woman had to seek medical care related to her CRPT, further data will be collected by reviewing the secondary care medical records.

Independent data validators will assess a proportion of the data from included to assess generalisability, inclusivity and data accuracy via validation of the primary outcome and critical data items.

Safety considerations and assessment of risk

CHAPTER is a cohort study, therefore any interventions that CHAPTER participants undergo will be as part of their routine clinical care. For this reason, there are no safety considerations relating to the study. We do not anticipate any risks to study participants. Enrolment in the study will not have any impact on patient care as participants will be receiving the same treatment that they would if they were not enrolled. There is a potential benefit for participants in that contact with a member of the research team may identify a woman experiencing concerning symptoms and/or signs of a physical or mental illness. Any women identified through questionnaires as being particularly distressed will be contacted and offered support by the research team with signposting to appropriate local services. Safeguarding elements related to significant concerns related to physical or mental health will involve contact with local services (primary and/or secondary care as appropriate).

Study participants may find the follow-up contacts for completion of the questionnaires an inconvenience given that the follow-up period continues up to 12 months post-study entry. We will mitigate any potential risk of attrition bias by ensuring that participants fully understand the time commitment at enrolment stage and that they know they may withdraw at any time. In accordance with the University of Birmingham’s standard operating procedures, this study has been risk assessed to clarify any risks relating uniquely to this study beyond that associated with usual care. A risk assessment has been conducted and concluded that this study presents no higher risk than the risk of standard medical care.

Women and clinicians may become distressed when completing the questionnaires. We have therefore developed care pathways within the study to manage this ( online supplemental appendix S2 ). 20 For participants who have completed the questionnaires electronically, we will ask them if they have found the questionnaires distressing and would like additional support from the CHAPTER team. Should participants indicate distress and would like a telephone call, they will be contacted within 7 days and a member of the team will direct them towards appropriate postnatal support services and their GP. If a woman experiences distress while completing the questionnaires with the clinician over the telephone she will be offered an opportunity to stop the questionnaire, or postpone to a later point and directed to support services as above. Should the clinicians conducting the telephone questionnaires, who are trained midwives/obstetricians experienced in the care of postnatal women with perineal trauma, become distressed by women’s experiences and/or symptoms, they will be offered support within the CHAPTER team through the chief investigator, in keeping with the normal clinical pathways for doctors and midwives working in the National Health Service.

Data management

Data entry will be completed by the sites via a bespoke BiCOPS REDCap study database. The data capture system will conduct automatic range checks for specific data values to ensure high levels of data quality. Queries and requests for missing clinical data will be raised using data clarification forms via the study database, with the expectation that these queries will be completed by the site within 30 days of receipt.

Participant questionnaires will be completed online, by post or telephone according to participant preference. At the time of consent and entry into CHAPTER, what the study involves will be discussed with each woman. It will be explained that completion of quality-of-life questionnaires plus other patient-reported outcomes will be requested until 12 months post partum and the methods of completion of the questionnaires discussed. Participants who have not returned completed forms will be contacted up to three times after the due date to request completion of the questionnaires. After this time, unreturned forms will be regarded as missing and will not be requested again. At the 6-week time point, participant questionnaires can be completed at 6 weeks post partum, ±1 week. At the 6 and 12-month time points, participant questionnaires can be completed ±1 month.

The University of Birmingham has policies in place, which are designed to protect the security, accuracy, integrity and confidentiality of personal data. The study is registered with the Data Protection Officer at the University of Birmingham and will hold data in accordance with the Data Protection Act (2018 and subsequent amendments). The CHAPTER study office has arrangements in place for the secure storage and processing of the study data which comply with University of Birmingham policies.

It is the responsibility of the PI to ensure all essential study documentation and source documents (eg, signed consent forms, ISFs, participants’ hospital notes) at their site are securely retained for the contractual period. Archiving will be authorised by BiCOPS following the submission of the end-of-study report. No documents should be destroyed without prior approval from the BiCOPS Director. The electronic study master file will be stored at BiCOPS for at least 3 years after the end of the study. Long-term offsite data archiving facilities will be considered for storage after this time; data will be stored securely and confidentially for at least 25 years.

End of study definition

The end of study will be when the last enrolled participant completes their 12-month questionnaires, all database queries have been resolved and the database has been locked and analyses completed. The CHAPTER study office will notify the Research Ethics Council (REC) and the sponsor within 90 days of the end of study. The CHAPTER study office will provide the REC and the sponsor with a summary report of the study.

Data analyses and statistical considerations

Summary statistics: Simple descriptive statistics will be used to summarise characteristics and outcomes, with categorical variables expressed as percentages and continuous variables as mean averages alongside the corresponding standard deviation. To allow for hospital variation, differences in primary and secondary outcomes by participant characteristics will be assessed using multilevel logistic and linear regression models; unadjusted and adjusted models, using clinically plausible explanatory variables, will be reported. Further analysis will investigate potential subgroups, identified from our ongoing systematic reviews.

Explanatory variables/characteristics: We plan to explore the risk of our outcomes adjusted for variables deemed potentially significant. These will be identified in the following ways: other work packages within the programme grant related to primary care data and systematic reviews of existing literature, patient and public involvement and clinical co-applicants.

Status and timeline of study

The CHAPTER cohort study started participant recruitment on 1 September 2023 and has undergone two rounds of recruitment to date (correct as of 19 March 2024). Questionnaires have followed at the initial 6-month time point and are currently being distributed at the 6-month time point. The 12-month questionnaires will follow accordingly from 1 September 2024 onwards.

Data availability

Requests for data generated during this study will be considered by BiCOPS. Data will typically be available 6 months after the primary publication. Only scientifically sound proposals from appropriately qualified research groups will be considered for data sharing. The request will be reviewed by the BiCOPS Data Sharing Committee in discussion with the chief investigator and, where appropriate (or in the absence of the cheif investigator) any of the following: the study sponsor, the study management group, and the programme steering committee. A formal data sharing agreement (DSA) may be required between respective organisations once the release of the data is approved and before data can be released. Data will be fully de-identified (anonymised) unless the DSA covers the transfer of participant-identifiable information.

Patient and public involvement statement

Patient and public involvement has been key to the CHAPTER project. We have a patient advisory group (PAG) who have been providing guidance on the development and initiation of this cohort study. The PAG have been instrumental in developing study materials, ethical considerations and in guiding decisions about rounds of recruitment needed. The PAG will continue to guide all aspects of the CHAPTER project development.

Ethics and dissemination

Ethical approval has been granted by the REC with reference 23/WA/0169. It is anticipated that minor amendments may need to be submitted after the commencement of the study. These will be dealt with via submission to the ethics board and subsequently communicating this amendment to sites to ensure their consent is in place.

Results of the study will ultimately be submitted for publication in a peer-reviewed journal after study completion. Findings will also be submitted to national and international conferences as well as disseminated to the Department of Health and Royal Colleges. Appropriate resources for patients will be developed and any relevant findings are expected to be rapidly incorporated into guidelines by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the National Institute for Health and Care Excellence.

Ethics statements

Patient consent for publication.

Not applicable.

Acknowledgments

This project is part of the CHAPTER programme grant and therefore a larger group of collaborators have contributed to the project and are detailed as part of the CHAPTER group.

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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
• Data supplement 2

Collaborators CHAPTER group: Laura Jones- Institute of Applied Health Research, University of Birmingham, UK; Sara Webb- Royal College of Midwives, UK; John Maltby- School of Psychology and Vision Sciences, University of Leicester, UK; Sarah Hillman- Warwick Medical School, UK; Nicola J Adderley- Institute of Applied Health Research, University of Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, UK; Alice Sitch- Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; Olalekan Lee Aiyegbusi- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK; Marian Knight- National Perinatal Epidemiology Unit, University of Oxford, UK; Krishnarajah Nirantharakumar- Institute of Applied Health Research, University of Birmingham, UK; NIHR Birmingham Biomedical Research Centre, UK; Health Data Research UK, London, UK; Jane Whitehurst- NIHR Applied Research Collaboration West Midlands, UK; Amie Wilson- Institute of Metabolism and Systems Research, University of Birmingham, UK.

Contributors VHM: initial protocol development, design of methodology, overseeing protocol revisions. RM: writing protocol for submission, editing and revisions. RP: project administration, reviewing work. TH: data curation, project administration, reviewing work. ST: project administration, reviewing work. CM: design of methodology, drafting protocol. LM: design of methodology, drafting protocol. RKM: initial protocol development, conceptualisation, funding acquisition, design of methodology. CHAPTER collaborative: conception and design, drafting of work. All authors read and approved the final manuscript.

Funding This project is funded by the National Institute for Health and Care Research (NIHR), grant number NIHR202869. The views expressed are those of the authors and not necessarily those of NIHR or the Department of Health and Social Care.

Competing interests None declared.

Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.

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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Excerpt: State of Fair Housing in Northeast Ohio (list of fair housing ordinances)

Chapter 5: Prohibited Acts

Test Your Knowledge: Prohibited Acts

Chapter 6: Section 504

Test Your Knowledge: Section 504

Chapter 7: Additional Protections for Persons with Disabilities

Chapter 7: Additional Protections & Special Considerations for Persons with a Disability

Test Your Knowledge: Additional Protections for Persons with Disabilities

Chapter 8: Criminal Record Screening

Test your Knowledge: Criminal Record Screening

Chapter 9: Special Topics

Test your Knowledge: Special Topics

Chapter 10: Goals & Best Practices

A Story of The Sum of Us

Course Survey

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