how to critically evaluate psychological research

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How to demonstrate critical evaluation in your psychology assignments

Thinking critically about psychology research

Critical thinking is often taught in undergraduate psychology degrees, and is a key marking criteria for higher marks in many assignments. But getting your head around how to write critically can sometimes be difficult. It can take practice. The aim of this short blog is to provide an introduction to critical evaluation, and how to start including evidence of critical evaluation in your psychology assignments.

So what does “critical evaluation” really mean?

Broadly speaking, critical evaluation is the process of thinking and writing critically about the quality of the sources of evidence used to support or refute an argument. By “ evidence “, I mean the literature you cite (e.g., a journal article or book chapter). By “ quality   of the evidence “, I mean thinking about whether this topic has been tested is in a robust way. If the quality of the sources is poor, then this could suggest poor support for your argument, and vice versa. Even if the quality is poor, this is important to discuss in your assignments as evidence of critical thinking in this way!

In the rest of this blog, I outline a few different ways you can start to implement critical thinking into your work and reading of psychology. I talk about the quality of the evidence, a few pointers for critiquing the methods, theoretical and practical critical evaluation too. This is not an exhaustive list, but hopefully it’ll help you to start getting those higher-level marks in psychology. I also include an example write-up at the end to illustrate how to write all of this up!

The quality of the evidence

There are different types of study designs in psychology research, but some are of higher quality than others. The higher the quality of the evidence, the stronger the support for your argument the research offers, because the idea has been tested more rigorously. The pyramid image below can really help to explain what we mean by “quality of evidence”, by showing different study designs in the order of their quality. 

Not every area of psychology is going to be full of high quality studies, and even the strongest sources of evidence (i.e., systematic reviews and/or meta-analyses) can have limitations! Because no study is perfect, it can be a good habit to tell the reader, in your report, (i) what the  design  of the study is that you’re citing, AND, (ii)  how  this affects your argument. Doing so would be evidence of critical thought. (See an example write-up below for implementing this, but do not copy and paste it!) 

But first, what do I mean by “design”? The design of the study refers to  how  the study was carried out. There are sometimes broad categories of design that you’ll have heard of, like a ‘survey design’, ‘a review paper’, or an ‘experimental design’. Within these categories, though, there can be more specific types of design (e.g. a  cross-sectional  survey design, or a  longitudinal  survey design; a  randomised controlled  experiment or a  simple pre-post  experiment). Knowing these specific types of design is a good place to start when thinking about how to critique the evidence when citing your sources, and the image below can help with that. 

Image source: https://thelogicofscience.com/2016/01/12/the-hierarchy-of-evidence-is-the-studys-design-robust/

In summary, there are various types of designs in psychology research. To name a few from the image above, we have: a meta-analysis or a systematic review (a review paper that summarises the research that explores the same research question); a cross-sectional survey study (a questionnaire that people complete once – these are really common in psychology!). If you’re not familiar with these, I would  highly suggest  doing a bit of reading around these methods and some of their general limitations – you can then use these limitation points in your assignments! To help with this, you could do a Google Scholar search for ‘limitations of a cross-sectional study’, or ‘why are randomised control trials gold standard?’. You can use any published papers as further support as a limitation.

Methodological critical evaluation

• Internal validity: Are the findings or the measures used in the study reliable (e.g., have they been replicated by another study, and is the reliability high)? 
• External validity: Are there any biases in the study that might affect generalisability(e.g., gender bias, where one gender may be overrepresented for the population in the sample recruited)?  Lack of generalisability is a common limitation that undergraduates tend to use by default as a limitation in their reports. It’s a perfectly valid limitation, but it can usually be made much more impactful by explaining exactly  how  it’s a problem for the topic of study. In some cases, this limitation may not be all that warranted; for example, a female bias may be expected in a sample of psychology students, because undergraduate courses tend to be filled mostly with females! 
• What is the design of the study, and how it a good or bad quality design (randomised control trial, cross-sectional study)? 

Theoretical critical evaluation

• Do the findings in the literature support the relevant psychological theories?
• Have the findings been replicated in another study? (If so, say so and add a reference!)

Practical critical evaluation

• In the real world, how easy would it be to implement these findings?
• Have these findings been implemented? (If so, you could find out if this has been done well!)

Summary points

In summary, there are various types of designs in psychology research. To name a few from the image above, we have: a meta-analysis or a systematic review (a review paper that summarises the research that explores the same research question); a cross-sectional survey study (a questionnaire that people complete once – these are really common in psychology!). If you’re not familiar with these, I would highly suggest doing a bit of reading around these methods and some of their general limitations – you can then use these limitation points in your assignments! To help with this, I would do a Google Scholar search for ‘limitations of a cross-sectional study’, or ‘why are randomised control trials gold standard?’. You can use these papers as further support as a limitation.

You don’t have to use all of these points in your writing, these are just examples of how you can demonstrate critical thinking in your work. Try to use at least a couple in any assignment. Here is an example of how to write these up:

An example write-up

“Depression and anxiety are generally associated with each other (see the meta-analysis by [reference here]). For example, one of these studies was a cross-sectional study [reference here] with 500 undergraduate psychology students. The researchers found that depression and anxiety (measured using the DASS-21 measure) were correlated at  r  = .76, indicating a strong effect. However, this one study is limited in that it used a cross-sectional design, which do not tell us whether depression causes anxiety or whether anxiety causes depression; it just tells us that they are correlated. It’s also limited in that the participants are not a clinical sample, which does not tell us about whether these are clinically co-morbid constructs. Finally, a strength of this study is that it used the DASS-21 which is generally found to be a reliable measure. Future studies would therefore benefit from using a longitudinal design to gain an idea as to how these variables are causally related to one another, and use more clinical samples to understand the implications for clinical practice. Overall, however, the research generally suggests that depression and anxiety are associated. That there is a meta-analysis on this topic [reference here], showing that there is lots of evidence, suggests that this finding is generally well-accepted.”

• Notice how I first found a review paper on the topic to broadly tell the reader how much evidence there is in the first place. I set the scene of the paragraph with the first sentence, and then the last sentence I brought it back, rounding the paragraph off. 
• Notice how I then described one study from this paper in more detail. Specifically, I mentioned the participants, the design of the study and the measure the researchers used to assess these variables. Critically, I then described  how  each of these pieces of the method are disadvantages/strengths of the study. Sometimes, it’s enough to just say “the study was limited in that it was a cross-sectional study”, but it can really show that you are thinking critically, if you also add “… because it does not tell us….”. 
• Notice how I added a statistic there to further illustrate my point (in this case, it was the correlation coefficient), showing that I didn’t just read the abstract of the paper. Doing this for the effect sizes in a study can also help demonstrate to a reader that you understand statistics (a higher-level marking criteria). 

Are these points you can include in your own work?

Thanks for reading,

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Understanding and Evaluating Research: A Critical Guide

• By: Sue L. T. McGregor
• Publisher: SAGE Publications, Inc
• Publication year: 2018
• Online pub date: December 20, 2019
• Discipline: Sociology , Education , Psychology , Health , Anthropology , Social Policy and Public Policy , Social Work , Political Science and International Relations , Geography
• Methods: Theory , Research questions , Mixed methods
• DOI: https:// doi. org/10.4135/9781071802656
• Keywords: discipline , emotion , Johnson & Johnson , journals , knowledge , law , peer review Show all Show less
• Print ISBN: 9781506350950
• Online ISBN: 9781071802656
• Buy the book icon link

Subject index

Understanding and Evaluating Research: A Critical Guide shows students how to be critical consumers of research and to appreciate the power of methodology as it shapes the research question, the use of theory in the study, the methods used, and how the outcomes are reported. The book starts with what it means to be a critical and uncritical reader of research, followed by a detailed chapter on methodology, and then proceeds to a discussion of each component of a research article as it is informed by the methodology. The book encourages readers to select an article from their discipline, learning along the way how to assess each component of the article and come to a judgment of its rigor or quality as a scholarly report.

Front Matter

• Acknowledgments
• About the Author
• INTRODUCTION
• Chapter 1: Critical Research Literacy
• PHILOSOPHICAL AND THEORETICAL ASPECTS OF RESEARCH
• Chapter 2: Research Methodologies
• Chapter 3: Conceptual Frameworks, Theories, and Models
• ORIENTING AND SUPPORTIVE ELEMENTS OF RESEARCH
• Chapter 4: Orienting and Supportive Elements of a Journal Article
• Chapter 5: Peer-Reviewed Journals
• RESEARCH JUSTIFICATIONS, AUGMENTATION, AND RATIONALES
• Chapter 6: Introduction and Research Questions
• Chapter 7: Literature Review
• RESEARCH DESIGN AND RESEARCH METHODS
• Chapter 8: Overview of Research Design and Methods
• Chapter 9: Reporting Qualitative Research Methods
• Chapter 10: Reporting Quantitative Methods and Mixed Methods Research
• RESULTS AND FINDINGS
• Chapter 11: Statistical Literacy and Conventions
• Chapter 12: Descriptive and Inferential Statistics
• Chapter 13: Results and Findings
• DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS
• Chapter 14: Discussion
• Chapter 15: Conclusions
• Chapter 16: Recommendations
• ARGUMENTATIVE ESSAYS AND THEORETICAL PAPERS
• Chapter 17: Argumentative Essays: Position, Discussion, and Think-Piece Papers
• Chapter 18: Conceptual and Theoretical Papers

Back Matter

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Writing in Psychology

For most (if not all) your psychology assignments, you'll be required to critically analyse relevant psychological theory and research. If you're just starting out in psychology, you might not know what this involves. This guide will give you an idea of what it means to critically analyse research, along with some practical suggestions for how you can demonstrate your critical-thinking skills. 

What is critical analysis, and why is it important?

Critical analysis involves thinking about the merits and drawbacks of what you're reading. It doesn't necessarily mean tearing apart what you've read-it could also involve highlighting what an author or researcher has done well, and thinking through the implications of a study on the broader research area.

Critical analysis is extremely important in evaluating published research: Psychology studies often build on the limitations of others, and it's important to assess the merits of a study before accepting its conclusions. Furthermore, as a student, your critical analysis of the literature is a way of showing your marker that you've engaged with the field.

What makes critical analysis in psychology different, and how do I critically analyse the literature?

In psychology, critical analysis typically involves evaluating both theory and empirical research (i.e., scientific studies). When critically analysing theory , relevant questions include:

• Does the theory make sense (i.e., is it logical)?
• Can the theory explain psychological phenomena (i.e., what we actually observe in terms of people's behaviour), or does it leave some things unexplained?
• Have any studies been conducted to specifically test this theory, and if so, what did they find? Can we believe this study's conclusions?

In terms of evaluating empirical research , relevant questions include:

• Does the study's research question come logically from the literature the authors have reviewed?
• Are there any issues with the participant sample (e.g., not representative of the population being studied)?
• Do the measures (e.g., questionnaires) actually assess the process of interest?
• Have the appropriate statistical analyses been conducted?
• Do the authors make appropriate conclusions based on their findings, or do they go beyond their findings (i.e., overstate their conclusions)?

Before you critically analyse research, it's important to make sure that you understand what is being argued. We have some resources that can help you get the most out of your reading ( R eading strategies ), as well as some note-taking strategies ( N ote-taking ). The Cornell method might be especially useful, since it involves jotting down your own thoughts/opinions as you're reading, rather than simply summarising information.

As you get more practise critically analysing the literature, you'll find that it starts to feel more natural, and becomes something that you engage in automatically. However, as you're starting out, deliberately thinking through some of the questions in the previous section can help add structure to this process.

What does critical analysis look like?

After you've had a think about the merits and drawbacks of a published piece of work, how do you actually show that you've engaged in critical analysis? Below are some examples of sentences where critical analysis has been demonstrated:

• "Although Brown's (1995) theory can account for [abc], it cannot explain [xyz]."
• "This study is a seminal one in the area, given that it was the first to investigate...".
• "In order to clarify the role of [abc], the study could have controlled for...".
• "This study was a significant improvement over earlier efforts to investigate this topic because...".

What these statements have in common is that they are evaluative : They show that you're making a judgment about the theory or empirical study you're discussing. In general, your marker will be able to tell whether you have engaged in critical analysis by seeing if you've made such statements throughout your work.

Critical analysis in psychology: Some common pitfalls

"The sample size of the study was too small."

Your critiques need to have evidence behind them. Making statements such as this is fine, as long as you follow them up with your reasoning (in this case, on what basis have you decided that the study didn't have enough participants?).

" The study didn't look at participants of [this age/this gender/this ethnic group]."

Traditionally, the area of psychology has tended to focus on WEIRD (white, educated, industrialised, rich, and democratic) individuals. This is certainly an issue for the generalisability of research findings. However, if you make this type of statement, you can further demonstrate your critical-thinking skills by talking about why you think this is an issue for the particular topic you're researching: For example, how might the results of a study differ if a non-WEIRD participant sample had been recruited instead?

Being too critical.

Chances are that if a study is a highly cited one in your area, it probably has some merits (even if it's just that it drew attention to an important topic). You should always be on the lookout for strengths as well as limitations, be they theoretical (i.e., a cohesive, well-elaborated theory) or experimental (i.e., a clever study design).

Other assessments

Writing a creative piece

Writing a critical review

Writing a policy brief

Writing an abstract

Writing an annotated bibliography

Writing in Law

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Clinical Psychology: Critical Appraisal and Evaluation Skills

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Evaluating your results

Just because material has been published in a journal or appears on a wesbite, this does not mean it is suitable for your purpose.  The Open University, in its SAFARI guide to information skills , suggests the following criteria, which you can use for the web and for printed material:

P resentation - is the information presented in a clear and readable way? Are there relevant diagrams and photographs?  Is it written objectively or is it emotive?

R elevance - is it relevant and appropriate for your needs? Does it cover the countries or regions which interest you? Does it cover all aspects of your topic?

O bjectivity - is it balanced or is there some bias? Can you easily establish who the authors are and what their authority might be? Are there vested interests behind the website?  Is it trying to sell you something?

M ethod - how was the information gathered together? Are the methods clearly stated?  Ask yourself basic questions about sample size, use of control groups. questionnaire design etc.

P rovenance or Authority - who or what originated the information and are they reliable sources? Are the authors acknowledged experts in this area? What else have they published on this topic?  Do you they belong to well-known institutions? If you're looking at a journal article, is it from a peer-reviewed journal? If it is a website, did you find the link on a trusted site, such as NHS Evidence or a professional body or a university?

T imeliness - is the information up-to-date and can you tell if it has been superseded? Is it clear when the website was produced?

Critical Appraisal

Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in an evidence-based context. This is of high relevance for medicine, biomedicine and health care contexts. Here are online courses, websites and checklists to help you appraise the material you have retrieved.

• Health Knowledge: Finding and Appraising the Evidence Online course from HealthKnowledge. Aimed at public health practitioners who are new to evidence based practice and critical appraisal. There are six modules including an overall introduction to critical appraisal, systematic reviews, economic evaluations and making sense of results.
• Critical Appraisal Checklists From SIGN. This is a basic course intended for those who need critical appraisal skills for their job or to further their professional education. You may also find it useful if you have not done critical appraisal for some time and want to revive your skills.
• Critical Appraisal Skills Programme (CASP) Oxford-based CASP runs workshops and provides a wealth of checklists and training materials on critical appraisal. Useful, downloadable checklists for different study types, such as systematic review or randomised clinical trials.
• Centre for Evidence-Based Medicine: Critical Appraisal CEBM based at Oxford University, provides worksheets, checklists and other tools to use for critical appraisal. The CEBM also provides other tools for EBM, such as likelihood ratios and the CATmaker, a computer-assisted critical appraisal tool.

Evaluating grey literature

• AACODS Checklist

Grey literature has not been through any sort of peer review process.  Therefore it is particularly important that you evaluate material very carefully to decide whether to use it.

The AACODS checklist is designed to enable evaluation and critical appraisal of grey literature.

A Authority

O Objectivity

S Significance.

It was prepared at Flinders University and there is a very helpful annotated checklist available.

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Understanding the Information Cycle

Scholarly vs popular, evaluating popular and web-based sources, sorting google results, not scholarly.

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The Information Cycle is the progression of media coverage of a particular newsworthy event. Understanding this cycle will help you know what information is available on your topic and to better evaluate information sources covering that topic at that time.

The Information Cycle from UCF Libraries on Vimeo .

(For a larger view of this chart, right click and open in a new tab).

What is the distinction between popular and scholarly sources? Below is a chart comparing works with a more scholarly focus and those that are less so. Additionally, there are three main types of publications:

• Scholarly sources are intended for academic use with a specialized vocabulary and extensive citations; they  are often peer-reviewed. Scholarly sources help answer the "so what?" questions and make connections between variables (or issues).
• Popular sources are intended for the general public and are typically written to entertain, inform or persuade. Popular sources help you answer "who, what, where, and when" questions. Popular sources range from research-oriented to propaganda-focused.
• Trade publications  share general news, trends, and opinions in a certain industry; they are not considered scholarly, because, although generally written by experts, they do not focus on advanced research and are not peer-reviewed.

For a detailed chart comparing these three types of publications, visit: 

• Publication Types and Bias

Once you have located online sources you are considering using for your research project, it is important to critically evaluate the source for reliability.

One method to evaluate sources is the SIFT Method, developed by Mike Caulfield .

The SIFT Method

The SIFT method is used for critically navigating and assessing digital information. It is designed to evaluate the credibility of information, understand its context, and decide on its reliability. It involves four critical moves: Stop, Investigate the Source, Find Better Coverage, and Trace Claims to the Original Context. This method Adopting SIFT establishes a critical mindset when you pause to consider the source, search for diverse perspectives, and locate the original source of claims, fostering a more informed and critical approach to consuming digital content.

The four critical moves of SIFT:

• Stop: Before engaging with content, pause to consider your familiarity with the source and its credibility. This step encourages mindful information consumption Ask yourself whether you know the website or source of the information, and what the reputation of both the claim and the website is.
• Investigate the Source: Take a moment to understand the source's background. Knowing the author or publisher's expertise and agenda aids in interpreting the content accurately.For example, watching a video promoting milk benefits created by the dairy industry, recognizing the source's vested interest is key to understanding biased reporting. This awareness informs your understanding and critical assessment of the information presented.
• Find Better Coverage: Look for reputable sources that cover the same topic. This helps in understanding different perspectives and the consensus around a claim. Should you start to feel bogged down while verifying facts, pause and reflect on your goal. For intentions like sharing, reading for enjoyment, or grasping basic concepts, confirming the credibility of the source may suffice. However, for in-depth research, it's beneficial to meticulously investigate and confirm each claim made in an article on your own.
• Trace Claims to Original Context: Go back to the original source of the information to see it in its true context, ensuring a comprehensive understanding of the material. Online content often lacks the full context, such as potentially misleading captions on seemingly real images. Similarly, health claims might reference research findings ambiguously. To address these issues, it's advised to track back to the original source of any claim, media, or quote to understand its true context and verify the accuracy of the claim you encountered.

Additional Evaluation Techniques

When finding sources online, ask yourself the following questions to determine if they are appropriate to use (SCAAN test):

• Source type: Does this source answer your research question? Is it an appropriate type (scholarly or popular, for instance) for your question? Does this contain the information you need to support your argument?
• Currency: Is this source up-to-date? Do I need a resource that contains historical information?
• Accuracy: Is this source accurate? Does its logic make sense to me? Are there any internal contradictions? Does it link or refer to its sources? Does more current data affect the accuracy of the content?
• Authority: Who created or authored this source? Could the author or creator bring any biases to the information presented? Is the author or creator a reputable or well-respected agent in the subject area?
• Neutrality: Is this source intended to educate, inform, or sell? What is the purpose of this source?

Other Evaluation Acronyms

• CARBS : Currency, Authority, Relevancy, Biased or Factual, Scholarly or Popular
• CARS: Credibility (authority), Accuracy, Reasonableness, Support
• CRAAP: Currency, Relevance (source), Accuracy, Authority, Purpose (neutrality)
• DUPED : Dated, Unambiguous, Purpose, Expertise, Determine (source)
• IMVAIN: Independent, Multiple sources quoted, Verified with evidence, Authoritative, Informed, Named sources
• RADAR : Rationale, Authority, Date, Accuracy, Relevance

Finally, consider your own biases when reviewing your information. If the paper/presentation/article had the opposite position/result, would your opinion of its validity change? 

• Determining Reliability

Google can be a powerful research tool that helps you find policy and legislative data, statistics, policy reports, and more. The trick is knowing how to get Google to find the good stuff for you.

Know your domains:

The end of a web address (URL), after the dot, is the domain. For example, www.usc.edu, edu is the domain. You can use domains to filter out your Google results. 

Common domains are:

• edu -- educational sites
• org -- non-profit sites
• gov -- government sites

I know that many statistics are available on government sites, so I can have Google search for sites that end in gov.

Google domain filtering:

Add the words "site:.gov" (or org/edu/com/etc.) to the end of your Google search. Use a semicolon to separate domains.

With the advent of Open Access, more research is becoming available to a wider variety of researchers. Unfortunately, unscrupulous publishers are also entering the field. These are often called "predatory publishers". Their goal is to raise money - generally by tricking legitimate researchers into submitting their articles to be published for a nominal fee. However, most of these will accept any article by anyone on any topic and call it "scientific."

Check the journal before submitting: Tricks by predatory publishers:

• Turn around time from 5 days to a month (the peer-review process takes a minimum of several months)
• Spam: emails to republish an old article of yours (plagiarizing yourself), serve on a editorial board (they need legitimate names), guaranteed publishing (legitimate journals reject 50-90 of their submissions), instant publishing (see above)
• Fake impact factor (made up numbers to trick potential authors; there are also fake impact factor sites)
• Fake peer review (see above)
• Fake editorial board (they invite people, but if you email members of the board, they may not even know they are being listed)
• True ISSN and doi (journals can get an ISSN and get their articles a doi, even if they are not a legitimate authority)

Always check the journal website before submitting an article.

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The Use of Research Methods in Psychological Research: A Systematised Review

Salomé elizabeth scholtz.

1 Community Psychosocial Research (COMPRES), School of Psychosocial Health, North-West University, Potchefstroom, South Africa

Werner de Klerk

Leon t. de beer.

2 WorkWell Research Institute, North-West University, Potchefstroom, South Africa

Research methods play an imperative role in research quality as well as educating young researchers, however, the application thereof is unclear which can be detrimental to the field of psychology. Therefore, this systematised review aimed to determine what research methods are being used, how these methods are being used and for what topics in the field. Our review of 999 articles from five journals over a period of 5 years indicated that psychology research is conducted in 10 topics via predominantly quantitative research methods. Of these 10 topics, social psychology was the most popular. The remainder of the conducted methodology is described. It was also found that articles lacked rigour and transparency in the used methodology which has implications for replicability. In conclusion this article, provides an overview of all reported methodologies used in a sample of psychology journals. It highlights the popularity and application of methods and designs throughout the article sample as well as an unexpected lack of rigour with regard to most aspects of methodology. Possible sample bias should be considered when interpreting the results of this study. It is recommended that future research should utilise the results of this study to determine the possible impact on the field of psychology as a science and to further investigation into the use of research methods. Results should prompt the following future research into: a lack or rigour and its implication on replication, the use of certain methods above others, publication bias and choice of sampling method.

Introduction

Psychology is an ever-growing and popular field (Gough and Lyons, 2016 ; Clay, 2017 ). Due to this growth and the need for science-based research to base health decisions on (Perestelo-Pérez, 2013 ), the use of research methods in the broad field of psychology is an essential point of investigation (Stangor, 2011 ; Aanstoos, 2014 ). Research methods are therefore viewed as important tools used by researchers to collect data (Nieuwenhuis, 2016 ) and include the following: quantitative, qualitative, mixed method and multi method (Maree, 2016 ). Additionally, researchers also employ various types of literature reviews to address research questions (Grant and Booth, 2009 ). According to literature, what research method is used and why a certain research method is used is complex as it depends on various factors that may include paradigm (O'Neil and Koekemoer, 2016 ), research question (Grix, 2002 ), or the skill and exposure of the researcher (Nind et al., 2015 ). How these research methods are employed is also difficult to discern as research methods are often depicted as having fixed boundaries that are continuously crossed in research (Johnson et al., 2001 ; Sandelowski, 2011 ). Examples of this crossing include adding quantitative aspects to qualitative studies (Sandelowski et al., 2009 ), or stating that a study used a mixed-method design without the study having any characteristics of this design (Truscott et al., 2010 ).

The inappropriate use of research methods affects how students and researchers improve and utilise their research skills (Scott Jones and Goldring, 2015 ), how theories are developed (Ngulube, 2013 ), and the credibility of research results (Levitt et al., 2017 ). This, in turn, can be detrimental to the field (Nind et al., 2015 ), journal publication (Ketchen et al., 2008 ; Ezeh et al., 2010 ), and attempts to address public social issues through psychological research (Dweck, 2017 ). This is especially important given the now well-known replication crisis the field is facing (Earp and Trafimow, 2015 ; Hengartner, 2018 ).

Due to this lack of clarity on method use and the potential impact of inept use of research methods, the aim of this study was to explore the use of research methods in the field of psychology through a review of journal publications. Chaichanasakul et al. ( 2011 ) identify reviewing articles as the opportunity to examine the development, growth and progress of a research area and overall quality of a journal. Studies such as Lee et al. ( 1999 ) as well as Bluhm et al. ( 2011 ) review of qualitative methods has attempted to synthesis the use of research methods and indicated the growth of qualitative research in American and European journals. Research has also focused on the use of research methods in specific sub-disciplines of psychology, for example, in the field of Industrial and Organisational psychology Coetzee and Van Zyl ( 2014 ) found that South African publications tend to consist of cross-sectional quantitative research methods with underrepresented longitudinal studies. Qualitative studies were found to make up 21% of the articles published from 1995 to 2015 in a similar study by O'Neil and Koekemoer ( 2016 ). Other methods in health psychology, such as Mixed methods research have also been reportedly growing in popularity (O'Cathain, 2009 ).

A broad overview of the use of research methods in the field of psychology as a whole is however, not available in the literature. Therefore, our research focused on answering what research methods are being used, how these methods are being used and for what topics in practice (i.e., journal publications) in order to provide a general perspective of method used in psychology publication. We synthesised the collected data into the following format: research topic [areas of scientific discourse in a field or the current needs of a population (Bittermann and Fischer, 2018 )], method [data-gathering tools (Nieuwenhuis, 2016 )], sampling [elements chosen from a population to partake in research (Ritchie et al., 2009 )], data collection [techniques and research strategy (Maree, 2016 )], and data analysis [discovering information by examining bodies of data (Ktepi, 2016 )]. A systematised review of recent articles (2013 to 2017) collected from five different journals in the field of psychological research was conducted.

Grant and Booth ( 2009 ) describe systematised reviews as the review of choice for post-graduate studies, which is employed using some elements of a systematic review and seldom more than one or two databases to catalogue studies after a comprehensive literature search. The aspects used in this systematised review that are similar to that of a systematic review were a full search within the chosen database and data produced in tabular form (Grant and Booth, 2009 ).

Sample sizes and timelines vary in systematised reviews (see Lowe and Moore, 2014 ; Pericall and Taylor, 2014 ; Barr-Walker, 2017 ). With no clear parameters identified in the literature (see Grant and Booth, 2009 ), the sample size of this study was determined by the purpose of the sample (Strydom, 2011 ), and time and cost constraints (Maree and Pietersen, 2016 ). Thus, a non-probability purposive sample (Ritchie et al., 2009 ) of the top five psychology journals from 2013 to 2017 was included in this research study. Per Lee ( 2015 ) American Psychological Association (APA) recommends the use of the most up-to-date sources for data collection with consideration of the context of the research study. As this research study focused on the most recent trends in research methods used in the broad field of psychology, the identified time frame was deemed appropriate.

Psychology journals were only included if they formed part of the top five English journals in the miscellaneous psychology domain of the Scimago Journal and Country Rank (Scimago Journal & Country Rank, 2017 ). The Scimago Journal and Country Rank provides a yearly updated list of publicly accessible journal and country-specific indicators derived from the Scopus® database (Scopus, 2017b ) by means of the Scimago Journal Rank (SJR) indicator developed by Scimago from the algorithm Google PageRank™ (Scimago Journal & Country Rank, 2017 ). Scopus is the largest global database of abstracts and citations from peer-reviewed journals (Scopus, 2017a ). Reasons for the development of the Scimago Journal and Country Rank list was to allow researchers to assess scientific domains, compare country rankings, and compare and analyse journals (Scimago Journal & Country Rank, 2017 ), which supported the aim of this research study. Additionally, the goals of the journals had to focus on topics in psychology in general with no preference to specific research methods and have full-text access to articles.

The following list of top five journals in 2018 fell within the abovementioned inclusion criteria (1) Australian Journal of Psychology, (2) British Journal of Psychology, (3) Europe's Journal of Psychology, (4) International Journal of Psychology and lastly the (5) Journal of Psychology Applied and Interdisciplinary.

Journals were excluded from this systematised review if no full-text versions of their articles were available, if journals explicitly stated a publication preference for certain research methods, or if the journal only published articles in a specific discipline of psychological research (for example, industrial psychology, clinical psychology etc.).

The researchers followed a procedure (see Figure 1 ) adapted from that of Ferreira et al. ( 2016 ) for systematised reviews. Data collection and categorisation commenced on 4 December 2017 and continued until 30 June 2019. All the data was systematically collected and coded manually (Grant and Booth, 2009 ) with an independent person acting as co-coder. Codes of interest included the research topic, method used, the design used, sampling method, and methodology (the method used for data collection and data analysis). These codes were derived from the wording in each article. Themes were created based on the derived codes and checked by the co-coder. Lastly, these themes were catalogued into a table as per the systematised review design.

Systematised review procedure.

According to Johnston et al. ( 2019 ), “literature screening, selection, and data extraction/analyses” (p. 7) are specifically tailored to the aim of a review. Therefore, the steps followed in a systematic review must be reported in a comprehensive and transparent manner. The chosen systematised design adhered to the rigour expected from systematic reviews with regard to full search and data produced in tabular form (Grant and Booth, 2009 ). The rigorous application of the systematic review is, therefore discussed in relation to these two elements.

Firstly, to ensure a comprehensive search, this research study promoted review transparency by following a clear protocol outlined according to each review stage before collecting data (Johnston et al., 2019 ). This protocol was similar to that of Ferreira et al. ( 2016 ) and approved by three research committees/stakeholders and the researchers (Johnston et al., 2019 ). The eligibility criteria for article inclusion was based on the research question and clearly stated, and the process of inclusion was recorded on an electronic spreadsheet to create an evidence trail (Bandara et al., 2015 ; Johnston et al., 2019 ). Microsoft Excel spreadsheets are a popular tool for review studies and can increase the rigour of the review process (Bandara et al., 2015 ). Screening for appropriate articles for inclusion forms an integral part of a systematic review process (Johnston et al., 2019 ). This step was applied to two aspects of this research study: the choice of eligible journals and articles to be included. Suitable journals were selected by the first author and reviewed by the second and third authors. Initially, all articles from the chosen journals were included. Then, by process of elimination, those irrelevant to the research aim, i.e., interview articles or discussions etc., were excluded.

To ensure rigourous data extraction, data was first extracted by one reviewer, and an independent person verified the results for completeness and accuracy (Johnston et al., 2019 ). The research question served as a guide for efficient, organised data extraction (Johnston et al., 2019 ). Data was categorised according to the codes of interest, along with article identifiers for audit trails such as authors, title and aims of articles. The categorised data was based on the aim of the review (Johnston et al., 2019 ) and synthesised in tabular form under methods used, how these methods were used, and for what topics in the field of psychology.

The initial search produced a total of 1,145 articles from the 5 journals identified. Inclusion and exclusion criteria resulted in a final sample of 999 articles ( Figure 2 ). Articles were co-coded into 84 codes, from which 10 themes were derived ( Table 1 ).

Journal article frequency.

Codes used to form themes (research topics).

These 10 themes represent the topic section of our research question ( Figure 3 ). All these topics except, for the final one, psychological practice , were found to concur with the research areas in psychology as identified by Weiten ( 2010 ). These research areas were chosen to represent the derived codes as they provided broad definitions that allowed for clear, concise categorisation of the vast amount of data. Article codes were categorised under particular themes/topics if they adhered to the research area definitions created by Weiten ( 2010 ). It is important to note that these areas of research do not refer to specific disciplines in psychology, such as industrial psychology; but to broader fields that may encompass sub-interests of these disciplines.

Topic frequency (international sample).

In the case of developmental psychology , researchers conduct research into human development from childhood to old age. Social psychology includes research on behaviour governed by social drivers. Researchers in the field of educational psychology study how people learn and the best way to teach them. Health psychology aims to determine the effect of psychological factors on physiological health. Physiological psychology , on the other hand, looks at the influence of physiological aspects on behaviour. Experimental psychology is not the only theme that uses experimental research and focuses on the traditional core topics of psychology (for example, sensation). Cognitive psychology studies the higher mental processes. Psychometrics is concerned with measuring capacity or behaviour. Personality research aims to assess and describe consistency in human behaviour (Weiten, 2010 ). The final theme of psychological practice refers to the experiences, techniques, and interventions employed by practitioners, researchers, and academia in the field of psychology.

Articles under these themes were further subdivided into methodologies: method, sampling, design, data collection, and data analysis. The categorisation was based on information stated in the articles and not inferred by the researchers. Data were compiled into two sets of results presented in this article. The first set addresses the aim of this study from the perspective of the topics identified. The second set of results represents a broad overview of the results from the perspective of the methodology employed. The second set of results are discussed in this article, while the first set is presented in table format. The discussion thus provides a broad overview of methods use in psychology (across all themes), while the table format provides readers with in-depth insight into methods used in the individual themes identified. We believe that presenting the data from both perspectives allow readers a broad understanding of the results. Due a large amount of information that made up our results, we followed Cichocka and Jost ( 2014 ) in simplifying our results. Please note that the numbers indicated in the table in terms of methodology differ from the total number of articles. Some articles employed more than one method/sampling technique/design/data collection method/data analysis in their studies.

What follows is the results for what methods are used, how these methods are used, and which topics in psychology they are applied to . Percentages are reported to the second decimal in order to highlight small differences in the occurrence of methodology.

Firstly, with regard to the research methods used, our results show that researchers are more likely to use quantitative research methods (90.22%) compared to all other research methods. Qualitative research was the second most common research method but only made up about 4.79% of the general method usage. Reviews occurred almost as much as qualitative studies (3.91%), as the third most popular method. Mixed-methods research studies (0.98%) occurred across most themes, whereas multi-method research was indicated in only one study and amounted to 0.10% of the methods identified. The specific use of each method in the topics identified is shown in Table 2 and Figure 4 .

Research methods in psychology.

Research method frequency in topics.

Secondly, in the case of how these research methods are employed , our study indicated the following.

Sampling −78.34% of the studies in the collected articles did not specify a sampling method. From the remainder of the studies, 13 types of sampling methods were identified. These sampling methods included broad categorisation of a sample as, for example, a probability or non-probability sample. General samples of convenience were the methods most likely to be applied (10.34%), followed by random sampling (3.51%), snowball sampling (2.73%), and purposive (1.37%) and cluster sampling (1.27%). The remainder of the sampling methods occurred to a more limited extent (0–1.0%). See Table 3 and Figure 5 for sampling methods employed in each topic.

Sampling use in the field of psychology.

Sampling method frequency in topics.

Designs were categorised based on the articles' statement thereof. Therefore, it is important to note that, in the case of quantitative studies, non-experimental designs (25.55%) were often indicated due to a lack of experiments and any other indication of design, which, according to Laher ( 2016 ), is a reasonable categorisation. Non-experimental designs should thus be compared with experimental designs only in the description of data, as it could include the use of correlational/cross-sectional designs, which were not overtly stated by the authors. For the remainder of the research methods, “not stated” (7.12%) was assigned to articles without design types indicated.

From the 36 identified designs the most popular designs were cross-sectional (23.17%) and experimental (25.64%), which concurred with the high number of quantitative studies. Longitudinal studies (3.80%), the third most popular design, was used in both quantitative and qualitative studies. Qualitative designs consisted of ethnography (0.38%), interpretative phenomenological designs/phenomenology (0.28%), as well as narrative designs (0.28%). Studies that employed the review method were mostly categorised as “not stated,” with the most often stated review designs being systematic reviews (0.57%). The few mixed method studies employed exploratory, explanatory (0.09%), and concurrent designs (0.19%), with some studies referring to separate designs for the qualitative and quantitative methods. The one study that identified itself as a multi-method study used a longitudinal design. Please see how these designs were employed in each specific topic in Table 4 , Figure 6 .

Design use in the field of psychology.

Design frequency in topics.

Data collection and analysis —data collection included 30 methods, with the data collection method most often employed being questionnaires (57.84%). The experimental task (16.56%) was the second most preferred collection method, which included established or unique tasks designed by the researchers. Cognitive ability tests (6.84%) were also regularly used along with various forms of interviewing (7.66%). Table 5 and Figure 7 represent data collection use in the various topics. Data analysis consisted of 3,857 occurrences of data analysis categorised into ±188 various data analysis techniques shown in Table 6 and Figures 1 – 7 . Descriptive statistics were the most commonly used (23.49%) along with correlational analysis (17.19%). When using a qualitative method, researchers generally employed thematic analysis (0.52%) or different forms of analysis that led to coding and the creation of themes. Review studies presented few data analysis methods, with most studies categorising their results. Mixed method and multi-method studies followed the analysis methods identified for the qualitative and quantitative studies included.

Data collection in the field of psychology.

Data collection frequency in topics.

Data analysis in the field of psychology.

Results of the topics researched in psychology can be seen in the tables, as previously stated in this article. It is noteworthy that, of the 10 topics, social psychology accounted for 43.54% of the studies, with cognitive psychology the second most popular research topic at 16.92%. The remainder of the topics only occurred in 4.0–7.0% of the articles considered. A list of the included 999 articles is available under the section “View Articles” on the following website: https://methodgarden.xtrapolate.io/ . This website was created by Scholtz et al. ( 2019 ) to visually present a research framework based on this Article's results.

This systematised review categorised full-length articles from five international journals across the span of 5 years to provide insight into the use of research methods in the field of psychology. Results indicated what methods are used how these methods are being used and for what topics (why) in the included sample of articles. The results should be seen as providing insight into method use and by no means a comprehensive representation of the aforementioned aim due to the limited sample. To our knowledge, this is the first research study to address this topic in this manner. Our discussion attempts to promote a productive way forward in terms of the key results for method use in psychology, especially in the field of academia (Holloway, 2008 ).

With regard to the methods used, our data stayed true to literature, finding only common research methods (Grant and Booth, 2009 ; Maree, 2016 ) that varied in the degree to which they were employed. Quantitative research was found to be the most popular method, as indicated by literature (Breen and Darlaston-Jones, 2010 ; Counsell and Harlow, 2017 ) and previous studies in specific areas of psychology (see Coetzee and Van Zyl, 2014 ). Its long history as the first research method (Leech et al., 2007 ) in the field of psychology as well as researchers' current application of mathematical approaches in their studies (Toomela, 2010 ) might contribute to its popularity today. Whatever the case may be, our results show that, despite the growth in qualitative research (Demuth, 2015 ; Smith and McGannon, 2018 ), quantitative research remains the first choice for article publication in these journals. Despite the included journals indicating openness to articles that apply any research methods. This finding may be due to qualitative research still being seen as a new method (Burman and Whelan, 2011 ) or reviewers' standards being higher for qualitative studies (Bluhm et al., 2011 ). Future research is encouraged into the possible biasness in publication of research methods, additionally further investigation with a different sample into the proclaimed growth of qualitative research may also provide different results.

Review studies were found to surpass that of multi-method and mixed method studies. To this effect Grant and Booth ( 2009 ), state that the increased awareness, journal contribution calls as well as its efficiency in procuring research funds all promote the popularity of reviews. The low frequency of mixed method studies contradicts the view in literature that it's the third most utilised research method (Tashakkori and Teddlie's, 2003 ). Its' low occurrence in this sample could be due to opposing views on mixing methods (Gunasekare, 2015 ) or that authors prefer publishing in mixed method journals, when using this method, or its relative novelty (Ivankova et al., 2016 ). Despite its low occurrence, the application of the mixed methods design in articles was methodologically clear in all cases which were not the case for the remainder of research methods.

Additionally, a substantial number of studies used a combination of methodologies that are not mixed or multi-method studies. Perceived fixed boundaries are according to literature often set aside, as confirmed by this result, in order to investigate the aim of a study, which could create a new and helpful way of understanding the world (Gunasekare, 2015 ). According to Toomela ( 2010 ), this is not unheard of and could be considered a form of “structural systemic science,” as in the case of qualitative methodology (observation) applied in quantitative studies (experimental design) for example. Based on this result, further research into this phenomenon as well as its implications for research methods such as multi and mixed methods is recommended.

Discerning how these research methods were applied, presented some difficulty. In the case of sampling, most studies—regardless of method—did mention some form of inclusion and exclusion criteria, but no definite sampling method. This result, along with the fact that samples often consisted of students from the researchers' own academic institutions, can contribute to literature and debates among academics (Peterson and Merunka, 2014 ; Laher, 2016 ). Samples of convenience and students as participants especially raise questions about the generalisability and applicability of results (Peterson and Merunka, 2014 ). This is because attention to sampling is important as inappropriate sampling can debilitate the legitimacy of interpretations (Onwuegbuzie and Collins, 2017 ). Future investigation into the possible implications of this reported popular use of convenience samples for the field of psychology as well as the reason for this use could provide interesting insight, and is encouraged by this study.

Additionally, and this is indicated in Table 6 , articles seldom report the research designs used, which highlights the pressing aspect of the lack of rigour in the included sample. Rigour with regards to the applied empirical method is imperative in promoting psychology as a science (American Psychological Association, 2020 ). Omitting parts of the research process in publication when it could have been used to inform others' research skills should be questioned, and the influence on the process of replicating results should be considered. Publications are often rejected due to a lack of rigour in the applied method and designs (Fonseca, 2013 ; Laher, 2016 ), calling for increased clarity and knowledge of method application. Replication is a critical part of any field of scientific research and requires the “complete articulation” of the study methods used (Drotar, 2010 , p. 804). The lack of thorough description could be explained by the requirements of certain journals to only report on certain aspects of a research process, especially with regard to the applied design (Laher, 20). However, naming aspects such as sampling and designs, is a requirement according to the APA's Journal Article Reporting Standards (JARS-Quant) (Appelbaum et al., 2018 ). With very little information on how a study was conducted, authors lose a valuable opportunity to enhance research validity, enrich the knowledge of others, and contribute to the growth of psychology and methodology as a whole. In the case of this research study, it also restricted our results to only reported samples and designs, which indicated a preference for certain designs, such as cross-sectional designs for quantitative studies.

Data collection and analysis were for the most part clearly stated. A key result was the versatile use of questionnaires. Researchers would apply a questionnaire in various ways, for example in questionnaire interviews, online surveys, and written questionnaires across most research methods. This may highlight a trend for future research.

With regard to the topics these methods were employed for, our research study found a new field named “psychological practice.” This result may show the growing consciousness of researchers as part of the research process (Denzin and Lincoln, 2003 ), psychological practice, and knowledge generation. The most popular of these topics was social psychology, which is generously covered in journals and by learning societies, as testaments of the institutional support and richness social psychology has in the field of psychology (Chryssochoou, 2015 ). The APA's perspective on 2018 trends in psychology also identifies an increased amount of psychology focus on how social determinants are influencing people's health (Deangelis, 2017 ).

This study was not without limitations and the following should be taken into account. Firstly, this study used a sample of five specific journals to address the aim of the research study, despite general journal aims (as stated on journal websites), this inclusion signified a bias towards the research methods published in these specific journals only and limited generalisability. A broader sample of journals over a different period of time, or a single journal over a longer period of time might provide different results. A second limitation is the use of Excel spreadsheets and an electronic system to log articles, which was a manual process and therefore left room for error (Bandara et al., 2015 ). To address this potential issue, co-coding was performed to reduce error. Lastly, this article categorised data based on the information presented in the article sample; there was no interpretation of what methodology could have been applied or whether the methods stated adhered to the criteria for the methods used. Thus, a large number of articles that did not clearly indicate a research method or design could influence the results of this review. However, this in itself was also a noteworthy result. Future research could review research methods of a broader sample of journals with an interpretive review tool that increases rigour. Additionally, the authors also encourage the future use of systematised review designs as a way to promote a concise procedure in applying this design.

Our research study presented the use of research methods for published articles in the field of psychology as well as recommendations for future research based on these results. Insight into the complex questions identified in literature, regarding what methods are used how these methods are being used and for what topics (why) was gained. This sample preferred quantitative methods, used convenience sampling and presented a lack of rigorous accounts for the remaining methodologies. All methodologies that were clearly indicated in the sample were tabulated to allow researchers insight into the general use of methods and not only the most frequently used methods. The lack of rigorous account of research methods in articles was represented in-depth for each step in the research process and can be of vital importance to address the current replication crisis within the field of psychology. Recommendations for future research aimed to motivate research into the practical implications of the results for psychology, for example, publication bias and the use of convenience samples.

Ethics Statement

This study was cleared by the North-West University Health Research Ethics Committee: NWU-00115-17-S1.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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1 Important points to consider when critically evaluating published research papers

Simple review articles (also referred to as ‘narrative’ or ‘selective’ reviews), systematic reviews and meta-analyses provide rapid overviews and ‘snapshots’ of progress made within a field, summarising a given topic or research area. They can serve as useful guides, or as current and comprehensive ‘sources’ of information, and can act as a point of reference to relevant primary research studies within a given scientific area. Narrative or systematic reviews are often used as a first step towards a more detailed investigation of a topic or a specific enquiry (a hypothesis or research question), or to establish critical awareness of a rapidly-moving field (you will be required to demonstrate this as part of an assignment, an essay or a dissertation at postgraduate level).

The majority of primary ‘empirical’ research papers essentially follow the same structure (abbreviated here as IMRAD). There is a section on Introduction, followed by the Methods, then the Results, which includes figures and tables showing data described in the paper, and a Discussion. The paper typically ends with a Conclusion, and References and Acknowledgements sections.

The Title of the paper provides a concise first impression. The Abstract follows the basic structure of the extended article. It provides an ‘accessible’ and concise summary of the aims, methods, results and conclusions. The Introduction provides useful background information and context, and typically outlines the aims and objectives of the study. The Abstract can serve as a useful summary of the paper, presenting the purpose, scope and major findings. However, simply reading the abstract alone is not a substitute for critically reading the whole article. To really get a good understanding and to be able to critically evaluate a research study, it is necessary to read on.

While most research papers follow the above format, variations do exist. For example, the results and discussion sections may be combined. In some journals the materials and methods may follow the discussion, and in two of the most widely read journals, Science and Nature, the format does vary from the above due to restrictions on the length of articles. In addition, there may be supporting documents that accompany a paper, including supplementary materials such as supporting data, tables, figures, videos and so on. There may also be commentaries or editorials associated with a topical research paper, which provide an overview or critique of the study being presented.

Box 1 Key questions to ask when appraising a research paper

• Is the study’s research question relevant?
• Does the study add anything new to current knowledge and understanding?
• Does the study test a stated hypothesis?
• Is the design of the study appropriate to the research question?
• Do the study methods address key potential sources of bias?
• Were suitable ‘controls’ included in the study?
• Were the statistical analyses appropriate and applied correctly?
• Is there a clear statement of findings?
• Does the data support the authors’ conclusions?
• Are there any conflicts of interest or ethical concerns?

There are various strategies used in reading a scientific research paper, and one of these is to start with the title and the abstract, then look at the figures and tables, and move on to the introduction, before turning to the results and discussion, and finally, interrogating the methods.

Another strategy (outlined below) is to begin with the abstract and then the discussion, take a look at the methods, and then the results section (including any relevant tables and figures), before moving on to look more closely at the discussion and, finally, the conclusion. You should choose a strategy that works best for you. However, asking the ‘right’ questions is a central feature of critical appraisal, as with any enquiry, so where should you begin? Here are some critical questions to consider when evaluating a research paper.

Look at the Abstract and then the Discussion : Are these accessible and of general relevance or are they detailed, with far-reaching conclusions? Is it clear why the study was undertaken? Why are the conclusions important? Does the study add anything new to current knowledge and understanding? The reasons why a particular study design or statistical method were chosen should also be clear from reading a research paper. What is the research question being asked? Does the study test a stated hypothesis? Is the design of the study appropriate to the research question? Have the authors considered the limitations of their study and have they discussed these in context?

Take a look at the Methods : Were there any practical difficulties that could have compromised the study or its implementation? Were these considered in the protocol? Were there any missing values and, if so, was the number of missing values too large to permit meaningful analysis? Was the number of samples (cases or participants) too small to establish meaningful significance? Do the study methods address key potential sources of bias? Were suitable ‘controls’ included in the study? If controls are missing or not appropriate to the study design, we cannot be confident that the results really show what is happening in an experiment. Were the statistical analyses appropriate and applied correctly? Do the authors point out the limitations of methods or tests used? Were the methods referenced and described in sufficient detail for others to repeat or extend the study?

Take a look at the Results section and relevant tables and figures : Is there a clear statement of findings? Were the results expected? Do they make sense? What data supports them? Do the tables and figures clearly describe the data (highlighting trends etc.)? Try to distinguish between what the data show and what the authors say they show (i.e. their interpretation).

Moving on to look in greater depth at the Discussion and Conclusion : Are the results discussed in relation to similar (previous) studies? Do the authors indulge in excessive speculation? Are limitations of the study adequately addressed? Were the objectives of the study met and the hypothesis supported or refuted (and is a clear explanation provided)? Does the data support the authors’ conclusions? Maybe there is only one experiment to support a point. More often, several different experiments or approaches combine to support a particular conclusion. A rule of thumb here is that if multiple approaches and multiple lines of evidence from different directions are presented, and all point to the same conclusion, then the conclusions are more credible. But do question all assumptions. Identify any implicit or hidden assumptions that the authors may have used when interpreting their data. Be wary of data that is mixed up with interpretation and speculation! Remember, just because it is published, does not mean that it is right.

O ther points you should consider when evaluating a research paper : Are there any financial, ethical or other conflicts of interest associated with the study, its authors and sponsors? Are there ethical concerns with the study itself? Looking at the references, consider if the authors have preferentially cited their own previous publications (i.e. needlessly), and whether the list of references are recent (ensuring that the analysis is up-to-date). Finally, from a practical perspective, you should move beyond the text of a research paper, talk to your peers about it, consult available commentaries, online links to references and other external sources to help clarify any aspects you don’t understand.

The above can be taken as a general guide to help you begin to critically evaluate a scientific research paper, but only in the broadest sense. Do bear in mind that the way that research evidence is critiqued will also differ slightly according to the type of study being appraised, whether observational or experimental, and each study will have additional aspects that would need to be evaluated separately. For criteria recommended for the evaluation of qualitative research papers, see the article by Mildred Blaxter (1996), available online. Details are in the References.

Activity 1 Critical appraisal of a scientific research paper

A critical appraisal checklist, which you can download via the link below, can act as a useful tool to help you to interrogate research papers. The checklist is divided into four sections, broadly covering:

• some general aspects
• research design and methodology
• the results
• discussion, conclusion and references.

Science perspective – critical appraisal checklist [ Tip: hold Ctrl and click a link to open it in a new tab. ( Hide tip ) ]

• Identify and obtain a research article based on a topic of your own choosing, using a search engine such as Google Scholar or PubMed (for example).
• The selection criteria for your target paper are as follows: the article must be an open access primary research paper (not a review) containing empirical data, published in the last 2–3 years, and preferably no more than 5–6 pages in length.
• Critically evaluate the research paper using the checklist provided, making notes on the key points and your overall impression.

Critical appraisal checklists are useful tools to help assess the quality of a study. Assessment of various factors, including the importance of the research question, the design and methodology of a study, the validity of the results and their usefulness (application or relevance), the legitimacy of the conclusions, and any potential conflicts of interest, are an important part of the critical appraisal process. Limitations and further improvements can then be considered.

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How to evaluate any study in 3 simple steps

Travis Dixon November 11, 2019 Research Methodology , Revision and Exam Preparation , Studies and Theories

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Being able to critically evaluate a study is a key skill for any budding psychologist. However, like anything, when you’re first learning how to do this it can be very difficult. In this post, we look at 3 simple steps you can take to evaluate any study.

• 7 exam tips for evaluating studies
• So you want to assess ecological validity
• So you want to assess population validity

Teaching Tip:  You could use this as a class activity by having students choose one study and following these steps by themselves.

Step 1: Identify the Method

Read the study you want to evaluate carefully and try to identify the method that is used. How was the data gathered and analyzed? Was it a true experiment, a correlational study, a case study, a survey, an observation, etc.? Perhaps it was a twin study, a meta-analysis, or a longitudinal study. Before you can evaluate the study, you must know the methodology.

The IB has very strict definitions of “research method.” When evaluating a study, feel free to focus on any methodology used by the researchers.

Tricky Bits: Sometimes studies combine multiple methods. For example, it might have been a survey that also calculated correlations. Or a twin-study that was longitudinal in nature. This is fine. Identifying more than one method or technique that was used in the study is OK. In fact, it might make the next steps a little easier.

Step 2: Identify General Strengths + Limitations

After you’ve identified the method, it’s important that you can recall the general strengths and limitations of this method. The table below is a brief summary.

Exam Tip: For IB Psychology exams, I recommend becoming an expert on true experiments and correlational studies. This makes all questions regarding research methods and ethics more manageable. It will also help you develop your ability to evaluate these two methodologies.

99% of IB Psychology students only do the first two, so learning how to complete the third step will separate your answers from the rest.

Step 3: Apply to YOUR Study ( + -)

Examiners are not impressed by one sentence, generic evaluations.

Nearly every student in psychology only ever gets as far as these two steps. The classic example of a student evaluating an experiment goes like this: “But this was a laboratory experiment so it lacks ecological validity.” This is not critical thinking. This third step is essential for you to show your critical thinking. You need to take one of the strengths and/or a limitation and explain how it might apply to your study . This is difficult and takes time and careful consideration. The following table gives you some pointers for a few common methods you may be evaluating.

Example: Loftus and Palmer’s Car Crash Study ( Read more )

This study was a true experiment because the researchers manipulated the independent variable (verbs in the question) in a controlled environment. One strength of this is the ability to control variables. In their second experiment, they had a control condition who didn’t watch any video. This helps to isolate the verb in the question as the single variable that’s increasing speed estimates and the memory of seeing broken glass. It can help control for demand characteristics because people may say “yes” to seeing broken glass because they may feel they’re supposed to.

However, it also means that we can question the extent to which this study may apply to real-life situations. To explain this properly you need to explain why it might not apply to a real-life situation by focusing on specific details ( this video on our YouTube channel will help explain how to do this).

So a student’s evaluation might look like this:

One strength of this this experiment is they could control variables to establish a cause-effect relationship. In their second experiment, they had a control condition who didn’t watch any video. This helps to make sure the verb in the question is the only factor affecting speed estimates and the memory of seeing broken glass. It can help control for demand characteristics because people may say “yes” to seeing broken glass because they may feel they’re supposed t o. Using all students also helps to control for participant variability, because people who are older may have more driving experience and be better at estimating speeds and so less likely to be influenced by a leading question.

However, it also means that we can question the generalizability of this study and the extent to which the results may apply to real-life situations. For example, could we expect the same effect in a court room or interrogation room involving a real life crime? In these situations there are massive consequences for false memory and misremembering key details, so people may focus more and try harder to remember. Perhaps even the stress could improve their memory of the event (because acute release of cortisol improves memory consolidation) so their memories will be more reliable.

You can see from the example above that a true evaluation of a study is difficult and takes very careful consideration. But if you can write a fully-developed explanation of the strengths and limitations of a study, you are on track to do very well in your exams.

Exam Tip:  If you are asked in an essay question to specifically evaluate a study, you should include strengths and limitations. However, if you’re evaluating a study as one of your counter-arguments in a more general question, then just focusing on the limitations is OK. 

Watch more here…

Question or comment? Leave it below. 

Find more exam tips in our Revision Textbook designed for IB Psychology students.

Travis Dixon is an IB Psychology teacher, author, workshop leader, examiner and IA moderator.

• Open access
• Published: 01 June 2024

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

• Seraina Petra Lerch 1 , 2 , 3 ,
• Rahel Hänggi 4 ,
• Yara Bussmann 4 &
• Andrea Lörwald 4  

BMC Primary Care volume  25 , Article number:  194 ( 2024 ) Cite this article

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The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Peer Review reports

Introduction

Trust, as a cornerstone of human relationships, applies to the patient-physician relationship. Relationship building is a basic skill for the medical professional [ 1 , 2 ]. There is evidence that trust between patients and doctors has a positive effect and, if trust is missing, leads to potentially negative consequences. A meta-analysis confirmed that trust was positively associated with improved health outcomes [ 3 ] in, for example, diabetes [ 4 ], cancer [ 5 ], and human immunodeficiency virus infections (HIV infections) [ 6 ]. Trust also increases positive behavioral outcomes in patients [ 7 ], such as treatment adherence [ 8 , 9 ]. In contrast, low trust in physicians has been shown to negatively affect various patient health outcomes [ 4 , 6 , 10 , 11 , 12 , 13 , 14 ]. Economically, if trust in physicians is missing, it has adverse financial effects on healthcare systems [ 15 ]. Furthermore, a physician may be more likely to incur complaints when trusting relationships with patients are lacking [ 16 ].

In medicine, trust can be understood as being social or interpersonal [ 17 , 18 ]. Social trust refers to individuals’ trust in institutions or systems, such as the healthcare system or physicians in general, while interpersonal trust refers to the trust between two individuals [ 18 , 19 ]. Social trust is believed to affect interpersonal trust in medical settings [ 17 , 18 ]. There are various theories of trust from different disciplines [ 20 , 21 , 22 , 23 ]. However, the most prominent interpersonal trust theory in psychology (and applied in medical settings) is from Mayer et al., who defined trust as the willingness of an individual to be vulnerable to the actions of another based on the expectation that the other will perform a particular action important to the trustor, irrespective of the ability to monitor or control the other party [ 24 ]. Their theory of interpersonal trust suggests that benevolence, integrity, ability, propensity to trust, and perceived risk are components of a trust relationship [ 24 ]. When applied to the patient-physician relationship, the physician’s ability, integrity, and benevolence act as contributors. At the same time, a patient’s propensity to trust—their willingness to trust others—and the perceived risk they take when trusting a physician are also important factors. However, the reality is likely more complex, and there are probably more contributors to a trusting patient-physician relationship than the theory proposes. While different evidence-based studies have investigated the patient-physician trust relationship, to our knowledge, there has been no synthesis of all the evidence-based contributors to the relationship. In 2000, there was a call for an empirical conceptualization of trust. Rather than single theories used to explain interpersonal patient-physician trust or studies investigating isolated contributors of trust, the idea was to synthesize empirical evidence concerning how patient-physician trust can evolve into a model [ 19 ]. A recent review on trust in the medical field has renewed the need for such an empirical conceptualization of patient-physician trust [ 25 ]. Therefore, this study aimed to summarize the empirical evidence, identify the contributors to a trusting patient-physician relationship, and integrate them into a model. This model can then be used to identify potential approaches and leverage points to improve patient-physician trust. The two main research questions were:

Which factors contribute to a trusting patient-physician relationship?

Which of these factors can act as potential leverage points to improve the patient-physician relationship?

In addition, we critically assessed contributors based on how they are already implemented in healthcare systems and medical education.

As the research questions were too broad for a systematic or scoping review, a critical review with a systematic search approach was used to answer the first research question. Critical reviews focus on empirical research [ 26 ] to evaluate what is known about a specific topic and integrate it into a framework [ 26 , 27 ]. They may use a systematic search strategy to integrate the strengths of systematic and critical reviews [ 27 ], including all relevant literature, to avoid biases.

Search strategy

We searched the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and ERIC (Ovid) for a combination of terms (or synonyms) referring to the patient-physician relationship and trust or psychological safety. Database searches were run simultaneously as multifile searches in Ovid. For the results, Ovid’s de-duplicator was used. No study or clinical trial registries or online resources were searched. No experts were contacted, nor was a citation search conducted. A reproducible search for all of the databases is as follows:

Embase (1974 to January 13, 2022), ERIC (1965 to May 2021), Ovid MEDLINE(R) ALL (1946 to January 13, 2022), APA PsycInfo (1806 to January Week 1, 2022).

(patient* adj2 physician* adj2 (relation* or alliance or rapport)).ti, ab.

(trust* or psychological safety).ti, ab.

remove duplicates from 3.

We did not use any language, time period, study design, or other restrictions for the searches, and no search filters were used. The comprehensive literature search was run on January 13, 2022 and 630 articles were retrieved. An information specialist assisted in framing the research questions and provided information on the different types of reviews. Once a first draft of the search strategy was developed, multiple feedback rounds with the information specialist were conducted until the search strategy was finalized.

Screening process

Fifty-three records were retrieved from Ovid MEDLINER ALL, 509 from Embase, 1 from ERIC, and 67 from APA PsycInfo. In total, 630 records were found. As OVID’s de-duplication process did not identify all duplicates, any remaining duplicates were removed by SPL using EndNote’s duplicate identification strategy and a manual approach. After de-duplication, 613 articles remained, which were screened in two rounds. The first round was screened according to title and abstract. In the second round, 116 articles were evaluated for inclusion based on the full texts. SPL and RH did the screening, and AL decided when there were disagreements between SPL and RH. A study selection flowchart is shown in Fig.  1 .

PRISMA study flowchart

We included studies that reported factors contributing to a trusting relationship between patients and physicians and excluded those that only reported contributing factors between patients and health professionals other than physicians (or no contributors). We also included studies that explicitly measured trust between a patient and physician either quantitatively or qualitatively and excluded those with no measure of patient trust in physicians (e.g., only generalized patient trust or trust in other health professionals). We included quantitative, qualitative, and mixed methods papers and excluded dissertations and conference abstracts. Only articles in English and German were included.

Data synthesis and categorization

We first extracted the contributors mentioned in the studies as this review focused on integrating contributors to a trusting patient-physician relationship into an overall model. Extracted data included information on the setting, patients, physicians, how trust was operationalized, and which factors had a positive, negative, or no effect on the relationship. Contributors were then categorized into patient-related, physician-related, context-related, or patient- and physician-related factors. Study sizes and methods of measurement were highlighted. The factors were then synthesized, and the modifiable ones were extracted and displayed in a model.

Forty-five heterogeneous studies reported factors contributing to a trusting patient-physician relationship. An overview of these studies, including the contributors to trust for each study, can be found in Appendix 1 .

Patient-related factors

Several patient-related contributors to a trusting relationship were investigated, sometimes with contrasting results from different studies. These included demographic characteristics (gender, marital status, age, ethnicity, birthplace, and country of residence), health condition, health education and literacy, socioeconomic status, religious beliefs, social environment, psychological factors, and the patient’s health condition and status.

Studies found better mental and physical health status tended to positively affect the relationship—although this result was mixed. In several studies, a good general health condition and better self-reported health status were associated with increased trust towards the physician [ 28 , 29 , 30 , 31 , 32 ]. However, other studies found no correlation between self-reported health status and trust. For specific health conditions, low-risk adults without chronic illnesses had higher trust in their physicians than adults with risk factors such as diabetes or high lipid levels [ 33 , 34 , 35 , 36 , 37 ]. Disease progression, including relapses and lack of improvement of a medical condition, was negatively associated with trust [ 38 , 39 ], whereas a shorter duration of illness increased trust in the physician [ 29 ]. However, two studies found no connection between trust, disease duration [ 40 ], and healing [ 36 ].

Patient health education and literacy levels were found to promote a trusting patient-physician relationship, with higher health education [ 41 ] and literacy [ 42 ] levels contributing to trust and low health literacy [ 43 ] hindering it.

Patient socioeconomic status, including occupation, employment, educational and income levels, and the presence or type of health insurance, were all potential contributors, with high (household) income and educational levels, having health insurance, and being employed positively related to trust; although, these findings were ambiguous. Religious belief was also associated with trust in physicians [ 31 ].

The social environment, including social support and the care experiences of family members, further contributed to a trusting patient-physician relationship. In particular, poor social support negatively influenced trust [ 43 ], as did dissatisfaction with the care of family members [ 44 , 45 ].

The health locus of control was also associated with trust. This describes how a person views control of their health. An internal health locus of control suggests that the person sees oneself as controlling their health, whereas an external locus means that the person perceives external factors influencing their health.

Several patient psychological factors, including a propensity to trust, their coping mechanisms and attachment style, the health locus of control, and general trust in caregivers contributed to a trusting patient-physician relationship. Individuals who see powerful others as their health locus of control (i.e., believing other people, such as health professionals, can control their health) exhibited higher trust in physicians [ 46 ]. Poor coping styles hindered trust [ 43 ], while the willingness to reframe situations (a healthy coping style) added to a trusting patient-physician relationship [ 44 ]. For the most part, a general trust in doctors, caregivers, the healthcare system, or online health communities was associated with higher trust [ 47 , 48 , 49 ]. However, these findings were ambiguous regarding the propensity to trust. One study found that a patient’s propensity to trust predicted trust in their physician [ 50 ], although other studies did not find this connection [ 31 , 36 ]. Table  1 summarizes all of the evidence concerning patient-related factors.

Physician-related factors

Demographic characteristics, competence, communication, exploring, caring, provisioning health education, reputation, professionalism, and availability were investigated as potential contributors to a trusting patient-physician relationship.

Demographic characteristics of the physician, such as age and gender, did not contribute to a trusting relationship, although these findings were ambiguous.

Physician competency, including the perceived competence of the physician by the patient [ 41 , 44 , 51 , 55 , 68 , 69 , 70 ], the physician being up-to-date in their specialization [ 71 ], and having more years of experience [ 71 ] helped to build a trusting relationship with patients. Communication skills, including general communication skills [ 29 , 38 , 44 , 52 , 70 , 72 , 73 ], compassion, listening to the patient [ 41 , 44 , 52 ], as well as nonverbal behavior such as good eye contact, providing undivided attention, open body language, and smiling [ 41 , 44 , 52 , 73 ] also enhanced the trust relationship as did patient-centered [ 63 , 74 , 75 ], comprehensive care [ 30 ].

Physicians exploring a patient’s disease and problems [ 69 ], illness experiences [ 28 ], and the context of the patient [ 44 , 68 ] promoted a trusting relationship along with caring behavior [ 52 , 70 , 75 ] such as empathy [ 50 , 76 ] and compassion [ 41 , 44 , 69 ].

Provisioning health education to the patient contributed to a trusting relationship [ 38 , 41 , 64 , 68 , 69 ]; however, one study did not find any association between these factors [ 71 ].

We did identify physician reputation [ 71 ] and the reputation of their medical specialty [ 28 , 34 , 39 ] as contributing to a trusting relationship. Moreover, different aspects of professionalism [ 71 , 73 ], such as honesty [ 51 , 55 , 69 ] and availability [ 41 ], contributed to a trusting patient-physician relationship, while being disrespectful, arrogant, or cynical were negatively associated with trust [ 41 , 73 , 75 ]. These results are summarized in Table  2 .

Physician- and patient-related factors

Contributors related to the physician and patient were concordance, time spent together, the patient-physician alliance, and shared decision-making.

In relation to concordance, both gender and race were tested as promoters of trust; however, only gender concordance was identified as being a contributor [ 35 , 41 ].

Time spent together included time spent in a single session, the overall time spent together, and the continuity of care. Most results indicated that more time spent together in a single session [ 28 , 71 , 73 ] (with the physician giving the patient enough time to explain the reason for the visit [ 77 ]) promoted trust, whereas physicians appearing rushed was a barrier to a trusting relationship [ 44 ]. If the duration of the relationship with the doctor was long-term [ 28 , 36 , 77 ], the patient had higher rates of follow-up visits [ 51 ] and more physician visits in general [ 37 , 57 ]. Nevertheless, those findings were mixed, and not all studies found an association between the duration of a relationship with the doctor [ 40 , 45 ] and the number of team visits [ 47 , 48 ]. However, continuity of care [ 51 ] and continuity with one physician added to a trusting relationship [ 30 ].

Within the patient-physician alliance, alliances in shared decision-making [ 65 ] and having a good rapport [ 71 ] were found to enhance trust, while a patient’s perception of a physician’s distrust was a barrier [ 41 ]. Finding common ground [ 28 ] and shared identity [ 52 ] were tested but did not show any association with trust. In contrast, shared decision-making contributed to a trusting relationship that promoted trust in most studies [ 41 , 42 , 44 ]. These findings are summarized in Table  3 .

Context-related factors

Context-related factors such as practice/institution, physician payments, and additional healthcare services were investigated as potential contributors to trusting relationships.

Most aspects of the practice or the institution were found to contribute to a trusting relationship, with easy accessibility [ 30 ] to the practice and a good reputation [ 71 ] promoting trust, while institutional betrayal [ 65 ] hindered it. The atmosphere of the practice also mattered. A good practice or organizational climate added to a trusting relationship [ 35 ], whereas perceived chaos hampered it [ 29 ]. Patients having enough physician choice also added to a trusting relationship [ 48 ], while managed care settings contributed to mistrust [ 41 ]. Inpatient settings enhanced trust compared to outpatient settings [ 59 ]. Regarding payments, situations where patients do not know how the physician is paid or the physician is paid by the number of office visits rather than a fixed salary [ 30 ] contributed to a trusting relationship. In contrast, public disclosure of payments was negatively associated with trust [ 78 ]. Additional health services such as addiction consultations [ 79 ], preventive services [ 77 ], and the coordination of specialty care [ 30 ] also contributed to patient-physician trust. These findings are summarized in Table  4 .

Potential leverage points to improve a trusting relationship

We integrated the modifiable contributors to a trusting patient-physician relationship from each conceptual group into a model and identified potential leverage points for improving the relationship (Fig.  2 ).

Model of contributors to a trusting patient-physician relationship

Patient-centered leverage points

Within patient-centered factors, health education and literacy, the social environment, and psychological factors were modifiable. A patient who is better educated about health and can understand and use this education for themselves (health literacy) may form better trusting relationships with their physicians; thus, interventions should focus on improving health education and literacy. Patient psychological factors such as coping styles and health locus of control are other potential leverage points to increase trust within the relationship. The social environment, specifically receiving sufficient social support, was a further modifiable contributor to trust, indicating that targeted interventions should aim to improve patients’ social support systems.

Physician-centered leverage points

We identified physicians’ competence, communication skills, exploring, caring, the provisioning of health education, and professionalism as modifiable contributors to a trusting patient-physician relationship. For competence, being up-to-date in the specialization and perceived as competent are leverage points that could increase trust. Communication skills, including verbal and nonverbal behavior, exploring patient health, and professionalism, can also be learned and are, hence, modifiable. Caring, including empathy and compassion, is a skill that can be increased through interventions and also used to increase trust. In addition, physicians can be taught how to provide health education, and specific material can be provided to them for health education, which is another potential leverage point.

Patient and physician-centered leverage points

We identified shared decision-making, the patient-physician alliance, and time spent together as contributors that can be modified. Although time spent together and the continuity of care is context-dependent, awareness can be raised among physicians, and specific training can help the physician allow patients to explain the reason for their visit. Alliances and shared decision-making are skills taught during medical school: therefore, potential interventions already exist. Shared decision-making also includes healthcare professionals other than physicians. Therefore, one possible intervention strategy would be to foster interprofessional education and teamwork to support shared decision-making between patients and healthcare professionals.

Context-dependent leverage points

The healthcare system, provisioning of additional healthcare services, transparency regarding physician payment, and characteristics of the practice or institution (e.g., keeping a good institutional climate and having mechanisms to prevent institutional betrayal) are modifiable contributors; however, these strongly depend on the specific country. Furthermore, only a few studies have investigated contributors to a trusting relationship within this conceptual group. Therefore, the list of context-dependent contributors may be limited.

We conducted a critical review with a systematic search strategy to identify evidence-based contributors to a trusting patient-physician relationship and integrated the modifiable contributors into a model. Our results confirm the existing theory of interpersonal trust [ 24 ], and, in line with this theory, we found that the physician’s caring (benevolence), competence and communication (ability), and professionalism (integrity) were contributors to a trusting patient-physician relationship. In addition, the physician’s exploring and provisioning of health education also contributed to a trusting relationship. We confirmed the importance of a patient’s propensity to trust as a psychological contributor and were able to add more psychological factors, including coping style and health locus of control. We further added the patient’s level of health education and literacy, and social environment as contributing factors and confirmed that, as the risk a patient must take concerning their health decreases, the easier it is for them to trust the physician. Our model further adds physician- and patient-related factors and the institutional context. The latter indicates the importance of including social trust in understanding interpersonal trust in medicine, as suggested by Mechanic [ 18 ]. One highly prominent factor was health education, which can be addressed by the physician, patient, and the context, which suggests that fostering health education is a promising intervention to increase trust.

Patient psychological factors such as coping styles and health locus of control are modifiable contributors to a trusting relationship. Previous studies have shown that coping styles can be improved for chronically ill patients [ 80 ], while other interventions can address a patient’s health locus of control and improve their social support systems. Furthermore, social support interventions have been shown to be effective in patients with different diseases [ 81 , 82 , 83 ]. Health education could be addressed through e-learning and by provisioning self-help groups that exchange ideas about diseases [ 84 ] with educational tools and teaching materials [ 85 ]. However, these interventions are system-related as the healthcare system must offer those interventions.

Medical education

Most physician-centered modifiable contributors to a trusting relationship fall under the scope of medical education. Competence is acquired and addressed through university education, graduate school, and continuing education. Communication skills are taught in medical education courses, and professionalism is addressed as a CanMED role [ 86 ]. Exploration is an important skill that is already part of communication curriculums [ 87 ] and is based on the common-sense model of illness [ 88 ]. Physicians can be taught to provide health education [ 89 ]; however, it is a skill that medical students find difficult to achieve [ 90 ]. Further intervention possibilities could address a physician’s ability to express compassion and empathy. A recent review summarized educational methods used to address medical student empathy [ 91 ], with simulation training shown to be an effective tool [ 92 ].

A practical example that implements the described practices can be found in the Presence 5 project, which teaches physicians to better listen to patients, explore their story and emotions, and connect with them. These teachings have had positive effects on the physicians’ attitude, compassion, communication, and exploring behavior [ 93 , 94 ].

Patient- and physician-related factors

As with physician-related contributors to trust, patient- and physician-related promoters of trust could be addressed through medical education. Building an alliance with patients and learning about shared decision-making are skills taught in medical school [ 95 ]. The physician can also be made aware that spending sufficient time with a patient is relevant to building trust; however, the ability to modify this contributor is dependent on the healthcare and billing system.

Context-dependent contributors

We found that a transparent billing system and institution-related contributors such as reputation, medical practice atmosphere, accessibility, and additional healthcare services contributed to a trusting patient-physician relationship. A recent discussion on making health care more accessible can be found in Gupta et al. [ 96 ].

One healthcare system that addresses many of these factors is Canada’s patient-centered model: ‘the patient’s medical home.’ Under this model, patients can choose a physician they feel comfortable with and who will continuously manage their health care over their lifespan. Each physician is surrounded by a team that considers the patient’s situation and may provide additional healthcare services when needed. This model ensures that each patient receives comprehensive and accessible care that provides sufficient time with the physician and guarantees continuity of care [ https://patientsmedicalhome.ca/ , 97 ]. Over the long term, patient medical homes have led to better care, decreased costs, and more satisfaction for providers and patients [ https://patientsmedicalhome.ca/ , 97 ]. Other positive aspects of the patient’s medical home, aside from increased continuity of care and the availability of additional health care services, may lie within the aspect of time spent together [ 98 ] or improved disease progression [ 99 ], which is also addressed within the patient’s medical homes.

Strengths and limitations

The strength of this critical review lies in the systematic search approach, which only included papers that operationalized or specifically described trust. Despite this approach, we cannot ensure that we have included all empirical contributors to patient-physician trust that have been researched. While the systematic search did limit bias in the identified contributors within the critical assessment of what could be modifiable or not, the critical assessment could be biased through the author’s background. However, we discussed the process in depth as a team.

Our search strategy included psychological safety as a synonym for trust, as well as the terms rapport, alliance, and relationship. We checked indexed search terms to ensure the inclusion of relevant synonyms. In the past, trust was more conceptualized as rapport or alliance, whereas today, it is associated with a newer term: “psychological safety.” While we tried to include relevant search terms, we might have missed some, limiting the results.

While our search was not limited to patients trusting their physicians, most papers focused on this and excluded physicians’ trust in their patients. Dyadic analyses of patient-physician trust are scarce. However, Petrocchi et al. (2019) have begun investigating patient-physician trust as a dyad [ 100 ]. Some papers only reported correlations of trust with unmodifiable, less relevant, but easy-to-gather factors, such as sex or age. Thus, more contributors to trust may have yet to be investigated.

Implications for future research

Interestingly, many non-modifiable or insignificant contributors, such as physician or patient demographics, were investigated in almost every study we reviewed. However, the most promising contributors, such as health education, were barely explored. Future research should investigate modifiable and promising contributors to a trusting relationship that have, as yet, been barely researched, including patient psychological factors and additional healthcare services. Additionally, factors that have not been investigated should be addressed, including digitized healthcare settings and how telemedicine, chatbots, and video consultations affect patients’ trust in physicians. Further research should also focus on measuring how successful physician interventions are, as previous research and interventions have not increased patient trust [ 101 , 102 ]. Future interventions should also consider multiple contributors to trust, as they are all related. For such interventions, the outcomes for each contributor should be evaluated first, with trust as a secondary outcome.

As the present review aimed to create a model of patient-physician trust, only studies that included trust between patients and physicians were included, with other healthcare professionals excluded. However, research has already acknowledged the importance of trusting relationships for all healthcare professionals [ 103 ], which should be further expanded. Thus, shared contributors to trust between healthcare professionals, their differences, and potential leverage points should also be identified.

Implications for practice

Our critical review has demonstrated that there are more contributors to a trusting patient-physician relationship than the theory of interpersonal trust proposes, and the context in which the patient-physician relationship takes place is highly relevant. One way to increase trust within the patient-physician relationship is to implement healthcare systems that are organized similarly to the Canadian ‘patient’s medical homes’ model. Changing the healthcare system is also an effective tool to simultaneously address multiple contributors to trust.

At the level of the institution, enhancing trust should focus on health education, which can be addressed through the implementation of self-help and support groups, providing high-quality health educational material, and training healthcare professionals.

At the physician level, we recommend taking as much time as possible for each patient to explore their perspective and current situation, organize (as much as possible) continuity of care, and ensure patient health education.

Using a systematic search, our model summarizes identified modifiable contributors to a trusting patient-physician relationship. Providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising leverage points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Data availability

The data (review search) of the current review are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the information specialist team at the library of the medical faculty of Bern. They supported the development of our research question and a search strategy. We also thank Adrian Michel (mediamatician) for the model illustration. The preliminary results of this review were presented at the European Health Psychology Conference on August 27, 2022 in Bratislava.

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Lerch, S.P., Hänggi, R., Bussmann, Y. et al. A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy. BMC Prim. Care 25 , 194 (2024). https://doi.org/10.1186/s12875-024-02435-z

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What to Expect in the Psychological Evaluation for Family Planning

Intended parents of third-party reproduction..

Posted June 4, 2024 | Reviewed by Abigail Fagan

• A Parent's Role
• Find a family therapist near me
• Family planning through egg donor or surrogacy is complex and stirs up a mixed range of emotions.
• The psychological evaluation contains several parts: an interview, family history, mental health history.
• Think of this time as a way to reflect on your strengths and challenges and better prepare for parenthood.

The anticipation of becoming a parent is a spectrum of emotions including excitement, hesitation, and even vulnerability. If you’ve arrived at family planning with the plan of third-party reproduction efforts, your journey has likely meant confusion, loss, cyclical hope and disappointment, and frustration. Your path has also meant reflective honesty, complicated communication, love, determination, and resilience .

The Psychological Evaluation: What Is It?

One of your many doctors’ appointments will include a psychological evaluation. It is an essential step to ensuring the best for your future family. The main goal of this meeting is to speak with a knowledgeable psychologist to think through your needs and wishes for the surrogate or egg donor, predict difficult parts of the journey and how to prepare emotionally for them, and to discuss and prepare for some of the early challenges of parenthood .

The psychological evaluation resembles a thorough health check-up for your mind and emotions. The psychologist will offer support as you discuss your strengths, uncover potential challenges, or risks, and identify areas requiring additional consideration.

The Interview

Interviews are like the first chapter of your story. The psychologist will ask you and your partner detailed questions about your background, family history, relationship dynamics, parenting experiences, and physical and emotional health. These questions aren’t a test of any sort, but, rather, it is a way for the professional to understand your emotional life and support you and your partner in welcoming a new baby.

Talking About the Hard Stuff

In the evaluation, we'll dig into your medical history, especially your mental health background. It's not about reopening old wounds, but about understanding how you and your partner have coped with challenges in the past.

The psychologist will ask questions to better understand your relationship and see how you communicate and work together. This includes how you talk to each other, share your feelings, and deal with challenges. The discussion may also include how you handle disagreements and support each other during difficult times.

Think of these discussions as helpful to pinpoint areas where both of you might benefit from extra support and ways to acknowledge and recognize your strengths as partners.

Lastly and importantly, you will talk about your plans to disclose your son or daughter’s unique birth narrative, which includes how they were conceived, and what that means for future contact and knowledge about their health. According to the American Society for Reproductive Medicine, openness is considered key, and parents should feel comfortable sharing their child’s birth narrative with them once they begin to ask questions, or when the parents feel the time is right.

The ethics and guidelines around donors and surrogacy are nuanced as they account for the donor or surrogate’s wishes for privacy while also considering what is important for the child’s health. For example, some legal agreements may allow for contact should one or the other party develop a health condition that may have implication for the other. This evaluation, along with consultations with your lawyer, may provide opportunities for you to think through both your wishes and limits to disclosure.

Feedback and Recommendations

Finally, as your time together wraps up, your provider may have some short-term and long-term recommendations to support the wellbeing of your family and future little one. Many providers will provide resource lists with journal articles, board books, and online support options.

Reflection and Opportunity

Embrace the evaluation as an opportunity for growth for you and your partner. You will be able to identify the strengths you and your partner have and figure out your areas of growth. Reflecting on the journey you and your partner are partaking in will help you feel more confident in you and your partner’s abilities to be intended parents. Through this guided psychological evaluation, you're not just fulfilling a requirement; you're actively shaping your readiness to embrace the joys and challenges of parenthood.

https://www.conceiveabilities.com/about/blog/do-intended-parents-undergo-psychological-screening

https://southwestsurro.com/blog/why-intended-parents-need-psych-eval

Amy Vigliotti, Ph.D. , is a child and adult psychologist and the founder of the NYC group therapy practice, SelfWorks.

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Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis

• Ruixuan Zhao 1 ,
• Shijie Fang 1 ,
• Dongwen Li 2 &
• Cheng Zhang 3  

BMC Nursing volume  23 , Article number:  370 ( 2024 ) Cite this article

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Nurses play an important role in the treatment of war wounds on the plateau, and they face multiple challenges and a variety of needs in their caregiving process. This study aimed to systematically integrate and evaluate qualitative research data to understand the altitude emergency rescue experience and training needs of nurses in military hospitals and provide them with targeted assistance.

We critically assessed the study using the Joanna Briggs Institute Critical Assessment Checklist for Qualitative Research. Extraction, summarization and meta-synthesis of qualitative data. Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM) were searched for relevant studies published from the establishment of the database to May 2023. Additionally, we conducted a manual search of the references of the identified studies. Registered on the PROSPERO database (CRD42024537104).

A total of 17 studies, including 428 participants, were included, and 139 research results were extracted, summarized into 10 new categories, and formed 3 meta-themes. Meta-theme 1: mental state of military nurses during deployment. Meta-theme 2: the experience of military nurses during deployment. Meta-theme 3: training needs for emergency care.

Conclusions

Emergency rescue of high-altitude war injuries is a challenging process. Leaders should pay full attention to the feelings and needs of military nurses during the first aid process and provide them with appropriate support.

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Introduction

The plateau area has the characteristics of high altitude, cold all the year round, many ice peaks and snow mountains, and hypoxia [ 1 ]. These characteristics pose major obstacles to both military operations and non-military operations and at the same time, due to the complex terrain and inconvenient transportation, the detection, handling, treatment, and evacuation of the wounded become very difficult. These special natural environments put forward higher requirements for medical rescue [ 2 , 3 ]. As an important part of military or non-military missions, military nurses play an important role in emergency rescue [ 4 ]. There has been a long history of military nurses engaging in war, military operations and humanitarian missions, they are required to provide not only routine health care during peacetime, but also medical services during conflict or humanitarian assistance in response to disasters, public emergencies and epidemics [ 5 , 6 ]. The rescue process is arduous, and nurses may face great challenges. When they are at high altitude environment, they are prone to hypoxia, frostbite, sunburn, fall, blindness, etc., and may be accompanied by high altitude pulmonary edema and high-altitude coma. In war and non-war military operations, military nurses are required to care for a variety of trauma patients, including burns, traumatic amputations, shock, bleeding, penetrating injuries, spinal cord injuries, head injuries, crush injuries, radiation injuries, chemical injuries, infectious diseases, and more. This has higher requirements for the physical, psychological and professional knowledge of military nurses [ 4 , 7 , 8 ].

To provide better care for the wounded and respond to various emergency situations, military nurses must continuously improve their competence. In addition, according to the literature [ 4 , 6 , 9 ], the demand of military nurses for emergency rescue training is gradually increasing, with nurses with deployment experience reporting limited first aid proficiency and a lack of practical training, and related qualitative studies are also increasing, but a single qualitative research result is difficult to fully and accurately reflect the needs of military nurses. Therefore, this study uses a meta-synthesis approach to analyze and summarize such studies the to understand experience and training needs of nurses in military hospitals with altitude war injury emergency rescue, to provide reference for formulating altitude emergency rescue training strategies, and better meet their needs and provide them with appropriate support.

Study design

The Joanna Briggs Institute(JBI)methodology for systematic reviews of qualitative evidence [ 10 ] guided this systematic review and qualitative meta-synthesis. We used the PROSPERO to identify published or ongoing research relevant to the topic and registered for this review(CRD42024537104). In addition, we report our findings by the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) Statement [ 11 ].

Search strategy

We performed systematic searches in Cochrane Library, PubMed, Embase, FMRS, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database (CECDB), VIP Database, and China Biomedical Database (CBM). The retrieval time limit was from the establishment of the database to May 2023. The following search terms were used in different combinations: plateau, qualitative study, Emergency rescue, train, Military nurses, education, disaster, public health emergency, rescue, army, War readiness, war. Additionally, we conducted a manual search of the references to the identified studies to find additional eligible articles.

Inclusion and exclusion criteria

Articles that satisfied the following criteria were included in the qualitative synthesis: 1)study population(P): military nurses; 2)phenomenon of interest(I): highland or mountain emergency rescue or emergency rescue experiences, experiences and training needs; 3)context(Co): military nurse emergency rescue process or training process; 4)type of study: qualitative research, including phenomenological, descriptive qualitative research, rooted theory, ethnography, etc.

The exclusion criteria were as follows: 1)duplicate literature, literature with unavailable full text or incomplete data, literature with substandard quality (The JBI qualitative research critical assessment is graded C); 2)literature not in English; 3) secondary research.

Article filtering and quality assessment

Literature screening was done independently by 2 researchers following strict inclusion and exclusion criteria, and they independently assessed the quality of the included literature using the JBI Manual for Systematic reviews of qualitative evidence [ 10 ]. The guideline has 10 evaluation items, each items uses “yes”, “no”, and “not provided” as evaluation indicators. In this study, literature quality is divided into A, B and C. A represents that the literature meets all the above evaluation indicators, B represents that the literature partially meets, and C represents that it does not meet all the above evaluation indicators. During the article selection and quality evaluation process, disagreements were settled with discussion or with a third author’s assistance.

Data extraction

Data management was enabled by the reference management program Endnote 20. Data extraction consists of two researchers reading the content contained in the study independently to extract relevant and useful information, cross-reviewed, and when any disagreement was discussion to resolve it with a third experienced researcher. The relevant content of each study was extracted using a standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review (JBI-QARI), the JBI-QARI qualitative criteria are: (1) unequivocal (U)—refers to findings that are a matter of fact, beyond a reasonable doubt; (2) credible (C)—refers to findings that are plausible interpretations of the primary data within the theoretical framework; (3) unsupported (Un)—relates to findings that are unsupported by the data [ 12 ]. The researchers extracted data according to the above criteria. Data extraction included author, country, objective, study population, research Methodology, and main results.

Data synthesis

This data extraction was carried out and checked independently by 2 researchers, and when disagreements were encountered, a third researcher was asked and consensus was reached on the results. We used Thomas and Hardens’ three stage thematic synthesis approach [ 13 ]: (1) coding the text; (2) developing descriptive themes; (3) generating analytical themes. First, two researchers independently coded the results based on text content and meaning; then, researchers looked for similarities and differences between the textual data, and classify the meaning of the original dataset; finally, the categories were evaluated repeatedly to identify similarities and obtain synthesized results.

Study characteristics

A total of 1070 articles were searched, we found two additional articles by checking the references of articles, and the exclusion of duplicate publications yielded 783 articles. After reading the titles and abstracts, 708 articles were excluded. After reading the remaining 75 articles 58 articles were excluded, including 52 articles with content mismatches, 3 articles studied population errors and full text information could not be obtained for 3 articles, Finally, 17 studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] were identified for inclusion in this analysis. The results of the search are shown in the PRISMA flowchart in Fig.  1 . The 17 included studies were published between 2005 and 2023, of which 16 were qualitative studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 28 ] and one were mixed-methods studies [ 27 ]. A total of 428 participants, involved 6 countries, including China (2 study [ 7 , 27 ]), USA (6 studies [ 9 , 15 , 17 , 20 , 21 , 22 ]), Sweden (2 studies [ 14 ]), Iran (3studies [ 19 , 24 , 25 ]), Israel (1 study [ 28 ]), Korean (2 studies [ 23 , 26 ]), and British (1 study [ 18 ]). The characteristics of the included literature are shown in Table  1 .

Quality assessment of studies

The included studies were evaluated separately by two trained researchers using the JBI Qualitative Research quality Evaluation criteria, who then participated in the discussion together. When disagreements arose, the help of a third researcher was sought and the final results were unanimously approved by the researchers. All literature included in this study was either A or B grade, which three studies were quality rating of A and 13 studies with a B. Table  2 presents the results of the critical appraisal of the 17 studies.

PRISMA flowchart and literature selection results

Results of synthesis

This study uses the method of aggregative integration [ 12 ] to integrate the results, that is, to further organize and summarize the meaning of the collected results, so as to make the results more convincing, targeted and general. Researchers in understanding the various qualitative research philosophy and methodology of the premise, through repeated reading, analysis and interpretation of each research results, are summarized, integration, form a new category and form integrated results. Finally extracted the results of 17 studies [ 7 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], which were summarized into 10 new categories and formed 3 meta-themes. The categories are presented below with supporting subcategories and illustrative quotes from the original studies.

Theme 1: Mental state of military nurses during deployment

Feeling down.

Military nurses are often frustrated by complex battlefield environments or natural disasters. For example, some nurses may be frustrated by the lack of equipment or supplies, or despair that they cannot save the lives of the wounded; They were frustrated that they could not do more for the wounded. Other nurses were depressed about life after witnessing the brutality of war.

“I am afraid of the battlefield situation on the plateau, and do not understand the local dialect, I do not know how to carry out the rescue work, and I am worried that I have not done anything, dragging everyone down.” [ 7 ]. “You are going to be frustrated at the lack of resources”; “you are going to see young people slaughtered more or less and feel hopelessness at not being able to save their lives.’’ [ 14 ]. “Nurses reported frustration at the time it took for patients to arrive, the extent of injuries, and that they could not do more to save some patients.” [ 9 ].

Emotion management

During deployment, nurses use a variety of methods to vent their emotions and keep them positive. Such as, taking a shower, keeping a journal, talking to others, Mutual acceptance and respect. By adopting positive coping measures, they enable themselves to be competent in their caring role and increase their belief in caring.

“After each surgery I went to take a shower, pouring out my heart in tears, washing myself changing to a clean uniform, then going back like a new person” [ 28 ]. “I’ve had some depression on and off since I came back from Vietnam. If I kept a journal maybe I could get a better handle on some of the things that happened to me over there” [ 15 ]. “Confide in you colleagues and don’t hold things in…I think that’s what kept us going real well” [ 15 ].

Sense of responsibility

It is crucially important for a nurse to understand the mission, policies, and procedures of the armed forces and the part one is asked to play as a military nurse. They need to understand that the purpose of the military is to support, protect, and defend a country’s national security interests. Performing military missions will enable them to serve a greater purpose in life. As both soldiers as well as nurses, based on the sense of responsibility to make them in a state of crisis to protect and serve the people, which make them proud. Military nurses also have an inspiring role to play by example.

“We worked together in the implementation of emergency rescue support tasks, filled with positive energy and a sense of honor, and strengthened our sense of mission” [ 7 ]. “To be something of a father-figure, to give the soldiers a feeling of safety. Keep your eye on your men so that they know they will be looked after if anything happens” [ 14 ].

Theme 2: the experience of military nurses during deployment

There are three main types of “chaos” here: Natural disasters and wars make the environment chaotic; the environment of disaster or war often makes the rescue work of nurses full of uncertainty, which leads to confusion in the team; chaos in the role of nurses during deployment.

“You get over there, [combat] it [the chaos] becomes real, bullets are flying, we’re being mortared … all these injuries, people with broken bones, blown off arms, burns … [In disasters, initially] “It was pure chaos, triage was going on, treatment was going on, people [were] everywhere, lying on the conveyor belt, in wheelchairs, tons of elderly, some had no clothing, it was just a sea of people that you could not see through” [ 22 ]. “One of our biggest challenges in critical situations is ambiguity or confusion in roles. These programs help us to clarify different roles in critical situations” [ 24 ].

Unique environment

This is different from the usual environment, its “Unique” is manifested as: the uncertainty of the war zone; patients with complex injuries, such as explosion injuries, penetrating injuries; lack of resources and poor health care; and the special natural environment at high-altitudes.

“We did not know what to expect in a war zone” [ 28 ]. “I usually have the habit of taking a bath every day, the most difficult to adapt to the field toilet and bathing, bathing like a market, the toilet is very simple, what flying animals can appear, often the toilet has not yet waited, it is necessary to gather training” [ 7 ]. “The biggest headache for me was the sweltering heat of the tent during the day and the shivering cold at night” [ 7 ].

Team support

Team support is important. Maintaining a cohesive team relationship can not only improve the efficiency of casualty rescue, but also provide psychological support to each other. During deployment, the team helps and supports each other, and they are like a family. In addition, successful teams need strong leadership to ensure that the task is completed smoothly.

“We were working in harmony, with collaboration between us. In this way, we could overcome this difficult and stressful time” [ 28 ]. “The chief nurse knew her people. She knew the nurses. She had a feel for what was going on in the unit and she knew who and when she could pull them, and where the staff needed to be to get the job done to cut down on the confusion ” [ 9 ].

The need for specialized skills

Due to the special nature of war trauma, medical personnel lack knowledge and experience in its cause mechanism and operation principle. Other nurses noted their lack of experience in military nursing because they had not been deployed before. Therefore, according to the study, military nurses need to improve their professional skills before deployment.

“I have not systematically received the training of the professional theoretical knowledge of war injury rescue, and I have a sense of panic about the lack of professional knowledge when facing the practical rescue” [ 7 ].

Training needs for emergency care

Psychological training needs.

Military nursing is different from traditional nursing in terms of military obligations and requirements. Firstly, nurses need to cultivate military values, responsibility, patriotism, and a sense of sacrifice. Second, in a battlefield or disaster environment, military nurses face a variety of scenarios, so it requires them to develop a positive mindset. Finally, they need to keep their confidence and overcome their fear.

“I think professional education should begin with enforcement in mind, and it is necessary for nurses to cultivate a spirit of sacrifice and patriotism.” [ 27 ]. “Be secure in yourself and in your professional abilities and limitations. Be realistic in your expectations. You have to cope with the reality and deal with it, even though it is very, very hard” [ 15 ].

Military training content needs

Nurses play an increasingly important role in military missions and are often deployed to different missions, such as humanitarian operations, natural disasters and public health emergencies. Therefore, it is necessary that they have the relevant knowledge, skills and abilities. And they suggest that it is best to train them in local customs and languages before deployment. The special nature of military medicine, they have a lot to learn in the military, including combat and trauma care areas; Chemical, biological, radiological or nuclear (CBRN) preparation/reaction, such as Combat Casualty Care Course, Emergency War Surgery Course, or Trauma Nursing Core Course, etc. In addition, in the plateau region, they also learn medical care under extreme conditions.

“I think the emergency response capacity should be enforced, such as when we run into public health emergencies and natural disasters; s” [ 27 ]. “Now, I think we are dealing with these cultural aspects in all our operational readiness courses” [ 15 ]. “Fluid resuscitation on plains and plateaus is different; thus, we also need to learn medical care and nursing skills for extreme environments” [ 27 ].

Training methods needs

Mixed training methods should be adopted in teaching. Among them, practice, scenario simulation and distance learning are effective training methods, for example, they participated in training exercises in a field training environment or simulation laboratory. At the same time, they should not forget that teamwork training is also important in training.

“I think scenario simulation is a good way, because theory lectures are too boring and we need to put theory into practice” [ 27 ]. “When participating in professional education, trainees should take part in exercise to avoid only talking on paper” [ 27 ]. “We had teamwork training during that education program, and I was impressed with this activity, which provided training on team cohesion” [ 27 ]. “Tabletop exercises were unrealistic and less helpful. We did not practice for a mass casualty.” [ 9 ].

This systematic review and comprehensive study discussed the experience and training needs of nurses in military hospital in altitude first aid. The findings of the review have shown that military nurses faced a lot of physical and emotional stress during deployment. These stressors came from lack of professional ability, inadequate professional preparation, chaotic battlefield environment and extreme natural environment and similar. Military nurses found reasonable ways to cope with stress in a variety of military Settings. They receive training to improve professional competence and self-efficacy, while external support from care managers and colleagues also plays a vital role. However, more strategies are needed to enhance this effect.

The comprehensive quality of the individual (including physical and psychological quality) has a crucial impact on the rescue mission of military nurses [ 8 ]. For rescue in various environments(aircraft carriers, hospital ships, evacuation aircraft, plateaus, hypoxia, cold, desert, Gobi, high humidity, low pressure, jungle, and other area), rescuers need to have good physical fitness, positive and optimistic psychological quality and self-adjustment ability, in order to maximize their own knowledge and skills of high quality play out [ 29 ]. However, the findings of this review [ 7 , 9 , 16 , 17 ] indicate that military nurses may experience altitude sickness, fatigue, nausea, and even acute pulmonary edema when faced with a cold, oxygen-deprived altitude environment; faced with many casualties, they feel depressed, helpless, sad and even depressed. Therefore, military nurses should pay attention to physical training, enhance physical quality, to resist and adapt to extreme environment; nursing managers accurately their psychological state, timely guidance, tracking comfort. The findings of this review also suggest strengthening teamwork and support, which can help nurses support each other during periods of loneliness and provide quality care to wounded patients [ 6 , 7 , 22 , 24 ]. Bonnie et al [ 30 ]. also suggests trying to change thinking and manage emotions by changing feelings and reframing experiences.

Knowledge and technology are the fundamental prerequisites for military nurses to accomplish rescue operations [ 31 ]. This review found that knowledge and skills were mentioned more frequently, indicating that knowledge and skills were the most concerned skills of nurses participating in deployment, and rich knowledge storage and skilled nursing skills are crucial to the first aid of the wounded. Other studies have also drawn a similar conclusion. For example, Harris [ 32 ] found that one unique aspect of clinical expertise in the context of military nursing is clinical diversity, and military nurses should not specialize in just one specialty, but should have multidisciplinary nursing knowledge and skills. Formulating a scientific and effective training program is helpful to improve the ability of military nurses. Caporiccio et al [ 33 ]. found continuing professional education (CPE) is widely recognized by nurses who learn the latest knowledge and skills through CPE, which has become the primary source for maintaining their competencies and ensuring better outcomes worldwide. The training including trauma care, combat knowledge, field nursing, the cultural customs and languages of the deployment place, chemical, biological, radiological or nuclear (CBRN) preparation/reaction(such as Combat Casualty Care Course, Emergency War Surgery Course, or Trauma Nursing Core Course, etc.) [ 8 , 9 , 14 , 15 , 27 ]. Learning barriers have family and work factors, trainees often did not want to attend training because they are worried about their children or heavy work, the learning environment is also an important factor, and the positive learning atmosphere organized by the staff can make the trainees full of passion for learning [ 34 ]. In addition, appropriate training methods have a positive effect on improving nurses’ professional skills. The main methods include practice, scene simulation and distance learning. And leaders should pay attention to teamwork training among medical staff [ 9 , 27 , 35 ]. Overall, making scientific training programs and creating a good learning atmosphere are helpful to improve the knowledge and technology of military nurses.

Competency is the key to affect the rescue mission of military nurses [ 31 ]. Competency is an important invisible feature for military nurses to complete rescue tasks, and is the driving force for other skills to play. Military nurses need to have the ability of organization and management, nursing risk prediction, nursing decision making, emergency handling and so on when performing rescue tasks [ 29 , 36 ]. These are essential conditions for successful treatment. Some studies have shown that team members from different majors simulate operation and rescue tasks in non-task environments, which can effectively prevent the repetition of wrong behaviors by improving leadership, communication skills, teamwork, etc [ 24 , 37 ]. Good communication and teamwork can also reduce the occurrence of adverse events during rescue [ 24 ]. Decisive decision-making ability becomes the key to winning survival time, and good emergency response ability can often avoid further damage [ 4 , 29 , 38 ]. Therefore, military nurses with good comprehensive ability can achieve the rescue effect of both efficiency and quality. Through simulation-based training, military nurses can improve their personal knowledge, skills, abilities, thinking and team ability [ 4 ]. Such as high-fidelity simulation could improve emergency management capabilities, team leadership, and basic nursing skills [ 39 ]; human patient simulators could improve their cognitive thinking and critical thinking skills [ 40 ]; hyper-realistic immersive training could improve the performance of multidisciplinary medical team members and facilitate effective collaboration between members and teams [ 41 ]. We found that military nurses are more willing to improve their ability through practice [ 27 ]. Consequently, it is suggested that the management should expand the practical training mode and combine various simulated training with simulated extreme environment to enhance the comprehensive ability and adaptability of military nurses to special environment.

Strengths and limitations

The advantage of this study is that we not only searched medical databases but supplemented this with manual searches to ensure that studies were fully retrieved. Secondly, we conducted quality control, data extraction, and study quality assessment. Finally, the study is largely reflective of the dilemmas and needs of military nurse and is of great significance to military emergency care. However, there are some limitations to this study. Although the search strategy was thorough, some articles may have been missed, such as the gray literature. And the lack of detailed discussion on the potential influence of the researchers on some of the research studies suggests a possible bias of the findings of original studies.

This qualitative systematic review reviews the experience of military nurses during deployment and analyzes the feelings, experiences, and needs of military nurses during military duty. In contrast, there is less research on emergency rescue operations in extreme environments such as high altitudes, which should be the focus of future exploratory research. Qualitative research in this area should address the lack of mental, physical, and professional preparedness of deployers by understanding the experiences of those with deployment experience in extreme environments. In the future, managers should design diversified, personalized training programs and training methods that are suitable for the deployment of military nurses in a variety of environments.

Data availability

Data used to support the findings of this study are available from the corresponding author upon request.

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This systematic review is supported by the military medical research project of General Hospital of Western Theater Command (2019ZY08).

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Ruixuan Zhao wrote the main manuscript text; Ruixuan Zhao, Shijie Fang and Dongwen Li Collectioned and analysis the data.; Ruixuan Zhao, Shijie Fang and Cheng Zhang were involved in data synthesis; Dongwen Li had a writing review; Ruixuan Zhao and Dongwen Li prepared Fig. 1 and Table 1, and 2; Ruixuan Zhao, Shijie Fang, Cheng Zhang, and Dongwen Li prepared additional file 1 – 4 ; All authors reviewed the manuscript.

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Zhao, R., Fang, S., Li, D. et al. Experience and training needs of nurses in military hospital on emergency rescue at high altitude: a qualitative meta-synthesis. BMC Nurs 23 , 370 (2024). https://doi.org/10.1186/s12912-024-02029-1

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Received : 18 September 2023

Accepted : 20 May 2024

Published : 03 June 2024

DOI : https://doi.org/10.1186/s12912-024-02029-1

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