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The top list of academic search engines

1. Google Scholar

4. science.gov, 5. semantic scholar, 6. baidu scholar, get the most out of academic search engines, frequently asked questions about academic search engines, related articles.

Academic search engines have become the number one resource to turn to in order to find research papers and other scholarly sources. While classic academic databases like Web of Science and Scopus are locked behind paywalls, Google Scholar and others can be accessed free of charge. In order to help you get your research done fast, we have compiled the top list of free academic search engines.

Google Scholar is the clear number one when it comes to academic search engines. It's the power of Google searches applied to research papers and patents. It not only lets you find research papers for all academic disciplines for free but also often provides links to full-text PDF files.

• Coverage: approx. 200 million articles
• Abstracts: only a snippet of the abstract is available
• Related articles: ✔
• References: ✔
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• Links to full text: ✔
• Export formats: APA, MLA, Chicago, Harvard, Vancouver, RIS, BibTeX

BASE is hosted at Bielefeld University in Germany. That is also where its name stems from (Bielefeld Academic Search Engine).

• Coverage: approx. 136 million articles (contains duplicates)
• Abstracts: ✔
• Related articles: ✘
• References: ✘
• Cited by: ✘
• Export formats: RIS, BibTeX

CORE is an academic search engine dedicated to open-access research papers. For each search result, a link to the full-text PDF or full-text web page is provided.

• Coverage: approx. 136 million articles
• Links to full text: ✔ (all articles in CORE are open access)
• Export formats: BibTeX

Science.gov is a fantastic resource as it bundles and offers free access to search results from more than 15 U.S. federal agencies. There is no need anymore to query all those resources separately!

• Coverage: approx. 200 million articles and reports
• Links to full text: ✔ (available for some databases)
• Export formats: APA, MLA, RIS, BibTeX (available for some databases)

Semantic Scholar is the new kid on the block. Its mission is to provide more relevant and impactful search results using AI-powered algorithms that find hidden connections and links between research topics.

• Coverage: approx. 40 million articles
• Export formats: APA, MLA, Chicago, BibTeX

Although Baidu Scholar's interface is in Chinese, its index contains research papers in English as well as Chinese.

• Coverage: no detailed statistics available, approx. 100 million articles
• Abstracts: only snippets of the abstract are available
• Export formats: APA, MLA, RIS, BibTeX

RefSeek searches more than one billion documents from academic and organizational websites. Its clean interface makes it especially easy to use for students and new researchers.

• Coverage: no detailed statistics available, approx. 1 billion documents
• Abstracts: only snippets of the article are available
• Export formats: not available

Consider using a reference manager like Paperpile to save, organize, and cite your references. Paperpile integrates with Google Scholar and many popular databases, so you can save references and PDFs directly to your library using the Paperpile buttons:

Google Scholar is an academic search engine, and it is the clear number one when it comes to academic search engines. It's the power of Google searches applied to research papers and patents. It not only let's you find research papers for all academic disciplines for free, but also often provides links to full text PDF file.

Semantic Scholar is a free, AI-powered research tool for scientific literature developed at the Allen Institute for AI. Sematic Scholar was publicly released in 2015 and uses advances in natural language processing to provide summaries for scholarly papers.

BASE , as its name suggest is an academic search engine. It is hosted at Bielefeld University in Germany and that's where it name stems from (Bielefeld Academic Search Engine).

CORE is an academic search engine dedicated to open access research papers. For each search result a link to the full text PDF or full text web page is provided.

Science.gov is a fantastic resource as it bundles and offers free access to search results from more than 15 U.S. federal agencies. There is no need any more to query all those resources separately!

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Home » Research Paper – Structure, Examples and Writing Guide

Research Paper – Structure, Examples and Writing Guide

Table of Contents

Research Paper

Definition:

Research Paper is a written document that presents the author’s original research, analysis, and interpretation of a specific topic or issue.

It is typically based on Empirical Evidence, and may involve qualitative or quantitative research methods, or a combination of both. The purpose of a research paper is to contribute new knowledge or insights to a particular field of study, and to demonstrate the author’s understanding of the existing literature and theories related to the topic.

Structure of Research Paper

The structure of a research paper typically follows a standard format, consisting of several sections that convey specific information about the research study. The following is a detailed explanation of the structure of a research paper:

The title page contains the title of the paper, the name(s) of the author(s), and the affiliation(s) of the author(s). It also includes the date of submission and possibly, the name of the journal or conference where the paper is to be published.

The abstract is a brief summary of the research paper, typically ranging from 100 to 250 words. It should include the research question, the methods used, the key findings, and the implications of the results. The abstract should be written in a concise and clear manner to allow readers to quickly grasp the essence of the research.

Introduction

The introduction section of a research paper provides background information about the research problem, the research question, and the research objectives. It also outlines the significance of the research, the research gap that it aims to fill, and the approach taken to address the research question. Finally, the introduction section ends with a clear statement of the research hypothesis or research question.

Literature Review

The literature review section of a research paper provides an overview of the existing literature on the topic of study. It includes a critical analysis and synthesis of the literature, highlighting the key concepts, themes, and debates. The literature review should also demonstrate the research gap and how the current study seeks to address it.

The methods section of a research paper describes the research design, the sample selection, the data collection and analysis procedures, and the statistical methods used to analyze the data. This section should provide sufficient detail for other researchers to replicate the study.

The results section presents the findings of the research, using tables, graphs, and figures to illustrate the data. The findings should be presented in a clear and concise manner, with reference to the research question and hypothesis.

The discussion section of a research paper interprets the findings and discusses their implications for the research question, the literature review, and the field of study. It should also address the limitations of the study and suggest future research directions.

The conclusion section summarizes the main findings of the study, restates the research question and hypothesis, and provides a final reflection on the significance of the research.

The references section provides a list of all the sources cited in the paper, following a specific citation style such as APA, MLA or Chicago.

How to Write Research Paper

You can write Research Paper by the following guide:

• Choose a Topic: The first step is to select a topic that interests you and is relevant to your field of study. Brainstorm ideas and narrow down to a research question that is specific and researchable.
• Conduct a Literature Review: The literature review helps you identify the gap in the existing research and provides a basis for your research question. It also helps you to develop a theoretical framework and research hypothesis.
• Develop a Thesis Statement : The thesis statement is the main argument of your research paper. It should be clear, concise and specific to your research question.
• Plan your Research: Develop a research plan that outlines the methods, data sources, and data analysis procedures. This will help you to collect and analyze data effectively.
• Collect and Analyze Data: Collect data using various methods such as surveys, interviews, observations, or experiments. Analyze data using statistical tools or other qualitative methods.
• Organize your Paper : Organize your paper into sections such as Introduction, Literature Review, Methods, Results, Discussion, and Conclusion. Ensure that each section is coherent and follows a logical flow.
• Write your Paper : Start by writing the introduction, followed by the literature review, methods, results, discussion, and conclusion. Ensure that your writing is clear, concise, and follows the required formatting and citation styles.
• Edit and Proofread your Paper: Review your paper for grammar and spelling errors, and ensure that it is well-structured and easy to read. Ask someone else to review your paper to get feedback and suggestions for improvement.
• Cite your Sources: Ensure that you properly cite all sources used in your research paper. This is essential for giving credit to the original authors and avoiding plagiarism.

Research Paper Example

Note : The below example research paper is for illustrative purposes only and is not an actual research paper. Actual research papers may have different structures, contents, and formats depending on the field of study, research question, data collection and analysis methods, and other factors. Students should always consult with their professors or supervisors for specific guidelines and expectations for their research papers.

Research Paper Example sample for Students:

Title: The Impact of Social Media on Mental Health among Young Adults

Abstract: This study aims to investigate the impact of social media use on the mental health of young adults. A literature review was conducted to examine the existing research on the topic. A survey was then administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO (Fear of Missing Out) are significant predictors of mental health problems among young adults.

Introduction: Social media has become an integral part of modern life, particularly among young adults. While social media has many benefits, including increased communication and social connectivity, it has also been associated with negative outcomes, such as addiction, cyberbullying, and mental health problems. This study aims to investigate the impact of social media use on the mental health of young adults.

Literature Review: The literature review highlights the existing research on the impact of social media use on mental health. The review shows that social media use is associated with depression, anxiety, stress, and other mental health problems. The review also identifies the factors that contribute to the negative impact of social media, including social comparison, cyberbullying, and FOMO.

Methods : A survey was administered to 200 university students to collect data on their social media use, mental health status, and perceived impact of social media on their mental health. The survey included questions on social media use, mental health status (measured using the DASS-21), and perceived impact of social media on their mental health. Data were analyzed using descriptive statistics and regression analysis.

Results : The results showed that social media use is positively associated with depression, anxiety, and stress. The study also found that social comparison, cyberbullying, and FOMO are significant predictors of mental health problems among young adults.

Discussion : The study’s findings suggest that social media use has a negative impact on the mental health of young adults. The study highlights the need for interventions that address the factors contributing to the negative impact of social media, such as social comparison, cyberbullying, and FOMO.

Conclusion : In conclusion, social media use has a significant impact on the mental health of young adults. The study’s findings underscore the need for interventions that promote healthy social media use and address the negative outcomes associated with social media use. Future research can explore the effectiveness of interventions aimed at reducing the negative impact of social media on mental health. Additionally, longitudinal studies can investigate the long-term effects of social media use on mental health.

Limitations : The study has some limitations, including the use of self-report measures and a cross-sectional design. The use of self-report measures may result in biased responses, and a cross-sectional design limits the ability to establish causality.

Implications: The study’s findings have implications for mental health professionals, educators, and policymakers. Mental health professionals can use the findings to develop interventions that address the negative impact of social media use on mental health. Educators can incorporate social media literacy into their curriculum to promote healthy social media use among young adults. Policymakers can use the findings to develop policies that protect young adults from the negative outcomes associated with social media use.

References :

• Twenge, J. M., & Campbell, W. K. (2019). Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Preventive medicine reports, 15, 100918.
• Primack, B. A., Shensa, A., Escobar-Viera, C. G., Barrett, E. L., Sidani, J. E., Colditz, J. B., … & James, A. E. (2017). Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among US young adults. Computers in Human Behavior, 69, 1-9.
• Van der Meer, T. G., & Verhoeven, J. W. (2017). Social media and its impact on academic performance of students. Journal of Information Technology Education: Research, 16, 383-398.

Appendix : The survey used in this study is provided below.

Social Media and Mental Health Survey

• How often do you use social media per day?
• Less than 30 minutes
• 30 minutes to 1 hour
• 1 to 2 hours
• 2 to 4 hours
• More than 4 hours
• Which social media platforms do you use?
• Others (Please specify)
• How often do you experience the following on social media?
• Social comparison (comparing yourself to others)
• Cyberbullying
• Fear of Missing Out (FOMO)
• Have you ever experienced any of the following mental health problems in the past month?
• Do you think social media use has a positive or negative impact on your mental health?
• Very positive
• Somewhat positive
• Somewhat negative
• Very negative
• In your opinion, which factors contribute to the negative impact of social media on mental health?
• Social comparison
• In your opinion, what interventions could be effective in reducing the negative impact of social media on mental health?
• Education on healthy social media use
• Counseling for mental health problems caused by social media
• Social media detox programs
• Regulation of social media use

Thank you for your participation!

Applications of Research Paper

Research papers have several applications in various fields, including:

• Advancing knowledge: Research papers contribute to the advancement of knowledge by generating new insights, theories, and findings that can inform future research and practice. They help to answer important questions, clarify existing knowledge, and identify areas that require further investigation.
• Informing policy: Research papers can inform policy decisions by providing evidence-based recommendations for policymakers. They can help to identify gaps in current policies, evaluate the effectiveness of interventions, and inform the development of new policies and regulations.
• Improving practice: Research papers can improve practice by providing evidence-based guidance for professionals in various fields, including medicine, education, business, and psychology. They can inform the development of best practices, guidelines, and standards of care that can improve outcomes for individuals and organizations.
• Educating students : Research papers are often used as teaching tools in universities and colleges to educate students about research methods, data analysis, and academic writing. They help students to develop critical thinking skills, research skills, and communication skills that are essential for success in many careers.
• Fostering collaboration: Research papers can foster collaboration among researchers, practitioners, and policymakers by providing a platform for sharing knowledge and ideas. They can facilitate interdisciplinary collaborations and partnerships that can lead to innovative solutions to complex problems.

When to Write Research Paper

Research papers are typically written when a person has completed a research project or when they have conducted a study and have obtained data or findings that they want to share with the academic or professional community. Research papers are usually written in academic settings, such as universities, but they can also be written in professional settings, such as research organizations, government agencies, or private companies.

Here are some common situations where a person might need to write a research paper:

• For academic purposes: Students in universities and colleges are often required to write research papers as part of their coursework, particularly in the social sciences, natural sciences, and humanities. Writing research papers helps students to develop research skills, critical thinking skills, and academic writing skills.
• For publication: Researchers often write research papers to publish their findings in academic journals or to present their work at academic conferences. Publishing research papers is an important way to disseminate research findings to the academic community and to establish oneself as an expert in a particular field.
• To inform policy or practice : Researchers may write research papers to inform policy decisions or to improve practice in various fields. Research findings can be used to inform the development of policies, guidelines, and best practices that can improve outcomes for individuals and organizations.
• To share new insights or ideas: Researchers may write research papers to share new insights or ideas with the academic or professional community. They may present new theories, propose new research methods, or challenge existing paradigms in their field.

Purpose of Research Paper

The purpose of a research paper is to present the results of a study or investigation in a clear, concise, and structured manner. Research papers are written to communicate new knowledge, ideas, or findings to a specific audience, such as researchers, scholars, practitioners, or policymakers. The primary purposes of a research paper are:

• To contribute to the body of knowledge : Research papers aim to add new knowledge or insights to a particular field or discipline. They do this by reporting the results of empirical studies, reviewing and synthesizing existing literature, proposing new theories, or providing new perspectives on a topic.
• To inform or persuade: Research papers are written to inform or persuade the reader about a particular issue, topic, or phenomenon. They present evidence and arguments to support their claims and seek to persuade the reader of the validity of their findings or recommendations.
• To advance the field: Research papers seek to advance the field or discipline by identifying gaps in knowledge, proposing new research questions or approaches, or challenging existing assumptions or paradigms. They aim to contribute to ongoing debates and discussions within a field and to stimulate further research and inquiry.
• To demonstrate research skills: Research papers demonstrate the author’s research skills, including their ability to design and conduct a study, collect and analyze data, and interpret and communicate findings. They also demonstrate the author’s ability to critically evaluate existing literature, synthesize information from multiple sources, and write in a clear and structured manner.

Characteristics of Research Paper

Research papers have several characteristics that distinguish them from other forms of academic or professional writing. Here are some common characteristics of research papers:

• Evidence-based: Research papers are based on empirical evidence, which is collected through rigorous research methods such as experiments, surveys, observations, or interviews. They rely on objective data and facts to support their claims and conclusions.
• Structured and organized: Research papers have a clear and logical structure, with sections such as introduction, literature review, methods, results, discussion, and conclusion. They are organized in a way that helps the reader to follow the argument and understand the findings.
• Formal and objective: Research papers are written in a formal and objective tone, with an emphasis on clarity, precision, and accuracy. They avoid subjective language or personal opinions and instead rely on objective data and analysis to support their arguments.
• Citations and references: Research papers include citations and references to acknowledge the sources of information and ideas used in the paper. They use a specific citation style, such as APA, MLA, or Chicago, to ensure consistency and accuracy.
• Peer-reviewed: Research papers are often peer-reviewed, which means they are evaluated by other experts in the field before they are published. Peer-review ensures that the research is of high quality, meets ethical standards, and contributes to the advancement of knowledge in the field.
• Objective and unbiased: Research papers strive to be objective and unbiased in their presentation of the findings. They avoid personal biases or preconceptions and instead rely on the data and analysis to draw conclusions.

Advantages of Research Paper

Research papers have many advantages, both for the individual researcher and for the broader academic and professional community. Here are some advantages of research papers:

• Contribution to knowledge: Research papers contribute to the body of knowledge in a particular field or discipline. They add new information, insights, and perspectives to existing literature and help advance the understanding of a particular phenomenon or issue.
• Opportunity for intellectual growth: Research papers provide an opportunity for intellectual growth for the researcher. They require critical thinking, problem-solving, and creativity, which can help develop the researcher’s skills and knowledge.
• Career advancement: Research papers can help advance the researcher’s career by demonstrating their expertise and contributions to the field. They can also lead to new research opportunities, collaborations, and funding.
• Academic recognition: Research papers can lead to academic recognition in the form of awards, grants, or invitations to speak at conferences or events. They can also contribute to the researcher’s reputation and standing in the field.
• Impact on policy and practice: Research papers can have a significant impact on policy and practice. They can inform policy decisions, guide practice, and lead to changes in laws, regulations, or procedures.
• Advancement of society: Research papers can contribute to the advancement of society by addressing important issues, identifying solutions to problems, and promoting social justice and equality.

Limitations of Research Paper

Research papers also have some limitations that should be considered when interpreting their findings or implications. Here are some common limitations of research papers:

• Limited generalizability: Research findings may not be generalizable to other populations, settings, or contexts. Studies often use specific samples or conditions that may not reflect the broader population or real-world situations.
• Potential for bias : Research papers may be biased due to factors such as sample selection, measurement errors, or researcher biases. It is important to evaluate the quality of the research design and methods used to ensure that the findings are valid and reliable.
• Ethical concerns: Research papers may raise ethical concerns, such as the use of vulnerable populations or invasive procedures. Researchers must adhere to ethical guidelines and obtain informed consent from participants to ensure that the research is conducted in a responsible and respectful manner.
• Limitations of methodology: Research papers may be limited by the methodology used to collect and analyze data. For example, certain research methods may not capture the complexity or nuance of a particular phenomenon, or may not be appropriate for certain research questions.
• Publication bias: Research papers may be subject to publication bias, where positive or significant findings are more likely to be published than negative or non-significant findings. This can skew the overall findings of a particular area of research.
• Time and resource constraints: Research papers may be limited by time and resource constraints, which can affect the quality and scope of the research. Researchers may not have access to certain data or resources, or may be unable to conduct long-term studies due to practical limitations.

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Researcher, Academic Writer, Web developer

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Students Are Likely Writing Millions of Papers With AI

Students have submitted more than 22 million papers that may have used generative AI in the past year, new data released by plagiarism detection company Turnitin shows.

A year ago, Turnitin rolled out an AI writing detection tool that was trained on its trove of papers written by students as well as other AI-generated texts. Since then, more than 200 million papers have been reviewed by the detector, predominantly written by high school and college students. Turnitin found that 11 percent may contain AI-written language in 20 percent of its content, with 3 percent of the total papers reviewed getting flagged for having 80 percent or more AI writing. (Turnitin is owned by Advance, which also owns Condé Nast, publisher of WIRED.) Turnitin says its detector has a false positive rate of less than 1 percent when analyzing full documents.

ChatGPT’s launch was met with knee-jerk fears that the English class essay would die . The chatbot can synthesize information and distill it near-instantly—but that doesn’t mean it always gets it right. Generative AI has been known to hallucinate , creating its own facts and citing academic references that don’t actually exist. Generative AI chatbots have also been caught spitting out biased text on gender and race . Despite those flaws, students have used chatbots for research, organizing ideas, and as a ghostwriter . Traces of chatbots have even been found in peer-reviewed, published academic writing .

Teachers understandably want to hold students accountable for using generative AI without permission or disclosure. But that requires a reliable way to prove AI was used in a given assignment. Instructors have tried at times to find their own solutions to detecting AI in writing, using messy, untested methods to enforce rules , and distressing students. Further complicating the issue, some teachers are even using generative AI in their grading processes.

Detecting the use of gen AI is tricky. It’s not as easy as flagging plagiarism, because generated text is still original text. Plus, there’s nuance to how students use gen AI; some may ask chatbots to write their papers for them in large chunks or in full, while others may use the tools as an aid or a brainstorm partner.

Students also aren't tempted by only ChatGPT and similar large language models. So-called word spinners are another type of AI software that rewrites text, and may make it less obvious to a teacher that work was plagiarized or generated by AI. Turnitin’s AI detector has also been updated to detect word spinners, says Annie Chechitelli, the company’s chief product officer. It can also flag work that was rewritten by services like spell checker Grammarly, which now has its own generative AI tool . As familiar software increasingly adds generative AI components, what students can and can’t use becomes more muddled.

Detection tools themselves have a risk of bias. English language learners may be more likely to set them off; a 2023 study found a 61.3 percent false positive rate when evaluating Test of English as a Foreign Language (TOEFL) exams with seven different AI detectors. The study did not examine Turnitin’s version. The company says it has trained its detector on writing from English language learners as well as native English speakers. A study published in October found that Turnitin was among the most accurate of 16 AI language detectors in a test that had the tool examine undergraduate papers and AI-generated papers.

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Schools that use Turnitin had access to the AI detection software for a free pilot period, which ended at the start of this year. Chechitelli says a majority of the service’s clients have opted to purchase the AI detection. But the risks of false positives and bias against English learners have led some universities to ditch the tools for now. Montclair State University in New Jersey announced in November that it would pause use of Turnitin’s AI detector. Vanderbilt University and Northwestern University did the same last summer.

“This is hard. I understand why people want a tool,” says Emily Isaacs, executive director of the Office of Faculty Excellence at Montclair State. But Isaacs says the university is concerned about potentially biased results from AI detectors, as well as the fact that the tools can’t provide confirmation the way they can with plagiarism. Plus, Montclair State doesn’t want to put a blanket ban on AI, which will have some place in academia. With time and more trust in the tools, the policies could change. “It’s not a forever decision, it’s a now decision,” Isaacs says.

Chechitelli says the Turnitin tool shouldn’t be the only consideration in passing or failing a student. Instead, it’s a chance for teachers to start conversations with students that touch on all of the nuance in using generative AI. “People don’t really know where that line should be,” she says.

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Title: jamba: a hybrid transformer-mamba language model.

Abstract: We present Jamba, a new base large language model based on a novel hybrid Transformer-Mamba mixture-of-experts (MoE) architecture. Specifically, Jamba interleaves blocks of Transformer and Mamba layers, enjoying the benefits of both model families. MoE is added in some of these layers to increase model capacity while keeping active parameter usage manageable. This flexible architecture allows resource- and objective-specific configurations. In the particular configuration we have implemented, we end up with a powerful model that fits in a single 80GB GPU. Built at large scale, Jamba provides high throughput and small memory footprint compared to vanilla Transformers, and at the same time state-of-the-art performance on standard language model benchmarks and long-context evaluations. Remarkably, the model presents strong results for up to 256K tokens context length. We study various architectural decisions, such as how to combine Transformer and Mamba layers, and how to mix experts, and show that some of them are crucial in large scale modeling. We also describe several interesting properties of these architectures which the training and evaluation of Jamba have revealed, and plan to release checkpoints from various ablation runs, to encourage further exploration of this novel architecture. We make the weights of our implementation of Jamba publicly available under a permissive license.

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How to Cite Sources | Citation Generator & Quick Guide

Citing your sources is essential in  academic writing . Whenever you quote or paraphrase a source (such as a book, article, or webpage), you have to include a  citation crediting the original author.

Failing to properly cite your sources counts as plagiarism , since you’re presenting someone else’s ideas as if they were your own.

The most commonly used citation styles are APA and MLA. The free Scribbr Citation Generator is the quickest way to cite sources in these styles. Simply enter the URL, DOI, or title, and we’ll generate an accurate, correctly formatted citation.

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Citations are required in all types of academic texts. They are needed for several reasons:

• To avoid plagiarism by indicating when you’re taking information from another source
• To give proper credit to the author of that source
• To allow the reader to consult your sources for themselves

A citation is needed whenever you integrate a source into your writing. This usually means quoting or paraphrasing:

• To quote a source , copy a short piece of text word for word and put it inside quotation marks .
• To paraphrase a source , put the text into your own words. It’s important that the paraphrase is not too close to the original wording. You can use the paraphrasing tool if you don’t want to do this manually.

Citations are needed whether you quote or paraphrase, and whatever type of source you use. As well as citing scholarly sources like books and journal articles, don’t forget to include citations for any other sources you use for ideas, examples, or evidence. That includes websites, YouTube videos , and lectures .

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The AI-powered Citation Checker helps you avoid common mistakes such as:

• Missing commas and periods
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• Missing reference entries

Usually, your institution (or the journal you’re submitting to) will require you to follow a specific citation style, so check your guidelines or ask your instructor.

In some cases, you may have to choose a citation style for yourself. Make sure to pick one style and use it consistently:

• APA Style is widely used in the social sciences and beyond.
• MLA style is common in the humanities.
• Chicago notes and bibliography , common in the humanities
• Chicago author-date , used in the (social) sciences
• There are many other citation styles for different disciplines.

If in doubt, check with your instructor or read other papers from your field of study to see what style they follow.

In most styles, your citations consist of:

• Brief in-text citations at the relevant points in the text
• A reference list or bibliography containing full information on all the sources you’ve cited

In-text citations most commonly take the form of parenthetical citations featuring the last name of the source’s author and its year of publication (aka author-date citations).

An alternative to this type of in-text citation is the system used in numerical citation styles , where a number is inserted into the text, corresponding to an entry in a numbered reference list.

There are also note citation styles , where you place your citations in either footnotes or endnotes . Since they’re not embedded in the text itself, these citations can provide more detail and sometimes aren’t accompanied by a full reference list or bibliography.

A reference list (aka “Bibliography” or “Works Cited,” depending on the style) is where you provide full information on each of the sources you’ve cited in the text. It appears at the end of your paper, usually with a hanging indent applied to each entry.

The information included in reference entries is broadly similar, whatever citation style you’re using. For each source, you’ll typically include the:

• Author name
• Publication date
• Container (e.g., the book an essay was published in, the journal an article appeared in)
• Location (e.g., a URL or DOI , or sometimes a physical location)

The exact information included varies depending on the source type and the citation style. The order in which the information appears, and how you format it (e.g., capitalization, use of italics) also varies.

Most commonly, the entries in your reference list are alphabetized by author name. This allows the reader to easily find the relevant entry based on the author name in your in-text citation.

In numerical citation styles, the entries in your reference list are numbered, usually based on the order in which you cite them. The reader finds the right entry based on the number that appears in the text.

Because each style has many small differences regarding things like italicization, capitalization , and punctuation , it can be difficult to get every detail right. Using a citation generator can save you a lot of time and effort.

Scribbr offers citation generators for both APA and MLA style. Both are quick, easy to use, and 100% free, with no ads and no registration required.

Just input a URL or DOI or add the source details manually, and the generator will automatically produce an in-text citation and reference entry in the correct format. You can save your reference list as you go and download it when you’re done, and even add annotations for an annotated bibliography .

Once you’ve prepared your citations, you might still be unsure if they’re correct and if you’ve used them appropriately in your text. This is where Scribbr’s other citation tools and services may come in handy:

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Plagiarism means passing off someone else’s words or ideas as your own. It’s a serious offense in academia. Universities use plagiarism checking software to scan your paper and identify any similarities to other texts.

When you’re dealing with a lot of sources, it’s easy to make mistakes that could constitute accidental plagiarism. For example, you might forget to add a citation after a quote, or paraphrase a source in a way that’s too close to the original text.

Using a plagiarism checker yourself before you submit your work can help you spot these mistakes before they get you in trouble. Based on the results, you can add any missing citations and rephrase your text where necessary.

Try out the Scribbr Plagiarism Checker for free, or check out our detailed comparison of the best plagiarism checkers available online.

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Scribbr’s Citation Checker is a unique AI-powered tool that automatically detects stylistic errors and inconsistencies in your in-text citations. It also suggests a correction for every mistake.

Currently available for APA Style, this is the fastest and easiest way to make sure you’ve formatted your citations correctly. You can try out the tool for free below.

If you need extra help with your reference list, we also offer a more in-depth Citation Editing Service.

Our experts cross-check your in-text citations and reference entries, make sure you’ve included the correct information for each source, and improve the formatting of your reference page.

If you want to handle your citations yourself, Scribbr’s free Knowledge Base provides clear, accurate guidance on every aspect of citation. You can see citation examples for a variety of common source types below:

And you can check out our comprehensive guides to the most popular citation styles:

At college level, you must properly cite your sources in all essays , research papers , and other academic texts (except exams and in-class exercises).

Add a citation whenever you quote , paraphrase , or summarize information or ideas from a source. You should also give full source details in a bibliography or reference list at the end of your text.

The exact format of your citations depends on which citation style you are instructed to use. The most common styles are APA , MLA , and Chicago .

The abbreviation “ et al. ” (Latin for “and others”) is used to shorten citations of sources with multiple authors.

“Et al.” is used in APA in-text citations of sources with 3+ authors, e.g. (Smith et al., 2019). It is not used in APA reference entries .

Use “et al.” for 3+ authors in MLA in-text citations and Works Cited entries.

Use “et al.” for 4+ authors in a Chicago in-text citation , and for 10+ authors in a Chicago bibliography entry.

The Scribbr Citation Generator is developed using the open-source Citation Style Language (CSL) project and Frank Bennett’s citeproc-js . It’s the same technology used by dozens of other popular citation tools, including Mendeley and Zotero.

You can find all the citation styles and locales used in the Scribbr Citation Generator in our publicly accessible repository on Github .

APA format is widely used by professionals, researchers, and students in the social and behavioral sciences, including fields like education, psychology, and business.

Be sure to check the guidelines of your university or the journal you want to be published in to double-check which style you should be using.

MLA Style  is the second most used citation style (after APA ). It is mainly used by students and researchers in humanities fields such as literature, languages, and philosophy.

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Published on 16.4.2024 in Vol 26 (2024)

User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study

Authors of this article:

Original Paper

• Kate J Wahl 1 , MSc   ; 
• Melissa Brooks 2 , MD   ; 
• Logan Trenaman 3 , PhD   ; 
• Kirsten Desjardins-Lorimer 4 , MD   ; 
• Carolyn M Bell 4 , MD   ; 
• Nazgul Chokmorova 4 , MD   ; 
• Romy Segall 2 , BSc, MD   ; 
• Janelle Syring 4 , MD   ; 
• Aleyah Williams 1 , MPH   ; 
• Linda C Li 5 , PhD   ; 
• Wendy V Norman 4, 6 * , MD, MHSc   ; 
• Sarah Munro 1, 3 * , PhD  

1 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada

2 Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada

3 Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States

4 Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

5 Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada

6 Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom

*these authors contributed equally

Corresponding Author:

Kate J Wahl, MSc

Department of Obstetrics and Gynecology

University of British Columbia

4500 Oak Street

Vancouver, BC, V6H 3N1

Phone: 1 4165231923

Email: [email protected]

Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive—there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices.

Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction.

Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers’ decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (“patient” participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses.

Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly.

Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.

Introduction

In total, 1 in 3 pregnancy-capable people in Canada will have an abortion in their lifetimes, and most will seek care early in pregnancy [ 1 ]. Medication abortion (using the gold-standard mifepristone/misoprostol regimen) and procedural abortion are common, safe, and effective options for abortion care in the first trimester [ 2 , 3 ]. The choice between using medications and presenting to a facility for a procedure is a preference-sensitive decision; there is no clinically superior option and the choice depends on what matters most to the individual patient regarding the respective treatments and the features of those options [ 4 - 6 ].

The choice of method of abortion can involve a process of shared decision-making, in which the patient and health care professional share the best available evidence about options, and the patient is supported to consider those options and clarify an informed preference [ 7 ]. There are many types of interventions available to support shared decision-making, including interventions targeting health care professionals (eg, educational materials, meetings, outreach visits, audit and feedback, and reminders) and patients (eg, patient decision aids [PtDA], appointment preparation packages, empowerment sessions, printed materials, and shared decision-making education) [ 8 ]. Of these interventions, PtDAs are well-suited to address challenges to shared decision-making about the method of abortion, including limited patient knowledge, public misinformation about options, poor access to health care professionals with sufficient expertise, and apprehension about abortion counseling [ 9 ].

PtDAs are widely used interventions that support people in making informed, deliberate health care choices by explicitly describing the health problem and decision, providing information about each option, and clarifying patient values [ 10 ]. The results of the 2023 Cochrane systematic review of 209 randomized controlled trials indicate that, compared to usual care (eg, information pamphlets or webpages), the use of PtDAs results in increases in patient knowledge, expectations of benefits and harms, clarity about what matters most to them, and participation in making a decision [ 11 ]. Of the studies included in the systematic review, 1 tested the effect of a PtDA leaflet for method of abortion and found that patients eligible for both medication and procedural abortion who received the PtDA were more knowledgeable, and had lower risk perceptions and decisional conflict than those who were in the control group [ 12 ]. However, that PtDA was developed 20 years ago in the UK health system and was not publicly available. A recent environmental scan of PtDAs for a method of abortion found that other available options meet few of the criteria set by the International Patient Decision Aid Standards (IPDAS) collaboration and do not include language and content optimized for end users [ 9 , 13 ].

Consequently, no PtDAs for method of abortion were available in Canada at the time of this study. This was a critical gap for both patients and health care professionals as, in 2017, mifepristone/misoprostol medication abortion came to the market, offering a new method of choice for people seeking abortion in the first trimester [ 14 ]. Unlike most jurisdictions, in Canada medication abortion is typically prescribed in primary care and dispensed in community pharmacies. Offering a PtDA in preparation for a brief primary care consultation allows the person seeking abortion more time to digest new information, consider their preferences, be ready to discuss their options, and make a quality decision.

In this context, we identified a need for a high-quality and publicly available PtDA to support people in making an informed choice about the method of abortion that reflects what is most important to them. Concurrently, our team was working in collaboration with knowledge users (health care professionals, patients, and health system decision makers) who were part of a larger project to investigate the implementation of mifepristone in Canada [ 15 , 16 ]. We, therefore, aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction.

Study Design

We performed a mixed methods user-centered development and evaluation study informed by principles of integrated knowledge translation. Integrated knowledge translation is an approach to collaborative research in which researchers and knowledge users work together to identify a problem, conduct research as equal partners to address that problem, and coproduce research products that aim to impact health service delivery [ 17 ]. We selected this approach to increase the likelihood that our end PtDAs would be relevant, useable, and used for patients and health care professionals in Canada [ 17 ]. The need for a PtDA was identified through engagement with health care professionals. In 2017, they highlighted the need for patients to be supported in choosing between procedural care—which historically represented more than 90% of abortions in Canada [ 18 ]—and the newly available medication option [ 19 , 20 ]. This need was reaffirmed in 2022 by the Canadian federal health agency, Health Canada, which circulated a request for proposals to generate “evidence-based, culturally-relevant information aimed at supporting people in their reproductive decision-making and in accessing abortion services as needed” [ 21 ].

We operationalized integrated knowledge translation principles in a user-centered design process. User-centered design “grounds the characteristics of an innovation in information about the individuals who use that innovation, with a goal of maximizing ‘usability in context’” [ 22 ]. In PtDA development, user-centered design involves iteratively understanding users, developing and refining a prototype, and observing user interaction with the prototype [ 23 , 24 ]. Like integrated knowledge translation, this approach is predicated on the assumption that involving users throughout the process increases the relevance of the PtDA and the likelihood of successful implementation [ 24 ].

Our design process included the following steps ( Figure 1 ): identification of evidence about abortion patients’ decisional needs and the attributes of medication and procedural abortion that matter most from a patient perspective; development of a paper-based prototype; usability testing via think-aloud interviews with potential end users; refinement of the PtDA prototype into an interactive website; usability testing via a survey with potential end users and abortion health care professionals; and final revisions before launching the PtDA for real-world testing. Our systematic process was informed by user-centered methods for PtDA development [ 23 , 24 ], guidance from the IPDAS collaboration [ 25 - 27 ], and the Standards for Universal Reporting of Patient Decision Aid Evaluation checklist [ 10 ].

Our multidisciplinary team included experts in shared decision-making (SM and LT), a PhD student in patient-oriented knowledge translation (KJW), experts in integrated knowledge translation with health care professionals and policy makers (WVN and SM), clinical experts in abortion counseling and care (WVN and MB), a medical undergraduate student (RS), a research project coordinator (AW), and family medicine residents (KD-L, CMB, NC, and JS) who had an interest in abortion care. Additionally, a panel of experts external to the development process reviewed the PtDA for clinical accuracy following each revision of the prototype. These experts included coauthors of the national Society for Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guidelines for abortion care in Canada. They were invited to this project because of their knowledge of first-trimester abortion care as well as their ability to support the implementation of the PtDA in guidelines and routine clinical practice.

Ethical Considerations

The research was approved by the University of British Columbia Children’s and Women’s Research Ethics Board (H16-01006) and the Nova Scotia Health Research Ethics Board (1027637). In each round of testing, participants received a CAD $20 (US $14.75) Amazon gift card by email for their participation.

Preliminary Work: Identification of Evidence

We identified the decisional needs of people seeking early abortion care using a 2018 systematic review of reasons for choosing an abortion method [ 28 ], an additional search that identified 1 study conducted in Canada following the 2017 availability of mifepristone/misoprostol medication abortion [ 29 ], and the SOGC clinical practice guidelines [ 2 , 3 ]. The review identified several key factors that matter most for patient choice of early abortion method: perceived simplicity and “naturalness,” fear of complication or bleeding , fear of anesthesia or surgery , timing of the procedure , and chance of sedation . The additional Canadian study found that the time required to complete the abortion and side effects were important factors. According to the SOGC clinical practice guidelines, the key information that should be communicated to the patient are gestational age limits and the risk of complications with increasing gestational age [ 2 , 3 ]. The guidelines also indicate that wait times , travel times , and cost considerations may be important in a person’s choice of abortion method and should be addressed [ 2 , 3 ].

We compiled a long list of attributes for our expert panel and then consolidated and refined the attribute list through each stage of the prototype evaluation. For evidence of how these factors differed for medication and procedural abortion, we drew primarily from the SOGC clinical practice guidelines for abortion [ 2 , 3 ]. For cost considerations, we described the range of federal, provincial, and population-specific programs that provide free coverage of abortion care for people in Canada.

Step 1: Developing the Prototype

Our goal was to produce an interactive, web-based PtDA that would be widely accessible to people seeking an abortion in Canada by leveraging the widespread use of digital health information, especially among reproductive-aged people [ 30 ]. Our first prototype was based on a previously identified paper-based question-and-answer comparison grid that presented evidence-based information about the medication and procedural options [ 9 , 31 ]. We calculated readability by inputting the plain text of the paper-based prototype into a Simple Measure of Gobbledygook (SMOG) Index calculator [ 32 ].

We made 2 intentional deviations from common practices in PtDA development [ 33 ]. First, we did not include an “opt-out” or “do nothing” option, which would describe the natural course of pregnancy. We chose to exclude this option to ensure clarity for users regarding the decision point; specifically, our decision point of interest was the method of abortion, not the choice to terminate or continue a pregnancy. Second, we characterized attributes of the options as key points rather than positive and negative features to avoid imposing value judgments onto subjective features (eg, having the abortion take place at home may be beneficial for some people but may be a deterrent for others).

Step 2: Usability Testing of the Prototype

We first conducted usability testing involving think-aloud interviews with patient participants to assess the paper-based prototype. Inclusion criteria included people aged 18-49 years assigned-female-at-birth who resided in Canada and could speak and read English. In January 2020, we recruited participants for the first round of think-aloud interviews [ 34 ] via email and poster advertising circulated to (1) a network of parent research advisors who were convened to guide a broader program of research about pregnancy and childbirth in British Columbia, Canada, and (2) a clinic providing surgical abortion care in Nova Scotia, Canada, as well as snowball sampling with participants. We purposively sought to advertise this study with these populations to ensure variation in age, ethnicity, level of education, parity, and abortion experience. Interested individuals reviewed this study information form and provided consent to participate, before scheduling an interview. The interviewer asked participants to think aloud as they navigated the prototype, for example describing what they liked or disliked, missing information, or lack of clarity. The interviewer noted the participant’s feedback on a copy of the prototype during the interview. Finally, the participant responded to questions adapted from the System Usability Scale [ 35 ], a measure designed to collect subjective ratings of a product’s usability, and completed a brief demographic questionnaire. The interviews were conducted via videoconferencing and were audio recorded. We deidentified the qualitative data and assigned each participant a unique identifier. Then, the interviewer listened to the recording and revised their field notes with additional information including relevant quotes.

For the analysis of think-aloud interviews, we used inductive content analysis to describe the usability and acceptability of different elements of the PtDA [ 36 ]. Further, 3 family medicine residents (KD-L, CMB, and NC) under guidance from a senior coauthor (SM) completed open coding to develop a list of initial categories, which we grouped under higher-order headings. We then organized these results in a table to illustrate usability issues (categories), illustrative participant quotes, and modifications to make. We then used the results of interviews to adapt the prototype into a web-based format, which we tested via further think-aloud interviews and a survey with people capable of becoming pregnant and health care professionals involved with abortion care.

Step 3: Usability Testing of the Website

For the web-based format, we used DecideApp PtDA open-source software, which provides a sustainable solution to the problems of low quality and high maintenance costs faced by web-based PtDAs by allowing developers to host, maintain, and update their tools at no cost. This software has been user-tested and can be accessed by phone, tablet, or computer [ 37 , 38 ]. It organizes a PtDA into 6 sections: Introduction, About Me, My Values, My Choice, Review, and Next Steps. In the My Values section, an interactive values clarification exercise allows users to rank and make trade-offs between attributes of the options. The final pages provide an opportunity for users to make a choice, complete a knowledge self-assessment, and consider the next steps to access their chosen method.

From July to August 2020, we recruited patient and health care professional participants using Twitter and the email list of the Canadian Abortion Providers Support platform, respectively. Participants received an email with a link to the PtDA and were redirected to the survey once they had navigated through the PtDA. As above, inclusion criteria included people aged 18-49 years assigned as female-at-birth who resided in Canada. Among health care professionals, we included eligible prescribers who may not have previously engaged in abortion care (family physicians, residents, nurse practitioners, and midwives), and allied health professionals and stakeholders who provide or support abortion care, who practiced in Canada. All participants had to speak and read English.

The survey included 3 sections: usability, implementation, and participant characteristics. The usability section consisted of the System Usability Scale [ 35 ], and purpose-built questions about what participants liked and disliked about the PtDA. The implementation section included open- and close-ended questions about how the PtDA compares to other resources and when it could be implemented in the care pathway. Patient participants also completed the Control Preference Scale, a validated measure used to determine their preferred role in decision-making (active, collaborative, or passive) [ 39 ]. Data on participant characteristics included gender, abortion experience (patient participants), and abortion practice (health care professional participants). We deidentified the qualitative data and assigned each participant a unique identifier. For the analysis of survey data, we characterized close-ended responses using descriptive statistics, and, following the analysis procedures described in Step 2 in the Methods section, used inductive content analysis of open-ended responses to generate categories associated with usability and implementation [ 36 ]. In 2021, we made minor revisions to the website based on the results of usability testing and published the PtDA for use in routine clinical care.

In the following sections, we outline the results of the development process including the results of the think-aloud interviews and survey, as well as the final decision aid prototype.

Our initial prototype, a paper-based question-and-answer comparison grid, presented evidence-based information comparing medication and procedural abortion. The first version of the prototype also included a second medication abortion regimen involving off-label use of methotrexate, however, we removed this option following a review by the clinical expert panel who advised us that there is very infrequent use of this regimen in Canada in comparison to the gold standard medication abortion option, mifepristone. Other changes at this stage involved clarifying the scope of practice (health care professionals other than gynecologists can perform a procedural abortion), abortion practice (gestational age limit and how the medication is taken), the abortion experience (what to expect in terms of bleeding), and risk (removing information about second- and third-trimester abortion). The updated prototype was finalized by a scientist (SM) and trainee (KJW) with expertise in PtDA development. The prototype (see Multimedia Appendix 1 ) was ultimately 4 pages long and described 18 attributes of each option framed as Frequently Asked Questions, including abortion eligibility (How far along in pregnancy can I be?), duration (How long does it take?), and side effects (How much will I bleed?). The SMOG grade level was 8.4.

Participant Characteristics

We included 11 participants in think-aloud interviews between January and July 2020, including 7 recruited through a parent research advisory network and 4 individuals who had recently attended an abortion clinic. The mean interview duration was 36 minutes (SD 6 minutes). The participants ranged in age from 31 to 37 years. All had been pregnant and 8 out of 11 (73%) participants had a personal experience of abortion (4 participants who had recently attended an abortion clinic and 4 participants from the parent research advisory who disclosed their experience during the interview). The characteristics of the sample are reported in Table 1 .

Overall, participants had a positive view of the paper-based, comparison grid PtDA. In total, 1 participant who had recently sought an abortion said, “I think this is great and super helpful. It would’ve been awesome to have had access to this right away … I don’t think there’s really anything missing from here that I was Googling about” (DA010). The only participant who expressed antichoice views indicated that the PtDA would be helpful to someone seeking to terminate a pregnancy (DA001). Another participant said, “[The PtDA] is not biased, it’s not like you’re going to die. It’s a fact, you know the facts and then you decide whether you want it or not. A lot of people feel it’s so shameful and judgmental, but this is very straightforward. I like it.” (DA002). Several participants stated they felt more informed and knowledgeable about the options.

In response to questions adapted from the System Usability Scale, all 11 participants agreed that the PtDA was easy to use, that most people could learn to use it quickly, and that they felt very confident using the prototype, and disagreed that it was awkward to use. In total, 8 (73%) participants agreed with the statement that the components of the PtDA were well-integrated. A majority of participants disagreed with the statements that the website was unnecessarily complex (n=8, 73%), that they would need the support of an expert to use it (n=8, 73%), that it was too inconsistent (n=9, 82%), and that they would need to learn a lot before using it (n=8, 73%). Further, 2 (18%) participants agreed with the statements that the PtDA was unnecessarily complex and that they would need to learn a lot before using it. Furthermore, 1 (9%) participant agreed with the statement that the PtDA was too inconsistent.

Through inductive analysis of think-aloud interviews, we identified 4 key usability categories: design, language, process, and experience.

Participants liked the side-by-side comparison layout, appreciated the summary of key points to remember, and said that overall, the presented information was clear. For example, 1 participant reflected, “I think it’s very clear ... it’s very simplistic, people will understand the left-hand column is for medical abortion and the right-hand column is for surgical.” (DA005) Some participants raised concerns about the aesthetics of the PtDA, difficulties recalling the headers across multiple pages, and the overall length of the PtDA.

Participants sought to clarify language at several points in the PtDA. Common feedback was that the gestational age limit for the medication and the procedure should be clarified. Participants also pointed out inconsistent use of language (eg, doctor and health care professional) and medical jargon.

Several participants were surprised to learn that family doctors could provide abortion care. Others noted that information about the duration—including travel time—and number of appointments for both medication and procedural abortion could be improved. In addition to clarifying the abortion process, several participants suggested including additional information and resources to help identify an abortion health care professional, understand when to seek help for abortion-related complications, and access emotional support. It was also important to participants that financial impacts (eg, hospital parking and menstrual pads) were included for each option.

Participants provided insight into the description of the physical, psychological, and other consequences associated with the abortion medication and procedure. Participants who had both types of abortion care felt that the description of pain that “may be worse than a period” was inaccurate. Other participants indicated that information about perceived and real risks was distressing or felt out of place, such as correcting myths about future fertility or breast cancer. Some participants indicated that patient stories would be valuable saying, for example, “I think what might be nice to help with the decision-making process is reading stories of people’s experiences” (DA006).

Modifications Made

Changes made based on these findings are described in Table 2 . Key user-centered modifications included transitioning to a web-based format with a consistent color scheme, clarifying who the PtDA is for (for typical pregnancies up to 10 weeks), adding information about telemedicine to reflect guidelines for the provision of abortion during pandemics, and developing brief first-person qualitative descriptions of the pain intensity for each option.

Through analysis of the interviews and consultation with our panel of clinical experts, we also identified that, among the 18 initial attributes in our prototype, 7 had the most relative importance to patients in choosing between medication and procedural abortion. These attributes also represented important differences between each option which forced participants to consider the trade-offs they were willing to make. Thus we moved all other potential attributes into an information section (My Options) that supported the user to gain knowledge before clarifying what mattered most to them by considering the differences between options (My Values).

a PtDA: patient decision aid.

b SOGC: Society of Obstetricians and Gynaecologists of Canada.

Description of the PtDA

As shown in Figure 2 , the revised version of the PtDA resulting from our systematic process is an interactive website. Initially, the title was My Body, My Choice ; however, this was changed to avoid association with antivaccine campaigns that co-opted this reproductive rights slogan. The new title, It’s My Choice or C’est Mon Choix , was selected for its easy use in English and French. The PtDA leads the user through 6 sections:

• The Introduction section provides the user with information about the decision and the PtDA, as well as grids comparing positive and negative features of the abortion pill and procedure, including their chance of benefits (eg, effectiveness), harms (eg, complications), and other relevant factors (eg, number of appointments and cost).
• The About Me section asks the user to identify any contraindications to the methods. It then prompts users to consider their privacy needs and gives examples of how this relates to each option (eg, the abortion pill can be explained to others as a miscarriage; procedural care can be completed quickly).
• The My Values section includes a values clarification exercise, in which the user selects and weights (on a 0-100 scale) the relative importance of at least three of 7 decisional attributes: avoiding pain, avoiding bleeding, having the abortion at home, having an experience that feels like a miscarriage, having fewer appointments, less time off for recovery, and having a companion during the abortion.
• The My Choice section highlights 1 option, based on the attribute weights the user assigned in the My Values section. For instance, if a user strongly preferred to avoid bleeding and have fewer appointments, the software would suggest that a procedural abortion would be a better match. For a user who preferred having the abortion at home and having a companion present, the software would suggest that a medication abortion would be a better match. The user selects the option they prefer.
• The Review section asks the user to complete the 4-item SURE (Sure of Myself, Understand Information, Risk-Benefit Ratio, Encouragement) screening test [ 41 ], and advises them to talk with an expert if they answer “no” to any of the questions. This section also includes information phone lines to ensure that users can seek confidential, accurate, and nonjudgmental support.
• Lastly, in the Next Steps section, users see a summary of their choice and the features that matter most to them, instructions for how to save the results, keep the results private, and find an abortion health care professional. Each section of the PtDA includes a “Leave” button in case users need to navigate away from the website quickly.

We calculated readability by inputting the plain text of the web-based PtDA into a SMOG Index calculator [ 32 ], which assessed the reading level of the web-based PtDA as grade 9.2.

To ensure users’ trust in the information as accurate and unbiased we provided a data declaration on the landing page: “the clinical information presented in this decision aid comes from Society of Obstetricians and Gynaecologists best practice guidelines.” On the landing page, we also specify “This website was developed by researchers at the University of British Columbia and Dalhousie University. This tool is not supported or connected to any pharmaceutical company.”

A total of 50 participants, including 25 patients and 25 health care professionals, reviewed the PtDA website and completed the survey between January and March 2021. The majority of patient (n=23, 92%) and health care professional (n=23, 92%) participants identified as cisgender women. Among patient participants, 16% (n=4) reported one or more previous abortions in various clinical settings. More than half (n=16, 64%) of health care professionals offered care in private medical offices, with other locations including sexual health clinics, community health centers, and youth clinics. Many health care professionals were family physicians (n=11, 44%), and other common types were nurse practitioners (n=7, 28%) and midwives (n=3, 12%). The mean proportion of the clinical practice of each health care professional devoted to abortion care was 18% (SD 13%). Most health care professional respondents (n=18, 72%) were involved with the provision of medication, but not procedural, abortion care. The characteristics of patient and health care professional participants are reported in Table 3 .

a In total, 4 participants reported a history of abortion care, representing 6 abortion procedures.

b Not available.

The mean System Usability Score met the threshold for good usability among both patient (mean 85.7, SD 8.6) and health care professional (mean 80, SD 12) participants, although some health care professionals agreed with the statement, “I found the website to be unnecessarily complex,” (see Multimedia Appendix 3 for the full distribution of responses from patient and health care professionals). All 25 patients and 22 out of 25 (88%) health care professional respondents indicated that the user-friendliness of the PtDA was good or the best imaginable. When asked what they liked most about the PtDA, both participant groups described the ease of use, comparison of options, and the explicit values clarification exercise. When asked what they liked least about the PtDA, several health care professionals and some patients pointed out that it was difficult to use on a cell phone. A summary of usability results is presented in Table 4 .

In total, 21 (84%) patients and 18 (72%) health care professionals felt that the PtDA was not missing any information needed to decide about the method of abortion in early pregnancy. While acknowledging that it is “hard to balance being easy to read/understand while including enough accurate clinical information,” several health care professionals and some patients indicated that the PtDA was too long and repetitive. Among the 4 (16%) patient participants who felt information was missing, the most common suggestion was a tool for locating an abortion health care professional. The 7 (28%) health care professionals who felt information was missing primarily made suggestions about the medical information included in the PtDA (eg, listing midwives as health care professionals with abortion care in scope of practice and the appropriateness of gender-inclusive terminology) and the accessibility of information for various language and cultural groups.

a Not available.

Implementation

Participants viewed the PtDA as a positive addition to current resources. Patients with a history of abortion care described looking for the information on the internet and speaking with friends, family members, and health care professionals. Compared with these sources of information, many patients liked the credibility and anonymity of the PtDA, whereas some disliked that it was less personal than a conversation. Further, 18 (72%) health care professional participants said that the PtDA would add to or replace the resources they currently use in practice. Compared with these other resources, health care professionals liked that the PtDA could be explored by patients independently and that it would support them in thinking about the option that was best for them. The disadvantages of the PtDA compared with existing resources were the length—which health care professionals felt would make it difficult to use in a clinical interaction—and the lack of localized information. In total, 23 each (92%) of patient and health care professional participants felt that they would use the PtDA before a consultation.

Principal Results

We designed a web-based, interactive PtDA for the choice of method of abortion in early pregnancy [ 42 ], taking a user-centered approach that involved usability testing with 36 patients and 25 health care professionals. Both patient and health care professional participants indicated that the PtDA had good usability and would be a valuable resource for decision-making. This PtDA fills a critical need to support the autonomy of patients and shared decision-making with their health care professional related to the preference-sensitive choice of method of abortion.

Comparison With Prior Work

A 2017 systematic review and environmental scan found that existing PtDAs for the method of abortion are of suboptimal quality [ 9 ]. Of the 50 PtDAs identified, all but one were created without expertise in decision aid design (eg, abortion services, reproductive health organizations, and consumer health information organizations); however, the development process for this UK-based pamphlet-style PtDA was not reported. The remaining PtDAs were noninteractive websites, smartphone apps, and PDFs that were not tested with users. The authors found that the information about methods of abortion was presented in a disorganized, inconsistent, and unequal way. Subsequent work has found that existing PtDAs emphasize medical (versus social, emotional, and practical) attributes, do not include values clarification, and can be biased to persuade users of a certain method [ 13 ].

To address some of the challenges identified in the literature, we systematically structured and designed elements of the PtDA following newly proposed IPDAS criteria (eg, showing positive and negative features with equal detail) [ 33 ]. We included an explicit values-clarification exercise, which a recent meta-analysis found to decrease decisional conflict and values-incongruent choices [ 43 ].

We based the decision aid on comprehensive and up-to-date scientific evidence related to the effectiveness and safety of medication abortion and procedural abortion; however, less evidence was available for nonmedical attributes. For example, many existing PtDAs incorrectly frame privacy as a “factual advantage” of medication abortion [ 13 ]. To address this, we included privacy in the About Me section as something that means “different things to different people.” Similarly, evidence suggests that patients who do not feel appropriately informed about the pain associated with their method of abortion are less satisfied with their choice [ 44 , 45 ]; and the degree of pain experienced varies across options and among individuals. Following the suggestion of patient participants to include stories and recognizing that evidence for the inclusion of narratives in PtDAs is emerging [ 46 ], we elected to develop brief first-person qualitative descriptions of the pain experience. The inclusion of narratives in PtDAs may be effective in supporting patients to avoid surprise and regret, to minimize affective forecasting errors, and to “visualize” their health condition or treatment experience [ 46 ]. Guided by the narrative immersion model, our goal was to provide a “real-world preview” of the pain experience [ 47 ].

In addition to integrating user perspectives on the optimal tone, content, and format of the PtDA, user testing provided evidence to inform the future implementation of the PtDA. A clear barrier to the completion of the PtDA during the clinical encounter from the health care professional perspective was its length, supporting the finding of a recent rapid realist review, which theorized that health care professionals are less likely to use long or otherwise complex PtDAs that are difficult to integrate into routine practice [ 48 ]. However, 46 out of 50 (92%) participants endorsed the use of the PtDA by the patient alone before the initial consultation, which was aligned with the patient participant’s preference to take an active role in making the final decision about their method of abortion as well as the best practice of early, pre-encounter distribution of PtDAs [ 48 ].

A unique feature of this PtDA was that it resulted from a broader program of integrated knowledge translation designed to support access to medication abortion once mifepristone became available in Canada in 2017. Guided by the principle that including knowledge users in research yields results that are more relevant and useful [ 49 ], we developed the PtDA in response to a knowledge user need, involved health care professional users as partners in our research process, including as coauthors, and integrated feedback from the expert panel. This parallels a theory of PtDA implementation that proposes that early involvement of health care professionals in PtDA development “creates a sense of ownership, increases buy-in, helps to legitimize content, and ensures the PtDA (content and delivery) is consistent with current practice” thereby increasing the likelihood of PtDA integration into routine clinical settings [ 48 ].

Viewed through an integrated knowledge translation lens, our findings point toward future areas of work to support access to abortion in Canada. Several patient participants indicated a need for tools to identify health care professionals who offer abortion care. Some shared that their primary health care professionals did not offer medication abortion despite it being within their scope of practice, and instead referred them to an abortion clinic for methods of counseling and care. We addressed this challenge in the PtDA by including links to available resources, such as confidential phone lines that link patients to health care professionals in their region. On the website we also indicated that patient users could ask their primary care providers whether they provide abortion care; however, we acknowledge that this may place the patient in a vulnerable position if their health care professional is uncomfortable with, or unable to, provide this service for any reason. Future work should investigate opportunities to shorten the pathway to this time-sensitive care, including how to support patients who use the decision aid to act on their informed preference for the method of abortion. This work may involve developing a tool for patients to talk to their primary care provider about prescribing medication abortion.

Strengths and Limitations

Several factors affect the interpretation of our work. Although potential patient users participated in the iterative development process, the patient perspective was not represented in a formal advisory panel in the same way that the health care professional experts were. Participant characteristics collected for the think-aloud interviews demonstrated that our patient sample did not include people with lower education attainment, for whom the grade level and length of the PtDA could present a barrier [ 50 ]. Any transfer of the PtDA to jurisdictions outside Canada must consider how legal, regulatory, and other contextual factors affect the choice of the method of abortion. Since this study was completed, we have explored additional strategies to address these concerns, including additional user testing with people from equity-deserving groups, drop-down menus to adjust the level of detail, further plain language editing, and videos illustrating core content. Since the focus of this study was usability, we did not assess PtDA effectiveness, including impact on knowledge, decisional conflict, choice predisposition and decision, or concordance; however, a randomized controlled trial currently underway will measure the impact of the PtDA on these outcomes in a clinical setting. Finally, our integrated knowledge translation approach added to the robustness of our study by ensuring that health care professionals and patients were equal partners in the research process. One impact of this partnered approach is that our team has received funding support from Health Canada to implement the website on a national scale for people across Canada considering their abortion options [ 51 ].

Conclusions

The PtDA provides people choosing a method of early abortion and their health care professionals with a resource to understand methods of abortion available in the Canadian context and support to make a values-aligned choice. We designed the PtDA using a systematic approach that included both patient and health care professional participants to help ensure its relevance and usability. Our future work will seek to evaluate the implementation of the PtDA in clinical settings, create alternate formats to enhance accessibility, and develop a sustainable update policy. We will also continue to advance access to abortion care in Canada with our broader integrated knowledge translation program of research.

Acknowledgments

The authors thank the participants for contributing their time and expertise to the design of this tool. Family medicine residents CMB, NC, KD-L, and JS were supported by Sue Harris grants, Department of Family Practice, University of British Columbia. KJW was supported by the Vanier Scholar Award (2020-23). SM was supported by a Michael Smith Health Research BC Scholar Award (18270). WVN was supported by a Canadian Institutes of Health Research and Public Health Agency of Canada Chair in Applied Public Health Research (2014-2024, CPP-329455-107837). All grants underwent external peer review for scientific quality. The funders played no role in the design of this study, data collection, analysis, interpretation, or preparation of this paper.

Data Availability

Our ethics approval has specified the primary data is not available.

Authors' Contributions

KJW, SM, and MB conceived of and designed this study. CMB, NC, and KD-L led interview data collection, analysis, and interpretation with input from SM. RS and JS led survey data collection, analysis, and interpretation with input from SM and MB. AW, LCL, and WVN contributed to the synthesis and interpretation of results. KJW, SM, and LT wrote the first draft of this paper, and all authors contributed to this paper’s revisions and approved the final version.

Conflicts of Interest

None declared.

Patient decision aid prototype.

Raw data for pain narratives.

Full distribution of System Usability Scale scores for patients and providers.

• Norman WV. Induced abortion in Canada 1974-2005: trends over the first generation with legal access. Contraception. 2012;85(2):185-191. [ CrossRef ] [ Medline ]
• Costescu D, Guilbert E, Bernardin J, Black A, Dunn S, Fitzsimmons B, et al. Medical abortion. J Obstet Gynaecol Can. 2016;38(4):366-389. [ CrossRef ] [ Medline ]
• Costescu D, Guilbert É. No. 360-induced abortion: surgical abortion and second trimester medical methods. J Obstet Gynaecol Can. 2018;40(6):750-783. [ CrossRef ] [ Medline ]
• Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ. 2002;325(7370):961-964. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Elwyn G, Frosch D, Rollnick S. Dual equipoise shared decision making: definitions for decision and behaviour support interventions. Implement Sci. 2009;4:75. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sepucha KR, Mulley AG. A practical approach to measuring the quality of preference-sensitive decisions. In: Edwards A, Elwyn G, editors. Shared Decision-Making in Health Care: Achieving Evidence-based Patient Choice. Oxford. Oxford University Press; 2009;151-156.
• Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ. 2010;341:c5146. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, et al. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2018;7(7):CD006732. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Donnelly KZ, Elwyn G, Thompson R. Quantity over quality-findings from a systematic review and environmental scan of patient decision aids on early abortion methods. Health Expect. 2018;21(1):316-326. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Sepucha KR, Abhyankar P, Hoffman AS, Bekker HL, LeBlanc A, Levin CA, et al. Standards for Universal Reporting of Patient Decision Aid Evaluation studies: the development of SUNDAE checklist. BMJ Qual Saf. 2018;27(5):380-388. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2024;1(1):CD001431. [ CrossRef ] [ Medline ]
• Wong SSM, Thornton JG, Gbolade B, Bekker HL. A randomised controlled trial of a decision-aid leaflet to facilitate women's choice between pregnancy termination methods. BJOG. 2006;113(6):688-694. [ CrossRef ] [ Medline ]
• Donnelly KZ, Elwyn G, Theiler R, Thompson R. Promoting or undermining quality decision making? A qualitative content analysis of patient decision aids comparing surgical and medication abortion. Womens Health Issues. 2019;29(5):414-423. [ CrossRef ] [ Medline ]
• Grant K. Long-awaited abortion pill Mifegymiso makes Canadian debut. The Globe and Mail. 2017. URL: https:/​/www.​theglobeandmail.com/​news/​national/​long-awaited-abortion-pill-mifegymiso-rolls-out-in-canada/​article33695167/​?ref=http:/​/www.​theglobeandmail.​com& [accessed 2023-04-03]
• Norman WV, Munro S, Brooks M, Devane C, Guilbert E, Renner R, et al. Could implementation of mifepristone address Canada's urban-rural abortion access disparity: a mixed-methods implementation study protocol. BMJ Open. 2019;9(4):e028443. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Munro SB, Dunn S, Guilbert ER, Norman WV. Advancing reproductive health through policy-engaged research in abortion care. Semin Reprod Med. 2022;40(5-06):268-276. [ CrossRef ] [ Medline ]
• Dunn SI, Bhati DK, Reszel J, Kothari A, McCutcheon C, Graham ID. Understanding how and under what circumstances integrated knowledge translation works for people engaged in collaborative research: metasynthesis of IKTRN casebooks. JBI Evid Implement. 2023;21(3):277-293. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Norman WV, Guilbert ER, Okpaleke C, Hayden AS, Lichtenberg ES, Paul M, et al. Abortion health services in Canada: results of a 2012 national survey. Can Fam Physician. 2016;62(4):e209-e217. [ FREE Full text ] [ Medline ]
• Munro S, Guilbert E, Wagner MS, Wilcox ES, Devane C, Dunn S, et al. Perspectives among canadian physicians on factors influencing implementation of mifepristone medical abortion: a national qualitative study. Ann Fam Med. 2020;18(5):413-421. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Munro S, Wahl K, Soon JA, Guilbert E, Wilcox ES, Leduc-Robert G, et al. Pharmacist dispensing of the abortion pill in Canada: diffusion of innovation meets integrated knowledge translation. Implement Sci. 2021;16(1):76. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Health care policy and strategies program. Call for proposals: funding opportunities for sexual and reproductive health. Health Canada. URL: https://www.canada.ca/en/health-canada/programs/health-care-policy-strategies-program.html [accessed 2024-03-14]
• Dopp AR, Parisi KE, Munson SA, Lyon AR. A glossary of user-centered design strategies for implementation experts. Transl Behav Med. 2019;9(6):1057-1064. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Vaisson G, Provencher T, Dugas M, Trottier ME, Dansokho SC, Colquhoun H, et al. User involvement in the design and development of patient decision aids and other personal health tools: a systematic review. Med Decis Making. 2021;41(3):261-274. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Witteman HO, Maki KG, Vaisson G, Finderup J, Lewis KB, Steffensen KD, et al. Systematic development of patient decision aids: an update from the IPDAS collaboration. Med Decis Making. 2021;41(7):736-754. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Joseph-Williams N, Newcombe R, Politi M, Durand MA, Sivell S, Stacey D, et al. Toward minimum standards for certifying patient decision aids: a modified Delphi consensus process. Med Decis Making. 2014;34(6):699-710. [ CrossRef ] [ Medline ]
• Stacey D, Volk RJ, IPDAS Evidence Update Leads (Hilary Bekker, Karina Dahl Steffensen, Tammy C. Hoffmann, Kirsten McCaffery, Rachel Thompson, Richard Thomson, Lyndal Trevena, Trudy van der Weijden, and Holly Witteman). The International Patient Decision Aid Standards (IPDAS) collaboration: evidence update 2.0. Med Decis Making. 2021;41(7):729-733. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Hoffman AS, Volk RJ, Saarimaki A, Stirling C, Li LC, Härter M, et al. Delivering patient decision aids on the internet: definitions, theories, current evidence, and emerging research areas. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S13. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kanstrup C, Mäkelä M, Graungaard AH. Women's reasons for choosing abortion method: a systematic literature review. Scand J Public Health. 2018;46(8):835-845. [ CrossRef ] [ Medline ]
• Murray ME, Casson M, Pudwell J, Waddington A. Patients' motivation for surgical versus medical abortion. J Obstet Gynaecol Can. 2019;41(9):1325-1329. [ CrossRef ] [ Medline ]
• Kummervold PE, Chronaki CE, Lausen B, Prokosch HU, Rasmussen J, Santana S, et al. eHealth trends in Europe 2005-2007: a population-based survey. J Med Internet Res. 2008;10(4):e42. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Early abortion options. Reproductive Health Access Project. 2022. URL: https://www.reproductiveaccess.org/resource/early-abortion-options/ [accessed 2019-03-24]
• Readability Formulas: free readability assessment tools to help you write for your readers. URL: https://readabilityformulas.com/ [accessed 2022-12-15]
• Martin RW, Andersen SB, O'Brien MA, Bravo P, Hoffmann T, Olling K, et al. Providing balanced information about options in patient decision aids: an update from the International Patient Decision Aid Standards. Med Decis Making. 2021;41(7):780-800. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lundgrén-Laine H, Salanterä S. Think-aloud technique and protocol analysis in clinical decision-making research. Qual Health Res. 2010;20(4):565-575. [ CrossRef ] [ Medline ]
• Bangor A, Kortum PT, Miller JT. An empirical evaluation of the system usability scale. Int J Hum Comput Interact. 2008;24(6):574-594. [ CrossRef ]
• Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107-115. [ CrossRef ] [ Medline ]
• Bansback N, Li LC, Lynd L, Bryan S. Development and preliminary user testing of the DCIDA (Dynamic Computer Interactive Decision Application) for 'nudging' patients towards high quality decisions. BMC Med Inform Decis Mak. 2014;14:62. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Trenaman L, Munro S, Almeida F, Ayas N, Hicklin J, Bansback N. Development of a patient decision aid prototype for adults with obstructive sleep apnea. Sleep Breath. 2016;20(2):653-661. [ CrossRef ] [ Medline ]
• Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res. 1997;29(3):21-43. [ Medline ]
• Patev AJ, Hood KB. Towards a better understanding of abortion misinformation in the USA: a review of the literature. Cult Health Sex. 2021;23(3):285-300. [ CrossRef ] [ Medline ]
• Légaré F, Kearing S, Clay K, Gagnon S, D'Amours D, Rousseau M, et al. Are you SURE?: Assessing patient decisional conflict with a 4-item screening test. Can Fam Physician. 2010;56(8):e308-e314. [ FREE Full text ] [ Medline ]
• The Society of Obstetricians and Gynaecologists of Canada. URL: https://www.sexandu.ca/its-my-choice/ [accessed 2024-03-30]
• Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, et al. Clarifying values: an updated and expanded systematic review and meta-analysis. Med Decis Making. 2021;41(7):801-820. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Cavet S, Fiala C, Scemama A, Partouche H. Assessment of pain during medical abortion with home use of misoprostol. Eur J Contracept Reprod Health Care. 2017;22(3):207-211. [ CrossRef ] [ Medline ]
• Baraitser P, Free C, Norman WV, Lewandowska M, Meiksin R, Palmer MJ, et al. Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review. BMJ Open. 2022;12(11):e066650. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Shaffer VA, Brodney S, Gavaruzzi T, Zisman-Ilani Y, Munro S, Smith SK, et al. Do personal stories make patient decision aids more effective? An update from the International Patient Decision Aids Standards. Med Decis Making. 2021;41(7):897-906. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Shaffer VA, Focella ES, Hathaway A, Scherer LD, Zikmund-Fisher BJ. On the usefulness of narratives: an interdisciplinary review and theoretical model. Ann Behav Med. 2018;52(5):429-442. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Joseph-Williams N, Abhyankar P, Boland L, Bravo P, Brenner AT, Brodney S, et al. What works in implementing patient decision aids in routine clinical settings? A rapid realist review and update from the International Patient Decision Aid Standards collaboration. Med Decis Making. 2021;41(7):907-937. [ FREE Full text ] [ CrossRef ] [ Medline ]
• Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches. Government of Canada, Canadian Institutes of Health Research. 2012. URL: http://www.cihr-irsc.gc.ca/e/45321.html [accessed 2018-10-08]
• Muscat DM, Smith J, Mac O, Cadet T, Giguere A, Housten AJ, et al. Addressing health literacy in patient decision aids: an update from the International Patient Decision Aid Standards. Med Decis Making. 2021;41(7):848-869. [ FREE Full text ] [ CrossRef ] [ Medline ]
• The CART access project. Contraception and Abortion Research Team (CART-GRAC). 2024. URL: https://cart-grac.ubc.ca/the-cart-access-project-2/ [accessed 2024-01-28]

Abbreviations

Edited by T Leung; submitted 07.05.23; peer-reviewed by G Sebastian, R French, B Zikmund-Fisher; comments to author 11.01.24; revised version received 23.02.24; accepted 25.02.24; published 16.04.24.

©Kate J Wahl, Melissa Brooks, Logan Trenaman, Kirsten Desjardins-Lorimer, Carolyn M Bell, Nazgul Chokmorova, Romy Segall, Janelle Syring, Aleyah Williams, Linda C Li, Wendy V Norman, Sarah Munro. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 16.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

How Big Tech and Silicon Valley are Transforming the Military-Industrial Complex

America’s military-industrial complex has been rapidly expanding from the Capital Beltway to Silicon Valley. Although much of the Pentagon’s budget is spent on conventional weapons systems, the Defense Department has increasingly sought to adopt AI-enabled systems. Big tech companies, venture capital, and private equity firms benefit from multi-billion dollar Defense contracts, and smaller defense tech startups that “move fast and break things” also receive increased Defense funding.  This report illustrates how a growing portion of the Defense Department’s spending is going to large, well-known tech firms, including some of the most highly valued corporations in the world.

Given the often-classified nature of large defense and intelligence contracts, a lack of transparency makes it difficult to discern the true amount of U.S. spending diverted to Big Tech. Yet, research reveals that the amount is substantial, and growing. According to the nonprofit research organization  Tech Inquiry , three of the world’s biggest tech corporations were awarded approximately $28 billion from 2018 to 2022, including Microsoft ($13.5 billion), Amazon ($10.2 billion), and Alphabet, which is Google’s parent company ($4.3 billion). This paper found that the top five contracts to major tech firms between 2019 and 2022 had contract ceilings totaling at least $53 billion combined.

From 2021 through 2023, venture capital firms  reportedly  pumped nearly $100 billion into defense tech startup companies — an amount 40 percent higher than the previous seven years combined. This report examines how Silicon Valley startups, big tech, and venture capital who benefit from classified Defense contracts will create costly, high-tech defense products that are ineffective, unpredictable, and unsafe – all on the American taxpayer’s dime.

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Executive Summary >

Prestigious cancer research institute has retracted 7 studies amid controversy over errors

Seven studies from researchers at the prestigious Dana-Farber Cancer Institute have been retracted over the last two months after a scientist blogger alleged that images used in them had been manipulated or duplicated.

The retractions are the latest development in a monthslong controversy around research at the Boston-based institute, which is a teaching affiliate of Harvard Medical School. 

The issue came to light after Sholto David, a microbiologist and volunteer science sleuth based in Wales, published a scathing post on his blog in January, alleging errors and manipulations of images across dozens of papers produced primarily by Dana-Farber researchers . The institute acknowledged errors and subsequently announced that it had requested six studies to be retracted and asked for corrections in 31 more papers. Dana-Farber also said, however, that a review process for errors had been underway before David’s post. 

Now, at least one more study has been retracted than Dana-Farber initially indicated, and David said he has discovered an additional 30 studies from authors affiliated with the institute that he believes contain errors or image manipulations and therefore deserve scrutiny.

The episode has imperiled the reputation of a major cancer research institute and raised questions about one high-profile researcher there, Kenneth Anderson, who is a senior author on six of the seven retracted studies. 

Anderson is a professor of medicine at Harvard Medical School and the director of the Jerome Lipper Multiple Myeloma Center at Dana-Farber. He did not respond to multiple emails or voicemails requesting comment. 

The retractions and new allegations add to a larger, ongoing debate in science about how to protect scientific integrity and reduce the incentives that could lead to misconduct or unintentional mistakes in research. 

The Dana-Farber Cancer Institute has moved relatively swiftly to seek retractions and corrections. 

“Dana-Farber is deeply committed to a culture of accountability and integrity, and as an academic research and clinical care organization we also prioritize transparency,” Dr. Barrett Rollins, the institute’s integrity research officer, said in a statement. “However, we are bound by federal regulations that apply to all academic medical centers funded by the National Institutes of Health among other federal agencies. Therefore, we cannot share details of internal review processes and will not comment on personnel issues.”

The retracted studies were originally published in two journals: One in the Journal of Immunology and six in Cancer Research. Six of the seven focused on multiple myeloma, a form of cancer that develops in plasma cells. Retraction notices indicate that Anderson agreed to the retractions of the papers he authored.

Elisabeth Bik, a microbiologist and longtime image sleuth, reviewed several of the papers’ retraction statements and scientific images for NBC News and said the errors were serious. 

“The ones I’m looking at all have duplicated elements in the photos, where the photo itself has been manipulated,” she said, adding that these elements were “signs of misconduct.” 

Dr.  John Chute, who directs the division of hematology and cellular therapy at Cedars-Sinai Medical Center and has contributed to studies about multiple myeloma, said the papers were produced by pioneers in the field, including Anderson. 

“These are people I admire and respect,” he said. “Those were all high-impact papers, meaning they’re highly read and highly cited. By definition, they have had a broad impact on the field.” 

Chute said he did not know the authors personally but had followed their work for a long time.

“Those investigators are some of the leading people in the field of myeloma research and they have paved the way in terms of understanding our biology of the disease,” he said. “The papers they publish lead to all kinds of additional work in that direction. People follow those leads and industry pays attention to that stuff and drug development follows.”

The retractions offer additional evidence for what some science sleuths have been saying for years: The more you look for errors or image manipulation, the more you might find, even at the top levels of science. 

Scientific images in papers are typically used to present evidence of an experiment’s results. Commonly, they show cells or mice; other types of images show key findings like western blots — a laboratory method that identifies proteins — or bands of separated DNA molecules in gels. 

Science sleuths sometimes examine these images for irregular patterns that could indicate errors, duplications or manipulations. Some artificial intelligence companies are training computers to spot these kinds of problems, as well. 

Duplicated images could be a sign of sloppy lab work or data practices. Manipulated images — in which a researcher has modified an image heavily with photo editing tools — could indicate that images have been exaggerated, enhanced or altered in an unethical way that could change how other scientists interpret a study’s findings or scientific meaning. 

Top scientists at big research institutions often run sprawling laboratories with lots of junior scientists. Critics of science research and publishing systems allege that a lack of opportunities for young scientists, limited oversight and pressure to publish splashy papers that can advance careers could incentivize misconduct. 

These critics, along with many science sleuths, allege that errors or sloppiness are too common , that research organizations and authors often ignore concerns when they’re identified, and that the path from complaint to correction is sluggish. 

“When you look at the amount of retractions and poor peer review in research today, the question is, what has happened to the quality standards we used to think existed in research?” said Nick Steneck, an emeritus professor at the University of Michigan and an expert on science integrity.

David told NBC News that he had shared some, but not all, of his concerns about additional image issues with Dana-Farber. He added that he had not identified any problems in four of the seven studies that have been retracted. 

“It’s good they’ve picked up stuff that wasn’t in the list,” he said. 

NBC News requested an updated tally of retractions and corrections, but Ellen Berlin, a spokeswoman for Dana-Farber, declined to provide a new list. She said that the numbers could shift and that the institute did not have control over the form, format or timing of corrections. 

“Any tally we give you today might be different tomorrow and will likely be different a week from now or a month from now,” Berlin said. “The point of sharing numbers with the public weeks ago was to make clear to the public that Dana-Farber had taken swift and decisive action with regard to the articles for which a Dana-Farber faculty member was primary author.” 

She added that Dana-Farber was encouraging journals to correct the scientific record as promptly as possible. 

Bik said it was unusual to see a highly regarded U.S. institution have multiple papers retracted. 

“I don’t think I’ve seen many of those,” she said. “In this case, there was a lot of public attention to it and it seems like they’re responding very quickly. It’s unusual, but how it should be.”

Evan Bush is a science reporter for NBC News. He can be reached at [email protected].

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