Health Care Research Paper Introduction

The purpose of the Journal of the Medical Library Association (JMLA) is more than just archiving data from librarian research. Our goal is to present research findings to end users in the most useful way. The “Knowledge Transfer” model, in its simplest form, has three components: creating the knowledge (doing the research), translating and transferring it to the user, and incorporating the knowledge into use. The JMLA is in the middle part, transferring and translating to the user. We, the JMLA, must obtain the information and knowledge from researchers and then work with them to present it in the most useable form. That means the information must be in a standard acceptable format and be easily readable.

There is a standard, preferred way to write an original research paper. For format, we follow the IMRAD structure. The acronym, IMRAD, stands for Introduction, Methods, Results And Discussion. IMRAD has dominated academic, scientific, and public health journals since the second half of the twentieth century. It is recommended in the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals” [1]. The IMRAD structure helps to eliminate unnecessary detail and allows relevant information to be presented clearly in a logical sequence [2, 3].

Here are descriptions of the IMRAD sections, along with our comments and suggestions. If you use this guide for submission to another journal, be sure to check the publisher's prescribed formats.

Introduction

The Introduction sets the stage for your presentation. It has three parts: what is known, what is unknown, and what your burning question, hypothesis, or aim is. Keep this section short, and write for a general audience (clear, concise, and as nontechnical as you can be). How would you explain to a distant colleague why and how you did the study? Take your readers through the three steps ending with your specific question. Emphasize how your study fills in the gaps (the unknown), and explicitly state your research question. Do not answer the research question. Remember to leave details, descriptions, speculations, and criticisms of other studies for the Discussion.

Methods

The Methods section gives a clear overview of what you did. Give enough information that your readers can evaluate the persuasiveness of your study. Describe the steps you took, as in a recipe, but be wary of too much detail. If you are doing qualitative research, explain how you picked your subjects to be representative.

You may want to break it into smaller sections with subheadings, for example, context: when, where, authority or approval, sample selection, data collection (how), follow-up, method of analysis. Cite a reference for commonly used methods or previously used methods rather than explaining all the details. Flow diagrams and tables can simplify explanations of methods.

You may use first person voice when describing your methods.

Results

The Results section summarizes what the data show. Point out relationships, and describe trends. Avoid simply repeating the numbers that are already available in the tables and figures. Data should be restricted to tables as much as possible. Be the friendly narrator, and summarize the tables; do not write the data again in the text. For example, if you had a demographic table with a row of ages, and age was not significantly different among groups, your text could say, “The median age of all subjects was 47 years. There was no significant difference between groups (Table).” This is preferable to, “The mean age of group 1 was 48.6 (7.5) years and group 2 was 46.3 (5.8) years, a nonsignificant difference.”

Break the Results section into subsections, with headings if needed. Complement the information that is already in the tables and figures. And remember to repeat and highlight in the text only the most important numbers. Use the active voice in the Results section, and make it lively. Information about what you did belongs in the Methods section, not here. And reserve comments on the meaning of your results for the Discussion section.

Other tips to help you with the Results section:

  • ▪ If you need to cite the number in the text (not just in the table), and the total in the group is less than 50, do not include percentage. Write “7 of 34,” not “7 (21%).”
  • ▪ Do not forget, if you have multiple comparisons, you probably need adjustment. Ask your statistician if you are not sure.

Discussion

The Discussion section gives you the most freedom. Most authors begin with a brief reiteration of what they did. Every author should restate the key findings and answer the question noted in the Introduction. Focus on what your data prove, not what you hoped they would prove. Start with “We found that…” (or something similar), and explain what the data mean. Anticipate your readers' questions, and explain why your results are of interest.

Then compare your results with other people's results. This is where that literature review you did comes in handy. Discuss how your findings support or challenge other studies.

You do not need every article from your literature review listed in your paper or reference list, unless you are writing a narrative review or systematic review. Your manuscript is not intended to be an exhaustive review of the topic. Do not provide a long review of the literature—discuss only previous work that is directly pertinent to your findings. Contrary to some beliefs, having a long list in the References section does not mean the paper is more scholarly; it does suggest the author is trying to look scholarly. (If your article is a systematic review, the citation list might be long.)

Don't overreach

Do not overreach your results. Finding a perceived knowledge need, for example, does not necessarily mean that library colleges must immediately overhaul their curricula and that it will improve health care and save lives and money (unless your data show that, in which case give us a chance to publish it!). You can say “has the potential to,” though.

Always note limitations that matter, not generic limitations.

Point out unanswered questions and future directions. Give the big-picture implications of your findings, and tell your readers why they should care. End with the main findings of your study, and do not travel too far from your data. Remember to give a final take-home message along with implications.

Notice that this format does not include a separate Conclusion section. The conclusion is built into the Discussion. For example, here is the last paragraph of the Discussion section in a recent NEJM article:

In conclusion, our trial did not show the hypothesized benefit [of the intervention] in patients…who were at high risk for complications.

However, a separate Conclusion section is usually appropriate for abstracts. Systematic reviews should have an Interpretation section.

Other parts of your research paper independent of IMRAD include:

Tables and figures are the foundation for your story. They are the story. Editors, reviewers, and readers usually look at titles, abstracts, and tables and figures first. Figures and tables should stand alone and tell a complete story. Your readers should not need to refer back to the main text.

Abstracts can be free-form or structured with subheadings. Always follow the format indicated by the publisher; the JMLA uses structured abstracts for research articles. The main parts of an abstract may include introduction (background, question or hypothesis), methods, results, conclusions, and implications. So begin your abstract with the background of your study, followed by the question asked. Next, give a quick summary of the methods used in your study. Key results come next with limited raw data if any, followed by the conclusion, which answers the questions asked (the take-home message).

Tips

  • ▪ Recommended order for writing a manuscript is first to start with your tables and figures. They tell your story. You can write your sections in any order. Many recommend writing your Results, followed by Methods, Introduction, Discussion, and Abstract.
  • ▪ We suggest authors read their manuscripts out loud to a group of librarians. Look for evidence of MEGO, “My Eyes Glaze Over” (attributed to Washington Post publisher Ben Bradlee and others). Modify as necessary.
  • ▪ Every single paragraph should be lucid.
  • ▪ Every paragraph should answer your readers' question, “Why are you telling me this?”

All sizes welcome

The JMLA welcomes all sizes of research manuscripts: definitive studies, preliminary studies, critical descriptive studies, and test-of-concept studies. We welcome brief reports and research letters. But the JMLA is more than a research journal. We also welcome case studies, commentaries, letters to the editor about articles, and subject reviews.

References

1. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication. J Pharmacol Pharmacother. 2010 Jan;1(1):42–58. (Available from: < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142758/?report=classic>. [cited 10 Nov 2014].) [PMC free article][PubMed]

2. Sollaci LB, Pereira MG. The introduction, methods, results, and discussion (IMRAD) structure: a fifty-year survey. J Med Lib Assoc. 2004 Jul;92(3):364–71. Correction in: J Med Lib Assoc. 2004. Oct;92(4):506. [PMC free article][PubMed]

3. Day RA. The origins of the scientific paper: the IMRAD format. Am Med Writers Assoc J. 1989;4(2):16–8.

     In an issues paper, you are focusing on persuading rather than informing your reader.  While library research is fundamental to both an issues and a research paper, the nature of the information you select may differ.  While you weave your sources into your paper, your voice takes precedence.  You are making a unique and valuable contribution to the conversation about the issue.

 

 Testing your issue

  • Would reasonable people have more than one response?  Can someone disagree with the issue?  Is the issue debatable?
  • Can the issue be narrowed sufficiently to be thoroughly explored in the space available?  (narrowing the issue will make your argument more effective)
  • Why do you want to write about the issue?  Are you personally interested in it?  (this will help sustain you through the effort of writing the paper)
  • Can you find evidence to support your position on the issue?

Getting started

      Use your emotions to help you focus on the issue.

  • Write informally about your feelings when you think or read or speak about the issue.  Are you angry, afraid, or full of pity?  Why? 
  •  Make a list of the reasons for your feelings.  Thinking intellectually, add other points to the list that you may have missed.
  • Now consider opposite points of view.  Use them to clarify your ideas.

Types of sources for evidence to support your argument (be sure to verify the credibility of your sources!)

  •  Facts, events, dates
  •  Statistics – interpretation of facts
  •  Informed opinion – developed through research and/or expertise of another on your issue
  •  Personal testimony – personal experience related by a knowledgeable party

 Format of paper

Two models are suggested for issues papers:

First: the general format model

            Introduction

                        Background

                        Establish your premise and why you’re taking the position

                        Include appropriate place for illustrative anecdote or quotation

            Body

                        Begin with counter arguments and support for counterclaims

                        Refute and include evidence

                        State your position on the issue

                        Use separate paragraph for each reason and incorporate sources

            Conclusion

                        Review major reasons to reinforce your purpose

                        Include plan of action, if appropriate

Second model:

            Introduction

                        Introduce issues and capture reader’s interest

            Statement of background

                        Provide information reader needs to know to understand your point of

                        view

            Exposition

                        Interpret the information you’ve provided and define terms

            Proof

                        Give the reasons (with evidence) for the position you’ve taken

            Refutation

      Indicate why you’re not persuaded by the arguments of different positions/claims       (shows you are knowledgeable about all aspects of the issue)

            Conclusion

                        Summarize important points

       Frieda Mendelsohn, mentor at Empire State College, has written a helpful guide on writing issue papers for her students.  She includes tips on organizing, where to begin writing (not with the introduction!)  Check out her guide:  http://commons.esc.edu/frieda-mendelsohn/resourceshandouts/writing-the-issue-paper/

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