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APA Table of Contents – Format and Example

Table of Contents

APA Table of Contents

The APA (American Psychological Association) Table of Contents is a structured outline that provides an overview of the content of a research paper or manuscript. It is typically included in the front matter of the document and lists the major sections and subsections of the paper, along with their page numbers. The Table of Contents is an important organizational tool that helps readers navigate the document and locate specific information quickly and easily.

How to Make APA Table of Contents

Here are the steps you can follow:

• Create a new page for the table of contents. The page number should be the Roman numeral “i”.
• Center the title “Table of Contents” at the top of the page.
• List all the headings and subheadings in your paper in order. Be sure to include all major sections and subsections.
• Align the page numbers to the right margin of the page.
• Use dot leaders to connect the headings to their respective page numbers. Dot leaders are a row of dots that help guide the reader’s eye from the heading to the page number.

I. Introduction ……………………………………………………… i

II. Literature Review ……………………………………………….. 1

A. Subheading ………………………………………………………… 2

B. Subheading ………………………………………………………… 3

III. Methodology ………………………………………………………….. 4

A. Participants ………………………………………………………… 5

B. Procedure …………………………………………………………… 6

IV. Results ……………………………………………………………………. 8

V. Discussion ……………………………………………………………… 10

VI. Conclusion …………………………………………………………….. 12

How to Make APA Table of Contents in MS Words

To create an APA table of contents in Microsoft Word, follow these steps:

• Start by typing out your document in Microsoft Word.
• Once you have finished typing your document, place your cursor at the beginning of your document.
• Click on the “References” tab in the top menu bar.
• Click on the “Table of Contents” option on the left-hand side of the menu bar.
• Choose one of the APA table of contents styles from the drop-down menu that appears. There are two options for an APA table of contents: “APA 6th Edition” and “APA 7th Edition.”
• Once you have chosen your preferred APA table of contents style, click on it to insert it into your document.
• Now you need to format your headings to be included in the table of contents. Select the heading you want to include in your table of contents.
• Click on the “Styles” option in the top menu bar.
• Choose the appropriate heading style from the drop-down menu that appears. You can choose from “Heading 1,” “Heading 2,” “Heading 3,” etc.
• Repeat the previous two steps for each heading you want to include in the table of contents.
• Once you have formatted all the headings, go back to the “References” tab in the top menu bar.
• Select the “Update Table” option from the drop-down menu that appears.
• Choose whether you want to update the page numbers only or the entire table of contents.
• Click “OK” to update your table of contents.

Your APA table of contents is now complete!

APA Table of Contents Format

Here’s the general format for creating a table of contents in APA style:

• Start a new page after the title page and abstract.
• Type “Table of Contents” at the top of the page, centered.
• List all the major sections of your paper, including the introduction, body, and conclusion.
• Indent each level of subheading, using either the tab key or your word processor’s formatting tools.
• Use the same font and size for the table of contents as you did for the rest of the paper.
• Align page numbers on the right side of the page, directly after each section and sub-section.
• Include any appendices and references in the table of contents, if applicable.

Here is an example of an APA-formatted table of contents:

Table of Contents Format

Introduction ………………………………………. 1

Literature Review ………………………………… 2

Methods ………………………………………….. 6

Participants ……………………………………. 6

Procedure ……………………………………….. 8

Results ………………………………………….. 10

Discussion ………………………………………. 15

Appendices ………………………………………. 20

References ………………………………………. 21

APA Table of Contents Example

Here is an example of an APA-style table of contents:

I. Introduction ……………………………………………………………………. 1

II. Literature Review …………………………………………………………….. 3

A. Background………………………………………………………………… 3

B. Theoretical Framework ………………………………………………… 5

C. Empirical Studies………………………………………………………… 7

III. Methodology …………………………………………………………………. 10

A. Research Design ………………………………………………………… 10

B. Participants ……………………………………………………………….. 11

C. Materials ………………………………………………………………….. 12 ‘

D. Procedure …………………………………………………………………. 14

IV. Results …………………………………………………………………………. 16

V. Discussion ……………………………………………………………………… 19

A. Summary of Findings …………………………………………………. 19

B. Implications ………………………………………………………………. 21

C. Limitations and Future Directions ………………………………… 23

VI. Conclusion ……………………………………………………………………. 25

VII. References …………………………………………………………………… 27

VIII. Appendices ………………………………………………………………….. 31

When to use APA Table of Contents

You should use an APA TOC when:

• You are writing a research paper or a thesis that is more than 5 pages in length.
• Your document has multiple headings and subheadings that require organization and clarification for the reader.
• You want to make it easy for readers to find specific sections or information within your document.
• You want to comply with the APA style guidelines for formatting and referencing.
• Your document contains complex information that requires a clear structure to make it more comprehensible for the reader.

Advantages of APA Table of Contents

The American Psychological Association (APA) style table of contents has several advantages, including:

• Easy navigation: A well-organized table of contents makes it easy for readers to find the information they need quickly and easily. This is especially important in longer documents such as academic papers, theses, and dissertations.
• Standardized formatting: The APA style table of contents follows a standardized formatting style that is familiar to many academic readers. This makes it easier for readers to understand the structure and organization of the document.
• Consistency : By using the APA style table of contents, authors can ensure that the document is consistent and follows a clear organizational structure. This can help readers to better understand the content and stay focused on the main points.
• Professional appearance : A well-formatted APA style table of contents can enhance the professional appearance of the document. This is particularly important in academic and research settings where a professional appearance can increase the credibility of the work.
• Compliance with academic standards : Many academic institutions require the use of the APA style for academic papers, theses, and dissertations. By using the APA style table of contents, authors can ensure that their work complies with these academic standards.

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How to Structure the Table of Contents for a Research Paper

4-minute read

• 16th July 2023

So you’ve made it to the important step of writing the table of contents for your paper. Congratulations on making it this far! Whether you’re writing a research paper or a dissertation , the table of contents not only provides the reader with guidance on where to find the sections of your paper, but it also signals that a quality piece of research is to follow. Here, we will provide detailed instructions on how to structure the table of contents for your research paper.

Steps to Create a Table of Contents

• Insert the table of contents after the title page.

Within the structure of your research paper , you should place the table of contents after the title page but before the introduction or the beginning of the content. If your research paper includes an abstract or an acknowledgements section , place the table of contents after it.

• List all the paper’s sections and subsections in chronological order.

Depending on the complexity of your paper, this list will include chapters (first-level headings), chapter sections (second-level headings), and perhaps subsections (third-level headings). If you have a chapter outline , it will come in handy during this step. You should include the bibliography and all appendices in your table of contents. If you have more than a few charts and figures (more often the case in a dissertation than in a research paper), you should add them to a separate list of charts and figures that immediately follows the table of contents. (Check out our FAQs below for additional guidance on items that should not be in your table of contents.)

• Paginate each section.

Label each section and subsection with the page number it begins on. Be sure to do a check after you’ve made your final edits to ensure that you don’t need to update the page numbers.

• Format your table of contents.

The way you format your table of contents will depend on the style guide you use for the rest of your paper. For example, there are table of contents formatting guidelines for Turabian/Chicago and MLA styles, and although the APA recommends checking with your instructor for formatting instructions (always a good rule of thumb), you can also create a table of contents for a research paper that follows APA style .

• Add hyperlinks if you like.

Depending on the word processing software you’re using, you may also be able to hyperlink the sections of your table of contents for easier navigation through your paper. (Instructions for this feature are available for both Microsoft Word and Google Docs .)

To summarize, the following steps will help you create a clear and concise table of contents to guide readers through your research paper:

1. Insert the table of contents after the title page.

2. List all the sections and subsections in chronological order.

3. Paginate each section.

4. Format the table of contents according to your style guide.

5. Add optional hyperlinks.

If you’d like help formatting and proofreading your research paper , check out some of our services. You can even submit a sample for free . Best of luck writing your research paper table of contents!

What is a table of contents?

A table of contents is a listing of each section of a document in chronological order, accompanied by the page number where the section begins. A table of contents gives the reader an overview of the contents of a document, as well as providing guidance on where to find each section.

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What should I include in my table of contents?

If your paper contains any of the following sections, they should be included in your table of contents:

●  Chapters, chapter sections, and subsections

●  Introduction

●  Conclusion

●  Appendices

●  Bibliography

Although recommendations may differ among institutions, you generally should not include the following in your table of contents:

●  Title page

●  Abstract

●  Acknowledgements

●  Forward or preface

If you have several charts, figures, or tables, consider creating a separate list for them that will immediately follow the table of contents. Also, you don’t need to include the table of contents itself in your table of contents.

Is there more than one way to format a table of contents?

Yes! In addition to following any recommendations from your instructor or institution, you should follow the stipulations of your style guide .

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• Dissertation
• Dissertation Table of Contents in Word | Instructions & Examples

Dissertation Table of Contents in Word | Instructions & Examples

Published on 15 May 2022 by Tegan George .

The table of contents is where you list the chapters and major sections of your thesis, dissertation, or research paper, alongside their page numbers. A clear and well-formatted table of contents is essential, as it demonstrates to your reader that a quality paper will follow.

The table of contents (TOC) should be placed between the abstract and the introduction. The maximum length should be two pages. Depending on the nature of your thesis, dissertation, or paper, there are a few formatting options you can choose from.

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Table of contents

What to include in your table of contents, what not to include in your table of contents, creating a table of contents in microsoft word, table of contents examples, updating a table of contents in microsoft word, other lists in your thesis, dissertation, or research paper, frequently asked questions about the table of contents.

Depending on the length of your document, you can choose between a single-level, subdivided, or multi-level table of contents.

• A single-level table of contents only includes ‘level 1’ headings, or chapters. This is the simplest option, but it may be too broad for a long document like a dissertation.
• A subdivided table of contents includes chapters as well as ‘level 2’ headings, or sections. These show your reader what each chapter contains.
• A multi-level table of contents also further divides sections into ‘level 3’ headings. This option can get messy quickly, so proceed with caution. Remember your table of contents should not be longer than 2 pages. A multi-level table is often a good choice for a shorter document like a research paper.

Examples of level 1 headings are Introduction, Literature Review, Methodology, and Bibliography. Subsections of each of these would be level 2 headings, further describing the contents of each chapter or large section. Any further subsections would be level 3.

In these introductory sections, less is often more. As you decide which sections to include, narrow it down to only the most essential.

Including appendices and tables

You should include all appendices in your table of contents. Whether or not you include tables and figures depends largely on how many there are in your document.

If there are more than three figures and tables, you might consider listing them on a separate page. Otherwise, you can include each one in the table of contents.

• Theses and dissertations often have a separate list of figures and tables.
• Research papers generally don’t have a separate list of figures and tables.

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All level 1 and level 2 headings should be included in your table of contents, with level 3 headings used very sparingly.

The following things should never be included in a table of contents:

• Your acknowledgements page
• Your abstract
• The table of contents itself

The acknowledgements and abstract always precede the table of contents, so there’s no need to include them. This goes for any sections that precede the table of contents.

To automatically insert a table of contents in Microsoft Word, be sure to first apply the correct heading styles throughout the document, as shown below.

• Choose which headings are heading 1 and which are heading 2 (or 3!
• For example, if all level 1 headings should be Times New Roman, 12-point font, and bold, add this formatting to the first level 1 heading.
• Highlight the level 1 heading.
• Right-click the style that says ‘Heading 1’.
• Select ‘Update Heading 1 to Match Selection’.
• Allocate the formatting for each heading throughout your document by highlighting the heading in question and clicking the style you wish to apply.

Once that’s all set, follow these steps:

• Add a title to your table of contents. Be sure to check if your citation style or university has guidelines for this.
• Place your cursor where you would like your table of contents to go.
• In the ‘References’ section at the top, locate the Table of Contents group.
• Here, you can select which levels of headings you would like to include. You can also make manual adjustments to each level by clicking the Modify button.
• When you are ready to insert the table of contents, click ‘OK’ and it will be automatically generated, as shown below.

The key features of a table of contents are:

• Clear headings and subheadings
• Corresponding page numbers

Check with your educational institution to see if they have any specific formatting or design requirements.

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Write yourself a reminder to update your table of contents as one of your final tasks before submitting your dissertation or paper. It’s normal for your text to shift a bit as you input your final edits, and it’s crucial that your page numbers correspond correctly.

It’s easy to update your page numbers automatically in Microsoft Word. Simply right-click the table of contents and select ‘Update Field’. You can choose either to update page numbers only or to update all information in your table of contents.

In addition to a table of contents, you might also want to include a list of figures and tables, a list of abbreviations and a glossary in your thesis or dissertation. You can use the following guides to do so:

• List of figures and tables
• List of abbreviations

It is less common to include these lists in a research paper.

All level 1 and 2 headings should be included in your table of contents . That means the titles of your chapters and the main sections within them.

The contents should also include all appendices and the lists of tables and figures, if applicable, as well as your reference list .

Do not include the acknowledgements or abstract   in the table of contents.

To automatically insert a table of contents in Microsoft Word, follow these steps:

• Apply heading styles throughout the document.
• In the references section in the ribbon, locate the Table of Contents group.
• Click the arrow next to the Table of Contents icon and select Custom Table of Contents.
• Select which levels of headings you would like to include in the table of contents.

Make sure to update your table of contents if you move text or change headings. To update, simply right click and select Update Field.

The table of contents in a thesis or dissertation always goes between your abstract and your introduction.

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A Table of Contents in APA Format

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Adah Chung is a fact checker, writer, researcher, and occupational therapist. 

General Guidelines

• Table of Contents

APA style does not require a table of contents, but there are cases where you may need to include one. For example, your instructor may specify that your paper must be submitted with a table of contents. A table of contents can be particularly helpful in cases where your paper is lengthy or covers a lot of material, such as a thesis paper or dissertation. Research papers, in particular, may benefit from the addition of a table of contents.

APA style is the official publication style of the American Psychological Association. APA style is used in psychology courses as well as other social science classes including those in social science, behavioral sciences, and education.

The table of contents serves as a basic roadmap of your paper. It should list all of the major headings and subheadings within the body of your paper. For a standard psychology paper, it might include listings for the introduction, method, results, and discussion sections of your paper.

While the APA may not specify guidelines for a table of contents, you should use the basic APA format for formatting your table of contents:

• Use one-inch margins on all sides
• Use 12-point Times New Roman font
• Double-space

Since APA does not require a table of contents, you should always refer to your instructor’s guidelines when deciding whether or not to include one.

It is also important to note that the 7th edition of the Publication Manual of the American Psychological Association was published in 2020, and included updated guidelines on many topics.

For example, while the previous edition of the style manual required a running head on each page of a paper, the 7th edition has eliminated that requirement on student papers unless your instructor specifies to include it. Always ask first.

If you are using a standard APA paper format, your table of contents should include the following sections:

• Introduction

The above format may work well for a standard lab report or research paper. However, your table of contents will look much different if you are writing something such as a critique, essay, or case study.

Notice, that the table of contents does not include the abstract or acknowledgments pages. When applicable, it should list the appendices and the lists of tables and figures.

The exact order of your paper depends largely on the type of paper you are writing. In general, your paper should be presented in the following order:

• Main Body of Paper

Table of Contents Format

Because there is no standard format for a table of contents in APA style, you should always defer to the provided guidelines for your assignment.

If your instructor does not have a preferred format, consider using the following:

• Title the page “Table of Contents” and center the title at the top of the page.
• Most papers should include at least two levels of headings, up to five levels.
• Level one headings will be for main topics, such as chapter titles like "Chapter One; Name of Chapter," or research sections like "Method," "Results," and "Discussion."
• All level-one headings should be flush-left and sub-headings should be indented five spaces deeper than the last. 
• All heading levels should be in title case, capitalizing the first letter of each word. The font type, style, and size stay the same for each level.
• The page number for each heading is formatted flush-right. Include dot leaders between the headings and the page number to improve readability.

While you might not think that following APA format is important, it is one of those areas where students can lose points for making small errors. It pays to spend a little extra time and attention making sure that your paper is formatted in proper APA style.

• If you need help, you can get assistance from your school's writing lab.
• Getting your own copy of the latest edition of the APA publication manual can be very helpful.
• Always refer to any instructions or guidelines that were provided by your course instructor.
• There is a helpful feature in most word processors that you can use to pre-format your paper in APA style. It takes a little effort to set it up, but well worth it in the end, especially for longer documents. You can save the style to apply to your future papers saving you the effort next time.

For those writing a paper to submit for publication, check with the publisher for any specific formatting requirements that they may have.

American Psychological Association. Publication Manual of the American Psychological Association (7th ed.) ; 2020.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Microsoft Word for Dissertations

• Table of Contents
• Introduction, Template, & Resources
• Formatting for All Readers
• Applying a Style
• Modifying a Style
• Setting up a Heading 1 Example
• Images, Charts, Other Objects
• Footnotes, Endnotes, & Citations
• Cross-References
• Appendix Figures & Tables
• List of Figures/Tables
• Chapter and Section Numbering
• Page Numbers
• Landscape Pages
• Combining Chapter Files
• Commenting and Reviewing
• Tips & Tricks
• The Two-inch Top Margin
• Troubleshooting
• Finalizing Without Styles
• Preparing Your Final Document

Automatic Table of Contents

An automatic Table of Contents relies on Styles to keep track of page numbers and section titles for you automatically. Microsoft Word can scan your document and find everything in the Heading 1 style and put that on the first level of your table of contents, put any Heading 2’s on the second level of your table of contents, and so on.

If you want an automatic table of contents you need to apply the Heading 1 style to all of your chapter titles and front matter headings (like “Dedication” and “Acknowledgements”).  All section headings within your chapters should use the Heading 2  style.  All sub-section headings should use  Heading 3 , etc....

If you have used Heading styles in your document, creating an automatic table of contents is easy.

• Place your cursor where you want your table of contents to be.
• On the References Ribbon, in the Table of Contents Group , click on the arrow next to the Table of Contents icon, and select  Custom Table of Contents .
• We suggest that you set each level (Chapters, sections, sub-sections, aka TOC 1, TOC 2, TOC 3) to be single-spaced, with 12 points of space afterwards.  This makes each item in your ToC clump together if they're long enough to wrap to a second line, with the equivalent of a double space between each item, and makes the ToC easier to read and understand than if every line were double-spaced. See the video below for details.
• If you want to change which headings appear in your Table of Contents, you can do so by changing the number in the Show levels: field. Select "1" to just include the major sections (Acknowledgements, List of Figures, Chapters, etc...).  Select "4" to include Chapters, sections, sub-sections, and sub-sub-sections.
• Click OK to insert your table of contents.  

The table of contents is a snapshot of the headings and page numbers in your document, and does not automatically update itself as you make changes. At any time, you can update it by right-clicking on it and selecting Update field .  Notice that once the table of contents is in your document, it will turn gray if you click on it. This just reminds you that it is a special field managed by Word, and is getting information from somewhere else.

Modifying the format of your Table of Contents

The video below shows how to make your Table of Contents a little easier to read by formatting the spacing between items in your Table of Contents. You may recognize the "Modify Style" window that appears, which can serve as a reminder that you can use this window to modify more than just paragraph settings. You can modify the indent distance, or font, or tab settings for your ToC, just the same as you may have modified it for Styles. 

By default, the Table of Contents tool creates the ToC by pulling in Headings 1 through 3. If you'd like to modify that -- to only show H1's, or to show Headings 1 through 4 -- then go to the References tab and select Custom Table of Contents .  In the window that appears, set Show Levels to "1" to only show Heading 1's in the Table of Contents, or set it to "4" to show Headings 1 through 4.

Bonus tip for updating fields like the Table of Contents

You'll quickly realize that all of the automatic Lists and Tables need to be updated occasionally to reflect any changes you've made elsewhere in the document -- they do not dynamically update by themselves. Normally, this means going to each field, right-clicking on it and selecting "Update Field". 

Alternatively, to update all fields throughout your document (Figure/Table numbers & Lists, cross-references, Table of Contents, etc...), just select "Print". This will cause Word to update everything in anticipation of printing. Once the print preview window appears, just cancel.

Frequently asked questions

How do i create a table of contents.

To automatically insert a table of contents in Microsoft Word, follow these steps:

• Apply heading styles throughout the document.
• In the references section in the ribbon, locate the Table of Contents group.
• Click the arrow next to the Table of Contents icon and select Custom Table of Contents.
• Select which levels of headings you would like to include in the table of contents.

Make sure to update your table of contents if you move text or change headings. To update, simply right click and select Update Field.

Frequently asked questions: Dissertation

Dissertation word counts vary widely across different fields, institutions, and levels of education:

• An undergraduate dissertation is typically 8,000–15,000 words
• A master’s dissertation is typically 12,000–50,000 words
• A PhD thesis is typically book-length: 70,000–100,000 words

However, none of these are strict guidelines – your word count may be lower or higher than the numbers stated here. Always check the guidelines provided by your university to determine how long your own dissertation should be.

A dissertation prospectus or proposal describes what or who you plan to research for your dissertation. It delves into why, when, where, and how you will do your research, as well as helps you choose a type of research to pursue. You should also determine whether you plan to pursue qualitative or quantitative methods and what your research design will look like.

It should outline all of the decisions you have taken about your project, from your dissertation topic to your hypotheses and research objectives , ready to be approved by your supervisor or committee.

Note that some departments require a defense component, where you present your prospectus to your committee orally.

A thesis is typically written by students finishing up a bachelor’s or Master’s degree. Some educational institutions, particularly in the liberal arts, have mandatory theses, but they are often not mandatory to graduate from bachelor’s degrees. It is more common for a thesis to be a graduation requirement from a Master’s degree.

Even if not mandatory, you may want to consider writing a thesis if you:

• Plan to attend graduate school soon
• Have a particular topic you’d like to study more in-depth
• Are considering a career in research
• Would like a capstone experience to tie up your academic experience

The conclusion of your thesis or dissertation should include the following:

• A restatement of your research question
• A summary of your key arguments and/or results
• A short discussion of the implications of your research

The conclusion of your thesis or dissertation shouldn’t take up more than 5–7% of your overall word count.

For a stronger dissertation conclusion , avoid including:

• Important evidence or analysis that wasn’t mentioned in the discussion section and results section
• Generic concluding phrases (e.g. “In conclusion …”)
• Weak statements that undermine your argument (e.g., “There are good points on both sides of this issue.”)

Your conclusion should leave the reader with a strong, decisive impression of your work.

While it may be tempting to present new arguments or evidence in your thesis or disseration conclusion , especially if you have a particularly striking argument you’d like to finish your analysis with, you shouldn’t. Theses and dissertations follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the discussion section and results section .) The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

A theoretical framework can sometimes be integrated into a  literature review chapter , but it can also be included as its own chapter or section in your dissertation . As a rule of thumb, if your research involves dealing with a lot of complex theories, it’s a good idea to include a separate theoretical framework chapter.

A literature review and a theoretical framework are not the same thing and cannot be used interchangeably. While a theoretical framework describes the theoretical underpinnings of your work, a literature review critically evaluates existing research relating to your topic. You’ll likely need both in your dissertation .

While a theoretical framework describes the theoretical underpinnings of your work based on existing research, a conceptual framework allows you to draw your own conclusions, mapping out the variables you may use in your study and the interplay between them.

A thesis or dissertation outline is one of the most critical first steps in your writing process. It helps you to lay out and organize your ideas and can provide you with a roadmap for deciding what kind of research you’d like to undertake.

Generally, an outline contains information on the different sections included in your thesis or dissertation , such as:

• Your anticipated title
• Your abstract
• Your chapters (sometimes subdivided into further topics like literature review , research methods , avenues for future research, etc.)

When you mention different chapters within your text, it’s considered best to use Roman numerals for most citation styles. However, the most important thing here is to remain consistent whenever using numbers in your dissertation .

In most styles, the title page is used purely to provide information and doesn’t include any images. Ask your supervisor if you are allowed to include an image on the title page before doing so. If you do decide to include one, make sure to check whether you need permission from the creator of the image.

Include a note directly beneath the image acknowledging where it comes from, beginning with the word “ Note .” (italicized and followed by a period). Include a citation and copyright attribution . Don’t title, number, or label the image as a figure , since it doesn’t appear in your main text.

Definitional terms often fall into the category of common knowledge , meaning that they don’t necessarily have to be cited. This guidance can apply to your thesis or dissertation glossary as well.

However, if you’d prefer to cite your sources , you can follow guidance for citing dictionary entries in MLA or APA style for your glossary.

A glossary is a collection of words pertaining to a specific topic. In your thesis or dissertation, it’s a list of all terms you used that may not immediately be obvious to your reader. In contrast, an index is a list of the contents of your work organized by page number.

The title page of your thesis or dissertation goes first, before all other content or lists that you may choose to include.

The title page of your thesis or dissertation should include your name, department, institution, degree program, and submission date.

Glossaries are not mandatory, but if you use a lot of technical or field-specific terms, it may improve readability to add one to your thesis or dissertation. Your educational institution may also require them, so be sure to check their specific guidelines.

A glossary or “glossary of terms” is a collection of words pertaining to a specific topic. In your thesis or dissertation, it’s a list of all terms you used that may not immediately be obvious to your reader. Your glossary only needs to include terms that your reader may not be familiar with, and is intended to enhance their understanding of your work.

A glossary is a collection of words pertaining to a specific topic. In your thesis or dissertation, it’s a list of all terms you used that may not immediately be obvious to your reader. In contrast, dictionaries are more general collections of words.

An abbreviation is a shortened version of an existing word, such as Dr. for Doctor. In contrast, an acronym uses the first letter of each word to create a wholly new word, such as UNESCO (an acronym for the United Nations Educational, Scientific and Cultural Organization).

As a rule of thumb, write the explanation in full the first time you use an acronym or abbreviation. You can then proceed with the shortened version. However, if the abbreviation is very common (like PC, USA, or DNA), then you can use the abbreviated version from the get-go.

Be sure to add each abbreviation in your list of abbreviations !

If you only used a few abbreviations in your thesis or dissertation , you don’t necessarily need to include a list of abbreviations .

If your abbreviations are numerous, or if you think they won’t be known to your audience, it’s never a bad idea to add one. They can also improve readability, minimizing confusion about abbreviations unfamiliar to your reader.

A list of abbreviations is a list of all the abbreviations that you used in your thesis or dissertation. It should appear at the beginning of your document, with items in alphabetical order, just after your table of contents .

Your list of tables and figures should go directly after your table of contents in your thesis or dissertation.

Lists of figures and tables are often not required, and aren’t particularly common. They specifically aren’t required for APA-Style, though you should be careful to follow their other guidelines for figures and tables .

If you have many figures and tables in your thesis or dissertation, include one may help you stay organized. Your educational institution may require them, so be sure to check their guidelines.

A list of figures and tables compiles all of the figures and tables that you used in your thesis or dissertation and displays them with the page number where they can be found.

The table of contents in a thesis or dissertation always goes between your abstract and your introduction .

You may acknowledge God in your dissertation acknowledgements , but be sure to follow academic convention by also thanking the members of academia, as well as family, colleagues, and friends who helped you.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

In a thesis or dissertation, the discussion is an in-depth exploration of the results, going into detail about the meaning of your findings and citing relevant sources to put them in context.

The conclusion is more shorter and more general: it concisely answers your main research question and makes recommendations based on your overall findings.

In the discussion , you explore the meaning and relevance of your research results , explaining how they fit with existing research and theory. Discuss:

• Your  interpretations : what do the results tell us?
• The  implications : why do the results matter?
• The  limitation s : what can’t the results tell us?

The results chapter or section simply and objectively reports what you found, without speculating on why you found these results. The discussion interprets the meaning of the results, puts them in context, and explains why they matter.

In qualitative research , results and discussion are sometimes combined. But in quantitative research , it’s considered important to separate the objective results from your interpretation of them.

Results are usually written in the past tense , because they are describing the outcome of completed actions.

The results chapter of a thesis or dissertation presents your research results concisely and objectively.

In quantitative research , for each question or hypothesis , state:

• The type of analysis used
• Relevant results in the form of descriptive and inferential statistics
• Whether or not the alternative hypothesis was supported

In qualitative research , for each question or theme, describe:

• Recurring patterns
• Significant or representative individual responses
• Relevant quotations from the data

Don’t interpret or speculate in the results chapter.

All level 1 and 2 headings should be included in your table of contents . That means the titles of your chapters and the main sections within them.

The contents should also include all appendices and the lists of tables and figures, if applicable, as well as your reference list .

Do not include the acknowledgements or abstract in the table of contents.

The abstract appears on its own page in the thesis or dissertation , after the title page and acknowledgements but before the table of contents .

An abstract for a thesis or dissertation is usually around 200–300 words. There’s often a strict word limit, so make sure to check your university’s requirements.

In a thesis or dissertation, the acknowledgements should usually be no longer than one page. There is no minimum length.

The acknowledgements are generally included at the very beginning of your thesis , directly after the title page and before the abstract .

Yes, it’s important to thank your supervisor(s) in the acknowledgements section of your thesis or dissertation .

Even if you feel your supervisor did not contribute greatly to the final product, you must acknowledge them, if only for a very brief thank you. If you do not include your supervisor, it may be seen as a snub.

In the acknowledgements of your thesis or dissertation, you should first thank those who helped you academically or professionally, such as your supervisor, funders, and other academics.

Then you can include personal thanks to friends, family members, or anyone else who supported you during the process.

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How To Write a Table of Contents for Academic Papers

Posted by Rene Tetzner | Mar 17, 2021 | How To Get Published | 0 |

How To Write a Table of Contents for Academic Papers Although every author begins a writing project with the best of intentions and an ideal outline in mind, it often proves difficult to stick to one’s initial plans as the text begins to unfold and its complexities grow in number and depth. Sometimes a document quickly exceeds the word limits for a project, and at others certain important aspects are neglected or turn out a good deal shorter than intended. Drafting a working table of contents for your writing project can provide an excellent tool for keeping your discussion on track and your text within length requirements as you write.

A working table of contents should begin with a title. This title may change as you draft your text, but a working title will help you focus your thoughts as you devise the headings and plan the content for the main parts, chapters, sections and subsections that should be added beneath it. All headings, whether numbered or not, should be formatted in effective and consistent ways that distinguish section levels and clearly indicate the overall structure of the text. These headings can also be altered as your writing advances, but they will provide an effective outline of what you need to discuss and the order in which you think the main topics should be presented. At this initial stage, it is also a good idea to write under each heading a brief summary of or rough notes about what you hope to include in that part of the document, and you can continue to add, adjust and move material around within and among the sections as your table of contents and ultimately your text progresses. Reminders of how long (measured in words, paragraphs or pages) the entire text and each of its parts should ideally be may also prove helpful.

Once you have your annotated table of contents drafted, it will serve as an informative list of both content and order that can be productively consulted as you write. Assuming you construct your working table of contents as a computer file in the same program you intend to use for writing the entire document, you can also use the table of contents as a template for composing the text as a whole, replacing your rough notes under each heading with the formal text as you draft it. This practice lends an immediate physical presence to the guidance provided by your table of contents because you are literally working within that outline, which can be especially wise if you tend to run on or become distracted by new ideas as you write.

Finally, your working table of contents can become your final table of contents if one is required for your project. If you would like to use the working table of contents in this way and are also using it as a template, be sure to rename the file and save a separate copy before you begin adding the formal text of your document. Then you can simply delete your summaries and rough notes from the original table of contents to make your final one, leaving only the headings, to which you can add relevant page numbers as required.

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Creating a Table of Contents

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A table of contents is best used in a paper than can be divided into logical parts or chapters. You will find it necessary to create sections of your paper--either as you write or after you have completed the paper. Either way is fine.

Getting Started

If you are required to include a table of contents in your research paper , you should know that there is a certain way to generate this feature in Microsoft Word . Many students try to create a table of contents manually, without using the built-in process.

This is a big mistake! It is nearly impossible to line up the dots evenly and keep the page numbers correct during editing.

Students will quickly give up on creating a manual table of contents out of frustration because the spacing never comes out quite right, and the table is potentially incorrect as soon as you make any edits to your documents.

When you follow these steps, you will discover a simple process that takes a few moments, and it makes a world of difference in the look of your paper.

Using the Tool Bar

First, you'll need to make sure the necessary toolbar is showing at the top of your paper. The correct toolbar is the Formatting toolbar, and you can open this by selecting View and rolling your pointer down to Toolbar . You will need to select Formatting .

Your next step is to insert the phrases that you want to appear in your auto-generated table of contents. These are the words--in the form of headings--that the program pulls from your pages.

Insert Headings

To create a new chapter or division of your paper, you simply need to give a heading to the section. It can be as simple as one word, such as "Introduction." This is the phrase that will appear in your table of contents.

To insert a heading, go to the menu at the top left of your screen. From the drop-down menu, select HEADING 1 . Type the title or heading, and hit RETURN.

Remember, you don't have to format the paper as you write it. You can do this after your paper is completed. If you need to add headings and generate a table of contents after your paper is already written, you simply place your cursor in the desired spot and place your heading.

Note: if you want each section or chapter to start on a new page, go to the end of a chapter/section and go to Insert and select Break and Page Break .

Inserting the Table of Contents

Once your paper is divided into sections, you are ready to generate the table of contents. You are almost finished!

First, create a blank page at the beginning of your paper. Do this by going to the very beginning and selecting Insert and select Break and Page Break .

From the toolbar, go to Insert , then select Reference and Index and Tables from the drop-down lists.

A new window will pop up.

Select the Table of Contents tab and then select Okay .

You have a table of contents! Next, you may be interested in generating an index at the end of your paper.

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How to Create a Table of Contents for Dissertation, Thesis or Paper & Examples

Table of contents

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A dissertation table of contents is a list of the chapters and sections included in a dissertation or thesis, along with their page numbers. It helps to navigate the document easily and locate specific information. Each chapter or section should be listed with its corresponding page number. The table of contents should be formatted according to the guidelines of the specific style guide being used, such as APA or MLA.

We would guess that students usually start working on the table of contents at the last minute. It is quite apparent and makes sense, as this is the list of chapters and sections with page locations. Do you think it's easy? 

From our experience, it can be quite tricky to organize everything according to APA, Chicago, or any other academic writing style. In this blog, we will discuss how to write a table of contents for a research paper , thesis or dissertation in Microsoft Word. We will create it together to guide students through the process. 

Also, here you will find examples of table of contents created by thesis writers at StudyCrumb . Let’s go!

What Is a Table of Contents: Definition

It is obvious that the table of contents (TOC) is an essential manuscript part you can’t skip. If you are dealing with a dissertation, thesis or research paper, you need to know how to build it in accordance with academic guidance. This is a detailed roadmap for your work and outlined structure you can follow for a research presentation. 

In case you are working on an essay or report, you may not include the table of contents, as it is a short academic text. But for the research paper, thesis or dissertation, table of contents is essential and required. It is possible to say the same about any Master’s project. It should be located between the dissertation abstract and introduction chapter. In most cases, it is about 2-3 pages long. 

Our expert dissertation writing service prepared a great template that can be used for your work. Make your research formatting easy with ready solutions!

Types of Table of Contents

How to choose which table of contents will fit your research paper, thesis, dissertation, or report best? Make a decision based on your work length. Some academic writing styles, such as APA paper format or MLA style , have specific formatting for this list. 

However, we will outline the most commonly used typology:

• Single-level table of contents. At this type, we use only chapters. For instance, you will have an Introduction, Literature Review, methodology, and other chapters with page numbers. It can be used for shorter research work. For long writing forms like manuscripts, it can be too broad, and you will need to go into details.
• Subdivided table of contents. The most frequently used form to organize the contents table. It will include not only chapters but also sections — a level 2 subheading for each part. It will help to be more specific about what to expect in each part of your research work.
• Table of contents with multiple levels. This is a more divided structure, including subheadings with a level 3 for each section. Quite often, those subheadings can be rewritten or deleted during the last editing. It is essential to keep them in the right order.

Before you decide which type will work best for you, let us share with you some examples of each formatting style.

Example of Table of Contents With a Single Level

Introduction: The Misinformation Roots ………..…… 3 Literature Review .....................................….....………… 10 Research Methodology and Design ……................. 24 Results.............................................................................. 28 Discussion ....................................................................... 32

Sometimes, you will need to put an extra emphasis on subsections. Check this layout to see how your subheadings can be organized.

Example of Table of Contents Page with Subdivided Levels

Introduction: Information War ............……………….. 3       Background…………………………………….………..…… 4       Current State ……………………………………...…...…… 5       Defining Research Questions………………………. 9 Literature Review………………………...……………..……... 11       The Roots of Information Warfare ………....… 11        Information Wars …………………………….………..… 14        Cyber Wars Research ........................................ 17

If you are working on a lengthy, complex paper, this outline will suit your project most. It will help readers navigate through your document by breaking it down into smaller, more manageable sections.

Multi-Level Table of Contents Page Example

Introduction……………………………………………….......……….… 3       Emergence of Climate Change ………..……....….….. 3       Key Activist Groups in Climate Change .............. 5              Greenpeace International ………..…………......... 9              European Climate Foundation …….……………. 10              WWF ……………………………………….……….............. 11        Significant Movements ……………….………....……… 13 Literature Review ……………………………………......…………. 15

What Sections Should Be Included in a Table of Contents?

To start with, the scientific table of contents should include all chapters and its subheading. It is important to choose the formatting that will give your readers a full overview of your work from the very beginning. However, there are other chapters that you may miss constructing the 2-pager table. So, let's look at all you need to include:

• Dissertation introduction
• Literature review
• Research methodology
• Results section
• Dissertation discussion
• Conclusion of a thesis
• Reference list. Mention a number of a page where you start listing your sources.
• Appendices. For instance, if you have a data set, table or figure, include it in your research appendix .

This is how the ideal structured dissertation or research paper table of contents will look like. Remember that it still should take 2 pages. You need to choose the best formatting style to manage its length.

Tables, Figures, and Appendices in TOC

While creating a table of contents in a research paper, thesis or dissertation, you will need to include appendices in each case you have them. However, the formatting and adding tables and figures can vary based on the number and citation style. If you have more than 3 tables or figures, you may decide to have all of them at the end of your project. So, add them to the table of contents. 

Figures, graphics, and diagrams in research papers, dissertations and theses should be numbered. If you use them from another source, ensure that you make a proper citation based on the chosen style guide.

Appendix in Table of Contents Example

Appendix A. Row Data Set…………………………………… 41 Appendix B. IBR Data………………………………………….… 43 Appendix C. SPSS Data………………………………………… 44

What Shouldn't Be Included in a Table of Contents?

When creating a dissertation table of contents, students want to include everything they have in a document. However, some components should not be on this page. Here is what we are talking about:

• Thesis acknowledgement
• Paper abstract
• The content list itself

Acknowledgement and abstract should be located before the content list, so there is no need to add them. You need to present a clear structure that will help your readers to navigate through the work and quickly find any requested information.

How to Create a Table of Contents for a Research Paper or Dissertation In Word?

It may look like working with this list can take a long. But we have one proposal for our users. Instead of writing a table of contents manually, create it automatically in Microsoft Word. You do not need any specific tech knowledge to do this. Let’s go through this process step-by-step and explain how to make a table of contents for a research paper or dissertation in a few clicks.

• Open Home tab and choose the style for your table of contents (ToC next).
• Apply heading 1 to your chapters, heading 2 to the subheading, and if needed heading 3 to the level 3 heading.
• Next, you are going to create a research paper or PhD dissertation table of contents. Open References and choose ToC.
• Choose the citation style for your work. For example, let’s choose APL for now. Meeting all style requirements (bold font, title formatting, numbers) is essential.
• Define the number of levels for your dissertation or thesis table of contents. In case you want to have 3 levels, choose Automatic Table 2.
• You are done! Click ok, and here is your page with listed chapters!

You see how easy it can be! Every time you make changes to your text or headings, it will be automatic.

Updating Your Table of Contents in MS Word

Table of contents of a research paper or dissertation is created, and you continue to edit your work until submission. It is common practice, and with MS Word, you can automate all the updates. 

Let’s outline this process in our step-by-step guide!

• Right-click on your ToC in a document.
• Update field section is next.
• Choose “update ToC."
• Here, you can update your entire ToC — choose an option that works the best for you!

As you may see, working with automated solutions is much easier when you write a dissertation which has manifold subsections. That is why it is better to learn how to work on MS Word with the content list meaning be able to manage it effectively.

Table of Contents Examples

From our experience, students used to think that the content list was quite a complicated part of the work. Even with automated solutions, you must be clear about what to include and how to organize formatting. To solve the problem and answer all your questions, use our research paper or dissertation contents page example. Our paper writers designed a sample table of contents to illustrate the best practices and various styles in formatting the work. 

Check our samples to find advanced options for organizing your own list.

Example of Table of Contents in Research Paper

As you can see, this contents page includes sections with different levels.

Thesis/Dissertation Table of Contents Example

Have a question about your specific case? Check samples first, as we are sure you can get almost all the answers in our guides and sample sets. 

>> Read more: APA Format Table of Contents

Tips on Creating a Table of Contents

To finalize all that we shared on creating the table of contents page, let’s go through our tips list. We outline the best advice to help you with a dissertation table of contents.

• Use automated solutions for creating a list of chapters for your report, research papers, or dissertations — it will save you time in the future.
• Be clear with the formatting style you use for the research.
• Choose the best level type of list based on the paper length.
• Update a list after making changes to the text.
• Check the page list before submitting the work.

Bottom Line on Making Table of Contents for Dissertations/ Papers

To summarize, working with a research paper, thesis or dissertation table of contents can be challenging. This article outlines how to create a table of contents in Word and how to update it appropriately. You can learn what to include in the content list, how long it can be, and where to locate it. Write your work using more than one table of contents sample we prepared for students. It is often easy to check how the same list was made for other dissertations before finalizing yours. We encourage you to learn how to create a list with pages automatically and update it. It will definitely make your academic life easier.

Not sure if your work 's quality level is enough for getting a top-notch result? We’ve got you covered! Our team of skilled academic writers is always ready to help once you ask “ write my dissertation for me !" Just select your writer, send them your requirements and get a custom study tailored to your instructions.

Joe Eckel is an expert on Dissertations writing. He makes sure that each student gets precious insights on composing A-grade academic writing.

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Table of Contents Format

For Academic Papers

This table of contents is an essential part of writing a long academic paper, especially theoretical papers.

This article is a part of the guide:

• Outline Examples
• Example of a Paper
• Write a Hypothesis
• Introduction

Browse Full Outline

• 1 Write a Research Paper
• 2 Writing a Paper
• 3.1 Write an Outline
• 3.2 Outline Examples
• 4.1 Thesis Statement
• 4.2 Write a Hypothesis
• 5.2 Abstract
• 5.3 Introduction
• 5.4 Methods
• 5.5 Results
• 5.6 Discussion
• 5.7 Conclusion
• 5.8 Bibliography
• 6.1 Table of Contents
• 6.2 Acknowledgements
• 6.3 Appendix
• 7.1 In Text Citations
• 7.2 Footnotes
• 7.3.1 Floating Blocks
• 7.4 Example of a Paper
• 7.5 Example of a Paper 2
• 7.6.1 Citations
• 7.7.1 Writing Style
• 7.7.2 Citations
• 8.1.1 Sham Peer Review
• 8.1.2 Advantages
• 8.1.3 Disadvantages
• 8.2 Publication Bias
• 8.3.1 Journal Rejection
• 9.1 Article Writing
• 9.2 Ideas for Topics

It is usually not present in shorter research articles, since most empirical papers have similar structure .

A well laid out table of contents allows readers to easily navigate your paper and find the information that they need. Making a table of contents used to be a very long and complicated process, but the vast majority of word-processing programs, such as Microsoft WordTM and Open Office , do all of the hard work for you.

This saves hours of painstaking labor looking through your paper and makes sure that you have picked up on every subsection. If you have been using an outline as a basis for the paper, then you have a head start and the work on the table of contents formatting is already half done.

Whilst going into the exact details of how to make a table of contents in the program lies outside the scope of this article, the Help section included with the word-processing programs gives a useful series of tutorials and trouble-shooting guides.

That said, there are a few easy tips that you can adopt to make the whole process a little easier.

The Importance of Headings

In the word processing programs, there is the option of automatically creating headings and subheadings, using heading 1, heading 2, heading 3 etc on the formatting bar. You should make sure that you get into the habit of doing this as you write the paper, instead of manually changing the font size or using the bold format.

Once you have done this, you can click a button, and the program will do everything for you, laying out the table of contents formatting automatically, based upon all of the headings and subheadings.

In Word, to insert a table of contents, first ensure that the cursor is where you want the table of contents to appear. Once you are happy with this, click 'Insert' on the drop down menu, scroll down to 'Reference,' and then across to 'Index and Tables'.

Click on the 'Table of Contents' tab and you are ready to click OK and go. OpenOffice is a very similar process but, after clicking 'Insert,' you follow 'Indexes and Tables' and 'Indexes and Tables' again.

The table of contents should appear after the title page and after the abstract and keywords, if you use them. As with all academic papers, there may be slight variations from department to department and even from supervisor to supervisor.

Check the preferred table of contents format before you start writing the paper , because changing things retrospectively can be a little more time consuming.

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How to Write a Table of Contents

Last Updated: June 16, 2024 Fact Checked

This article was co-authored by Stephanie Wong Ken, MFA . Stephanie Wong Ken is a writer based in Canada. Stephanie's writing has appeared in Joyland, Catapult, Pithead Chapel, Cosmonaut's Avenue, and other publications. She holds an MFA in Fiction and Creative Writing from Portland State University. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 1,054,509 times.

The Table of Contents in a document acts as a map for the reader, making it easier for them to find information in the document based on title and page number. A good Table of Contents should be organized, easy to read and simple to use. You can write a Table of Contents manually on your computer or have a word processing tool create it for you. Make sure the Table of Contents is formatted properly in your final document so it is as accurate and accessible as possible.

Writing a Table of Contents

To write a simple table of contents, create a new page in your document and type the names of the chapters or sections of your piece of writing. Then, use your word processing program to insert the page number where each section starts. If you move things around, the page number in your table of contents will automatically update.

Sample Tables of Contents

Creating the Table of Contents on a Word Processor

• The Table of Contents should be on its own page. Do not include the introduction or a dedication on the same page as the Table of Contents.

• For example, you may write down main headings like, “Introduction,” “Case Study 1,” or “Conclusion.”

• For example, under the main heading “Introduction” you may write the subheading, “Themes and Concepts.” Or under the main heading “Conclusion” you may write, “Final Analysis.”
• You can also include sub-subheadings underneath the subheadings, if applicable. For example, under the subheading “Themes and Concepts” you may have the sub-subheading, “Identity.”
• Some papers do not have subheadings at all, only main headings. If this is the case, skip this step.

• For example, if the “Introduction” section begins on page 1, you will attach “page 1” to the Introduction heading. If the “Conclusion” section begins on page 45, attach “page 45” to the Conclusion heading.

• Check that the subheadings are located underneath the correct headings, indented to the right.
• Make sure there are page numbers for the subheadings listed as well.
• You can center the content in the table using the table options if you want the content to appear a few spaces away from the lines of the table. You can also leave the content indented to the left if you'd prefer.

• You can put the title above the table or in a separate row on the top of the rest of the content.

Using a Word Processing Tool

• You should also confirm the page numbers are correct in the document. Each page should be numbered in order. Having the correct page numbers will ensure the Table of Contents is created correctly when you use the word processing tool.

• If there are subheadings in your document, label them “Heading 2.” Highlight each subheading and click on “Heading 2” in the Styles tab.
• If there are sub-subheadings in your document, label them “Heading 3.” Highlight each subheading and click on “Heading 3” in the Styles tab.
• The text and font for each main heading may change based on the settings for “Heading 1,” “Heading 2,” and “Heading 3.” You can choose your preferred text and font for each main heading so they appear as you like in the Table of Contents.

• You can choose the built-in Table of Content options, where the tool will automatically choose a font size and style for you.
• You can also go for from a list of custom Table of Contents, where you choose the font color and size based on your preferences.

Polishing the Table of Contents

• You should also check the subheadings or sub-subheadings in the Table of Contents, if applicable, to ensure they match those in the document.

• If you created the Table of Contents manually, do this by going in and adjusting the headings and/or the page numbers when they change.
• If you created the Table of Contents with a word processing tool, update it by clicking the Update option by the Table of Contents option on the Reference tab. You can side clicking on the Table of Contents and choosing “update” that way.

Community Q&A

You Might Also Like

• ↑ https://edu.gcfglobal.org/en/word-tips/how-to-create-a-table-of-contents-in-word/1/#
• ↑ https://examples.yourdictionary.com/reference/examples/table-of-content-examples.html
• ↑ http://bitesizebio.com/21549/using-word-to-write-your-thesis-making-a-table-of-contents-inserting-captions-and-cross-referencing/
• ↑ https://guides.lib.umich.edu/c.php?g=283073&p=1886010
• ↑ https://nsufl.libguides.com/c.php?g=413851&p=2820026

About This Article

To write a table of contents, open a new document and list the major headings, titles, or chapters of the project in chronological order. Next, insert subheadings or subtopics if your project has those. Fill in the page number where each heading starts, then format the content in a table with 2 columns. Place the headings and subheadings in order in the first column, then put the page numbers in the second column. Don't forget to add a "Table of Contents" title at the top of the document! To learn more about polishing your Table of Contents, read on! Did this summary help you? Yes No

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Free Table of Contents Templates (for Microsoft Word)

Whether you are writing a book, large essay, dissertation, or other longer academic papers, you will have to include a table of contents. It will act as a roadmap for the reader to each portion of your writing. It helps the reader to locate specific information in a document or revisit their favorite parts easily within the text. A well-structured TOC should simplify the way the reader finds what they are looking for and should always be placed on a separate page, just after the first page of an academic paper and after the abstract.

Depending on the type of writing, you may find that different documents require different styles of a TOC. Some may require numbers, while others may require a non-numbered TOC. It is, therefore, the writer’s duty to check the type of TOC they are required to include in their writing.

Free Table of Contents Templates

Simple templates

What is a Table of Contents?

A Table of Contents (TOC) is an organized list of all the parts of a document or book organized in the order in which the parts appear.

The TOC usually contains the titles, chapters, figures, and major sections of a document clearly labeled by their page number. It should be added last or updated after completing the whole document or book to capture all the contents accurately.

The Purpose of table of contents

If a book, business proposal , business report , or publication is long enough to include chapters, then a TOC will likely be included at the beginning of the book, report, or publication.

The TOC provides a sequential list of the book’s organizational structure, most commonly denoting the title, chapter number, and the starting page location. The chapter, page number, and title will help guide the reader in finding specific sections.

Basically, it serves two main purposes; one is to provide the reader with a general overview of what is contained in the document and how the content is organized, and the other is to enable the reader to go directly to the specific section of an on-line document.

Key Elements of a Table of Contents

The TOC is where one lists the chapters and major sections of their document, together with their page numbers. A clear and well-out table is very important as it indicates a quality paper is structured.

The key elements that should be included in the TOC are:

• The page titles
• Clear headings and subheadings
• The page numbers that show where in the document each section can be found

When creating your table, make sure to include all level one and two headings. You may also decide to include level three headings, although they are optional to include and should not be included in the TOC has reached its maximum length of two pages.

Level One:   CHAPTER 2: Literature Review

Level Two: 2.1 Overview of Information

Level Three: 2.1.1 Discipline of Knowledge

Ensure that you use clear headings throughout your document to make your table easy to understand. Keep in mind that the reader will see the table first before reading through your document.

Other things to include in your table include the appendices and tables. Including these two, however, depend largely on how many there are in your document.

If there are more than three tables and figures, you might consider listing them on a separate page. Else, you can include them in your table.

Steps to Create a Table of Contents in MS Word

For you to create a TOC in Microsoft Word, you must first define what you’d like to include in this part. First, start off by applying the different heading styles throughout your document.

Once you’ve done that, follow these steps to insert a TOC in MS Word automatically:

Add a title on the TOC page. Ensure that you follow the standard format specific to your document or as per your department’s guidelines.

Put your cursor where you want the table to go. The table is usually included between the abstract and the introduction.

In the ribbon, find the reference section and locate the TOC section. Use the search tab on the ribbon to search for the table.

Click the arrow that is next to the TOC icon and select Custom Table of Contents. Here, select the level of heading that you would like to include in your table and also make the necessary adjustments to each level by clicking the modify button.

Click on Custom table of contents.

After you’ve made sure that everything is OK. Click OK, and your TOC will be automatically generated.

Tips on Preparing Table of Contents

It is recommended that you use your TOC template last after to make sure that it provides a clear overview of your document. You can still draw up a mock TOC in your early stages of writing to help you formulate a structure and think through your topics and how you are going to research.

Make sure that all the heading levels are properly defined in your document before inserting the template.

Remember that the reader will most likely go through your table first before diving into the document to get an overview of what to expect. Make sure that your TOC is clear and that it captures your entire document.

Frequently Asked Questions

No, the TOC is basically a snapshot of the headings, tables, and page numbers in a document and does not automatically update itself as you make changes. Anytime you make changes to your document, you can update it by simply right-clicking on it and selecting the update field.

No, the TOC is usually included between the abstract and the introduction.

Yes, the maximum length of a TOC should be two pages, regardless of the type of document you are writing.

Regardless of your document’s type or size, using a TOC can help direct the readers to exactly where they want to be. Other than making your document more reader-friendly, the table also makes it easier for the author to go back and change or update contents throughout their document if necessary. By default, MS Word generates a TOC when you use the first three built-in heading styles, i.e., Heading 1, Heading 2, and Heading 3. To apply the different heading styles, simply select the style from the “Home” tab, or you can use a TOC template. Once you’ve properly defined the heading styles, follow the procedure given above to insert your table automatically.

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This paper is in the following e-collection/theme issue:

Published on 18.6.2024 in Vol 26 (2024)

Identification of Ethical Issues and Practice Recommendations Regarding the Use of Robotic Coaching Solutions for Older Adults: Narrative Review

Authors of this article:

• Cécilia Palmier 1, 2 * , MSc   ; 
• Anne-Sophie Rigaud 1, 2 * , Prof Dr Med   ; 
• Toshimi Ogawa 3 , PhD   ; 
• Rainer Wieching 4 , Prof Dr   ; 
• Sébastien Dacunha 1, 2 * , MSc   ; 
• Federico Barbarossa 5 , MEng   ; 
• Vera Stara 5 , PhD   ; 
• Roberta Bevilacqua 5 , MSc   ; 
• Maribel Pino 1, 2 * , PhD  

1 Maladie d’Alzheimer, Université de Paris, Paris, France

2 Service de Gériatrie 1 & 2, Hôpital Broca, Assistance Publique - Hôpitaux de Paris, Paris, France

3 Smart-Aging Research Center, Tohoku University, Sendai, Japan

4 Institute for New Media & Information Systems, University of Siegen, Siegen, Germany

5 Scientific Direction, Istituto Nazionale di Ricovero e Cura per Anziani, Ancona, Italy

*these authors contributed equally

Corresponding Author:

Anne-Sophie Rigaud, Prof Dr Med

Service de Gériatrie 1 & 2

Hôpital Broca

Assistance Publique - Hôpitaux de Paris

54 rue Pascal

Paris, 75013

Phone: 33 144083503

Fax:33 144083510

Email: [email protected]

Background: Technological advances in robotics, artificial intelligence, cognitive algorithms, and internet-based coaches have contributed to the development of devices capable of responding to some of the challenges resulting from demographic aging. Numerous studies have explored the use of robotic coaching solutions (RCSs) for supporting healthy behaviors in older adults and have shown their benefits regarding the quality of life and functional independence of older adults at home. However, the use of RCSs by individuals who are potentially vulnerable raises many ethical questions. Establishing an ethical framework to guide the development, use, and evaluation practices regarding RCSs for older adults seems highly pertinent.

Objective: The objective of this paper was to highlight the ethical issues related to the use of RCSs for health care purposes among older adults and draft recommendations for researchers and health care professionals interested in using RCSs for older adults.

Methods: We conducted a narrative review of the literature to identify publications including an analysis of the ethical dimension and recommendations regarding the use of RCSs for older adults. We used a qualitative analysis methodology inspired by a Health Technology Assessment model. We included all article types such as theoretical papers, research studies, and reviews dealing with ethical issues or recommendations for the implementation of these RCSs in a general population, particularly among older adults, in the health care sector and published after 2011 in either English or French. The review was performed between August and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases. Selected publications were analyzed using the European Network of Health Technology Assessment Core Model (version 3.0) around 5 ethical topics: benefit-harm balance, autonomy, privacy, justice and equity, and legislation.

Results: In the 25 publications analyzed, the most cited ethical concerns were the risk of accidents, lack of reliability, loss of control, risk of deception, risk of social isolation, data confidentiality, and liability in case of safety problems. Recommendations included collecting the opinion of target users, collecting their consent, and training professionals in the use of RCSs. Proper data management, anonymization, and encryption appeared to be essential to protect RCS users’ personal data.

Conclusions: Our analysis supports the interest in using RCSs for older adults because of their potential contribution to individuals’ quality of life and well-being. This analysis highlights many ethical issues linked to the use of RCSs for health-related goals. Future studies should consider the organizational consequences of the implementation of RCSs and the influence of cultural and socioeconomic specificities of the context of experimentation. We suggest implementing a scalable ethical and regulatory framework to accompany the development and implementation of RCSs for various aspects related to the technology, individual, or legal aspects.

Introduction

Challenges associated to population aging.

Technological and medical advances have led to a demographic shift in the population, with the number of older adults constantly increasing. According to the United Nations [ 1 ], older adults (aged 60-65 years) will represent 16% of the world’s population in 2050. In addition, life expectancy is increasing, from 64.2 years in 1990 to 72.6 years in 2019, and is expected to reach 77.1 years in 2050 [ 1 ]. However, there is a wide diversity of health conditions among older adults. The health status of older adults is dependent on multiple factors, including nonmodifiable genetic factors and environmental factors, such as lifestyle [ 2 ]. Thus, older adults represent a very heterogeneous population with multiple and diverse needs and desires. With advancing age, the loss of functional independence; frailty; and other health diseases such as cardiovascular problems, cancers, osteoarthritis, osteoporosis, or major neurocognitive disorders may appear [ 3 - 5 ]. Among age-related conditions, major neurocognitive disorders (eg, Alzheimer disease) receive particular attention due to the increasing prevalence of these diseases [ 6 ].

The aging population is not only a public health issue but also a socioeconomic one. To face this challenge, it is important to develop preventive measures to support active and healthy aging and to preserve the independent functioning and quality of life of older adults. The adoption of healthy behaviors can help prevent or delay the onset of pathologies or treat them if detected early [ 7 ].

The Use of Technologies for Older Adults

Preventive health measures can be supported through new technologies, such as robotic coaching solutions (RCSs) that promote healthy aging among older adults [ 8 , 9 ]. RCSs have been defined as personalized systems that continuously monitor the activities and environment of the user and provide them with timely health-related advice and interventions [ 10 - 12 ]. These systems can help users define and achieve different health-oriented goals [ 12 ].

RCSs may encompass artificial intelligence (AI) technologies that can analyze user data, personalize coaching programs, and adapt recommendations based on each individual’s needs [ 1 , 13 - 19 ]. RCSs can involve robots equipped with sensors such as cameras, microphones, or motion sensors to collect real-time data about the user, AI, and programming that enables their interaction with users [ 20 , 21 ]. These technologies are often equipped with voice and visual recognition and learning capabilities [ 20 , 21 ]. They can benefit from advanced natural language processing techniques, which allow for understanding of the user’s input, facilitating natural and effective communication [ 22 ]. RCSs can offer guidance, support, and feedback based on preprogrammed information or real-time data analysis. These data can inform coaching strategies and allow RCSs to provide users with relevant feedback [ 8 ].

RCSs can also encompass a virtual agent, which refers to a computer program or an AI system that interacts with users in a manner that simulates human conversation [ 14 , 18 , 23 ]. A virtual agent is an animated character capable of adopting a social behavior mimicking that of humans to encourage the users to make changes in their habits [ 14 ]. Virtual agents might take the form of a chatbot, voice assistant, or other AI-driven communication system [ 14 ]. Biometric monitoring devices to track physiological data such as heart rate, sleep patterns, or stress levels can also be included in RCSs [ 8 , 20 , 21 ]. These data can contribute to the configuration of personalized coaching plans. RCSs can also encompass advanced data analytics that can process large data sets generated by users’ interactions and behaviors. This functionality helps in identifying patterns, trends, and areas for improvement in coaching strategies [ 24 ]. Integrating Internet-of-Things devices in RCSs can provide additional data points about a user’s environment, lifestyle, or habits, thus contributing to a personalized coaching approach [ 25 ].

Health-oriented RCSs could enable users to lead a healthy lifestyle, by identifying needs and goals and providing appropriate risk predictions and individualized recommendations [ 12 , 26 - 28 ]. There are RCSs dedicated to a particular domain, such as physical activity or motor rehabilitation [ 9 , 16 ]. Others may have the objective of promoting independent and healthy aging [ 29 ].

Promoting active and healthy aging can allow older adults to maintain their independence and continue to live at home [ 4 , 30 ], which is a wish of many [ 3 ]. This intervention could also help to reduce the need for assistance, usually provided by informal caregivers and health professionals [ 4 , 19 , 30 - 33 ]. Furthermore, RCSs could lead to a reduction in individual and collective health care expenses [ 4 , 32 , 34 ] by easing access to health and social care interventions to a wide population, including hard-to-reach (eg, geographically isolated) individuals. However, although the use of health-related RCSs could have many benefits, several ethical issues arise with their development and implementation in human environments [ 3 , 35 - 38 ].

An Ethical Framework for the Use of Technologies for Older Adults

For RCSs to contribute to active and healthy aging, it is important that all the stakeholders (engineers, geriatricians, psychologists, etc) involved in their design and implementation refer to an ethical framework [ 3 , 38 ]. It is also important to inform society (politicians and legal experts) about such an extension of technology in people’s lives (private, professional, medicosocial, and commercial context), so that we can create a legal framework for the use of these technologies. An analysis of the way in which ethical and legal dimensions have been addressed by studies, in the field of RCSs for health care, seems useful to support the key actors in their development and implementation. The growing interest in the ethical questions associated with the use of social and assistive robots is evidenced by the volume of literature reviews [ 3 , 12 , 18 , 31 , 32 , 37 , 39 - 51 ] on the topic.

Now, it appears appropriate to systematically examine this body of work, focusing on the ethical analysis, and provide an overview of the literature. Therefore, we performed a review of the literature on RCSs for older adults using the European Network of Health Technology Assessment (EUnetHTA Core Model; version 3.0) model [ 52 ] for analysis. This Health Technology Assessment (HTA) model makes it possible to assess the intended and unintended consequences of the use of a specific technology regarding multiple domains (eg, technological, ethical, clinical, and organizational), providing methods and concepts for this analysis [ 53 ]. Therefore, HTA is a process that informs decision-making about the introduction of new technologies such as RCSs in health care. It also seems necessary to issue guidelines for the development and implementation of health-oriented RCSs [ 54 ].

The objective of this study was to highlight the main ethical questions and corresponding recommendations linked to the use of RCSs for older adults for engineers, researchers, and health professionals in this field. For this purpose, we conducted a narrative literature review using the ethical dimension of the EUnetHTA Core Model to guide the analysis. To the best of our knowledge, such a study has not been conducted so far.

A thematic analysis of the literature was performed to identify publications that describe RCSs for supporting older adults in health care and prevention and those that address ethical issues and recommendations regarding their development and implementation. The methodology used for the narrative review was inspired by the study by Green et al [ 55 ].

Inclusion and Exclusion Criteria

The review encompassed papers focusing on all populations, with particular attention to older adults. It focused on the concept of RCSs for health, while also incorporating publications discussing other health technologies for older adults if the authors have delved into relevant ethical considerations for their development or implementation.

The context of the review revolved around the use of RCSs (or related technologies), especially for older adults, across diverse living environments such as homes, hospitals, and nursing homes. Publications addressing RCSs and related ethical issues within the health care domain were considered, whereas those focusing solely on technical aspects (eg, AI and deep learning) or those outside the health care domain were excluded.

Various types of publications, including theoretical papers, research studies, and reviews, were included if they offered ethical reflections or recommendations for RCS use in health care. These reflections and recommendations were expected to align with the topics and issues of the ethical dimension of the EUnetHTA Core Model.

All publications, regardless of language (English or French), were eligible if published after 2011. This time frame was chosen considering the technological advancements over the past decade, which may have influenced the evolution of ethical issues and recommendations in the field of remote care systems and related technologies. Textbox 1 summarizes the inclusion and exclusion criteria adopted for the selection of papers in this review.

Inclusion criteria

• Types of participants: all populations
• Interventions or phenomena of interest: RCSs or other technologies used in health care, if ethical issues are discussed
• Context: the use of RCSs in the health care sector
• Paper type: all paper types (theoretical papers, research studies, and reviews) that discuss ethical issues
• Language: English or French
• Date of publication: after 2011

Exclusion criteria

• Types of participants: not applicable
• Interventions or phenomena of interest: RCSs or all other types of technology outside the health care sector
• Context: the use of RCSs in non–health care sectors
• Paper type: papers about RCSs and other technologies that are not dealing with ethical issues
• Language: all other languages
• Date of publication: before 2011

Search Strategy and Study Selection

The review was conducted using the following keywords: “seniors,” “older adults,” “social robots,” “assistive robots,” “assistive technology,” “robots,” “virtual coach,” “e-coaching,” “coaching system,” “coaching device,” “ethics,” and “recommendations.”

The review was performed between August 2021 and December 2021 using the PubMed, CINAHL, Embase, Scopus, Web of Science, IEEE Explore, SpringerLink, and PsycINFO databases.

This search allowed us to find 4928 initial publications. Then, secondary research using references from other articles and the same inclusion criteria was conducted. This search allowed us to find 13 additional papers.

In total, 4943 papers were analyzed. The selection of the final publications was performed after reading the title and abstract first and, then, the full article. This selection process helped us to exclude irrelevant papers and duplicates ( Figure 1 ). In total, 0.51% (25/4943) of the papers were included in our review.

Data Analysis Criteria

The selected papers were analyzed using the ethical domain of the EUnetHTA Core Model [ 52 ]. Proper registration of the use of EUnetHTA Core Model for the purpose of this review was made on the HTA Core Model website [ 52 ].

The model was developed for the production and sharing of HTA information, allowing for the support of evidence-based decision-making in health care, but it can also be customized to other research needs. The EUnetHTA Core Model is composed of 9 domains, each including several topics. Each topic also includes different issues (ie, questions that should be considered for the evaluation of health technologies). Thus, the model is structured into 3 levels: domain (level 1), topic (level 2), and issue (level 3). The combination of a domain, topic, and issue is linked to an assessment element ID, which can be identified using a specific code for standardization purposes (B0001, B0002, etc).

The main EUnetHTA model domains include the following: (1) health and current use of the technology, (2) description and technical characteristics of the technology, (3) safety, (4) clinical effectiveness, (5) costs and economic evaluation, (6) ethical aspects, (7) organizational aspects, (8) patient and social aspects, and (9) legal aspects.

The ethical domain (level 1) in the EUnetHTA Core Model [ 52 ] includes 5 topics (level 2): “benefit-harm balance,” “autonomy,” “respect for people,” “justice and equity,” and “legislation.” Each of these topics includes several issues (level 3) [ 52 ].

In this study, 2 authors (CP and ASR) independently analyzed the 25 selected articles. First, they read the articles several times to improve familiarity with the ideas addressing the ethical aspects of RCSs. Then, in each publication (methods, results, and discussion sections), they identified segments of data that were relevant or captured an idea linked to the “ethical” domain of the model. A subsequent exploration of the coded data (sentences or set of statements) was performed to get a more precise classification at the topic level (level 2) and at the issue level (level 3). Then, the coding was performed using the HTA nomenclature. The 2 experts (CP and ASR) compared their results. In a few cases, the coding results showed a lack of consensus between the 2 coding authors, which was resolved through a subsequent discussion between them. Interrater correlation was not calculated.

A thematic analysis using the EUnetHTA framework for conducting a literature review has been described in other studies [ 56 , 57 ]. Furthermore, the use of EUnetHTA to perform an ethical analysis of health technologies has already been proposed [ 58 ]. The 25 selected articles were all coded using this methodology. Some authors have previously emphasized the possibility of overlapping issues between topics in the HTA analysis. They have suggested to assess the overlapping issues in the most relevant topic section [ 59 ].

This review was not registered, and a protocol for the review was not prepared.

Selected articles are presented in Multimedia Appendix 1 [ 3 , 12 , 18 , 31 , 32 , 37 - 51 , 60 - 64 ]. For each topic, we have presented our findings in terms of questions and recommendations according to the EUnetHTA Core Model, wherever possible.

Ethical Issues and Recommendations for the Use of New Technologies

This section aims to summarize the ethical analysis performed regarding the use of RCSs with older adults and to provide recommendations for ethical use of these devices. Table 1 presents a synthetic summary of the elements presented in this section.

Topic 1: Benefit-Harm Balance

RCSs should be developed according to the principles of beneficence (ie, to promote the interest of users) and nonmaleficence (ie, to avoid inflicting harm) [ 39 , 60 , 64 ].

What Are the Known and Estimated Benefits and Harms for Patients When Implementing or Not Implementing the Technology?

Risk of social isolation.

According to Sharkey and Sharkey [ 50 ], technological devices, when used appropriately, could benefit older adults by promoting social interaction and connection with their loved ones [ 4 , 31 , 40 ]. Broadbent et al [ 19 ] have discussed the potential of robots to reduce older adults’ social isolation. However, other authors reported the negative influence of the use of robotic devices on human contact [ 31 , 32 , 65 ]. The use of robots (eg, telepresence robots) to make some cost savings (eg, reducing travel costs and time spent on trips for family and professionals to visit older adults) would reduce face-to-face interactions [ 3 , 36 , 39 , 40 ]. Moreover, according to Körtner [ 47 ], the more people become accustomed to communicating with robots, the less they will be used to communicating with humans. The use of social robots could lead to a reduction of interactions with humans and thus to social isolation and emotional dependence [ 39 ]. However, the influence of technological devices, such as RCSs, on social isolation is still under debate, and the impact of technology would depend on the manner in which it is used.

To avoid exacerbating the users’ social isolation, Portacolone et al [ 38 ] advocate that social robots and similar technologies should be designed with the objective of fostering interactions with other humans, for instance, keeping users informed about the entertainment and socializing activities near their home, connecting them with their loved ones, and so on.

Risk of Deception

Another major risk for users is deception [ 39 , 64 , 66 ]. Portacolone et al [ 38 ] described 3 types of deception that people with neurocognitive disorders may face when interacting with social robotic systems but which may also apply to all users. The first type involves the user’s misconception of what is driving the technological device [ 51 ]. Users may be misled if they think that behind a medical chatbot, there is a real physician who communicates and reads their messages [ 44 ] or, alternatively, if they are not aware that, at some point, there are real humans guiding the technological device [ 38 ]. The second type refers to robotic devices programmed to express feelings or other types of affective communication, which may lead the user to believe that the system’s emotions are authentic. Related to this issue, Körtner [ 47 ] discussed how some older adults may fear that their social robot will forget them during their absence from home. The resemblance with the living in terms of affective behavior (eg, crying, laughing, or expressing concern) can make the user believe that there is a reciprocity between human and robot feelings [ 43 ]. The last type of deception is related to the inadequate interpretations that older adults may have regarding the nature of the robot, for example, thinking that an animal-shaped robot is a real animal or a pet [ 38 ]. Some current developments of social robots tend to make them resemble a living being, in terms of their verbal and nonverbal behaviors [ 34 , 60 ] or by highly anthropomorphizing their design [ 47 ], which may blur the boundary between the real and the artificial [ 45 , 60 ]. These design choices can also impact users’ dignity by infantilizing them as they are led to believe in something that is false [ 50 ].

However, according to some researchers [ 51 , 63 , 64 ], the notion of deception should be considered in terms of the gradation between what is morally acceptable and what is not. Deception would be morally acceptable when it aims to improve a person’s health or quality of life, for example, the use companion robots to calm a person experiencing behavioral disorders linked to dementia [ 51 ].

According to Danaher [ 43 ] and Vandemeulebroucke et al [ 40 ], to avoid deception, it is essential to be transparent to users about the design and operation of devices. As the information given to the participants is the basis for obtaining consent to use the technology, it is essential to offer them documents explaining how the device is built and its advantages and limitations in a clear manner adapted to the user’s knowledge and experience. It is also important to inform users on how to behave with technology [ 12 ]. Researchers should also answer users’ questions, pay attention to their feedback, and use it to improve the device and its documentation [ 60 ]. During experiments with RCSs, it is also important that researchers regularly remind participants of the nature of the technological device to reduce the risk of misinterpretation and to ensure that they still consent to participate in the study [ 38 ].

Biases of Algorithms

An autonomous device does not work without AI or algorithms that allow it to make decisions. However, these technologies are created by humans, and programming biases can be incorporated into them and lead to failures [ 44 ]. A technological device can, for instance, misread a situation and react accordingly, leading to a safety risk for the user [ 18 ]. Thus, it is essential that the researcher scrutinizes the algorithms used in RCSs before their implementation [ 44 ]. Fiske et al [ 44 ] also suggest providing the users with detailed explanations about the algorithms present in the technological device they are using.

What Are the Benefits and Harms of the Technology for Relatives, Other Patients, Organizations, Commercial Entities, Society, Etc?

At the society level, Boada et al [ 39 ] mentioned an ethical consideration related to the ecological impact of robotic devices in the current context of climate crisis and the lack of natural resources. The construction of RCSs requires raw materials, high energy consumption, and the management of their waste. Therefore, it is important for developers to design technologies that consume less energy and can be recycled.

Are There Any Unintended Consequences of the Technology and Its Application for Patients?

Technologies evolving very quickly.

For some older adults, technologies evolve very quickly, which makes it difficult for them to keep up with [ 62 ]. Denning et al [ 67 ] encourage designers to develop products that are intuitive to use or to offer users a simplified training. However, although some technologies are progressing quickly, technological limitations are still present, especially regarding social robotic systems, impacting their performance [ 68 ] and generating frustration among some users [ 69 ].

Unsuitability of Technology

The lack of experience with the technologies and the fact that the systems are not suitable to everyone can reduce the usability and acceptability of RCSs among older adults [ 3 , 60 , 62 ]. Frennert and Östlund [ 62 ] highlighted that some older adults were not confident in their ability to handle a robot because of previous complicated experience with technology. Peek et al [ 70 ] also reported that users had doubts about their ability to use the technology and feared that they would easily forget how to use it. They may also fear false alarms generated by monitoring technologies. For example, a person may decide to sit on the floor, but this behavior can be considered as a fall by the technology, and it could call for an ambulance to be sent to the person’s home in vain [ 70 ].

To promote acceptability and usability of RCSs, it is essential to develop them considering the capabilities, needs, and wishes of various users [ 31 , 47 ]. “User-centered design” approaches should be used for this purpose [ 71 ]. This methodology must be performed in a continuous manner to consider the development, new preferences, and experiences of the users. Technology assessment should also be conducted before deployment in ecological environments to improve the predictability of RCSs and decrease the risk of confusion and accidents [ 40 , 47 ].

Topic 2: Autonomy

According to Anderson and Kamphorst [ 42 ], the notion of autonomy implies the recognition of people, for instance, users of RCSs, as thinking individuals who have their own perspective on matters and are able to judge what is best for them.

Is the Technology Used for Individuals Who Are Especially Vulnerable?

Free and informed consent is a prerequisite for the involvement of an individual in research, regardless of the domain. This aspect is mentioned in numerous codes and declarations such as the Declaration of Helsinki (1964-2008) [ 72 ]. In the context of studies of the use of RCSs, this principle ensures that the person has freely chosen to use a device. However, some older adults, particularly those with cognitive disorders, may have difficulties in understanding and evaluating information related to RCSs and therefore in making appropriate choices [ 3 ]. Moreover, the person may not remember that the RCS is in their environment or how it works [ 38 , 44 ]. The question of how to ensure that the older adult has understood the purpose of RCS and that their choice of using the technology is based solely on their own decision and not that of a relative, caregiver, or institution has also been discussed [ 46 ].

Researchers in the field of RCS should adapt to the cognitive abilities of the populations they work with to facilitate communication and decision-making [ 46 ]. Thus, the observation of the person’s behavior is necessary to identify potential reservations regarding the use of RCSs. When the person is very vulnerable to respond, informed consent could be sought by proxy such as from children, spouse, or partner [ 46 , 64 ]. However, according to Diaz-Orueta et al [ 37 ], the final decision of using RCSs lies with the user. To prevent loss of capacity and to guard against any risk of inducement to participate, advance directives [ 46 , 64 ] or implementation of an advance power of attorney [ 46 ] can be proposed.

Does the Implementation or Use of the Technology Affect the Patient’s Capability and Possibility to Exercise Autonomy?

Dependence on the technology.

Although the main interest of RCSs for older adults is the maintenance of functional independence, it has been claimed that these devices could make people dependent on them. By replacing users in tasks that they can still perform, the use of RCSs could create new forms of vulnerability [ 3 , 31 , 39 , 41 , 51 ].

People could rely entirely on autonomous technological devices, such as RCSs, to guide their behaviors, goals, and actions [ 12 , 73 ]. A questioning of the authenticity of users’ actions has been mentioned by Anderson and Kamphorst [ 42 ]. Users might not feel responsible for the success of their actions if they feel they are completely driven by the guidance of the RCS. People could also develop emotional and psychological feelings toward the technology. This may have negative consequences for the individuals [ 38 , 49 ] and lead to new vulnerabilities [ 39 ].

Loss of Freedom

Another ethical issue relates to the conflict between the user’s safety, encouraged by the technology guidance, and a loss of freedom. The RCS could impose constraints on the user under the pretext that the user’s actions are not good for them [ 39 , 40 , 74 ]. Sharkey and Sharkey [ 50 ] explained that to promote home care, RCS could act as a supervisor (ie, programmed to ensure that no danger is present and, if there is a danger, to implement procedures to stop it and avoid it in the future). For instance, the RCS could prevent the person from eating fatty and high-caloric food because it is harmful to them. To protect users and ensure that they live in good health, individuals using RCSs could end up being deprived of certain actions or being under some type of “house arrest” [ 50 ].

One of the goals of using such RCSs is to support older adults’ independence; therefore, it is essential that developers and researchers in the field take measures to preserve the person’s autonomy [ 75 ]. Furthermore, RCS users must have the opportunity to evaluate and re-evaluate the role given to the device, to assess whether the system is reliable and whether it is serving their interests [ 12 , 42 ].

Creating a New Source of Authority

The use of RCSs could alter human relationships, for example, by creating tensions between older adults and their informal caregivers. Their use could also create some tensions with health care professionals by creating a new source of authority [ 12 ]. Monitoring older adults through RCSs can generate anger in the user, for example, when the device insists that the older adult should take a medication that they do not want to take [ 41 , 75 ].

Topic 3: Respect for Persons

Does the implementation or use of the technology affect human dignity.

Human dignity may be affected by the use of RCSs as these technologies may be perceived as “problem evocators” [ 41 ]. Some RCSs are used to compensate for impaired capacities. However, according to Körtner [ 47 ], their use can make older adults aware of their limitations and lead to negative feelings, anxiety, or exhaustion. RCS use can also lead to a form of stigmatization by making one’s own inabilities visible to others [ 3 , 70 ]. It is important to have positive communication regarding RCSs, to provide a less stigmatizing view of their use.

Does the Technology Invade the Sphere of Privacy of the Patient or User?

To continue living at home, users are increasingly willing to tolerate intrusion in their privacy [ 70 ], but they are not always aware of when and how they are being monitored by RCSs [ 61 ]. Portacolone et al [ 38 ] provided the example of an animal-shaped companion robot, for which the older adults can signal that they no longer wish to interact with it by putting the robot to sleep. However, the animal-shaped robot can record data even when it is sleeping, but users are not always aware of this information. Forgetfulness and the lack of understanding of the device can lead to the risk of manipulation and coercion [ 44 ]. The person who is vulnerable may forget that they are being monitored and reveal personal information [ 50 ].

Technological devices, such as RCSs, must remain under the control of the users [ 47 ]. Users should have the ability to define when and where the device is used—when it collects data—to maintain their privacy, especially in intimate or private care settings.

Security of Data

According to Portacolone et al [ 38 ], remote monitoring technologies are usually controlled by third parties, sometimes even operating in another country, which can lead to cultural biases during the interaction between the older adult and the RCS. This context involves the risk that the person controlling the device (third party) takes advantage of the older adult’s vulnerability to steal their personal information or exposes the user to financial abuse [ 38 ]. Older adults are not always aware or vigilant about the sharing and use of data, which may be personal and sensitive [ 73 ]. Furthermore, RCSs can be connected to internet services that collect, store, and transfer these sensitive data [ 47 ] for commercial use [ 49 , 61 ].

In addition, the use of technologies connected to digital networks involves the risk of hacking and unauthorized surveillance [ 34 , 51 ], which can make people vulnerable [ 62 ]. Denning et al [ 67 ] found that home robots could not only be remotely located and identified but also hacked and controlled. First, users may have either preconceived and erroneous ideas about the capabilities of the device or a lack of knowledge to evaluate the safety, especially regarding data protection [ 3 ]. Second, users do not always configure their technological device correctly or update them [ 67 ].

Encryption or security systems must be put in place to protect users’ personal data captured by the devices at every stage: during collection, storage, transmission, and processing [ 3 ]. Researchers must also give particular attention to data security. In Europe, for instance, researchers and technology providers are required to comply with the General Data Protection Regulation [ 40 , 76 ]. Data collection must be performed legally or approved by the local relevant ethical committees.

To address data security challenges, 3 principles are recommended by Ienca et al [ 46 ] when developing technological devices: transparency, legitimate purpose, and proportionality. Transparency refers to the fact that the user knows that the system is collecting data and has consented to it. The user must also have precise information about when and what type of data are recorded and who has access to them [ 47 ]. Legitimate purpose refers to the notion that the monitoring and collection of data is performed for a specific purpose, (ie, in the best interest of the user or, if applicable, a relative who has consented to it). Finally, the principle of proportionality refers to the fact that the data collected are not disproportionate to the user’s needs.

Topic 4: Justice and Equity

The consequences of the technology implementation on the distribution of health care resources was discussed in the literature.

How Does Implementation or Withdrawal of the Technology Affect the Distribution of Health Care Resources?

Societal pressure.

Socioeconomic issues are also linked to the development and use of RCSs can also be raised. Individual freedom may be hindered by the “incentive” of certain stakeholders or authorities to enforce the use of RCSs [ 37 ]. The use of RCSs and similar systems may also lead to a lesser involvement of relatives, caregivers, and institutions that provide care to older adults and to the reduction of care costs; these perceived economic benefits may pressurize older adults to consent to use these devices [ 40 , 46 ]. It is also possible that older adults may have to agree to use the technological device to receive other health care benefits (eg, aids and subsidies) [ 42 ].

Digital Divide

Different opportunities to access RCSs can result in digital divide, defined by the Organisation for Economic Cooperation and Development [ 77 ] as a gap between those who have access to information and communication technologies and those who do not. This difference can create educational, economic, social, and even health-related disparities among citizens. Some citizens would be able to use these devices and, therefore, could benefit from their advantages, whereas others will not be able to use them and will not enjoy their benefits. The use of technologies in the health care context, through public or private institutions, should be subject to previous authorization by independent ethical committees to ensure that the use of these devices will not harm users in any way.

Inequalities in Resources

Questions about justice, equity, and equality among all citizens also arise [ 12 , 40 , 46 ]. RCSs have relatively high costs [ 64 ] and can generate additional expenses such as an internet subscription [ 3 ] that only a part of the population can afford, and this may be owing to the lack of research allowing to measure the cost-to-benefit ratio of these technologies on health [ 32 ]. It is important to ensure the access to RCSs among different living areas (ie, urban and rural). Therefore, involving municipalities and neighborhood associations seems an interesting way of raising awareness about the opportunities offered by RCSs for older adults and reaching a wider range of people.

To promote justice, equity, and fair distribution, Ienca et al [ 46 ] and Wangmo et al [ 64 ] recommend reducing the development costs of RCSs by promoting an open dissemination of source codes. In addition, RCSs should be distributed in priority to those in greatest need; therefore, measures to ensure access to RCSs under fair conditions should be established [ 51 ]. Joachim [ 78 ] also suggests to cover some of the costs of these health care–oriented technologies through health insurance.

Recommendations have been published by researchers to improve equality of access to technologies, such as using open-source software, providing priority access for individuals with low income, or relying on certain collective financing systems such as retirement or health insurance [ 46 , 51 , 78 ]. Discussions must be conducted among developers, legislators, and private and public organizations to identify viable financing solutions that allow for fair distribution of RCSs.

Replacement of Professionals

Researchers have also reported fears expressed by older adults and caregivers about how the use of technological devices could eliminate care-related jobs or replace humans [ 17 , 34 , 48 , 61 ]. There are also concerns about the use of these technological tools to reduce health care costs by decreasing the number of available health care resources and services, thereby exacerbating social inequalities [ 44 ]. The introduction of health-oriented RCSs requires adapting the contexts of care practices, which may threaten their quality [ 39 ]. Their incorporation into the care work environment can be difficult because the devices are automated and some care situations are unpredictable [ 17 , 62 ]. Furthermore, the gestion of certain tasks by technological devices requires a restructuring of the roles and responsibilities of caregivers [ 39 ]. Fiske et al [ 44 ] highlight that there are currently no recommendations or training to enable health care professionals to adopt RCSs, even though these professionals are increasingly confronted with technological devices in their practice.

The incorporation of RCSs must always be accompanied by a discussion with concerned care professionals regarding the advantages and limits of the technology. Professionals must also be supported in the use of these devices through effective training. Structured training and supervision will contribute to the development of a controlled framework of practice around the use of RCSs and thus avoid potential abuse [ 44 ]. Moreover, to encourage their use among professionals, it is essential to clearly define the role of RCSs as an additional resource for professionals and not a replacement of human care services [ 44 ].

Topic 5: Legislation

The ethical challenges linked to the lack of existing legislations and regulations dedicated to the use of the technology were discussed in the literature.

Can the Use of the Technology Pose Ethical Challenges That Have Not Been Considered in the Existing Legislations and Regulations?

Safety of devices.

The use of RCSs by older adults can result in damage and harm to their environment [ 79 ], especially when the device is still at the prototype stage [ 47 ]. Safety risks linked to the use of RCSs (eg, malfunctioning of the technology and incorrect decisions made by the coaching system) arise when they share a common space with humans and interact with them [ 39 ]. The following questions must be considered: Who is responsible in case of an accident, and who pays for the damages [ 39 , 40 , 48 , 62 , 80 ]? Is it the designer, the device, or the user himself? Currently, the civil code favors the cascade system (ie, first, the liability falls on the designer of the product; then, on the developer; and finally, on the user who has not followed the rules of use) [ 74 ]. However, the more the machine becomes autonomous, the less the existing legal frameworks can answer these questions [ 80 ]. This is a key legal issue regarding the implementation of RCSs in real settings because the person responsible for damage to the user or the environment may incur legal or even penal proceedings.

Damage and prejudice can also be caused by a failure to share authority [ 45 , 49 , 60 ]. Who between the human and the technological device holds the power to make decisions and control a functionality [ 81 ]? According to Grinbaum et al [ 45 ], it is important to specify the circumstances in which the human must take control over the technological device (RCS) and those in which the device should decide autonomously. According to Riek and Howard [ 49 ], it is preferable that in certain cases, the technological device, although autonomous, requires a human validation of its actions to keep the user in control of the device. In addition, Bensoussan and Puigmal [ 80 ] suggested the idea that technological devices must have an emergency stop button, so that the human can switch off the technology at any time.

Regulation of Technology

Currently, there is a gray area between the capabilities of RCSs, the reality of the field, and the regulations in force [ 38 ]. To accompany the researcher during the whole process of development and diffusion of RCSs, an ethical framework should be established [ 18 , 60 ]. Specifically, this can be in the form of an ethical code of conduct illustrating the expectations to all the employees of a company [ 18 ]. The researcher must regularly inform themselves about the ethics to be consistent with the evolution of the regulatory framework [ 60 ]. However, according to Nevejans [ 82 ], these ethical recommendations have no legal value and cannot protect humans from the damage caused by new technologies. Thus, it is necessary to think about a new legal framework to protect the users of RCSs [ 37 ].

The use of technologies, such as RCSs, in the health care field has grown significantly in recent years [ 17 , 18 ]. RCSs are increasingly being used for older adults with the aim of promoting healthy behaviors, quality of life, and well-being. However, the use of RCSs also raises several ethical challenges regarding the cost-to-benefit balance of these new care practices, respect for the autonomy of users, respect for privacy, justice and equity linked to their access, or need for a suitable legal framework. Such challenges could be addressed by establishing relevant recommendations for the development and use of RCSs. Some guidelines regarding the use of robotic systems have been published [ 49 , 83 ]. Moreover, in April 2021, the European Commission unveiled the first legal framework about AI [ 84 ]. However, to the best of our knowledge, no recommendations have been proposed in this field directly linked to an analysis of the literature dealing specifically with these ethical issues and potential solutions to address them.

This narrative review identified 25 articles in which authors highlighted ethical issues and recommendations related to the use of RCSs and similar technologies. The use of the EUnetHTA Core Model for the analysis of these articles made it possible to classify the information retrieved in the publications according to 5 main ethical topics—“benefit-harm balance,” “autonomy,” “respect for persons,” “justice and equity,” and “legislation”—and to provide a detailed analysis of RCS-related ethical issues. Our review also aimed to identify recommendations for better development, diffusion, and use of RCSs by a population of older adults.

Technology devices, such as RCSs, are used with older adults to enable them to live independently; to enhance their quality of life and well-being; and, therefore, to cope with the increasing care demands for older populations. RCSs may be used to encourage a range of health-related goals: physical, cognitive, nutritional, social, and emotional domains. To be effective, RCSs must be able to motivate the user by providing highly personalized care programs [ 85 , 86 ]. However, studies have shown that not all potential target users are included in the development of these devices [ 37 , 87 , 88 ]. Therefore, RCSs design might fail to meet a wide range of users’ needs, capabilities, and wishes. Thus, it is essential to apply “user-centered design” approaches and involve target users with various sociodemographic characteristics and technology experience throughout the development process. A strong involvement of the intended users of these systems in their design process would also improve the quality of the information provided to potential users of RCSs regarding their operation, type of data collected, and potential benefits of the technology. In this way, the involvement of the users would improve the quality of the process of obtaining the consent required from older adults to use the technology.

Another ethical challenge related to the use of RCSs is the fact that their wide implementation for older adults’ care may affect the distribution of health care resources. For instance, it has been found that for some older adults and informal and formal caregivers, the use of RCSs could replace humans in many caregiving tasks, eventually leading to a suppression of jobs or to a degradation of the quality of health care services [ 17 , 34 , 48 , 61 ]. In this regard, the participation of a third person (professional, volunteer, or family member) as a “human coach” could be considered when implementing RCSs in the older adults’ environment. This “human coach” could help build a “chain of trust” by being an intermediary between the RCS and the user. On the one hand, the involvement of a real person in the use of the RCS could reduce the risk of replacement of human assistance by technological assistance. On the other hand, the “human coach” could help enhance the acceptability and usability of the device, while at the same time, reassuring the user and providing recommendations to the developers, so that the RCS is consistent with users’ needs and desires. However, the benefits of involving a “human coach” in the RCS service provision has yet to be evaluated by scientific studies.

According to some studies [ 3 , 39 , 41 , 51 , 65 ], the use of RCSs can have an impact on social relationships, reducing human contact and even altering social relationships by creating tension between older adults and their caregivers. Thus, it would be interesting to identify the repercussions and implications of these devices in older adults’ daily life and in the life of the members of their social environment through new studies. It also seems necessary to evaluate the organizational impact of the implementation of RCSs and to identify potential obstacles to their use in the care professionals’ work context.

Our analysis also confirmed that for RCSs to provide personalized health-related recommendations, the collection of sensitive data is necessary. Data collection in this context also raises several ethical issues. For instance, personal data can be exposed to hacking and misuse. Proper data management, anonymization, and encryption are essential to protect the personal data of RCS users [ 86 ]. In addition, researchers and developers in this field must evaluate RCSs before implementation to ensure that they do not cause physical or moral harm to users. Thus, it has been suggested that stakeholders refer to local and regional regulatory and safety standards to guide their development and use.

Finally, our analysis also discussed how legal and ethical frameworks regarding the use of RCSs need to be adapted to cope with the constant development of new technologies. So far, existing legal frameworks are not yet adequate to respond effectively to the question of liability in case of damage caused by RCSs, particularly because these devices are becoming increasingly autonomous [ 80 ]. The establishment of “operational ethics committees in digital sciences and technologies” could help in the development and conduct of projects in this area [ 60 ]. Guidelines should be established to identify the types of applications and technological devices that require regulatory review and approval [ 44 ]. Research projects and working groups involving users, researchers, and lawyers should be set up to further investigate the legal and ethical issues related to the use of RCSs.

Some countries and regions, such as Europe and Japan have initiated the work of structuring relevant legal and ethical frameworks; however, their orientations and measures may differ culturally [ 78 ]. Future studies in the area of RCSs could consider the influence of cultural and socioeconomic specificities of the contexts of experimentation (countries and regions) regarding the acceptance and use of RCSs by older adults and formal and informal caregivers and regarding the definition of ethical and legal frameworks governing their uses. Therefore, the use of validated and widely applied analysis frameworks, for example, the Western, Educated, Industrialized, Rich and Democratic framework [ 89 ], formulated to measure countries’ commonalities in their approaches to the interpretation of behavioral research findings (eg, regarding technology adoption) could be interesting. The Western, Educated, Industrialized, Rich and Democratic framework [ 89 ] could help not only to explore the differences among countries regarding the validation and adoption of new technologies for older adult care but also to seek greater cultural and demographic diversity in technology research.

This dimension of cross-cultural comparison has received particular attention in the framework of a current international research partnership between Europe and Japan, such as the EU-Japan Virtual Coach for Smart Ageing (e-VITA) project. This project aims to develop a cross-cultural RCS that can be tailored to the needs of healthy older adults to promote aging well. The e-VITA RCS will be made available to older adults in their homes, which raises many of the ethical questions discussed in this paper. Therefore, the study will require the researchers to set up procedures adapted not only to the users but also to the 2 cultures (European and Japanese), respecting the corresponding ethical and legal regulations. Thus, it would be interesting to perform an analysis of the ethical issues raised by users from different countries and cultures within the framework of the e-VITA project.

Limitations

A narrative review of the literature was conducted to provide a nonexhaustive synthesis of the various ethical concerns and recommendations when using RCSs for older adults. This review has some limitations. Only articles in French and English were included. Some articles indicating ethical concerns or recommendations may not have been included when this information was not mentioned in the keywords or abstract.

Conclusions

The use of RCSs in the context of health care, particularly with an older adult population, tends to show many benefits. RCSs have the potential to improve the quality of life of older adults and their independence. When used in an ethical and appropriate manner, RCSs can help improve older adults’ emotions and cognitive and physical abilities and promote social relationships. By helping older adults to continue living at home for as long as possible, the use of health-oriented RCSs could help to address some of the challenges resulting from demographic aging. However, the use of these new health care technologies involves some ethical concerns, with the most cited issues being not only the risk of accidents, lack of reliability, loss of control, risk of deception, and risk of social isolation but also the confidentiality of data and liability in case of safety problems.

Some recommendations have been made in the past regarding the use of social and assistive robotic technologies for older adults, such as considering the opinion of target users; collecting their consent; training the care professionals to use them; and ensuring proper data management, anonymization, and encryption. However, the integration of RCSs in current health practices and, particularly, in the private homes of older adults can be disruptive. It requires the establishment of scalable and adapted ethical and regulatory frameworks that follow the technology progress and the social and digital change of society Thus, studies are needed to identify new ethical concerns arising from the organizational impact of the implementation of RCSs in different contexts, especially in the homes of older adults. The influence of cultural and socioeconomic specificities of the contexts of experimentation (countries and regions) regarding the acceptance and use of RCSs by older adults and formal and informal caregivers is also an area of interest for future studies.

Acknowledgments

This paper is a part of the EU-Japan Virtual Coach for Smart Ageing (e-VITA) project, which aims to develop a robotic coaching system for older adults [ 90 ]. The authors thank the collaborators who made this project possible: European Commission and Assistance Publique–Hôpitaux de Paris (Délégation à la Recherche Clinique et à l’Innovation). This review was based on data collected within the e-Vita project, funded by the European Union H2020 Program (grant 101016453) and the Japanese Ministry of Internal Affairs and Communication (Ministry of Internal Affairs and Communication; grant JPJ000595).

Data Availability

Data sharing is not applicable to this paper as no data sets were generated or analyzed during this review.

Conflicts of Interest

None declared.

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Abbreviations

Edited by A Mavragani; submitted 12.04.23; peer-reviewed by J Sedlakova, S Liu; comments to author 20.08.23; revised version received 22.12.23; accepted 12.03.24; published 18.06.24.

©Cécilia Palmier, Anne-Sophie Rigaud, Toshimi Ogawa, Rainer Wieching, Sébastien Dacunha, Federico Barbarossa, Vera Stara, Roberta Bevilacqua, Maribel Pino. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 18.06.2024.

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