pubmed research problem statement

The Research Problem & Statement

What they are & how to write them (with examples)

By: Derek Jansen (MBA) | Expert Reviewed By: Eunice Rautenbach (DTech) | March 2023

If you’re new to academic research, you’re bound to encounter the concept of a “ research problem ” or “ problem statement ” fairly early in your learning journey. Having a good research problem is essential, as it provides a foundation for developing high-quality research, from relatively small research papers to a full-length PhD dissertations and theses.

In this post, we’ll unpack what a research problem is and how it’s related to a problem statement . We’ll also share some examples and provide a step-by-step process you can follow to identify and evaluate study-worthy research problems for your own project.

Overview: Research Problem 101

What is a research problem.

• What is a problem statement?

Where do research problems come from?

• How to find a suitable research problem
• Key takeaways

A research problem is, at the simplest level, the core issue that a study will try to solve or (at least) examine. In other words, it’s an explicit declaration about the problem that your dissertation, thesis or research paper will address. More technically, it identifies the research gap that the study will attempt to fill (more on that later).

Let’s look at an example to make the research problem a little more tangible.

To justify a hypothetical study, you might argue that there’s currently a lack of research regarding the challenges experienced by first-generation college students when writing their dissertations [ PROBLEM ] . As a result, these students struggle to successfully complete their dissertations, leading to higher-than-average dropout rates [ CONSEQUENCE ]. Therefore, your study will aim to address this lack of research – i.e., this research problem [ SOLUTION ].

A research problem can be theoretical in nature, focusing on an area of academic research that is lacking in some way. Alternatively, a research problem can be more applied in nature, focused on finding a practical solution to an established problem within an industry or an organisation. In other words, theoretical research problems are motivated by the desire to grow the overall body of knowledge , while applied research problems are motivated by the need to find practical solutions to current real-world problems (such as the one in the example above).

As you can probably see, the research problem acts as the driving force behind any study , as it directly shapes the research aims, objectives and research questions , as well as the research approach. Therefore, it’s really important to develop a very clearly articulated research problem before you even start your research proposal . A vague research problem will lead to unfocused, potentially conflicting research aims, objectives and research questions .

What is a research problem statement?

As the name suggests, a problem statement (within a research context, at least) is an explicit statement that clearly and concisely articulates the specific research problem your study will address. While your research problem can span over multiple paragraphs, your problem statement should be brief , ideally no longer than one paragraph . Importantly, it must clearly state what the problem is (whether theoretical or practical in nature) and how the study will address it.

Here’s an example of a statement of the problem in a research context:

Rural communities across Ghana lack access to clean water, leading to high rates of waterborne illnesses and infant mortality. Despite this, there is little research investigating the effectiveness of community-led water supply projects within the Ghanaian context. Therefore, this study aims to investigate the effectiveness of such projects in improving access to clean water and reducing rates of waterborne illnesses in these communities.

As you can see, this problem statement clearly and concisely identifies the issue that needs to be addressed (i.e., a lack of research regarding the effectiveness of community-led water supply projects) and the research question that the study aims to answer (i.e., are community-led water supply projects effective in reducing waterborne illnesses?), all within one short paragraph.

Need a helping hand?

Wherever there is a lack of well-established and agreed-upon academic literature , there is an opportunity for research problems to arise, since there is a paucity of (credible) knowledge. In other words, research problems are derived from research gaps . These gaps can arise from various sources, including the emergence of new frontiers or new contexts, as well as disagreements within the existing research.

Let’s look at each of these scenarios:

New frontiers – new technologies, discoveries or breakthroughs can open up entirely new frontiers where there is very little existing research, thereby creating fresh research gaps. For example, as generative AI technology became accessible to the general public in 2023, the full implications and knock-on effects of this were (or perhaps, still are) largely unknown and therefore present multiple avenues for researchers to explore.

New contexts – very often, existing research tends to be concentrated on specific contexts and geographies. Therefore, even within well-studied fields, there is often a lack of research within niche contexts. For example, just because a study finds certain results within a western context doesn’t mean that it would necessarily find the same within an eastern context. If there’s reason to believe that results may vary across these geographies, a potential research gap emerges.

Disagreements – within many areas of existing research, there are (quite naturally) conflicting views between researchers, where each side presents strong points that pull in opposing directions. In such cases, it’s still somewhat uncertain as to which viewpoint (if any) is more accurate. As a result, there is room for further research in an attempt to “settle” the debate.

Of course, many other potential scenarios can give rise to research gaps, and consequently, research problems, but these common ones are a useful starting point. If you’re interested in research gaps, you can learn more here .

How to find a research problem

Given that research problems flow from research gaps , finding a strong research problem for your research project means that you’ll need to first identify a clear research gap. Below, we’ll present a four-step process to help you find and evaluate potential research problems.

If you’ve read our other articles about finding a research topic , you’ll find the process below very familiar as the research problem is the foundation of any study . In other words, finding a research problem is much the same as finding a research topic.

Step 1 – Identify your area of interest

Naturally, the starting point is to first identify a general area of interest . Chances are you already have something in mind, but if not, have a look at past dissertations and theses within your institution to get some inspiration. These present a goldmine of information as they’ll not only give you ideas for your own research, but they’ll also help you see exactly what the norms and expectations are for these types of projects.

At this stage, you don’t need to get super specific. The objective is simply to identify a couple of potential research areas that interest you. For example, if you’re undertaking research as part of a business degree, you may be interested in social media marketing strategies for small businesses, leadership strategies for multinational companies, etc.

Depending on the type of project you’re undertaking, there may also be restrictions or requirements regarding what topic areas you’re allowed to investigate, what type of methodology you can utilise, etc. So, be sure to first familiarise yourself with your institution’s specific requirements and keep these front of mind as you explore potential research ideas.

Step 2 – Review the literature and develop a shortlist

Once you’ve decided on an area that interests you, it’s time to sink your teeth into the literature . In other words, you’ll need to familiarise yourself with the existing research regarding your interest area. Google Scholar is a good starting point for this, as you can simply enter a few keywords and quickly get a feel for what’s out there. Keep an eye out for recent literature reviews and systematic review-type journal articles, as these will provide a good overview of the current state of research.

At this stage, you don’t need to read every journal article from start to finish . A good strategy is to pay attention to the abstract, intro and conclusion , as together these provide a snapshot of the key takeaways. As you work your way through the literature, keep an eye out for what’s missing – in other words, what questions does the current research not answer adequately (or at all)? Importantly, pay attention to the section titled “ further research is needed ”, typically found towards the very end of each journal article. This section will specifically outline potential research gaps that you can explore, based on the current state of knowledge (provided the article you’re looking at is recent).

Take the time to engage with the literature and develop a big-picture understanding of the current state of knowledge. Reviewing the literature takes time and is an iterative process , but it’s an essential part of the research process, so don’t cut corners at this stage.

As you work through the review process, take note of any potential research gaps that are of interest to you. From there, develop a shortlist of potential research gaps (and resultant research problems) – ideally 3 – 5 options that interest you.

Step 3 – Evaluate your potential options

Once you’ve developed your shortlist, you’ll need to evaluate your options to identify a winner. There are many potential evaluation criteria that you can use, but we’ll outline three common ones here: value, practicality and personal appeal.

Value – a good research problem needs to create value when successfully addressed. Ask yourself:

• Who will this study benefit (e.g., practitioners, researchers, academia)?
• How will it benefit them specifically?
• How much will it benefit them?

Practicality – a good research problem needs to be manageable in light of your resources. Ask yourself:

• What data will I need access to?
• What knowledge and skills will I need to undertake the analysis?
• What equipment or software will I need to process and/or analyse the data?
• How much time will I need?
• What costs might I incur?

Personal appeal – a research project is a commitment, so the research problem that you choose needs to be genuinely attractive and interesting to you. Ask yourself:

• How appealing is the prospect of solving this research problem (on a scale of 1 – 10)?
• Why, specifically, is it attractive (or unattractive) to me?
• Does the research align with my longer-term goals (e.g., career goals, educational path, etc)?

Depending on how many potential options you have, you may want to consider creating a spreadsheet where you numerically rate each of the options in terms of these criteria. Remember to also include any criteria specified by your institution . From there, tally up the numbers and pick a winner.

Step 4 – Craft your problem statement

Once you’ve selected your research problem, the final step is to craft a problem statement. Remember, your problem statement needs to be a concise outline of what the core issue is and how your study will address it. Aim to fit this within one paragraph – don’t waffle on. Have a look at the problem statement example we mentioned earlier if you need some inspiration.

Key Takeaways

We’ve covered a lot of ground. Let’s do a quick recap of the key takeaways:

• A research problem is an explanation of the issue that your study will try to solve. This explanation needs to highlight the problem , the consequence and the solution or response.
• A problem statement is a clear and concise summary of the research problem , typically contained within one paragraph.
• Research problems emerge from research gaps , which themselves can emerge from multiple potential sources, including new frontiers, new contexts or disagreements within the existing literature.
• To find a research problem, you need to first identify your area of interest , then review the literature and develop a shortlist, after which you’ll evaluate your options, select a winner and craft a problem statement .

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

You Might Also Like:

I APPRECIATE YOUR CONCISE AND MIND-CAPTIVATING INSIGHTS ON THE STATEMENT OF PROBLEMS. PLEASE I STILL NEED SOME SAMPLES RELATED TO SUICIDES.

Very pleased and appreciate clear information.

Your videos and information have been a life saver for me throughout my dissertation journey. I wish I’d discovered them sooner. Thank you!

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

• Research Process

What is a Problem Statement? [with examples]

• 5 minute read
• 990.1K views

Table of Contents

The statement of the problem is one of the first things that a colleague or potential client will read. With the vastness of the information available at one’s fingertips in the online9 world, your work may have just a few seconds to draw in a reader to take a deeper look at your proposal before moving on to the next option. It explains quickly to the reader, the problem at hand, the need for research, and how you intend to do it.

A strong, clear description of the problem that drew you to your research has to be straightforward, easy to read and, most important, relevant. Why do you care about this problem? How can solving this problem impact the world? The problem statement is your opportunity to explain why you care and what you propose to do in the way of researching the problem.

A problem statement is an explanation in research that describes the issue that is in need of study . What problem is the research attempting to address? Having a Problem Statement allows the reader to quickly understand the purpose and intent of the research. The importance of writing your research proposal cannot be stressed enough. Check for more information on Writing a Scientific Research Project Proposal .

It is expected to be brief and concise , and should not include the findings of the research or detailed data . The average length of a research statement is generally about one page . It is going to define the problem, which can be thought of as a gap in the information base. There may be several solutions to this gap or lack of information, but that is not the concern of the problem statement. Its purpose is to summarize the current information and where a lack of knowledge may be presenting a problem that needs to be investigated .

The purpose of the problem statement is to identify the issue that is a concern and focus it in a way that allows it to be studied in a systematic way . It defines the problem and proposes a way to research a solution, or demonstrates why further information is needed in order for a solution to become possible.

What is Included in a Problem Statement?

Besides identifying the gap of understanding or the weakness of necessary data, it is important to explain the significance of this lack.

-How will your research contribute to the existing knowledge base in your field of study?

-How is it significant?

-Why does it matter?

Not all problems have only one solution so demonstrating the need for additional research can also be included in your problem statement. Once you identify the problem and the need for a solution, or for further study, then you can show how you intend to collect the needed data and present it.

How to Write a Statement of Problem in Research Proposal

It is helpful to begin with your goal. What do you see as the achievable goal if the problem you outline is solved? How will the proposed research theoretically change anything? What are the potential outcomes?

Then you can discuss how the problem prevents the ability to reach your realistic and achievable solution. It is what stands in the way of changing an issue for the better. Talk about the present state of affairs and how the problem impacts a person’s life, for example.

It’s helpful at this point to generally layout the present knowledge and understanding of the subject at hand, before then describing the gaps of knowledge that are currently in need of study. Your problem statement is a proposed solution to address one of these gaps.

A good problem statement will also layout the repercussions of leaving the problem as it currently stands. What is the significance of not addressing this problem? What are the possible future outcomes?

Example of Problem Statement in Research Proposal

If, for example , you intended to research the effect of vitamin D supplementation on the immune system , you would begin with a review of the current knowledge of vitamin D’s known function in relation to the immune system and how a deficiency of it impacts a person’s defenses.

You would describe the ideal environment in the body when there is a sufficient level of vitamin D. Then, begin to identify the problems associated with vitamin D deficiency and the difficulty of raising the level through supplementation, along with the consequences of that deficiency. Here you are beginning to identify the problem of a common deficiency and the current difficulty of increasing the level of vitamin D in the blood.

At this stage, you may begin to identify the problem and narrow it down in a way that is practical to a research project. Perhaps you are proposing a novel way of introducing Vitamin D in a way that allows for better absorption by the gut, or in a combination with another product that increases its level in the blood.

Describe the way your research in this area will contribute to the knowledge base on how to increase levels of vitamin D in a specific group of subjects, perhaps menopausal women with breast cancer. The research proposal is then described in practical terms.

How to write a problem statement in research?

Problem statements differ depending on the type and topic of research and vary between a few sentences to a few paragraphs.

However, the problem statement should not drag on needlessly. Despite the absence of a fixed format, a good research problem statement usually consists of three main parts:

Context: This section explains the background for your research. It identifies the problem and describes an ideal scenario that could exist in the absence of the problem. It also includes any past attempts and shortcomings at solving the problem.

Significance: This section defines how the problem prevents the ideal scenario from being achieved, including its negative impacts on the society or field of research. It should include who will be the most affected by a solution to the problem, the relevance of the study that you are proposing, and how it can contribute to the existing body of research.

Solution: This section describes the aim and objectives of your research, and your solution to overcome the problem. Finally, it need not focus on the perfect solution, but rather on addressing a realistic goal to move closer to the ideal scenario.

Here is a cheat sheet to help you with formulating a good problem statement.

1. Begin with a clear indication that the problem statement is going to be discussed next. You can start with a generic sentence like, “The problem that this study addresses…” This will inform your readers of what to expect next.

2. Next, mention the consequences of not solving the problem . You can touch upon who is or will be affected if the problem continues, and how.

3. Conclude with indicating the type of research /information that is needed to solve the problem. Be sure to reference authors who may have suggested the necessity of such research.

This will then directly lead to your proposed research objective and workplan and how that is expected to solve the problem i.e., close the research gap.

Language Editing Plus

Elsevier Language Editing Plus service will provide you with a thorough language review of your thesis, article or presentation. It offers review of logic and flow, reference checks, document formatting, a customized cover letter and more.

• Manuscript Preparation

What is and How to Write a Good Hypothesis in Research?

How to Use Tables and Figures effectively in Research Papers

You may also like.

Descriptive Research Design and Its Myriad Uses

Five Common Mistakes to Avoid When Writing a Biomedical Research Paper

Making Technical Writing in Environmental Engineering Accessible

To Err is Not Human: The Dangers of AI-assisted Academic Writing

When Data Speak, Listen: Importance of Data Collection and Analysis Methods

Choosing the Right Research Methodology: A Guide for Researchers

Why is data validation important in research?

Writing a good review article

Input your search keywords and press Enter.

Research Problem and Questions

• First Online: 20 September 2022

Cite this chapter

• Habeeb Adewale Ajimotokan 2  

Part of the book series: SpringerBriefs in Applied Sciences and Technology ((BRIEFSAPPLSCIENCES))

987 Accesses

The objectives of this chapter are to

Describe the research problem and questions;

Identify appropriate research problems and questions;

Specify the different sources for research problems;

Enumerate the criteria for selecting a problem for research; and

Describe the statement of problem.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Kothari, C. R. (2004). Research methodology: Methods and techniques . New Age International (P) Ltd.

Google Scholar  

Walliman, N. (2011). Research methods: The basics . Routledge—Taylor and Francis Group.

Pandey, P., & Pandey, M. M. (2015). Research methodology: Methods and techniques . Bridge Center.

Walliman, N. (2011). Your research project: Designing and planning your work . Sage Publications Ltd.

Download references

Author information

Authors and affiliations.

Department of Mechanical Engineering, University of Ilorin, Ilorin, Nigeria

Habeeb Adewale Ajimotokan

You can also search for this author in PubMed   Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Ajimotokan, H.A. (2023). Research Problem and Questions. In: Research Techniques. SpringerBriefs in Applied Sciences and Technology. Springer, Cham. https://doi.org/10.1007/978-3-031-13109-7_2

Download citation

DOI : https://doi.org/10.1007/978-3-031-13109-7_2

Published : 20 September 2022

Publisher Name : Springer, Cham

Print ISBN : 978-3-031-13108-0

Online ISBN : 978-3-031-13109-7

eBook Packages : Engineering Engineering (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Literature Searching

In this guide.

• Introduction
• Steps for searching the literature in PubMed
• Step 1 - Formulate a search question
• Step 2- Identify primary concepts and gather synonyms
• Step 3 - Locate subject headings (MeSH)
• Step 4 - Combine concepts using Boolean operators
• Step 5 - Refine search terms and search in PubMed
• Step 6 - Apply limits

Steps for Searching the Literature

Searching is an iterative process and often requires re-evaluation and testing by adding or changing keywords and the ways they relate to each other. To guide your search development, you can follow the search steps below. For more information on each step, navigate to its matching tab on the right menu. 

1. Formulate a clear, well-defined, answerable search question

Generally, the basic literature search process begins with formulating a clear, well-defined research question. Asking the right research question is essential to creating an effective search. Your research question(s) must be well-defined and answerable. If the question is too broad, your search will yield more information than you can possibly look through.

2. Identify primary concepts and gather synonyms

Your research question will also help identify the primary search concepts. This will allow you to think about how you want the concepts to relate to each other. Since different authors use different terminology to refer to the same concept, you will need to gather synonyms and all the ways authors might express them. However, it is important to balance the terms so that the synonyms do not go beyond the scope of how you've defined them.

3. Locate subject headings (MeSH)

Subject databases like PubMed use 'controlled vocabularies' made up of subject headings that are preassigned to indexed articles that share a similar topic. These subject headings are organized hierarchically within a family tree of broader and narrower concepts. In PubMed and MEDLINE, the subject headings are called Medical Subject Headings (MeSH). By including MeSH terms in your search, you will not have to think about word variations, word endings, plural or singular forms, or synonyms. Some topics or concepts may even have more than one appropriate MeSH term. There are also times when a topic or concept may not have a MeSH term. 

4. Combine concepts using Boolean operators AND/OR

Once you have identified your search concepts, synonyms, and MeSH terms, you'll need to put them together using nesting and Boolean operators (e.g. AND, OR, NOT). Nesting uses parentheses to put search terms into groups. Boolean operators are used to combine similar and different concepts into one query. 

5. Refine search terms and search in PubMed

There are various database search tactics you can use, such as field tags to limit the search to certain fields, quotation marks for phrase searching, and proximity operators to search a number of spaces between terms to refine your search terms. The constructed search string is ready to be pasted into PubMed. 

6. Apply limits (optional)

If you're getting too many results, you can further refine your search results by using limits on the left box of the results page. Limits allow you to narrow your search by a number of facets such as year, journal name, article type, language, age, etc. 

Depending on the nature of the literature review, the complexity and comprehensiveness of the search strategies and the choice of databases can be different. Please contact the Lane Librarians if you have any questions. 

The type of information you gather is influenced by the type of information source or database you select to search. Bibliographic databases contain references to published literature, such as journal articles, conference abstracts, books, reports, government and legal publications, and patents. Literature reviews typically synthesis indexed, peer-reviewed articles (i.e. works that generally represent the latest original research and have undergone rigorous expert screening before publication), and gray literature (i.e. materials not formally published by commercial publishers or peer-reviewed journals). PubMed offers a breadth of health sciences literature and is a good starting point to locate journal articles.

What is PubMed?

PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. Available to the public online since 1996, PubMed was developed and is maintained by the  National Center for Biotechnology Information (NCBI) , at the  U.S. National Library of Medicine (NLM) , located at the  National Institutes of Health (NIH) .

MEDLINE is the National Library of Medicine’s (NLM) premier bibliographic database that contains more than 27 million references to journal articles from more than 5,200 worldwide journals in life sciences with a concentration on biomedicine. The Literature Selection Technica Review Committee (LSTRC) reviews and selects journals for MEDLINE based on the research quality and impact of the journals. A distinctive feature of MEDLINE is that the records are indexed with NLM  Medical Subject Headings  (MeSH).

PubMed also contains citations for  PubMed Central (PMC)  articles. PMC is a full-text archive that includes articles from journals reviewed and selected by NLM for archiving (current and historical), as well as individual articles collected for archiving in compliance with funder policies.  PubMed allows users to search keywords in the bibliographic data, but not the full text of the PMC articles.

How to Access PubMed?

To access PubMed, go to the Lane Library homepage and click PubMed in "Top Resources" on the left. This PubMed link is coded with Find Fulltext @ Lane Library Stanford that links you to Lane's full-text articles online. 

• << Previous: Introduction
• Next: Step 1 - Formulate a search question >>
• Last Updated: Jan 9, 2024 10:30 AM
• URL: https://laneguides.stanford.edu/LitSearch

Reference management. Clean and simple.

How to write a problem statement

What is a problem statement?

Why write a problem statement, when are problem statements commonly written, how do i write a problem statement, the format of a problem statement, the trademarks of a good problem statement, an example of a problem statement, frequently asked questions about problem statements, related articles.

A problem statement is a clear and concise description of the problem or issue a team aims to address in a project.

A problem statement identifies a problem’s current state, desired future state, and the gaps that lie between the two. It doesn't define the solution to the problem or provide a road map for solving the problem; it only gives an outline of what the problem is.

However, the researcher or team can later use the problem statement to validate that their work delivered an outcome that resulted in the solution.

A problem statement is a useful communication tool, as it keeps the whole team on track and tells them why the project is important. A problem statement helps someone to define and understand the problem, identify the goals of the project, and outline the scope of work.

A problem statement is especially relevant for projects that aim to improve processes, as it allows for the easier development of solutions. Referencing it helps guide the activities carried out and aids the research team in staying focused. The information in a problem statement also helps a team make important decisions.

When the desired solution is implemented later on, a problem statement can help make sure that steps are put into place to prevent the original problem from recurring in the future.

Problem statements are used in both academic and business contexts. In a business environment, project managers can use them to help execute process improvement projects.

But in an academic setting, they can help researchers to contextualize and understand the significance of the problem in a research project. This guide focuses on academic problem statements.

Before planning or writing out your academic problem statement, ask yourself some important questions, and make notes with your answers:

• What is the problem?
• How often does the problem occur?
• Where does the problem occur?
• When does the problem occur?
• Who does the problem impact?
• What causes the problem?
• How would things ideally work if the problem wasn't present?
• Why is this a problem, and why does it matter?
• What impact does the problem cause?
• Which possible solution/s to the problem are you going to propose?
• What are the predicted benefits or outcomes of your solutions?

When you write your problem statement, split it into four sections:

• Problem: Here, simply define what your problem is, clearly and concisely. Make it no longer than one or two sentences.
• Background: This is the section where you can describe what causes the problem, how often it occurs, where and when it occurs, and who the problem impacts.
• Relevance: You'll want to show how the problem is relevant, as well as why it matters and requires a solution. This is a great space to specify why it's a problem and what impacts it causes. If it fits comfortably, you can also articulate how things would ideally work if the problem wasn't present.
• Objectives: This section doesn't require great detail or length, as the problem statement isn't the area of your research project in which to specifically problem-solve. However, you should lay out a brief plan of what you're going to do to investigate and how that should help you formulate solutions. You can also hypothesize on possible solutions you're going to propose, and the benefits you predict from these.

A quality problem statement should be:

• Concise: You should be able to summarize your problem, as well as the different elements of how and why it's a problem, in succinct sentences. If you can't, revisit your initial notes and clarify what you want to achieve with your project.
• Specific: Only write about one issue in a problem statement, even if there's more than one impact of that issue. Your research and actions then only have to focus on solving the one problem, and there's no confusion.
• Measurable: Be clear about how you're able to measure and convey both the problem and your proposed objectives. This is usually by communicating the problem in terms of degree and frequency.

Below is an academic problem statement example. You don't need to include any headers in your real problem statement, but we'll do so here to show you how the sections of the document function in practice.

There is worryingly low uptake of free cervical cancer screening in the UK amongst women aged 25 to 35.

According to an assessment conducted by X Health Trust, only 60% of 25- to 35-year-old female patients attended cervical cancer screening appointments within the last two years.

This could be due to several contributing factors:

• Female patients in this age group may be more likely to believe they are not susceptible to cervical cancer due to their younger age.
• There has been an absence of regular and informative public health announcements on this subject within the last seven years.
• Cervical cancer screening has a reputation for being an unpleasant experience, which could be off-putting for patients due to attend one.

Cervical cancer is the 14th most common cancer in females in the UK, representing a notable health risk. As of 2017, there were around 3,200 new cervical cancer cases, with 850 consequent deaths, in the UK every year.

Although mortality rates in the UK for cervical cancer are highest in females aged 85 to 89, incidence rates for the disease are still highest in females aged 30 to 34.

When cervical cancer is diagnosed at its earliest stage, 96% of people diagnosed will survive their disease for one year or more. This is compared with only 50% of people when the disease is diagnosed at the latest stage.

Screening is a vital health service as many cervical cancer patients will be symptomless until they are in a later stage of the disease.

We are going to conduct a survey of 10,000 females in the UK between the ages of 25 and 35. We will first ask them the question of whether they have attended a cervical screening appointment in the last five years. For those who answer “no,” we will then present them with multiple-choice options that answer the question, “why not?”

From the results we gather, we should be able to accurately assess the most common reasons why there is a low uptake in cervical cancer screening in this age group. We will then propose interventions to the medical community based on our findings.

Our ultimate goal is to increase the uptake of cervical cancer screening by females between 25 and 35 in the UK over the next five years.

🔲 Background

🔲 Relevance

🔲 Objectives

A problem statement helps you define and understand a problem, identify the goals of your project, and outline the scope of your work. A problem statement is especially important for projects that aim to improve processes, as it allows for the easier development of solutions.

A good problem statement is concise, specific and measurable. It summarizes the different elements of how and why it's a problem. It focusses on solving this one problem, and there is no confusion as to what the problem is and how it is solved. It is clear how the problem can be solved and how this can be measured.

To start a problem statement, first ask yourself some important questions to define the problem, like:

• Which possible solutions to the problem are you going to propose?

When you write your problem statement, split it into these sections:

A smart problem statement is concise, specific and measurable. It should briefly describe the problem, where it is occurring, the timeframe over which it has been occurring, and the size and magnitude of the problem.

Nursing Research Guide

• Searching with PubMed
• Searching for Books
• Primary & Secondary Research This link opens in a new window
• AI in Healthcare Education
• APA Style Examples This link opens in a new window
• Zotero This link opens in a new window
• How to Cite ChatGPT in APA This link opens in a new window
• Evidence-Based Research This link opens in a new window
• Drug Information Resources
• Public Health This link opens in a new window
• Tests, Instruments, Scales, & Questionnaires
• Remote Access To Databases

Use MeSH to Build a Better PubMed Query

PubMed Searches

Searching for evidence-based medicine/nursing articles using CLINICAL QUERIES in the PubMed database

Clinical Queries within PubMed is designed for people who are looking for those few good articles that might help someone make an informed decision. It is designed for the busy working professional in the medical field.  This is the database that is available in most hospitals and clinics for working professionals.

PubMed is on the open web for anyone to use it, however to get links to the maximum number of FREE full text articles you should access PubMed from the Otterbein library home page.

Choose Clinical Queries listed on the left side and drill down to SYSTEMATIC REVIEWS : In PubMed, Systematic Reviews cover a broad set of articles including:  meta-analysis, reviews of clinical trials, evidence-based medicine, consensus development conferences and guidelines.

Capitalize the Boolean operator’s AND/OR/NOT between your keywords

Cancer AND smoking 

Depression OR Sadness AND women OR female

Abdominal pain NOT ectopic

Hand washing AND infection control

Carbonated beverages AND childhood obesity

Autism AND Vaccines

For more specification in your search there are also FILTERS within the Clinical Queries:

• THERAPY- will retrieve the studies that discuss the treatments of diseases
• DIAGNOSIS- will find studies that discuss disease diagnosis
• ETIOLOGY – will find studies that discuss the causation/harm in disease and diagnostics
• PROGNOSIS – will find studies that discuss disease prognosis
• CLINICAL PREDICTION GUIDES: will find studies that discuss methods for predicting the likelihood of disease presence or absence.
• LIMIT your search in other ways too: by date range, by language, Just Nursing Journals, etc… 

Use SPECIFIC subject terms like Myocardial Infarction not “heart attack”

Spell terms out don’t use acronyms like “COPD”

Limit the years or the search will search the entire database back to 1950.

Building & Refining Your MEDLINE Searches

PubMed comprises over 20 million citations for biomedical literature from MEDLINE, life science journals, and online books. PubMed citations and abstracts include the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and preclinical sciences. PubMed also provides access to additional relevant Web sites and links to the other NCBI molecular biology resources.

PubMed is a free resource that is developed and maintained by the National Center for Biotechnology Information (NCBI), at the U.S. National Library of Medicine (NLM), located at the National Institutes of Health (NIH).

PubMed Quick Start Guide: Tips on how to search for clinical articles, systematic reviews and more.

• More PubMed tutorials
• << Previous: Searching for Articles
• Next: Primary & Secondary Research >>
• Last Updated: Apr 16, 2024 3:32 PM
• URL: https://otterbein.libguides.com/nursingresearch

• Introduction
• Conclusions
• Article Information

See More About

Sign up for emails based on your interests, select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing

Get the latest research based on your areas of interest.

Others also liked.

• Download PDF
• X Facebook More LinkedIn
• CME & MOC

Fortuna KL , Lebby S , Geiger P, et al. Lived Experience–Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness : A Consensus Statement . JAMA Netw Open. 2023;6(5):e2315479. doi:10.1001/jamanetworkopen.2023.15479

Manage citations:

© 2024

• Permissions

Lived Experience–Led Research Agenda to Address Early Death in People With a Diagnosis of a Serious Mental Illness : A Consensus Statement

• 1 Geisel School of Medicine, Department of Psychiatry, Dartmouth College; Concord, New Hampshire
• 2 Collaborative Design for Recovery and Health, Nashua, New Hampshire
• 3 College of Nursing and Health Sciences, The University of Vermont, Burlington, Vermont
• 4 Optum/UnitedHealthcare, Minneapolis, Minnesota
• 5 International Association of Pre-Menstrual Disorders, Boston, Massachusetts
• 6 The Hormel Institute, University of Minnesota, Austin, Minnesota
• 7 OPROMAMER, Rwanda, Africa
• 8 HealthPartners Institute, Minneapolis, Minnesota
• 9 University of Rwanda, Rwanda, Africa
• 10 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
• 11 Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington
• 12 University North, University Centre Varazdin, Varazdin, Croatia
• 13 The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
• 14 Centerstone, Clarksville, Tennessee
• 15 Center for Behavioral Health, University of Pittsburgh, Pittsburgh, Pennsylvania
• 16 Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
• 17 VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Pennsylvania Healthcare System, Pittsburgh
• 18 Northeast Program Evaluation Center, Department of Veterans Affairs, West Haven, Connecticut
• 19 National Center for PTSD Evaluation Division, Department of Veterans Affairs, West Haven, Connecticut
• 20 Riverside Community Mental Health, Dedham, Massachusetts
• 21 Rutgers University, Department of Biology, Camden, New Jersey
• 22 Families in Trauma and Recovery, PeerLed, Lived Experience Social Enterprise, Fife Renewables Innovation Centre, Ajax Way, LEVEN, Fife, Scotland
• 23 Temple University, Department of Social and Behavioral Sciences, College of Public Health, Philadelphia, Pennsylvania
• 24 The Bridge, New York, New York
• 25 Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
• 26 Harvard Medical School, Boston, Massachusetts
• 27 VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, Connecticut
• 28 Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut
• 29 Johns Hopkins University School of Medicine, Baltimore, Maryland
• 30 Pat Deegan and Associates, LLC
• 31 Uncompagre Band of the Ute Indian Tribe from the Uintah and Ouray Agency in Fort Duchesne, Utah
• 32 Seven Counties Services, Inc, Louisville, Kentucky
• 33 Forbes Senior Contributor and, Rebel Talent
• 34 The National Council for Mental Wellbeing, Washington, DC
• 35 Pittsburgh Mercy, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
• 36 The Danya Institute, Silver Spring, Maryland
• 37 Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC
• 38 Duke University School of Medicine, Durham, North Carolina
• 39 L.E.A.R.N. (Lived Experience Academic and Research Network) Queensland, Australia
• 40 National Alliance on Mental Illness, Arlington, Virginia
• 41 The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
• 42 Community Care Behavioral Health, UPMC Insurance Services Division, Pittsburgh, Pennsylvania
• 43 Massachusetts Department of Mental Health, Boston, Massachusetts
• 44 Health Science, University of Stavanger, Stavanger, Norway

Importance   People with serious mental illness (SMI), defined as a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or disabling major depressive disorder) die approximately 10 to 25 years earlier than the general population.

Objective   To develop the first-ever lived experience–led research agenda to address early mortality in people with SMI.

Evidence Review   A virtual 2-day roundtable comprising 40 individuals convened on May 24 and May 26, 2022, and used a virtual Delphi method to arrive at expert group consensus. Participants responded to 6 rounds of virtual Delphi discussion via email that prioritized research topics and agreement on recommendations. The roundtable was composed of individuals with lived experience of mental health and/or substance misuse, peer support specialists, recovery coaches, parents and caregivers of people with SMI, researchers and clinician-scientists with and without lived experience, policy makers, and patient-led organizations. Twenty-two of 28 (78.6%) of the authors who provided data represented people with lived experiences. Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI, direct email, and snowball sampling.

Findings   The following recommendations are presented in order of priority as identified by the roundtable participants: (1) improve the empirical understanding of the direct and indirect social and biological contributions of trauma on morbidity and early mortality; (2) advance the role of family, extended families, and informal supporters; (3) recognize the importance of co-occurring disorders and early mortality; (4) redefine clinical education to reduce stigma and support clinicians through technological advancements to improve diagnostic accuracy; (5) examine outcomes meaningful to people with an SMI diagnosis, such as loneliness and sense of belonging, and stigma and their complex relationship with early mortality; (6) advance the science of pharmaceuticals, drug discovery, and choice in medication use; (7) use precision medicine to inform treatment; and (8) redefine the terms system literacy and health literacy.

Conclusions and Relevance   The recommendations of this roundtable are a starting point for changing practice and highlighting lived experience–led research priorities as an option to move the field forward.

People with serious mental illness (SMI), such as schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder, die 10 to 25 years earlier than the general population, irrespective of geography, race and ethnicity, health care systems, or financing. 1 - 3 Poor diet, smoking, and physical inactivity are the prominent contributors to preventable early mortality in this population in the US. 4 Over the past 3 decades, health promotion and self-management interventions and national initiatives (eg, Substance Abuse and Mental Health Services Administration 10 × 10 campaign) 5 have promoted health behavior change to address modifiable risk factors in people with SMI. 6 Additionally, research agendas to address this health inequity, including a group gathered by the World Health Organization (WHO) and another, titled the Blueprint to Address Early Mortality, have been developed. 7 Despite these efforts, the mortality gap between those with SMI and the general population is increasing. 2 , 3 , 8 It is critical to consider alternative approaches to prevention and treatment.

Community engagement with people with SMI can inform research to make it relevant to target populations, potentially producing greater uptake and better clinical outcomes. 9 A new paradigm led by individuals with lived experience may reveal innovative avenues to address this health disparity. This report presents a lived experience–led research agenda to address early death in people with SMI.

We participated in and are members of the Early Mortality in People with SMI Roundtable, which convened virtually on May 24 and 26, 2022. The roundtable is a collaborative committed to addressing the early mortality health disparity in people with SMI through patient-centered research ( Table ). Twenty-two of 28 of the participants (78.6%) represented people with lived experiences.

Roundtable members were selected by reviewing the peer-reviewed and gray literature on early mortality and SMI. Two of us (K.L.F. and R.W.) conducted a Google Scholar search using variations of search terms: early mortality and SMI and death, premature death, schizophrenia, bipolar and then emailed authors identified through this search. Those identified members recommended additional members using a snowball sampling framework. 10 Patient partners were identified through direct email to partners of the Collaborative Design for Recovery and Health, an international group of patients and scientists. The collaborative uses community-based participatory research with people with SMI to coproduce solutions to address community-identified needs. For example, this group developed the PeerTECH app designed to support the delivery of evidence-based practices by peer support specialists. 11

Session 1 began with a welcome and introductions, followed by a discussion on the scientific understanding of early mortality documented in the peer-reviewed literature. Next, one of us (D.J.) presented a story with a gap 12 to elicit gaps in the research. The story with a gap technique includes 2 contrasting pictures of before and after situations. Another one of us (R.W.) implemented “go wild” prompts (ie, “wouldn’t it be good if…?”) and reverse brainstorming to generate ideas about the causes of early mortality. Immediately following the first day, 3 of us (K.L.F., S.L., and P.G.) drafted a research agenda based on the gaps identified during the first day of the virtual convening. All authors were emailed a shared document of the draft research agenda 24 hours before the next session and were encouraged to review the materials. Session 2 began with a review of the draft research agenda in a shared document. One of us (R.W.) used multivoting, ranking, and problem-solving methods to help members refine language and ideas.

After the convening, all members received a web link to a shared document. Next, the roundtable used a virtual Delphi method—an empirically supported process used to arrive at expert group consensus 13 —to reach consensus ( Figure ). Participants responded to 6 rounds of virtual Delphi via email that prioritized research topics and agreement on recommendations. Participants were asked to rank items via the anonymous survey to allow for nuance in opinion and avoid the pitfalls of making binary choices. After each round, all responses were aggregated by one of us (K.L.F.) and shared with the group via email, and an anonymous survey link was sent until a 100% consensus of the authors was achieved.

The following recommendations are presented in order of priority as identified by virtual convening members.

Compared with the general population, people with SMI experience a substantially higher incidence and prevalence rates of trauma—between 51% and 98% of people in the public mental health system have experienced trauma at some point. 14 , 15 Trauma is defined as a psychological or emotional response to a disturbing or distressing experience 14 (eg, singular traumas, such as interpersonal violence, intergenerational trauma, and iatrogenic trauma, and ongoing traumas, such as food insecurity, racism, and discrimination). According to a longitudinal study of 4462 male veterans, the experience of trauma, in particular posttraumatic stress disorder, contributes to poor physical, emotional, and mental health and early mortality. 16 - 21 For example, people may develop harmful coping mechanisms, such as unhealthy eating, substance abuse, or self-harm. Biologically, the experience of trauma can also create inflammation in the body, which can lead to the development and exacerbation of conditions such as pulmonary and metabolic diseases. 22

Current recommendations, including those put forth by a group gathered by the WHO, 23 did not discuss trauma as a factor in early mortality. The Blueprint to Address Early Mortality 24 discussed the role of child abuse as a social determinant of health, which is an important type of traumatic event that may impact individuals throughout their lifespan.

We make the following recommendations. Existing or new interventions designed to increase the lifespan of people with SMI (ie, self-management and health promotion) currently do not address the role of trauma in early mortality. 6 Furthermore, research agendas, including those put forth by the WHO 23 and Lancet , 24 only recognized child abuse as a social determinant of health. Interventions need to recognize the role of trauma and its impact on the lifespan and potential impact on health behaviors. A strategic approach may be using community-engaged research to adapt interventions with widespread uptake, such as peer support, 20 to include intervention components that focus on addressing trauma (eg, emotional CPR). Methodologically rigorous studies can then integrate complexity science to use multimodal treatment to explore the role of trauma and its effect on early mortality and potential impact on health behaviors. Complexity science is physical, biological, and social systems research to understand complex systems. 25

We adopted a culturally informed definition of family, which includes immediate family, extended families (eg, grandparents, aunts, and uncles), chosen families (ie, people who have intentionally chosen to support each other regardless of blood or marriage), and informal supporters (eg, neighbors, school, and church). Family members and informal supporters provide unpaid care. 26

Current recommendations from the WHO recognize family interventions as an evidence-based practice to support individualized treatment or assist with interventions that focus on self-management or recovery. 23 Delivering family psychoeducation to caregivers and patients with schizophrenia spectrum disorders has shown improvements in caregivers’ functioning and burden and patient outcomes. 27 While important, to our knowledge, the impact of interventions that include family broadly defined on early mortality has not been explored scientifically. Future scientific exploration could examine the best practices to support engagement and collaboration using technology to promote the reach of these interventions.

We make the following recommendations. First, when possible, include family, extended family, and informal supporters in existing interventions to support their loved one in the community between intervention sessions. Such involvement may affect outcomes, such as early psychosis and relapse and rehospitalization rates, and it could improve social functioning and employment rates and increase hope and empowerment. For example, family psychoeducation (ie, an evidence-based approach designed to help families and informal supporters of people with SMI better understand mental health challenges) has been associated with great reductions in relapse and rehospitalization rates, higher employment rates, greater social functioning, and higher levels of hope and empowerment among people with an SMI diagnosis. 28 Subpopulation analyses should explore race and ethnicity, age, and gender. Second, consider the bidirectional impact of caregiving on the care partner. Examining family interventions, such as family member respite, family consultation, system navigation, family member training, and family psychoeducation—and their role in optimizing outcomes associated with early mortality—can support the advancement of this unpaid workforce.

Individuals with co-occurring disorders commonly have at least 1 mental disorder as well as a substance abuse disorder. 29 In 2020, for adults aged 18 years or older, people with an SMI diagnosis had the following prevalence rates of substance use disorders: 39.2% for marijuana, 47.8% for illicit drugs, 11.6% for opioids, 30.9% for binge alcohol use, and 37.4% for tobacco or vaped nicotine. 29 Individuals with co-occurring disorders are at an increased risk of premature drug death, suicide, and violent victimization. 29 Despite the high comorbidity of substance use and mental health challenges in the general population, 30 the mental health and substance abuse treatment systems remain mostly separate and create barriers to treatment for people with SMI. Many people with an SMI diagnosis have difficulty navigating both the mental health and substance abuse systems. 31

We make the following recommendations. First, research on integrated treatment and comparison with sequential and parallel models of care is needed. The Blueprint to Address Early Mortality recommends the following: integrated interventions as the highest standard and a clear referral policy between mental health and substance use treatment services in sequential or parallel treatments. 24 In contrast, a systematic review of the literature on a general (non-SMI) population 24 has reported preliminary evidence of this treatment system; however, a superiority or an inferiority trial has never been conducted with a fully powered sample. Research in this area could compare an integrated co-occurring disorders system with sequential or parallel treatment programs.

Second, a research area to consider is smoking cessation postintervention withdrawal in settings other than studies. Although most smokers with SMI want to quit 32 and cessation is most likely when both pharmacologic and psychosocial treatment are used, 33 cessation rates are low, and most smokers with SMI relapse months after treatment, 33 suggesting room for improvement in cessation treatments. An initial step may be the integration of qualitative research guided by implementation science to explore barriers and facilitators to cessation postintervention outside of study settings.

Historically, people with an SMI diagnosis have received inadequate physical health care. 4 Despite having twice as many health care encounters as the general population, individuals with SMI receive fewer screenings, prescriptions, diagnoses, and surgical procedures. 34 In response, health homes were developed to coordinate physical health care by integrating primary health care within community-based behavioral health care. Health homes have resulted in increased preventive screening; however, patients’ cardiometabolic outcomes associated with early mortality rarely improved. 20 Current recommendations indicate a need for increased screening for medical conditions alongside integrated care initiatives, including appropriate, timely interventions, care coordination, and collaboration with social welfare involvement. 23 Existing recommendations also specify the need to develop local, national, and global health policy around SMI; provide equitable access to universal health care; improve the use of medical investigation and treatment; and prevent diagnostic overshadowing (ie, physical conditions inaccurately characterized as being the result of a mental condition). 24

We make the following recommendations. First, social workers, nurses, home health aides, psychologists, primary care practitioners, and psychiatrists need exposure to people with SMI in residency via coursework in formal education or through continuing education and internships. This exposure can include (1) instruction on physical health, mental health, and social health complexity; (2) therapeutic techniques to support the integration of the patient’s voice into clinical encounters (eg, active listening); and (3) education on the history of the mental health system in the US from asylums to nontrauma-informed care and deinstitutionalization and how this experience may affect clinical encounters. Second, technology can be incorporated into clinical care to support clinicians in universal screening and the accuracy of diagnosis and treatment. For example, audio recordings of medical appointments between people diagnosed with an SMI and clinical practitioners can incorporate natural-language processing to record conversations longitudinally. Audio data can then be coded for self-reported symptoms and verified with medical records to study diagnostic accuracy.

The prevailing understanding of the cause of early mortality in people with SMI has been defined as poor health behaviors (eg, diet, smoking, and exercise); however, limited knowledge exists on the association between poor health behaviors and early mortality in people with SMI. McGinnis and Foege 35 reported the causes of death in the US were predominately due to poor health behaviors. This study was conducted with the general population and excluded people with SMI, yet these findings have been generalized to people with SMI. Furthermore, health behaviors in comparison with social determinants of health or patient-identified risk factors for early mortality may have a direct or mechanistic effect on early mortality and/or engagement in health behaviors.

Current recommendations from the WHO and the Blueprint to Address Early Mortality cite traditional social determinants of health, such as poverty, poor education, unemployment, homelessness, and childhood abuse as having an impact on mortality. 23 , 24 The WHO recommends stigma-reduction programs for people with SMI. The Blueprint to Address Early Mortality recommends that stigma within health care and among practitioners be addressed and that neuromotor adverse drug reactions, which carry stigma, be dealt with by research into psychotropic interventions. 24

We make the following recommendations. First, we recommend the development of a lived experience–powered research network 36 (ie, coproduced database that is governed by people with SMI and supports data collection directly from persons with an SMI). This research network can support examining outcomes meaningful to people with SMI in combination with biological, psychological (health behaviors), and social (loneliness) variables throughout the lifespan. This database can determine a longevity phenotype to guide intervention and drug development and an SMI exposome to allow for the examination of the relationships between the person, their environment, and health disparities. The database infrastructure can be designed to conduct population health research to accelerate the pace of science.

Appropriate administration of antipsychotic medications through continuous medication treatment and proper dosing reduces excess mortality in persons with SMI. 37 , 38 For example, the Clinical Antipsychotic Trials of Intervention Effectiveness Study, a nationwide public health–focused clinical trial, outlines a prescription protocol for people with schizophrenia at greater baseline risk for cardiometabolic events. 39 However, despite this advancement, the leading cause of death among people with an SMI diagnosis is cardiovascular disease, which is associated with a higher relative risk of dyslipidemia, smoking, diabetes, and obesity. 40

We make the following recommendations. First, decision aids or decision support could be integrated with decision-making to support informed patient decision-making regarding medication use. 41 The Antipsychotic Medication Decision Aid 41 - 43 is an example of a decision-aid intervention used during psychiatric visits. Development and implementation of additional decision-support tools for other drugs with adverse effects (eg, lithium) may expand our empirical understanding of the role of these aids in early mortality. Second, successful drug discovery may require exploring stem cell research, novel protein-drug conjugate modeling and assays, and advancement toward precision medicine. 44 - 46 One compelling proof of concept that links pertinent physiologic models of human disease to drug development endeavors is to advance the testing of experimental therapeutics using patient-specific induced pluripotent stem cell models. 47 This strategy, an advancement toward precision medicine, 47 has the potential to close the loop of discovery that is propelled by human illness biologic factors at every step of the process. In the future, such innovations hold considerable potential as a contribution to developing clinically effective drugs that address the issue of early death in people with an SMI diagnosis.

We note the prevailing definition of SMI that groups people with heterogeneous diagnoses, which include clinical and biological variability, 24 , 48 as a homogeneous population. While transdiagnostic approaches aim to produce scalable strategies, 7 this type of categorization likely explains the observed heterogeneity of effect sizes for the same treatment between different people with SMI who have the same diagnosis. 48 , 49 Analytic approaches based on big data, combined with recent scientific discoveries on the dynamic relationships between biopsychosocial, medical, and environmental determinants of SMI, afford the opportunity of personally tailored programs through precision medicine. Broadly defined, precision medicine is treatment that is tailored to each patient. Novel tools based on an individual’s biopsychosocial signature can enhance treatment decisions to produce the best possible outcome.

Scientific studies commonly group people with an SMI diagnosis as a homogeneous group; rather, the overlap in polygenic risk between bipolar disorder and schizophrenia for some patients, bipolar and major depressive disorder for others, and bipolar disorder and attention-deficit hyperactivity disorder for others may have implications for mental health treatment outcomes. 24 As such, empirically exploring outcomes by SMI type in fully powered samples may elucidate nuances to individual differences and best modifiable treatment practices for improved outcomes. 24 Researchers call for transdiagnostic approaches to better account for individual-level differences (eg, gender, cultural, and racial and ethnic identity) to lead to tailored and scalable strategies. To date, it is not known whether individually tailored approaches in comparison with transdiagnostic approaches lead to better outcomes and/or scalable strategies.

We make the following recommendations. First, people with SMI represent a heterogeneous group and the exploration of the Sequential, Multiple Assignment Randomized Trial (SMART) 50 research method is warranted. The SMART design is a useful technique for building stepped-care models and just-in-time adaptive interventions. 50 SMART trials allow for rerandomization based on an individual’s response. The SMART research method can allow for the field to progress more rapidly and perhaps reduce the time for effective interventions to be implemented. Second, use all data sources to inform personalized treatment options. Because of the nature of SMI, patients often have frequent encounters with the health care system that produce vast amounts of data. Accurate use of these data through predictive analytics is paramount to identifying beneficial treatment options before the trial of any interventions.

Health literacy is the degree to which an individual has the capacity to find, understand, and use health-related information to inform health-related decisions and behaviors. 51 Being health literate also includes being able to place the health of one’s family and community into context, understanding the factors that influence health, and being equipped to address them. Up to 66% of people with SMI have suboptimal health literacy, compared with 26% of those in the general population. 51 Low health literacy among people with an SMI diagnosis can affect engagement in interventions and increase the risk for hospitalization and other adverse health outcomes. 51 , 52 The potential low level of health literacy in people with SMI, as well as their increased risk of preventable chronic diseases associated with early mortality, call for advancing the health literacy of this group. 52 The WHO recommends focusing interventions on lower socioeconomic groups with lower health literacy. 23

We make the following recommendations. Universal design should be incorporated into paper-based or technology-based interventions, peer-delivered or clinician-delivered interventions, and dissemination strategies. Universal design is “the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.” 53 Universal design is incorporated to support the readability and learnability of health-related information. It is accessible to people with varying literacy levels and impairments in vision and hearing, including people with SMI. 54 This framework can improve usability and learnability (eg, by reducing memory and cognitive loads).

This lived experience–led research is a starting point to support interested parties in advancing the science of early mortality in people with SMI. The identified recommendations are a departure from what is known, and may offer a potentially viable path to extending the life span of people with SMI.

While we tried to account for various early mortality causes, not all causes of mortality were considered (eg, suicidality) as the roundtable was a 2-day event with select people with varying perspectives. However, this convening is an important step in including people with a lived experience in the conversation.

The recommendations presented herein offer a starting point for changing practice and highlighting lived experience–led research priorities as an option to move the field forward. If we recognize the value of disrupting our current research and make changes in how we design and conduct research, select interventionists, and structure our health care systems, medical education systems, and dissemination, we may impact the early mortality health disparity for persons with SMI.

Accepted for Publication: March 18, 2023.

Published: May 26, 2023. doi:10.1001/jamanetworkopen.2023.15479

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Fortuna KL et al. JAMA Network Open .

Corresponding Author: Karen L. Fortuna, PhD, LICSW, The Geisel School of Medicine at Dartmouth, 70 Commercial St, Concord, NH 03301 ( [email protected] ).

Author Contributions: Dr Fortuna and Mr Walker had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fortuna, Lebby, Johnson, MacDonald, Chefetz, Ferron, St George, Rossom, Kalisa, Mestrovic, Rotondi, Sica, Wright, Zisman-Ilani, Rhee, Daumit, Angel, Deegan, Butler, Brodey, Williams, Parks, Reimann, Wahrenberger, Morgan, Stafford, Carney, Gold, Storm, Walker.

Acquisition, analysis, or interpretation of data: Fortuna, Lebby, Geiger, Rossom, Kalisa, Mestrovic, Nicholson, Pringle, Sippel, Solesio, Gambee, Hill, Brundrett, Cather, Rhee, Angel, Manion, Deegan, Pitts, Bradford, Bright, Stafford, Bohm, Carney, Haragirimana, Gold.

Drafting of the manuscript: Fortuna, Lebby, Johnson, Ferron, St George, Kalisa, Mestrovic, Pringle, Sippel, Sica, Wright, Gambee, Hill, Cather, Angel, Butler, Pitts, Brodey, Williams, Reimann, Wahrenberger, Stafford, Bohm, Haragirimana, Gold, Walker.

Critical revision of the manuscript for important intellectual content: Fortuna, Geiger, MacDonald, Chefetz, St George, Rossom, Kalisa, Mestrovic, Nicholson, Pringle, Rotondi, Sippel, Sica, Solesio, Wright, Zisman-Ilani, Gambee, Hill, Brundrett, Rhee, Daumit, Angel, Manion, Deegan, Butler, Brodey, Williams, Parks, Morgan, Bradford, Bright, Stafford, Bohm, Carney, Storm, Walker.

Statistical analysis: Hill, Rhee, Bohm.

Obtained funding: Fortuna, Walker.

Administrative, technical, or material support: Fortuna, Lebby, Geiger, MacDonald, Chefetz, Rossom, Nicholson, Pringle, Rotondi, Sica, Wright, Rhee, Butler, Pitts, Williams, Reimann, Bradford, Stafford, Carney, Haragirimana, Gold, Walker.

Supervision: Fortuna, Johnson, Hill, Bohm, Walker.

Conflict of Interest Disclosures: Dr Fortuna reported offering consulting through Social Wellness LLC during the conduct of the study. Dr Daumit reported receiving grants from the National Institute of Mental Health (NIMH) during the conduct of the study; and grants from NIMH and the National Heart, Lung, and Blood Institute outside the submitted work. Ms Pitts reported receiving grants from Dartmouth College outside the submitted work. Dr Parks reported receiving personal fees from Boehringer-Ingelheim outside the submitted work. No other disclosures were reported.

Funding/Support: This project was funded through a Eugene Washington Patient-Centered Outcomes Research Institute Engagement Award EASCS-22925 (Dr Fortuna, Mr Walker).

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Rockville (MD): Agency for Healthcare Research and Quality; 2008 Aug.

Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment).

Figure 2 Use a problem statements in health care organizations.

From: Structure and Features of a Care Enhancement Model Implementing the Patient Safety and Quality Improvement Act

• Cite this Page Riley W, Liang BA, Rutherford W, et al. Structure and Features of a Care Enhancement Model Implementing the Patient Safety and Quality Improvement Act. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Rockville (MD): Agency for Healthcare Research and Quality; 2008 Aug. Figure 2, Use a problem statements in health care organizations.
• PDF version of this page (211K)

Other titles in this collection

• Advances in Patient Safety

Related information

• PMC PubMed Central citations
• PubMed Links to PubMed

Similar articles in PubMed

• Review Patient Safety and Quality Improvement Act of 2005. [Ann Pharmacother. 2006] Review Patient Safety and Quality Improvement Act of 2005. Fassett WE. Ann Pharmacother. 2006 May; 40(5):917-24. Epub 2006 Apr 25.
• The Patient Safety and Quality Improvement Act of 2005--The federal law and its implications for Mssouri. [Mo Med. 2007] The Patient Safety and Quality Improvement Act of 2005--The federal law and its implications for Mssouri. Miller RG, Druckman JL. Mo Med. 2007 Jan-Feb; 104(1):17-20.
• The Child Health PSO at 10 Years: An Emerging Learning Network. [Pediatr Qual Saf. 2021] The Child Health PSO at 10 Years: An Emerging Learning Network. Levy FH, Conrad KA, Kemper C, Green M. Pediatr Qual Saf. 2021 Jul-Aug; 6(4):e449. Epub 2021 Jul 28.
• Struggling to invent high-reliability organizations in health care settings: Insights from the field. [Health Serv Res. 2006] Struggling to invent high-reliability organizations in health care settings: Insights from the field. Dixon NM, Shofer M. Health Serv Res. 2006 Aug; 41(4 Pt 2):1618-32.
• Review A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study [ 2015] Review A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study Herepath A, Kitchener M, Waring J. 2015 Sep

Recent Activity

• Figure 2, Use a problem statements in health care organizations. - Advances in P... Figure 2, Use a problem statements in health care organizations. - Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment)

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

Reporting standards for outbreak data: A systematic review

• Find this author on Google Scholar
• Find this author on PubMed
• Search for this author on this site
• ORCID record for Alex W Zhu
• ORCID record for Caitlin M Rivers
• For correspondence: [email protected]
• Info/History
• Preview PDF

The current landscape of data reporting for outbreaks is ad hoc and inconsistent. Public health authorities have discretion to determine when, where, how, and what outbreak data to report. This uneven information flow hampers response efforts by decreasing the accountability and transparency needed to build public trust in the public health response. We performed a systematic literature review using the PubMed, EMBASE, MedLine Plus, and Google Scholar databases to identify existing guidelines that address timing, methodology and content of outbreak reporting. Our search strategy produced 46 manuscripts for initial screening to determine eligibility, after which we performed a full-text review of those selected for comprehensive evaluation. We identified four manuscripts that discuss minimum standards and expectations for outbreak reports. Included manuscripts highlight the absence of and the consequent need for minimum standards for what information should be reported to the public during outbreaks. Together, they suggest that the ideal outbreak report should contain information on disease severity, epidemic size and geographic extent, daily and total case count, demographics, transmissibility, signs and symptoms, probable disease transmission and exposure pathways, countermeasure status, and sources of uncertainty. This systematic review of existing guidelines is part of a larger effort to develop consensus guidelines for the public reporting of outbreak data.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The Center for Health Security received funding from the Open Philanthropy Project: https://www.openphilanthropy.org/ The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Data Availability

All data produced in the present work are contained in the manuscript

View the discussion thread.

Thank you for your interest in spreading the word about medRxiv.

NOTE: Your email address is requested solely to identify you as the sender of this article.

Citation Manager Formats

• EndNote (tagged)
• EndNote 8 (xml)
• RefWorks Tagged
• Ref Manager
• Tweet Widget
• Facebook Like
• Google Plus One
• Addiction Medicine (324)
• Allergy and Immunology (632)
• Anesthesia (168)
• Cardiovascular Medicine (2398)
• Dentistry and Oral Medicine (289)
• Dermatology (207)
• Emergency Medicine (381)
• Endocrinology (including Diabetes Mellitus and Metabolic Disease) (850)
• Epidemiology (11795)
• Forensic Medicine (10)
• Gastroenterology (705)
• Genetic and Genomic Medicine (3766)
• Geriatric Medicine (350)
• Health Economics (637)
• Health Informatics (2408)
• Health Policy (939)
• Health Systems and Quality Improvement (905)
• Hematology (342)
• HIV/AIDS (786)
• Infectious Diseases (except HIV/AIDS) (13346)
• Intensive Care and Critical Care Medicine (769)
• Medical Education (368)
• Medical Ethics (105)
• Nephrology (401)
• Neurology (3523)
• Nursing (199)
• Nutrition (528)
• Obstetrics and Gynecology (679)
• Occupational and Environmental Health (667)
• Oncology (1832)
• Ophthalmology (538)
• Orthopedics (221)
• Otolaryngology (287)
• Pain Medicine (234)
• Palliative Medicine (66)
• Pathology (447)
• Pediatrics (1037)
• Pharmacology and Therapeutics (426)
• Primary Care Research (424)
• Psychiatry and Clinical Psychology (3187)
• Public and Global Health (6178)
• Radiology and Imaging (1290)
• Rehabilitation Medicine and Physical Therapy (751)
• Respiratory Medicine (832)
• Rheumatology (380)
• Sexual and Reproductive Health (373)
• Sports Medicine (324)
• Surgery (403)
• Toxicology (50)
• Transplantation (172)
• Urology (147)

Patient satisfaction and research-related problems (Part 1). Problems while using a questionnaire and the possibility to solve them by using different methods of analysis

Affiliation.

• 1 University of Tampere, Department of Nursing Science, PO Box 607, SF-33101 Tampere, Finland.
• PMID: 11309914
• DOI: 10.1046/j.1365-2834.2000.00177.x

Introduction: This article comprises two parts describing a research project for validating quality monitoring tools. This is part 1.

Aim: To examine the problems of patient satisfaction inquiries by means of the literature, earlier research and an example.

Background: The topic is of current interest, since quality management by way of research-based knowledge has become an increasingly common demand. In this context, patient satisfaction inquiries are a central method of data collection. Although the problems relating to the reliability of the methods and results of these inquiries have been identified, their comprehensive examination is yet to be done. Quality management is none the less a challenge to nursing administrators requiring a broad-based utilization of feedback data, and this calls for a critical examination of the reliability of these results.

Methods: The exemplary material were collected using a questionnaire from patients (n = 282) on three different hospital wards. Different statistical methods and content analysis were used in the analysis.

Findings: The example used in the study indicates that the results of the inquiry were highly positive time after time. The reliability of the instrument presented a problem. The low amount of information collected in the open-ended question was another problem that can be criticised in relation to the amount of work required in the analysis. The results of the factor analysis showed that the questionnaire needs further development.

Conclusions: To conclude, patient satisfaction inquiries yield a relatively small and limited amount of information on quality management and improvement, but this information is necessary specifically for ward sisters for the follow-up of long-term trends in patient satisfaction. The second part of this article (part 2) examines the description of patient satisfaction by means of triangulation.

Publication types

• Validation Study
• Data Collection / methods
• Data Collection / standards
• Data Interpretation, Statistical*
• Educational Status
• Factor Analysis, Statistical
• Health Care Surveys / methods*
• Hospitals, University
• Inpatients / psychology*
• Length of Stay / statistics & numerical data
• Middle Aged
• Patient Satisfaction / statistics & numerical data*
• Quality Indicators, Health Care*
• Surveys and Questionnaires / standards*