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Reumatologia
v.59(1); 2021

Peer review guidance: a primer for researchers

Olena zimba.

1 Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Armen Yuri Gasparyan

2 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK

The peer review process is essential for quality checks and validation of journal submissions. Although it has some limitations, including manipulations and biased and unfair evaluations, there is no other alternative to the system. Several peer review models are now practised, with public review being the most appropriate in view of the open science movement. Constructive reviewer comments are increasingly recognised as scholarly contributions which should meet certain ethics and reporting standards. The Publons platform, which is now part of the Web of Science Group (Clarivate Analytics), credits validated reviewer accomplishments and serves as an instrument for selecting and promoting the best reviewers. All authors with relevant profiles may act as reviewers. Adherence to research reporting standards and access to bibliographic databases are recommended to help reviewers draft evidence-based and detailed comments.

Introduction

The peer review process is essential for evaluating the quality of scholarly works, suggesting corrections, and learning from other authors’ mistakes. The principles of peer review are largely based on professionalism, eloquence, and collegiate attitude. As such, reviewing journal submissions is a privilege and responsibility for ‘elite’ research fellows who contribute to their professional societies and add value by voluntarily sharing their knowledge and experience.

Since the launch of the first academic periodicals back in 1665, the peer review has been mandatory for validating scientific facts, selecting influential works, and minimizing chances of publishing erroneous research reports [ 1 ]. Over the past centuries, peer review models have evolved from single-handed editorial evaluations to collegial discussions, with numerous strengths and inevitable limitations of each practised model [ 2 , 3 ]. With multiplication of periodicals and editorial management platforms, the reviewer pool has expanded and internationalized. Various sets of rules have been proposed to select skilled reviewers and employ globally acceptable tools and language styles [ 4 , 5 ].

In the era of digitization, the ethical dimension of the peer review has emerged, necessitating involvement of peers with full understanding of research and publication ethics to exclude unethical articles from the pool of evidence-based research and reviews [ 6 ]. In the time of the COVID-19 pandemic, some, if not most, journals face the unavailability of skilled reviewers, resulting in an unprecedented increase of articles without a history of peer review or those with surprisingly short evaluation timelines [ 7 ].

Editorial recommendations and the best reviewers

Guidance on peer review and selection of reviewers is currently available in the recommendations of global editorial associations which can be consulted by journal editors for updating their ethics statements and by research managers for crediting the evaluators. The International Committee on Medical Journal Editors (ICMJE) qualifies peer review as a continuation of the scientific process that should involve experts who are able to timely respond to reviewer invitations, submitting unbiased and constructive comments, and keeping confidentiality [ 8 ].

The reviewer roles and responsibilities are listed in the updated recommendations of the Council of Science Editors (CSE) [ 9 ] where ethical conduct is viewed as a premise of the quality evaluations. The Committee on Publication Ethics (COPE) further emphasizes editorial strategies that ensure transparent and unbiased reviewer evaluations by trained professionals [ 10 ]. Finally, the World Association of Medical Editors (WAME) prioritizes selecting the best reviewers with validated profiles to avoid substandard or fraudulent reviewer comments [ 11 ]. Accordingly, the Sarajevo Declaration on Integrity and Visibility of Scholarly Publications encourages reviewers to register with the Open Researcher and Contributor ID (ORCID) platform to validate and publicize their scholarly activities [ 12 ].

Although the best reviewer criteria are not listed in the editorial recommendations, it is apparent that the manuscript evaluators should be active researchers with extensive experience in the subject matter and an impressive list of relevant and recent publications [ 13 ]. All authors embarking on an academic career and publishing articles with active contact details can be involved in the evaluation of others’ scholarly works [ 14 ]. Ideally, the reviewers should be peers of the manuscript authors with equal scholarly ranks and credentials.

However, journal editors may employ schemes that engage junior research fellows as co-reviewers along with their mentors and senior fellows [ 15 ]. Such a scheme is successfully practised within the framework of the Emerging EULAR (European League Against Rheumatism) Network (EMEUNET) where seasoned authors (mentors) train ongoing researchers (mentees) how to evaluate submissions to the top rheumatology journals and select the best evaluators for regular contributors to these journals [ 16 ].

The awareness of the EQUATOR Network reporting standards may help the reviewers to evaluate methodology and suggest related revisions. Statistical skills help the reviewers to detect basic mistakes and suggest additional analyses. For example, scanning data presentation and revealing mistakes in the presentation of means and standard deviations often prompt re-analyses of distributions and replacement of parametric tests with non-parametric ones [ 17 , 18 ].

Constructive reviewer comments

The main goal of the peer review is to support authors in their attempt to publish ethically sound and professionally validated works that may attract readers’ attention and positively influence healthcare research and practice. As such, an optimal reviewer comment has to comprehensively examine all parts of the research and review work ( Table I ). The best reviewers are viewed as contributors who guide authors on how to correct mistakes, discuss study limitations, and highlight its strengths [ 19 ].

Structure of a reviewer comment to be forwarded to authors

Some of the currently practised review models are well positioned to help authors reveal and correct their mistakes at pre- or post-publication stages ( Table II ). The global move toward open science is particularly instrumental for increasing the quality and transparency of reviewer contributions.

Advantages and disadvantages of common manuscript evaluation models

Since there are no universally acceptable criteria for selecting reviewers and structuring their comments, instructions of all peer-reviewed journal should specify priorities, models, and expected review outcomes [ 20 ]. Monitoring and reporting average peer review timelines is also required to encourage timely evaluations and avoid delays. Depending on journal policies and article types, the first round of peer review may last from a few days to a few weeks. The fast-track review (up to 3 days) is practised by some top journals which process clinical trial reports and other priority items.

In exceptional cases, reviewer contributions may result in substantive changes, appreciated by authors in the official acknowledgments. In most cases, however, reviewers should avoid engaging in the authors’ research and writing. They should refrain from instructing the authors on additional tests and data collection as these may delay publication of original submissions with conclusive results.

Established publishers often employ advanced editorial management systems that support reviewers by providing instantaneous access to the review instructions, online structured forms, and some bibliographic databases. Such support enables drafting of evidence-based comments that examine the novelty, ethical soundness, and implications of the reviewed manuscripts [ 21 ].

Encouraging reviewers to submit their recommendations on manuscript acceptance/rejection and related editorial tasks is now a common practice. Skilled reviewers may prompt the editors to reject or transfer manuscripts which fall outside the journal scope, perform additional ethics checks, and minimize chances of publishing erroneous and unethical articles. They may also raise concerns over the editorial strategies in their comments to the editors.

Since reviewer and editor roles are distinct, reviewer recommendations are aimed at helping editors, but not at replacing their decision-making functions. The final decisions rest with handling editors. Handling editors weigh not only reviewer comments, but also priorities related to article types and geographic origins, space limitations in certain periods, and envisaged influence in terms of social media attention and citations. This is why rejections of even flawless manuscripts are likely at early rounds of internal and external evaluations across most peer-reviewed journals.

Reviewers are often requested to comment on language correctness and overall readability of the evaluated manuscripts. Given the wide availability of in-house and external editing services, reviewer comments on language mistakes and typos are categorized as minor. At the same time, non-Anglophone experts’ poor language skills often exclude them from contributing to the peer review in most influential journals [ 22 ]. Comments should be properly edited to convey messages in positive or neutral tones, express ideas of varying degrees of certainty, and present logical order of words, sentences, and paragraphs [ 23 , 24 ]. Consulting linguists on communication culture, passing advanced language courses, and honing commenting skills may increase the overall quality and appeal of the reviewer accomplishments [ 5 , 25 ].

Peer reviewer credits

Various crediting mechanisms have been proposed to motivate reviewers and maintain the integrity of science communication [ 26 ]. Annual reviewer acknowledgments are widely practised for naming manuscript evaluators and appreciating their scholarly contributions. Given the need to weigh reviewer contributions, some journal editors distinguish ‘elite’ reviewers with numerous evaluations and award those with timely and outstanding accomplishments [ 27 ]. Such targeted recognition ensures ethical soundness of the peer review and facilitates promotion of the best candidates for grant funding and academic job appointments [ 28 ].

Also, large publishers and learned societies issue certificates of excellence in reviewing which may include Continuing Professional Development (CPD) points [ 29 ]. Finally, an entirely new crediting mechanism is proposed to award bonus points to active reviewers who may collect, transfer, and use these points to discount gold open-access charges within the publisher consortia [ 30 ].

With the launch of Publons ( http://publons.com/ ) and its integration with Web of Science Group (Clarivate Analytics), reviewer recognition has become a matter of scientific prestige. Reviewers can now freely open their Publons accounts and record their contributions to online journals with Digital Object Identifiers (DOI). Journal editors, in turn, may generate official reviewer acknowledgments and encourage reviewers to forward them to Publons for building up individual reviewer and journal profiles. All published articles maintain e-links to their review records and post-publication promotion on social media, allowing the reviewers to continuously track expert evaluations and comments. A paid-up partnership is also available to journals and publishers for automatically transferring peer-review records to Publons upon mutually acceptable arrangements.

Listing reviewer accomplishments on an individual Publons profile showcases scholarly contributions of the account holder. The reviewer accomplishments placed next to the account holders’ own articles and editorial accomplishments point to the diversity of scholarly contributions. Researchers may establish links between their Publons and ORCID accounts to further benefit from complementary services of both platforms. Publons Academy ( https://publons.com/community/academy/ ) additionally offers an online training course to novice researchers who may improve their reviewing skills under the guidance of experienced mentors and journal editors. Finally, journal editors may conduct searches through the Publons platform to select the best reviewers across academic disciplines.

Peer review ethics

Prior to accepting reviewer invitations, scholars need to weigh a number of factors which may compromise their evaluations. First of all, they are required to accept the reviewer invitations if they are capable of timely submitting their comments. Peer review timelines depend on article type and vary widely across journals. The rules of transparent publishing necessitate recording manuscript submission and acceptance dates in article footnotes to inform readers of the evaluation speed and to help investigators in the event of multiple unethical submissions. Timely reviewer accomplishments often enable fast publication of valuable works with positive implications for healthcare. Unjustifiably long peer review, on the contrary, delays dissemination of influential reports and results in ethical misconduct, such as plagiarism of a manuscript under evaluation [ 31 ].

In the times of proliferation of open-access journals relying on article processing charges, unjustifiably short review may point to the absence of quality evaluation and apparently ‘predatory’ publishing practice [ 32 , 33 ]. Authors when choosing their target journals should take into account the peer review strategy and associated timelines to avoid substandard periodicals.

Reviewer primary interests (unbiased evaluation of manuscripts) may come into conflict with secondary interests (promotion of their own scholarly works), necessitating disclosures by filling in related parts in the online reviewer window or uploading the ICMJE conflict of interest forms. Biomedical reviewers, who are directly or indirectly supported by the pharmaceutical industry, may encounter conflicts while evaluating drug research. Such instances require explicit disclosures of conflicts and/or rejections of reviewer invitations.

Journal editors are obliged to employ mechanisms for disclosing reviewer financial and non-financial conflicts of interest to avoid processing of biased comments [ 34 ]. They should also cautiously process negative comments that oppose dissenting, but still valid, scientific ideas [ 35 ]. Reviewer conflicts that stem from academic activities in a competitive environment may introduce biases, resulting in unfair rejections of manuscripts with opposing concepts, results, and interpretations. The same academic conflicts may lead to coercive reviewer self-citations, forcing authors to incorporate suggested reviewer references or face negative feedback and an unjustified rejection [ 36 ]. Notably, several publisher investigations have demonstrated a global scale of such misconduct, involving some highly cited researchers and top scientific journals [ 37 ].

Fake peer review, an extreme example of conflict of interest, is another form of misconduct that has surfaced in the time of mass proliferation of gold open-access journals and publication of articles without quality checks [ 38 ]. Fake reviews are generated by manipulating authors and commercial editing agencies with full access to their own manuscripts and peer review evaluations in the journal editorial management systems. The sole aim of these reviews is to break the manuscript evaluation process and to pave the way for publication of pseudoscientific articles. Authors of these articles are often supported by funds intended for the growth of science in non-Anglophone countries [ 39 ]. Iranian and Chinese authors are often caught submitting fake reviews, resulting in mass retractions by large publishers [ 38 ]. Several suggestions have been made to overcome this issue, with assigning independent reviewers and requesting their ORCID IDs viewed as the most practical options [ 40 ].

Conclusions

The peer review process is regulated by publishers and editors, enforcing updated global editorial recommendations. Selecting the best reviewers and providing authors with constructive comments may improve the quality of published articles. Reviewers are selected in view of their professional backgrounds and skills in research reporting, statistics, ethics, and language. Quality reviewer comments attract superior submissions and add to the journal’s scientific prestige [ 41 ].

In the era of digitization and open science, various online tools and platforms are available to upgrade the peer review and credit experts for their scholarly contributions. With its links to the ORCID platform and social media channels, Publons now offers the optimal model for crediting and keeping track of the best and most active reviewers. Publons Academy additionally offers online training for novice researchers who may benefit from the experience of their mentoring editors. Overall, reviewer training in how to evaluate journal submissions and avoid related misconduct is an important process, which some indexed journals are experimenting with [ 42 ].

The timelines and rigour of the peer review may change during the current pandemic. However, journal editors should mobilize their resources to avoid publication of unchecked and misleading reports. Additional efforts are required to monitor published contents and encourage readers to post their comments on publishers’ online platforms (blogs) and other social media channels [ 43 , 44 ].

The authors declare no conflict of interest.

Finding Scholarly Articles: Home

What's a Scholarly Article?

Your professor has specified that you are to use scholarly (or primary research or peer-reviewed or refereed or academic) articles only in your paper. What does that mean?

Scholarly or primary research articles are peer-reviewed , which means that they have gone through the process of being read by reviewers or referees before being accepted for publication. When a scholar submits an article to a scholarly journal, the manuscript is sent to experts in that field to read and decide if the research is valid and the article should be published. Typically the reviewers indicate to the journal editors whether they think the article should be accepted, sent back for revisions, or rejected.

To decide whether an article is a primary research article, look for the following:

The author’s (or authors') credentials and academic affiliation(s) should be given;
There should be an abstract summarizing the research;
The methods and materials used should be given, often in a separate section;
There are citations within the text or footnotes referencing sources used;
Results of the research are given;
There should be discussion and conclusion ;
With a bibliography or list of references at the end.

Caution: even though a journal may be peer-reviewed, not all the items in it will be. For instance, there might be editorials, book reviews, news reports, etc. Check for the parts of the article to be sure.

You can limit your search results to primary research, peer-reviewed or refereed articles in many databases. To search for scholarly articles in HOLLIS , type your keywords in the box at the top, and select Catalog&Articles from the choices that appear next. On the search results screen, look for the Show Only section on the right and click on Peer-reviewed articles . (Make sure to login in with your HarvardKey to get full-text of the articles that Harvard has purchased.)

Many of the databases that Harvard offers have similar features to limit to peer-reviewed or scholarly articles. For example in Academic Search Premier , click on the box for Scholarly (Peer Reviewed) Journals on the search screen.

Review articles are another great way to find scholarly primary research articles. Review articles are not considered "primary research", but they pull together primary research articles on a topic, summarize and analyze them. In Google Scholar , click on Review Articles at the left of the search results screen. Ask your professor whether review articles can be cited for an assignment.

A note about Google searching. A regular Google search turns up a broad variety of results, which can include scholarly articles but Google results also contain commercial and popular sources which may be misleading, outdated, etc. Use Google Scholar through the Harvard Library instead.

About Wikipedia . W ikipedia is not considered scholarly, and should not be cited, but it frequently includes references to scholarly articles. Before using those references for an assignment, double check by finding them in Hollis or a more specific subject database .

Still not sure about a source? Consult the course syllabus for guidance, contact your professor or teaching fellow, or use the Ask A Librarian service.

Last Updated: Oct 3, 2023 3:37 PM
URL: https://guides.library.harvard.edu/FindingScholarlyArticles

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Evaluation – Peer review is an effective form of research evaluation to help select the highest quality articles for publication.
Integrity – Peer review ensures the integrity of the publishing process and the scholarly record. Reviewers are independent of journal publications and the research being conducted.
Quality – The filtering process and revision advice improve the quality of the final research article as well as offering the author new insights into their research methods and the results that they have compiled. Peer review gives authors access to the opinions of experts in the field who can provide support and insight.

Types of peer review

Single-anonymized – the name of the reviewer is hidden from the author.
Double-anonymized – names are hidden from both reviewers and the authors.
Triple-anonymized – names are hidden from authors, reviewers, and the editor.
Open peer review comes in many forms . At Sage we offer a form of open peer review on some journals via our Transparent Peer Review program , whereby the reviews are published alongside the article. The names of the reviewers may also be published, depending on the reviewers’ preference.
Post publication peer review can offer useful interaction and a discussion forum for the research community. This form of peer review is not usual or appropriate in all fields.

To learn more about the different types of peer review, see page 14 of ‘ The Nuts and Bolts of Peer Review ’ from Sense about Science.

Please double check the manuscript submission guidelines of the journal you are reviewing in order to ensure that you understand the method of peer review being used.

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Systematic Review
Open access
Published: 12 May 2024

Association between problematic social networking use and anxiety symptoms: a systematic review and meta-analysis

Mingxuan Du 1 ,
Chengjia Zhao 2 ,
Haiyan Hu 1 ,
Ningning Ding 1 ,
Jiankang He 1 ,
Wenwen Tian 1 ,
Wenqian Zhao 1 ,
Xiujian Lin 1 ,
Gaoyang Liu 1 ,
Wendan Chen 1 ,
ShuangLiu Wang 1 ,
Pengcheng Wang 3 ,
Dongwu Xu 1 ,
Xinhua Shen 4 &
Guohua Zhang 1

BMC Psychology volume 12 , Article number: 263 ( 2024 ) Cite this article

186 Accesses

Metrics details

A growing number of studies have reported that problematic social networking use (PSNU) is strongly associated with anxiety symptoms. However, due to the presence of multiple anxiety subtypes, existing research findings on the extent of this association vary widely, leading to a lack of consensus. The current meta-analysis aimed to summarize studies exploring the relationship between PSNU levels and anxiety symptoms, including generalized anxiety, social anxiety, attachment anxiety, and fear of missing out. 209 studies with a total of 172 articles were included in the meta-analysis, involving 252,337 participants from 28 countries. The results showed a moderately positive association between PSNU and generalized anxiety (GA), social anxiety (SA), attachment anxiety (AA), and fear of missing out (FoMO) respectively (GA: r = 0.388, 95% CI [0.362, 0.413]; SA: r = 0.437, 95% CI [0.395, 0.478]; AA: r = 0.345, 95% CI [0.286, 0.402]; FoMO: r = 0.496, 95% CI [0.461, 0.529]), and there were different regulatory factors between PSNU and different anxiety subtypes. This study provides the first comprehensive estimate of the association of PSNU with multiple anxiety subtypes, which vary by time of measurement, region, gender, and measurement tool.

Peer Review reports

Introduction

Social network refers to online platforms that allow users to create, share, and exchange information, encompassing text, images, audio, and video [ 1 ]. The use of social network, a term encompassing various activities on these platforms, has been measured from angles such as frequency, duration, intensity, and addictive behavior, all indicative of the extent of social networking usage [ 2 ]. As of April 2023, there are 4.8 billion social network users globally, representing 59.9% of the world’s population [ 3 ]. The usage of social network is considered a normal behavior and a part of everyday life [ 4 , 5 ]. Although social network offers convenience in daily life, excessive use can lead to PSNU [ 6 , 7 ], posing potential threats to mental health, particularly anxiety symptoms (Rasmussen et al., 2020). Empirical research has shown that anxiety symptoms, including generalized anxiety (GA), social anxiety (SA), attachment anxiety (AA), and fear of missing out (FoMO), are closely related to PSNU [ 8 , 9 , 10 , 11 , 12 ]. While some empirical studies have explored the relationship between PSNU and anxiety symptoms, their conclusions are not consistent. Some studies have found a significant positive correlation [ 13 , 14 , 15 ], while others have found no significant correlation [ 16 , 17 , 18 , 19 ]. Furthermore, the degree of correlation varies widely in existing research, with reported r-values ranging from 0.12 to 0.80 [ 20 , 21 ]. Therefore, a systematic meta-analysis is necessary to clarify the impact of PSNU on individual anxiety symptoms.

Previous research lacks a unified concept of PSNU, primarily due to differing theoretical interpretations by various authors, and the use of varied standards and diagnostic tools. Currently, this phenomenon is referred to by several terms, including compulsive social networking use, problematic social networking use, excessive social networking use, social networking dependency, and social networking addiction [ 22 , 23 , 24 , 25 , 26 ]. These conceptual differences hinder the development of a cohesive and systematic research framework, as it remains unclear whether these definitions and tools capture the same underlying construct [ 27 ]. To address this lack of uniformity, this paper will use the term “problematic use” to encompass all the aforementioned nomenclatures (i.e., compulsive, excessive, dependent, and addictive use).

Regarding the relationship between PSNU and anxiety symptoms, two main perspectives exist: the first suggests a positive correlation, while the second proposes a U-shaped relationship. The former perspective, advocating a positive correlation, aligns with the social cognitive theory of mass communication. It posits that PSNU can reinforce certain cognitions, emotions, attitudes, and behaviors [ 28 , 29 ], potentially elevating individuals’ anxiety levels [ 30 ]. Additionally, the cognitive-behavioral model of pathological use, a primary framework for explaining factors related to internet-based addictions, indicates that psychiatric symptoms like depression or anxiety may precede internet addiction, implying that individuals experiencing anxiety may turn to social networking platforms as a coping mechanism [ 31 ]. Empirical research also suggests that highly anxious individuals prefer computer-mediated communication due to the control and social liberation it offers and are more likely to have maladaptive emotional regulation, potentially leading to problematic social network service use [ 32 ]. Turning to the alternate perspective, it proposes a U-shaped relationship as per the digital Goldilocks hypothesis. In this view, moderate social networking usage is considered beneficial for psychosocial adaptation, providing individuals with opportunities for social connection and support. Conversely, both excessive use and abstinence can negatively impact psychosocial adaptation [ 33 ]. In summary, both perspectives offer plausible explanations.

Incorporating findings from previous meta-analyses, we identified seven systematic reviews and two meta-analyses that investigated the association between PSNU and anxiety. The results of these meta-analyses indicated a significant positive correlation between PSNU and anxiety (ranging from 0.33 to 0.38). However, it is evident that these previous meta-analyses had certain limitations. Firstly, they focused only on specific subtypes of anxiety; secondly, they were limited to adolescents and emerging adults in terms of age. In summary, this systematic review aims to ascertain which theoretical perspective more effectively explains the relationship between PSNU and anxiety, addressing the gaps in previous meta-analyses. Additionally, the association between PSNU and anxiety could be moderated by various factors. Drawing from a broad research perspective, any individual study is influenced by researcher-specific designs and associated sample estimates. These may lead to bias compared to the broader population. Considering the selection criteria for moderating variables in empirical studies and meta-analyses [ 34 , 35 ], the heterogeneity of findings on problematic social network usage and anxiety symptoms could be driven by divergence in sample characteristics (e.g., gender, age, region) and research characteristics (measurement instrument of study variables). Since the 2019 coronavirus pandemic, heightened public anxiety may be attributed to the fear of the virus or heightened real life stress. The increased use of electronic devices, particularly smartphones during the pandemic, also instigates the prevalence of problematic social networking. Thus, our analysis focuses on three moderators: sample characteristics (participants’ gender, age, region), measurement tools (for PSNU and anxiety symptoms) and the time of measurement (before COVID-19 vs. during COVID-19).

The present study was conducted in accordance with the 2020 statement on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 36 ]. To facilitate transparency and to avoid unnecessary duplication of research, this study was registered on PROSPERO, and the number is CRD42022350902.

Literature search

Studies on the relationship between the PSNU and anxiety symptoms from 2000 to 2023 were retrieved from seven databases. These databases included China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Information Co. Ltd. (VIP), Web of Science, ScienceDirect, PubMed, and PsycARTICLES. The search strings consisted of (a) anxiety symptoms, (b) social network, and (c) Problematic use. As shown in Table 1 , the keywords for anxiety are as follows: anxiety, generalized anxiety, social anxiety, attachment anxiety, fear of missing out, and FoMO. The keywords for social network are as follows: social network, social media, social networking site, Instagram, and Facebook. The keywords for addiction are as follows: addiction, dependence, problem/problematic use, excessive use. The search deadline was March 19, 2023. A total of 2078 studies were initially retrieved and all were identified ultimately.

Inclusion and exclusion criteria

Retrieved studies were eligible for the present meta-analysis if they met the following inclusion criteria: (a) the study provided Pearson correlation coefficients used to measure the relationship between PSNU and anxiety symptoms; (b) the study reported the sample size and the measurement instruments for the variables; (c) the study was written in English and Chinese; (d) the study provided sufficient statistics to calculate the effect sizes; (e) effect sizes were extracted from independent samples. If multiple independent samples were investigated in the same study, they were coded separately; if the study was a longitudinal study, they were coded by the first measurement. In addition, studies were excluded if they: (a) examined non-problematic social network use; (b) had an abnormal sample population; (c) the results of the same sample were included in another study and (d) were case reports or review articles. Two evaluators with master’s degrees independently assessed the eligibility of the articles. A third evaluator with a PhD examined the results and resolved dissenting views.

Data extraction and quality assessment

Two evaluators independently coded the selected articles according to the following characteristics: literature information, time of measurement (before the COVID-19 vs. during the COVID-19), sample source (developed country vs. developing country), sample size, proportion of males, mean age, type of anxiety, and measurement instruments for PSNU and anxiety symptoms. The following principles needed to be adhered to in the coding process: (a) effect sizes were extracted from independent samples. If multiple independent samples were investigated in the same study, they were coded separately; if the study was a longitudinal study, it was coded by the first measurement; (b) if multiple studies used the same data, the one with the most complete information was selected; (c) If studies reported t or F values rather than r , the following formula \( r=\sqrt{\frac{{t}^{2}}{{t}^{2}+df}}\) ; \( r=\sqrt{\frac{F}{F+d{f}_{e}}}\) was used to convert them into r values [ 37 , 38 ]. Additionally, if some studies only reported the correlation matrix between each dimension of PSNU and anxiety symptoms, the following formula \( {r}_{xy}=\frac{\sum {r}_{xi}{r}_{yj}}{\sqrt{n+n(n-1){r}_{xixj}}\sqrt{m+m(m-1){r}_{yiyj}}}\) was used to synthesize the r values [ 39 ], where n or m is the number of dimensions of variable x or variable y, respectively, and \( {r}_{xixj} \) or \( {r}_{yiyj}\) represents the mean of the correlation coefficients between the dimensions of variable x or variable y, respectively.

Literature quality was determined according to the meta-analysis quality evaluation scale developed [ 40 ]. The quality of the post-screening studies was assessed by five dimensions: sampling method, efficiency of sample collection, level of publication, and reliability of PSNU and anxiety symptom measurement instruments. The total score of the scale ranged from 0 to 10; higher scores indicated better quality of the literature.

Data analysis

All data were performed using Comprehensive Meta Analysis 3.3 (CMA 3.3). Pearson’s product-moment coefficient r was selected as the effect size index in this meta-analysis. Firstly, \( {\text{F}\text{i}\text{s}\text{h}\text{e}\text{r}}^{{\prime }}\text{s} Z=\frac{1}{2}\times \text{ln}\left(\frac{1+r}{1-r}\right)\) was used to convert the correlation coefficient to Fisher Z . Then the formula \( SE=\sqrt{\frac{1}{n-3}}\) was used to calculate the standard error ( SE ). Finally, the summary of r was obtained from the formula \( r=\frac{{e}^{2z}-1}{{e}^{2z}+1}\) for a comprehensive measure of the relationship between PSNU and anxiety symptoms [ 37 , 41 ].

Although the effect sizes estimated by the included studies may be similar, considering the actual differences between studies (e.g., region and gender), the random effects model was a better choice for data analysis for the current meta-analysis. The heterogeneity of the included study effect sizes was measured for significance by Cochran’s Q test and estimated quantitatively by the I 2 statistic [ 42 ]. If the results indicate there is a significant heterogeneity (the Q test: p -value < 0.05, I 2 > 75) and the results of different studies are significantly different from the overall effect size. Conversely, it indicates there are no differences between the studies and the overall effect size. And significant heterogeneity tends to indicate the possible presence of potential moderating variables. Subgroup analysis and meta-regression analysis were used to examine the moderating effect of categorical and continuous variables, respectively.

Funnel plots, fail-safe number (Nfs) and Egger linear regression were utilized to evaluate the publication bias [ 43 , 44 , 45 ]. The likelihood of publication bias was considered low if the intercept obtained from Egger linear regression was not significant. A larger Nfs indicated a lower risk of publication bias, and if Nfs < 5k + 10 (k representing the original number of studies), publication bias should be a concern [ 46 ]. When Egger’s linear regression was significant, the Duval and Tweedie’s trim-and-fill was performed to correct the effect size. If there was no significant change in the effect size, it was assumed that there was no serious publication bias [ 47 ].

A significance level of P < 0.05 was deemed applicable in this study.

Sample characteristics

The PRISMA search process is depicted in Fig. 1 . The database search yielded 2078 records. After removing duplicate records and screening the title and abstract, the full text was subject to further evaluation. Ultimately, 172 records fit the inclusion criteria, including 209 independent effect sizes. The present meta-analysis included 68 studies on generalized anxiety, 44 on social anxiety, 22 on attachment anxiety, and 75 on fear of missing out. The characteristics of the selected studies are summarized in Table 2 . The majority of the sample group were adults. Quality scores for selected studies ranged from 0 to 10, with only 34 effect sizes below the theoretical mean, indicating high quality for the included studies. The literature included utilized BSMAS as the primary tool to measure PSNU, DASS-21-A to measure GA, IAS to measure SA, ECR to measure AA, and FoMOS to measure FoMO.

Flow chart of the search and selection strategy

Overall analysis, homogeneity tests and publication bias

As shown in Table 3 , there was significant heterogeneity between PSNU and all four anxiety symptoms (GA: Q = 1623.090, I 2 = 95.872%; SA: Q = 1396.828, I 2 = 96.922%; AA: Q = 264.899, I 2 = 92.072%; FoMO: Q = 1847.110, I 2 = 95.994%), so a random effects model was chosen. The results of the random effects model indicate a moderate positive correlation between PSNU and anxiety symptoms (GA: r = 0.350, 95% CI [0.323, 0.378]; SA: r = 0.390, 95% CI [0.347, 0.431]; AA: r = 0.345, 95% CI [0.286, 0.402]; FoMO: r = 0.496, 95% CI [0.461, 0.529]).

Figure 2 shows the funnel plot of the relationship between PSNU and anxiety symptoms. No significant symmetry was seen in the funnel plot of the relationship between PSNU and GA and between PSNU and SA. And the Egger’s regression results also indicated that there might be publication bias ( t = 3.775, p < 0.001; t = 2.309, p < 0.05). Therefore, it was necessary to use fail-safe number (Nfs) and the trim and fill method for further examination and correction. The Nfs for PSNU and GA as well as PSNU and SA are 4591 and 7568, respectively. Both Nfs were much larger than the standard 5 k + 10. After performing the trim and fill method, 14 effect sizes were added to the right side of the funnel plat (Fig. 2 .a), the correlation coefficient between PSNU and GA changed to ( r = 0.388, 95% CI [0.362, 0.413]); 10 effect sizes were added to the right side of the funnel plat (Fig. 2 .b), the correlation coefficient between PSNU and SA changed to ( r = 0.437, 95% CI [0.395, 0.478]). The correlation coefficients did not change significantly, indicating that there was no significant publication bias associated with the relationship between PSNU and these two anxiety symptoms (GA and SA).

Funnel plot of the relationship between PSNU and anxiety symptoms. Note: Black dots indicated additional studies after using trim and fill method; ( a ) = Funnel plot of the PSNU and GA; ( b ) = Funnel plot of the PSNU and SA; ( c ) = Funnel plot of the PSNU and AA; ( d ) = Funnel plot of the PSNU and FoMO

Sensitivity analyses

Initially, the findings obtained through the one-study-removed approach indicated that the heterogeneities in the relationship between PSNU and anxiety symptoms were not attributed to any individual study. Nevertheless, it is important to note that sensitivity analysis should be performed based on literature quality [ 223 ] since low-quality literature could potentially impact result stability. In the relationship between PSNU and GA, the 10 effect sizes below the theoretical mean scores were excluded from analysis, and the sensitivity analysis results were recalculated ( r = 0.402, 95% CI [0.375, 0.428]); In the relationship between PSNU and SA, the 8 effect sizes below the theoretical mean scores were excluded from analysis, and the sensitivity analysis results were recalculated ( r = 0.431, 95% CI [0.387, 0.472]); In the relationship between PSNU and AA, the 5 effect sizes below the theoretical mean scores were excluded from analysis, and the sensitivity analysis results were recalculated ( r = 0.367, 95% CI [0.298, 0.433]); In the relationship between PSNU and FoMO, the 11 effect sizes below the theoretical mean scores were excluded from analysis, and the sensitivity analysis results were recalculated ( r = 0.508, 95% CI [0.470, 0.544]). The revised estimates indicate that meta-analysis results were stable.

Moderator analysis

The impact of moderator variables on the relation between psnu and ga.

The results of subgroup analysis and meta-regression are shown in Table 4 , the time of measurement significantly moderated the correlation between PSNU and GA ( Q between = 19.268, df = 2, p < 0.001). The relation between the two variables was significantly higher during the COVID-19 ( r = 0.392, 95% CI [0.357, 0.425]) than before the COVID-19 ( r = 0.270, 95% CI [0.227, 0.313]) or measurement time uncertain ( r = 0.352, 95% CI [0.285, 0.415]).

The moderating effect of the PSNU measurement was significant ( Q between = 6.852, df = 1, p = 0.009). The relation was significantly higher when PSNU was measured with the BSMAS ( r = 0.373, 95% CI [0.341, 0.404]) compared to others ( r = 0.301, 95% CI [0.256, 0.344]).

The moderating effect of the GA measurement was significant ( Q between = 60.061, df = 5, p < 0.001). Specifically, when GA measured by the GAD ( r = 0.398, 95% CI [0.356, 0.438]) and the DASS-21-A ( r = 0.433, 95% CI [0.389, 0.475]), a moderate positive correlation was observed. However, the correlation was less significant when measured using the STAI ( r = 0.232, 95% CI [0.187, 0.276]).

For the relation between PSNU and GA, the moderating effect of region, gender and age were not significant.

The impact of moderator variables on the relation between PSNU and SA

The effects of the moderating variables in the relation between PSNU and SA were shown in Table 5 . The results revealed a gender-moderated variances between the two variables (b = 0.601, 95% CI [ 0.041, 1.161], Q model (1, k = 41) = 4.705, p = 0.036).

For the relation between PSNU and SA, the moderating effects of time of measurement, region, measurement of PSNU and SA, and age were not significant.

The impact of moderator variables on the relation between PSNU and AA

The effects of the moderating variables in the relation between PSNU and AA were shown in Table 6 , region significantly moderated the correlation between PSNU and AA ( Q between = 6.410, df = 2, p = 0.041). The correlation between the two variables was significantly higher in developing country ( r = 0.378, 95% CI [0.304, 0.448]) than in developed country ( r = 0.242, 95% CI [0.162, 0.319]).

The moderating effect of the PSNU measurement was significant ( Q between = 6.852, df = 1, p = 0.009). Specifically, when AA was measured by the GPIUS-2 ( r = 0.484, 95% CI [0.200, 0.692]) and the PMSMUAQ ( r = 0.443, 95% CI [0.381, 0.501]), a moderate positive correlation was observed. However, the correlation was less significant when measured using the BSMAS ( r = 0.248, 95% CI [0.161, 0.331]) and others ( r = 0.313, 95% CI [0.250, 0.372]).

The moderating effect of the AA measurement was significant ( Q between = 17.283, df = 2, p < 0.001). The correlation was significantly higher when measured using the ECR ( r = 0.386, 95% CI [0.338, 0.432]) compared to the RQ ( r = 0.200, 95% CI [0.123, 0.275]).

For the relation between PSNU and AA, the moderating effects of time of measurement, region, gender, and age were not significant.

The impact of moderator variables on the relation between PSNU and FoMO

The effects of the moderating variables in the relation between PSNU and FoMO were shown in Table 7 , the moderating effect of the PSNU measurement was significant ( Q between = 8.170, df = 2, p = 0.017). Among the sub-dimensions, the others was excluded because there was only one sample. Specifically, when measured using the FoMOS-MSME ( r = 0.630, 95% CI [0.513, 0.725]), a moderate positive correlation was observed. However, the correlation was less significant when measured using the FoMOS ( r = 0.472, 95% CI [0.432, 0.509]) and the T-S FoMOS ( r = 0.557, 95% CI [0.463, 0.639]).

For the relationship between PSNU and FoMO, the moderating effects of time of measurement, region, measurement of PSNU, gender and age were not significant.

Through systematic review and meta-analysis, this study established a positive correlation between PSNU and anxiety symptoms (i.e., generalized anxiety, social anxiety, attachment anxiety, and fear of missing out), confirming a linear relationship and partially supporting the Social Cognitive Theory of Mass Communication [ 28 ] and the Cognitive Behavioral Model of Pathological Use [ 31 ]. Specifically, a significant positive correlation between PSNU and GA was observed, implying that GA sufferers might resort to social network for validation or as an escape from reality, potentially alleviating their anxiety. Similarly, the meta-analysis demonstrated a strong positive correlation between PSNU and SA, suggesting a preference for computer-mediated communication among those with high social anxiety due to perceived control and liberation offered by social network. This preference is often accompanied by maladaptive emotional regulation, predisposing them to problematic use. In AA, a robust positive correlation was found with PSNU, indicating a higher propensity for such use among individuals with attachment anxiety. Notably, the study identified the strongest correlation in the context of FoMO. FoMO’s significant association with PSNU is multifaceted, stemming from the real-time nature of social networks that engenders a continuous concern about missing crucial updates or events. This drives frequent engagement with social network, thereby establishing a direct link to problematic usage patterns. Additionally, social network’s feedback loops amplify this effect, intensifying FoMO. The culture of social comparison on these platforms further exacerbates FoMO, as users frequently compare their lives with others’ selectively curated portrayals, enhancing both their social networking usage frequency and the pursuit for social validation. Furthermore, the integral role of social network in modern life broadens FoMO’s scope, encompassing anxieties about staying informed and connected.

The notable correlation between FoMO and PSNU can be comprehensively understood through various perspectives. FoMO is inherently linked to the real-time nature of social networks, which cultivates an ongoing concern about missing significant updates or events in one’s social circle [ 221 ]. This anxiety prompts frequent engagement with social network, leading to patterns of problematic use. Moreover, the feedback loops in social network algorithms, designed to enhance user engagement, further intensify this fear [ 224 ]. Additionally, social comparison, a common phenomenon on these platforms, exacerbates FoMO as users continuously compare their lives with the idealized representations of others, amplifying feelings of missing out on key social experiences [ 225 ]. This behavior not only increases social networking usage but also is closely linked to the quest for social validation and identity construction on these platforms. The extensive role of social network in modern life further amplifies FoMO, as these platforms are crucial for information exchange and maintaining social ties. FoMO thus encompasses more than social concerns, extending to anxieties about staying informed with trends and dynamics within social networks [ 226 ]. The multifaceted nature of FoMO in relation to social network underscores its pronounced correlation with problematic social networking usage. In essence, the combination of social network’s intrinsic characteristics, psychological drivers of user behavior, the culture of social comparison, and the pervasiveness of social network in everyday life collectively make FoMO the most pronouncedly correlated anxiety type with PSNU.

Additionally, we conducted subgroup analyses on the timing of measurement (before COVID-19 vs. during COVID-19), measurement tools (for PSNU and anxiety symptoms), sample characteristics (participants’ region), and performed a meta-regression analysis on gender and age in the context of PSNU and anxiety symptoms. It was found that the timing of measurement, tools used for assessing PSNU and anxiety, region, and gender had a moderating effect, whereas age did not show a significant moderating impact.

Firstly, the relationship between PSNU and anxiety symptoms was significantly higher during the COVID-19 period than before, especially between PSNU and GA. However, the moderating effect of measurement timing was not significant in the relationship between PSNU and other types of anxiety. This could be attributed to the increased uncertainty and stress during the pandemic, leading to heightened levels of general anxiety [ 227 ]. The overuse of social network for information seeking and anxiety alleviation might have paradoxically exacerbated anxiety symptoms, particularly among individuals with broad future-related worries [ 228 ]. While the COVID-19 pandemic altered the relationship between PSNU and GA, its impact on other types of anxiety (such as SA and AA) may not have been significant, likely due to these anxiety types being more influenced by other factors like social skills and attachment styles, which were minimally impacted by the epidemic.

Secondly, the observed variance in the relationship between PSNU and AA across different economic contexts, notably between developing and developed countries, underscores the multifaceted influence of socio-economic, cultural, and technological factors on this dynamic. The amplified connection in developing countries may be attributed to greater socio-economic challenges, distinct cultural norms regarding social support and interaction, rising social network penetration, especially among younger demographics, and technological disparities influencing accessibility and user experience [ 229 , 230 ]. Moreover, the role of social network as a coping mechanism for emotional distress, potentially fostering insecure attachment patterns, is more pronounced in these settings [ 231 ]. These findings highlight the necessity of considering contextual variations in assessing the psychological impacts of social network, advocating for a nuanced understanding of how socio-economic and cultural backgrounds mediate the relationship between PSNU and mental health outcomes [ 232 ]. Additionally, the relationship between PSNU and other types of anxiety (such as GA and SA) presents uniform characteristics across different economic contexts.

Thirdly, the significant moderating effects of measurement tools in the context of PSNU and its correlation with various forms of anxiety, including GA, and AA, are crucial in interpreting the research findings. Specifically, the study reveals that the Bergen Social Media Addiction Scale (BSMAS) demonstrates a stronger correlation between PSNU and GA, compared to other tools. Similarly, for AA, the Griffiths’ Problematic Internet Use Scale 2 (GPIUS2) and the Problematic Media Social Media Use Assessment Questionnaire (PMSMUAQ) show a more pronounced correlation with AA than the BSMAS or other instruments, but for SA and FoMO, the PSNU instrument doesn’t significantly moderate the correlation. The PSNU measurement tool typically contains an emotional change dimension. SA and FoMO, due to their specific conditional stimuli triggers and correlation with social networks [ 233 , 234 ], are likely to yield more consistent scores in this dimension, while GA and AA may be less reliable due to their lesser sensitivity to specific conditional stimuli. Consequently, the adjustment effects of PSNU measurements vary across anxiety symptoms. Regarding the measurement tools for anxiety, different scales exhibit varying degrees of sensitivity in detecting the relationship with PSNU. The Generalized Anxiety Disorder Scale (GAD) and the Depression Anxiety Stress Scales 21 (DASS-21) are more effective in illustrating a strong relationship between GA and PSNU than the State-Trait Anxiety Inventory (STAI). In the case of AA, the Experiences in Close Relationships-21 (ECR-21) provides a more substantial correlation than the Relationship Questionnaire (RQ). Furthermore, for FoMO, the Fear of Missing Out Scale - Multi-Social Media Environment (FoMOS-MSME) is more indicative of a strong relationship with PSNU compared to the standard FoMOS or the T-S FoMOS. These findings underscore the importance of the selection of appropriate measurement tools in research. Different tools, due to their unique design, focus, and sensitivity, can reveal varying degrees of correlation between PSNU and anxiety disorders. This highlights the need for careful consideration of tool characteristics and their potential impact on research outcomes. It also cautions against drawing direct comparisons between studies without acknowledging the possible variances introduced by the use of different measurement instruments.

Fourthly, the significant moderating role of gender in the relationship between PSNU and SA, particularly pronounced in samples with a higher proportion of females. Women tend to engage more actively and emotionally with social network, potentially leading to an increased dependency on these platforms when confronting social anxiety [ 235 ]. This intensified use might amplify the association between PSNU and SA. Societal and cultural pressures, especially those related to appearance and social status, are known to disproportionately affect women, possibly exacerbating their experience of social anxiety and prompting a greater reliance on social network for validation and support [ 236 ]. Furthermore, women’s propensity to seek emotional support and express themselves on social network platforms [ 237 ] could strengthen this link, particularly in the context of managing social anxiety. Consequently, the observed gender differences in the relationship between PSNU and SA underscore the importance of considering gender-specific dynamics and cultural influences in psychological research related to social network use. In addition, gender consistency was observed in the association between PSNU and other types of anxiety, indicating no significant gender disparities.

Fifthly, the absence of a significant moderating effect of age on the relationship between PSNU and various forms of anxiety suggests a pervasive influence of social network across different age groups. This finding indicates that the impact of PSNU on anxiety is relatively consistent, irrespective of age, highlighting the universal nature of social network’s psychological implications [ 238 ]. Furthermore, this uniformity suggests that other factors, such as individual psychological traits or socio-cultural influences, might play a more crucial role in the development of anxiety related to social networking usage than age [ 239 ]. The non-significant role of age also points towards a potential generational overlap in social networking usage patterns and their psychological effects, challenging the notion that younger individuals are uniquely susceptible to the adverse effects of social network on mental health [ 240 ]. Therefore, this insight necessitates a broader perspective in understanding the dynamics of social network and mental health, one that transcends age-based assumptions.

Limitations

There are some limitations in this research. First, most of the studies were cross-sectional surveys, resulting in difficulties in inferring causality of variables, longitudinal study data will be needed to evaluate causal interactions in the future. Second, considerable heterogeneity was found in the estimated results, although heterogeneity can be partially explained by differences in study design (e.g., Time of measurement, region, gender, and measurement tools), but this can introduce some uncertainty in the aggregation and generalization of the estimated results. Third, most studies were based on Asian samples, which limits the generality of the results. Fourth, to minimize potential sources of heterogeneity, some less frequently used measurement tools were not included in the classification of measurement tools, which may have some impact on the results of heterogeneity interpretation. Finally, since most of the included studies used self-reported scales, it is possible to get results that deviate from the actual situation to some extent.

This meta-analysis aims to quantifies the correlations between PSNU and four specific types of anxiety symptoms (i.e., generalized anxiety, social anxiety, attachment anxiety, and fear of missing out). The results revealed a significant moderate positive association between PSNU and each of these anxiety symptoms. Furthermore, Subgroup analysis and meta-regression analysis indicated that gender, region, time of measurement, and instrument of measurement significantly influenced the relationship between PSNU and specific anxiety symptoms. Specifically, the measurement time and GA measurement tools significantly influenced the relationship between PSNU and GA. Gender significantly influenced the relationship between PSNU and SA. Region, PSNU measurement tools, and AA measurement tools all significantly influenced the relationship between PSNU and AA. The FoMO measurement tool significantly influenced the relationship between PSNU and FoMO. Regarding these findings, prevention interventions for PSNU and anxiety symptoms are important.

Data availability

The datasets are available from the corresponding author on reasonable request.

Abbreviations

Problematic social networking use
Generalized anxiety
Social anxiety
Attachment anxiety

Fear of miss out

Bergen Social Media Addiction Scale

Facebook Addiction Scale

Facebook Intrusion Questionnaire

Generalized Problematic Internet Use Scale 2

Problematic Mobile Social Media Usage Assessment Questionnaire

Social Network Addiction Tendency Scale

Brief Symptom Inventory

The anxiety subscale of the Depression Anxiety Stress Scales

Generalized Anxiety Disorder

The anxiety subscale of the Hospital Anxiety and Depression Scale

State-Trait Anxiety Inventory

Interaction Anxiousness Scale

Liebowitz Social Anxiety Scale

Social Anxiety Scale for Social Media Users

Social Anxiety for Adolescents

Social Anxiety Subscale of the Self-Consciousness Scale

Social Interaction Anxiety Scale

Experiences in Close Relationship Scale

Relationship questionnaire

Fear of Missing Out Scale

FoMO Measurement Scale in the Mobile Social Media Environment

Trait-State Fear of missing Out Scale

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This research was supported by the Social Science Foundation of China (Grant Number: 23BSH135).

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Mingxuan Du, Haiyan Hu, Ningning Ding, Jiankang He, Wenwen Tian, Wenqian Zhao, Xiujian Lin, Gaoyang Liu, Wendan Chen, ShuangLiu Wang, Dongwu Xu & Guohua Zhang

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Du, M., Zhao, C., Hu, H. et al. Association between problematic social networking use and anxiety symptoms: a systematic review and meta-analysis. BMC Psychol 12 , 263 (2024). https://doi.org/10.1186/s40359-024-01705-w

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SYSTEMATIC REVIEW article

Research of visual attention networks in deaf individuals: a systematic review.

1 Department of Psychology, University of Almería, Almería, Spain
2 CIBIS Research Center, University of Almería, Almería, Spain
3 Growing Brains, Washington, DC, United States

The impact of deafness on visual attention has been widely discussed in previous research. It has been noted that deficiencies and strengths of previous research can be attributed to temporal or spatial aspects of attention, as well as variations in development and clinical characteristics. Visual attention is categorized into three networks: orienting (exogenous and endogenous), alerting (phasic and tonic), and executive control. This study aims to contribute new neuroscientific evidence supporting this hypothesis. This paper presents a systematic review of the international literature from the past 15 years focused on visual attention in the deaf population. The final review included 24 articles. The function of the orienting network is found to be enhanced in deaf adults and children, primarily observed in native signers without cochlear implants, while endogenous orienting is observed only in the context of gaze cues in children, with no differences found in adults. Results regarding alerting and executive function vary depending on clinical characteristics and paradigms used. Implications for future research on visual attention in the deaf population are discussed.

1 Introduction

1.1 background.

Early auditory deprivation is recognized as a factor influencing the development of visual attention in deaf individuals ( Colmenero et al., 2004 ; Bavelier et al., 2006 ; Stevens and Neville, 2006 ). However, existing evidence on the nature of this effect is conflicting and, crucially for the present review, unclear concerning the temporal versus spatial distribution of visual attention. Historically, research on this topic has been centered on two seemingly opposing hypotheses: the deficiency hypothesis, positing that early profound deafness leads to visual attention deficits, and the enhancement hypothesis, suggesting compensatory changes to visual attention processes ( Dye and Bavelier, 2010 ).

According to the deficiency hypothesis , integrating information from different senses is essential for the normal development of attention functioning within each sensory modality. Consequently, the absence of auditory input results in underdeveloped selective attention capacities. For deaf individuals, the lack of audition impairs the development of multisensory integration, thereby impeding the typical development of visual attention skills. Put simply, while hearing people can selectively attend to a narrow visual field and still monitor the broader environment through sounds, deaf individuals must use vision to accomplish both specific tasks and monitor the broader environment ( Smith et al., 1998 ).

This view has been primarily supported by studies examining sustained visual attention or vigilance using the Continuous Performance Test or “CPT.” For example, using the Gordon Diagnostic System (GDS), a widely used CPT, the participant is presented with digits and must respond when a “1” is followed by a “9” for around 10 min ( Dye and Hauser, 2014 ). These studies have found consistent underperformance in CPTs among the deaf population, indicating that auditory input plays a role in organizing visual attention. These results are consistent with a deficit view of cross-modal reorganization stemming from early sensory deprivation ( Mitchell and Quittner, 1996 ; Smith et al., 1998 ; Quittner et al., 2004 ).

Although CPTs have been widely used to assess sustained visual attention, these tasks are sensitive to certain additional cognitive factors ( Parasnis et al., 2003 ). Specifically, CPTs require sustained attention and the ability to hold information about the target sequence in working memory, and performance is negatively affected by the inability to inhibit responses to non-target stimuli.

In contrast to the deficiency hypothesis, the enhancement hypothesis or compensation view is based on the common assumption that deficits in one sensory modality lead to heightened sensitivities in the remaining modalities ( Bavelier et al., 2006 ). In the case of early deafness, this perspective posits that the visual system is reorganized to compensate for the lack of auditory input. Consequently, visual skills assume the functional roles previously performed by audition in the typically developing child, such as monitoring the environment or discriminating temporally complex stimuli ( Bottari et al., 2014 ; Benetti et al., 2017 ; Bola et al., 2017 ; Seymour et al., 2017 ).

The enhancement or compensation hypothesis has primarily received support from studies measuring the allocation of attention across space. The results of these studies suggest that in deaf individuals, there is a spatial redistribution of visual attention toward the periphery, allowing them to better monitor their peripheral environment based on visual rather than auditory cues ( Loke and Song, 1991 ; Sladen et al., 2005 ). For example, deaf individuals can be faster than hearing controls in detecting the onset of peripheral visual targets ( Chen et al., 2006 ; Bottari et al., 2010 ; Codina et al., 2011 , 2017 ) or in discriminating the direction of visual motion with attention to peripheral locations ( Neville and Lawson, 1987 ; Bavelier et al., 2001 ).

This redistribution of visual attention can alter the trade-off in the responses of deaf people to the periphery versus the centre. Specifically, in situations where central and peripheral static stimuli compete for selective attention resources, deaf participants are more likely to orient visual attention toward peripheral than central locations ( Sladen et al., 2005 ; Chen et al., 2006 ). Consistent with these findings, Proksch and Bavelier (2002) observed that deaf individuals are more distracted by irrelevant peripheral information, whereas hearing individuals are more distracted by irrelevant central information. However, while deaf individuals have been shown to possess a field of view that extends further toward the periphery than hearing controls ( Sladen et al., 2005 ), no differences between deaf individuals and hearing controls have been documented when processing targets presented toward the centre of the visual field ( Neville and Lawson, 1987 ; Loke and Song, 1991 ).

In an initial review conducted by Tharpe et al. (2008) to examine evidence-based literature on visual attention and deafness, various paradigms were explored, including the CPT, the letter cancellation task, and conflict tasks. No conclusive evidence was found to support general enhancement or deficits in visual attention or enhanced fundamental visual sensory abilities ( Tharpe et al., 2002 ). Rather, the authors propose that the variability in performance across these paradigms could be explained by the extensive allocation of attentional resources across the visual field, driven by increased monitoring demands. This hypothesis explains why deaf individuals tend to show poorer performance on tasks requiring sustained attention to central stimuli over time compared to those involving the detection of peripheral stimuli. This idea has been supported by results found using a modified flanker paradigm incorporating several degrees of distance between distractor and target ( Sladen et al., 2005 ).

Functional brain studies have also revealed significant differences between deaf and hearing individuals that support the compensation view. These differences are related to alterations in the visual areas and the activation of visual and attention-related brain networks. For instance, Bavelier et al. (2001) found that the absence of auditory input and sign language use in the deaf population was associated with greater activation of visual cortex areas when processing peripheral and moving stimuli. Furthermore, Mayberry et al. (2011) reported that deaf individuals exhibited greater activation of visual and attention-related brain networks during peripheral visual tasks.

An area of the cortex that has been extensively studied in the context of deafness is the middle temporal (MT) or medial superior temporal (MST) area. MT/MST areas play a key role in detecting and analyzing movement and activity in these areas is modulated by attentional processes ( O’Craven et al., 1997 ). When observing unattended moving stimuli, both deaf and hearing participants show similar recruitment of the MT/MST cortex. However, when required to attend to peripheral movement and ignore concurrent central motion, enhanced recruitment of the MT/MST is observed in deaf individuals relative to hearing controls ( Bavelier et al., 2001 ; Fine et al., 2005 ). This pattern echoes a general trend in the literature, where the most significant population differences have been reported for motion stimuli in the visual periphery under conditions that engage selective attention, such as when the location or time of arrival of the stimulus is unknown or when the stimulus must be selected from distractors ( Bavelier et al., 2006 ). These findings suggest that deafness is associated with alterations in visual attention, resulting in changes in the recruitment of brain networks involved in the processing of visual information.

These apparently contradictory hypotheses highlight the necessity of organising previous research within a recognized model of attention. This review aims to respond to this need by systematically analysing the tasks employed to measure various aspects of attention in each study.

1.2 The integrative hypothesis

The contradictory results mentioned previously prompted an integrative review published by Dye and Bavelier (2010) . These authors proposed that while the deficiency hypothesis and enhancement hypothesis may appear to be mutually exclusive, the conflicting evidence concerning the impact of deafness on visual attention could arise from measuring different aspects of visual attention. Consequently, the deficit view is predominantly supported by studies focused on the allocation of attention over time, whereas the compensation view is backed by studies measuring the allocation of attention across space. Therefore, when considering different aspects of visual attention, a striking pattern of attentional enhancements and deficits emerges as a consequence of early deafness.

In addition, these two perspectives consider groups of different ages and backgrounds. Individuals in the deaf and hard of hearing population are quite diverse regarding their preferred mode of communication (sign language versus oral language), the age of acquisition of their native language, the hearing status of their parents, the aetiology of hearing loss (e.g., genetic, infection), and the implantation of cochlear implants [CI—a small electronic device that is surgically implanted into the inner ear to help provide a sense of sound to individuals with severe to profound hearing loss ( Wilson and Dorman, 2008 )]. Most of the research suggesting that deaf children have problems with visual attention has focused on deaf children learning spoken language, examining changes in sustained visual attention after restoration of auditory input through a CI ( Mitchell and Quittner, 1996 ; Smith et al., 1998 ; Quittner et al., 2004 ). In contrast, studies suggesting that the visual system compensates for the lack of auditory input by enhancing the monitoring of the peripheral visual field have primarily involved deaf adults. Specifically, these studies have focused on culturally deaf individuals born to Deaf parents, acquiring American Sign Language (ASL) as their first language and lacking CI. This group is compared to those who received oral speech therapy and have CI ( Bavelier et al., 2006 ; Dye et al., 2009 ).

Dye and Bavelier (2010) suggested that the deficiency and compensatory views were not necessarily contradictory but complementary in explaining the cross-modal reorganization of visual attention after early deafness. They propose an integrative view in which early auditory deprivation does not have an overall positive or negative impact on visual attention, but rather, selected aspects of visual attention are modified in various ways throughout the developmental trajectory.

However, this division of visual attention in temporal and spatial aspects is very broad, and the paradigms used to test these hypotheses have certain shortcomings. Studies examining the impact on temporal attention used measures from the Rapid Serial Visual Presentation Paradigms and the Attentional Blink; however, consistent results were not observed across different experiments ( Dye and Bavelier, 2010 ; Dye, 2014 ; Thakur et al., 2019 ). Concerning spatial attention, the Useful Field Of View (UFOV) task has been employed. However, this complex dual task requires following two instructions — to both detect and locate a target while ignoring several distractors. Consequently, working memory, inhibition, orienting, and divided attention can all be deployed in this task, giving rise to what is referred to as the task impurity problem ( Miyake et al., 2000 ).

1.3 The attention networks model

Understanding the potential deficits and enhancements in visual attention among deaf individuals requires recognizing that visual attention is not a unitary entity. From this perspective, based on behavioral and neuroscientific studies, Posner and colleagues have suggested a model that divides the human attentional system into three functionally and anatomically independent networks responsible for alerting, orienting, and executive attention ( Fan et al., 2002 , 2005 ; Posner and Rothbart, 2007 ; Petersen and Posner, 2012 ). As already mentioned, previous hypotheses suggest that various aspects of visual attention can be affected differently in deaf individuals due to compensatory changes. The attentional networks model offers a framework to measure these different changes by separating attention into several functions.

The alerting network is responsible for achieving and maintaining a state of elevated sensitivity to incoming information. Alertness can be further subdivided into tonic and phasic alertness (for a review, see Sturm and Willmes, 2001 ). Tonic alertness (also called vigilance or sustained attention) is a state of general wakefulness or vigilance and refers to the ability to sustain attention over a period of time. Phasic alertness is a more transient alert state, modulated by a warning that precedes a target stimulus and prepares the individual for a fast reaction. Performance within this network has been measured using tasks where the appearance of the target is preceded by an anticipatory alerting cue, provoking a phasic change in alertness. This transition involves a shift from a resting state to a prepared state, ready to detect and respond to an expected event ( Marrocco and Davidson, 1998 ; Beane and Marrocco, 2004 ). Tonic alertness, on the other hand, is typically evaluated through lengthy and repetitive tasks requiring participants to identify and respond to infrequently occurring targets, the most frequent example being CPTs ( Petersen and Posner, 2012 ).

The orienting network is responsible for the movement of attention throughout space, allowing the selection of specific information from numerous sensory inputs. In this regard, orienting can be reflexive ( exogenous ), such as when a sudden target event draws attention to its location, or it can be voluntary ( endogenous ), such as when a person searches the visual field looking for a target ( Jonides, 1981 ). Although overt orienting is often associated with head or eye movements toward the target, it can also enhance target processing by covertly orienting attention ( Posner, 1980 , 2016 ). Spatial orientation has traditionally been studied with tasks based on the “spatial orienting paradigm” or “cost and benefits paradigm.” In these tasks, the participants are presented with a fixation point and placeholders (the location where the target appears) at both sides of a fixation point. Following the onset of the fixation point, an attentional cue is presented, followed by the target to which participants must respond. Trials are categorized as cued/valid if the target appears at cued locations, uncued/invalid when it appears opposite to the cue, or neutral when the cue appears at the centre or both locations. In typical measures of exogenous orienting, a change occurs in the placeholder location to elicit an involuntary orienting response (such as the illumination of the locations). Conversely, in measures of endogenous orienting, a central cue is presented to prompt a voluntary orienting response toward a specific location or object ( Uncapher et al., 2011 ; Chica et al., 2014 ).

Finally, the executive attention network involves more complex mental operations to detect and resolve the conflict between expectation, stimulus, and response. While this network shares some overlap with executive functions, it specifically involves processes related to planning and executing goal-directed actions. However, executive functions are a more general domain that includes working memory, mental flexibility, conflict monitoring, and, in close association with executive attention, inhibitory control ( Botvinick et al., 2001 ; Matsumoto and Tanaka, 2004 ). Assessment of the executive attention network typically involves “resolution of conflict” paradigms, which require the suppression of either processing or responding to information that elicits incorrect or inappropriate responses ( Posner and DiGirolamo, 1998 ). Examples of such paradigms include the flanker ( Fan et al., 2002 ), Stroop ( Fan et al., 2003 ), or Simon tasks ( Simon and Craft, 1970 ).

One commonly used task specifically designed to measure most of these networks is the attention network test (ANT), which is based on two paradigms — the flanker task and the cost and benefits paradigm. The ANT enables the evaluation of three attentional networks in children and adults: phasic alerting, exogenous orienting, and executive attention ( Fan et al., 2002 ).

The main task is based on the flanker paradigm where the participant must press two keys indicating the direction (left or right) of a central arrow surrounded by congruent, incongruent, or neutral flankers. The difference in reaction times or accuracy between the congruent and incongruent conditions provides a measure of the executive attention network. The efficiency of the alerting network is examined by changes in performance resulting from a warning signal preceding the target, compared to trials without any previous cue. The efficiency of the orienting network is measured by comparing the performance benefits associated with a spatial cue predicting the location of the stimulus array (above or below fixation) with a central cue.

The integrative hypothesis proposed by Dye and Bavelier (2010) predicts that the strengths and weaknesses in visual attention resulting from early auditory deprivation are also linked to the abilities of orienting, alerting, and executive functions within the visual attention networks model developed by Petersen and Posner (2012) . Consequently, it is important to identify the tasks used to measure attention in deaf individuals and their possible interpretation according to the attention networks model. Understanding the weaknesses and strengths of visual attention networks related to early auditory deprivation aids in characterizing the developmental trajectory of these attentional functions during middle childhood (from 6 to 12 years old) since this is an important developmental stage for visual attention ( Rueda et al., 2004 ) and marks the beginning of formal schooling.

1.4 Objectives

To our knowledge, no systematic review has included evidence regarding the integrative hypothesis proposed by Dye and Bavelier (2010) . Furthermore, since the publication of the 2008 review by Tharpe and colleagues, no comprehensive review has been conducted to gather research findings enabling the identification of visual attention functions that could be diminished or enhanced in individuals with early auditory deprivation.

We conducted a systematic review of studies published between 2008 and 2023 focusing on deaf populations (from middle childhood through adulthood). The objective was to analyse investigations exploring one or more visual attention functions described in the attentional networks model. More specifically, our systematic review aims to:

1. Determine the most frequently studied functions of alerting, orienting, and executive attention in deaf individuals, along with the task paradigms employed to investigate such functions.

2. Identify the main strengths and impairments observed in the functioning of attentional networks in deaf adults and explore whether differences are found depending on the use of different communication systems, cochlear implants, and age of cochlear implant acquisition.

3. Examine the key developmental changes observed in the functioning of attention networks in deaf children during middle childhood (ages 6–12) and identify the main differences compared to typical hearing children of the same age.

2.1 Search strategy

We conducted a search on October 9th, 2023, of the peer-reviewed literature published in English between 2008 and 2023. The search was carried out on the Web of Science, Medline, Scielo, and Psycinfo databases, focusing on experimental studies of deaf populations aged 6–50 years. Using performance tasks to measure visual attention. The search utilized specific terms with relevant connectors to target visual attention measures and the population of interest. The search terms included: (deaf* OR “auditory deprivation” OR “hearing impairment”) AND (“orient*” OR “alert*” OR “spatial attention” OR “attention network” OR “visual selective attention” OR “visual attention” OR “sustained attention” OR “altered attention” OR “divided attention” OR “visuospatial attention” OR “executive attention”). Data extraction adhered to the recommendations provided by the Cochrane group ( Higgins and Green, 2011 ) and the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol (PRISMA; Moher et al., 2009 ).

2.2 Selection criteria

We use the PICOS strategy to define inclusion criteria (Participants, Intervention, Comparisons, Results, and Studies). This review includes studies with the following characteristics: (P) participants without a psychiatric history and typical neurodevelopment with mild, severe, or profound bilateral deafness aged between 6 and 50 year; (I) measures of some of the specific functions of the attention networks, including alerting orienting and executive attention. No specific intervention is considered in this review; (C) Transversal studies comparing performance between the deaf and typical hearing population, studies that compare the deaf population across different clinical variables such as CI and system of communication, and longitudinal studies within the deaf population assessing the development of visual attention; (O) studies are included where at least some of the attention networks can be separately measured through performance-based tasks based on the previously mentioned paradigms; and (S) Single case studies, doctoral theses, conference presentations, and papers without peer review are excluded.

2.3 Data extraction and quality evaluation

The initial search yielded 2,603 articles. After excluding duplicates between databases, 1,349 articles were removed. After applying the exclusion criteria, the studies were filtered by title and abstract, resulting in 86 remaining papers by the first author. The full texts of these 86 articles were then read and analysed by all authors. Most articles were excluded due to the inclusion of populations with other deficits, non-performance-based measures, or tasks that measured other aspects of visual attention not included in the attention networks model. In total, 24 articles met our inclusion criteria in agreement with all authors (see Figure 1 ).

Figure 1 . Flow chart of the identification, screening, eligibility, and selection of studies.

Based on our research objective, the articles were classified according to the age of the participants: individuals aged 18 to 60 were categorized as adults, while those aged 6 to 12 were considered children. After some deliberation among the authors, studies involving participants up to 14 years old were included in the children category, along with a study by Kronenberger et al. (2013) which encompassed individuals aged 7–25 years. Significant statistical differences between deaf or hard of hearing and fully hearing individuals in measures assessing attention network efficiency were used as an indication of specific outcomes for each study.

The risk of bias was assessed for all articles using the Newcastle-Ottawa scale (NOS; Wells et al., 2021 , adapted from Herzog et al., 2013 ) to evaluate the quality of the studies. In this version, the quality scores were based on the selection of sample, comparability between groups, and the measurement of results. For cross-sectional studies, a maximum score of 10 can be obtained, with a score above 6 considered a satisfactory methodology score ( Orton et al., 2014 ). In this systematic review, none of the studies included in the final analysis scored <7 (see Table 1 ).

Table 1 . Risk of bias scores adapted from the Newcastle-Ottawa scale.

3.1 Frequency of studies and tasks used

The initial objective of the study was to determine the most frequently studied aspects of attention. Of the 24 included studies, 23 adopted a cross-sectional experimental design and one was a longitudinal study. Additionally, 15 studies focused solely on adult samples, eight studies exclusively involved children, and one study included both adult and child participants. Not all studies investigated a single attention network (see Table 2 ).

Table 2 . Studies included in the review by group of age sample and function measured.

3.1.1 The alerting network

The alerting network was studied in 8 of 24 articles. Among these studies, five exclusively involved children aged between 6 and 12 years, two studies focused on adults aged between 19 and 57, and one study used a mixed sample of adults and children aged between 7 and 25. Except for two of the 11 studies ( Daza and Phillips-Silver, 2013 ; Bharadwaj et al., 2020 ), the rest compared the deaf group with their hearing peers. Six of the 11 studied the tonic alerting network using CPTs, while one studied phasic alerting using the ANT (see Table 3 ).

Table 3 . Paradigms used in the studies included in the review.

As mentioned above, CPTs are frequently used to measure visual attention in deaf individuals. Depending on the paradigm used, several interpretations are possible regarding the specific function measured. Following the previously described example of the GDS, commission errors due to responding to “9” when no “1” appeared are considered impulsive, lack of response or omission errors are considered distraction/inattention, and the most commonly used “ d ’” combines commission and omission errors to obtain a measure of sensitivity and is considered to show vigilance, which is why it has been classified as a tonic alerting measure ( Baijot et al., 2013 ).

3.1.2 The orienting network

The orienting network was studied in 12 of the 24 articles. Only two studies focused on children, one involving a sample aged between 6 and 14 years and another involving both children and adults aged between 10 and 58. The majority of studies (seven out of 12) were conducted exclusively with adults aged between 18 and 57. In eight out of 12 articles, exogenous orienting was studied, using spatial orienting paradigms, including the ANT. Four articles investigated endogenous orienting using spatial orienting paradigms. A visual search paradigm designed by Heimler et al. (2015a) allows for obtaining a measure of exogenous and endogenous orienting and was included in both categories (see Table 3 ).

As mentioned previously, the orienting paradigms facilitate the measurement of exogenous and endogenous orienting by manipulating cues before the appearance of targets. These paradigms provide various measures of the orienting process, the most common being the facilitation of a valid cue toward the target. Additionally, they can be used to measure the disengagement of attention following an invalid cue. In cases where eye movements are considered, overt orienting of attention is measured instead of covert attention. Four of the nine studies focusing on exogenous attention with orienting paradigms measured saccadic eye movements (overt attention), while the remaining five used only manual responses (covert attention). Heimler et al. (2015a) designed a visual search paradigm in which participants must search for a target (tilted line) among a visual field full of similar distractors (straight lines) while ignoring a salient distractor (line tilted opposite direction). The salience of the target and distractor was manipulated trial by trial by changing their colors. This approach was driven by the idea that the salient stimulus attracts exogenous attention while the target requires an endogenous search across the visual field. Through this method, they were able to obtain a measure of endogenous orienting and exogenous orienting.

3.1.3 The executive attention network

The executive attention network was studied in 7 of 24 articles. Four studies involved a sample of children aged between 6 and 13 (see Figure 2 ), while three focused exclusively on adults aged between 18 and 58 (see Figure 3 ). Three of the 7 used conflict tasks with several modifications, three used the ANT, and the remainder employed the modified CPT developed by Dye and Hauser (2014) (see Table 3 ).

Figure 2 . Number of studies with deaf children in each attention network function and the general findings in comparison to full hearing children. *Deficits in executive attention found with younger children [2, 74].

Figure 3 . Number of studies with deaf adults in each attention network function and the general findings in comparison to full hearing adults. *Enhancements found in overt orienting but not in covert orienting and deficits with executive attention found only during specific conditions.

Regarding measures of executive attention, paradigms classified as conflict tasks were included. These tasks require participants to ignore distractors while attending to a central target. Notably, the study conducted by Dye and Hauser (2014) used a CPT but compared the execution of a CPT with and without distractors in the same sample, thereby measuring executive attention.

3.2 Comparisons between deaf and hearing adults

Our second objective was to compile the differences found between deaf and full hearing adults. We note that all studies involving adults employed a cross-sectional design (see Figure 2 ). The two studies that measured tonic alerting in deaf adults revealed poorer performance compared to hearing peers when using CPTs as a measure ( Kronenberger et al., 2013 ; Bharadwaj et al., 2020 ). Specifically, Kronenberger et al. (2013) used the Test of Variables of Attention (TOVA), indicating poorer performance by deaf individuals across all measures. Similarly, Bharadwaj et al. (2020) used the Integrated Visual and Auditory Continuous Performance Test (IVA plus CPT), demonstrating that deaf individuals commit more omission errors and have slower reaction times.

The only study that measured phasic alerting with alerting cues found an advantage in deaf adults ( Prasad et al., 2022 ). Deaf adults also seem to have advantages in covert exogenous orienting ( Xingjuan et al., 2011 ; Brazão et al., 2021 ; Li et al., 2022 ; Prasad et al., 2022 ). However, studies that measured overt attention with saccadic movement found no facilitation of exogenous orienting with this measure ( Bottari et al., 2012 ; Prasad et al., 2015 ; Heimler et al., 2015a ; Jayaraman et al., 2016 ). The five studies that measured endogenous orienting found no differences between deaf and full-hearing adults ( Bottari et al., 2008 ; Heimler et al., 2015a , b ; Bonmassar et al., 2021 ; Li et al., 2022 ).

Regarding executive attention, no differences were found between deaf adults and their hearing peers in a typical flanker task ( Holmer et al., 2020 ). Chen et al. (2010) used a paradigm with three conditions: congruency, the distance of the distractor (central or peripheral), and screen proximity (typical computer screen or projected onto a wall) and found that deaf adults showed greater interference from peripheral distractors compared to central cues. This effect was reversed when the display was projected onto a wall. Hauthal et al. (2012) designed a paradigm where participants had to discern the gender of a central target while faces appeared as distractors at the flanks. The faces could either match or differ in gender from the target, creating interference. The study revealed that with a high volume of distractors, adult deaf signers without CI still showed interference effects while hearing adults did not.

Regarding our secondary objective, to explore any differences observed among deaf individuals in relation to variables concerning hearing loss history, device use and mode of communication, very few studies examined adults with CI (see Table 4 ), possibly due to the relative novelty of the technology ( Wilson and Dorman, 2008 ). The few studies that included adults with CI did not find any effect of implantation in tonic alerting ( Kronenberger et al., 2013 ; Bharadwaj et al., 2020 ). The rest of the findings will be discussed below along with the results of studies in children.

Table 4 . Basic deaf related variables regarding auditory access and system of communication.

3.3 Development of attention networks and comparison between deaf and full hearing children

With respect to our third and final objective, we found one longitudinal study and four studies that either compared groups across different ages or treated age as a continuous independent variable. In deaf individuals, tonic alerting was observed to develop between 6 and 13 years of age ( Dye and Hauser, 2014 ; Dye and Terhune-Cotter, 2023 ). With exogenous orienting, the only result found was that the fundamental operations of moving and engaging develop from 6 to 7 years of age ( Daza and Phillips-Silver, 2013 ). Lastly, executive attention appears to develop around 8 years of age in deaf individuals ( Dye and Hauser, 2014 ). As mentioned before, comparisons between differences between individuals with and without CIs and different systems of communication were almost exclusive to studies with children. When comparing deaf and typical hearing children, greater challenges in tonic alertness were evident in speaking deaf children with CI ( Yucel and Derim, 2008 ; Hoffman et al., 2018 ), but not in deaf signers without CI ( Dye and Hauser, 2014 ). Regarding phasic alertness, Daza and Phillips-Silver (2013) found a greater alerting effect in the ANT when comparing oral deaf children with CI and deaf signers without CI. Daza and Phillips-Silver (2013) also found faster movement and engagement in a spatial orienting paradigm when comparing deaf signers without CI to oral deaf children with CI. However, in endogenous orienting, an advantage was found in deaf children (independent of the system of communication) when a social central cue was employed ( Pavani et al., 2019 ). When measuring executive attention with a flanker task, no differences were found between deaf children (mostly speaking with CI) and hearing children ( Daza and Phillips-Silver, 2013 ; Daza González et al., 2021 ) except for Merchán et al. (2022) who observed poorer performance in deaf children. Dye and Hauser (2014) , examining the effect of distractors on a central target with a focus on the difference in performance on two CPTs, found that deaf signers without CI showed poorer performance than their full hearing counterparts.

4 Discussion

4.1 current frequency of studies and tasks used.

As observed, there exist notable gaps in our understanding of the visual attention network in deaf individuals, with research focusing on different functions depending on the age of the participants. While tonic alerting has been extensively researched in both adult and youth deaf populations, primarily through CPTs, the exploration of phasic alerting remains scarce in both groups. Notably, only one study in adults has investigated phasic alerting, emerging as an unexpected result from a cost and benefit paradigm measuring orienting behavior ( Prasad et al., 2022 ).

Similarly, concerning the orienting network, while there is a wide range of research on exogenous orienting in deaf adults, few studies have tested these differences in deaf children ( Daza and Phillips-Silver, 2013 ). Moreover, endogenous attention has been underexplored in both age groups.

Regarding executive attention, there appears to be a more balanced interest across developmental stages, primarily through flanker tasks in children and a broader range of conflict tasks in deaf adults. This is likely due to the fact that flanker tasks have been previously studied in deaf adults prior to the scope of this review ( Sladen et al., 2005 ; Dye et al., 2009 ).

From these observations, it becomes evident that there is a critical need to delve deeper into the exploration of phasic alerting and endogenous orienting of attention, particularly in deaf and hard of hearing children. This need arises from the potential existence of adaptive developmental aspects in visual attention that warrant further investigation.

4.2 Results of comparisons between deaf and hearing adults

The results in deaf adults seem to indicate a deficit in the tonic alerting network, which can be explained by several hypotheses. One possibility is that deaf individuals have difficulties in sustaining attention over time, possibly due to a more rapid depletion of attentional resources. To test this hypothesis, investigating how performance changes over the course of a task could provide insights into whether there is a faster decline in performance or a general difficulty in executing the task. While Hoffman et al. (2018) attempted to analyse this aspect, they focused exclusively on children, which will be discussed below. Another hypothesis emerges from the division of labor perspective, which supports the deficit view. According to this notion, the observed results may be due to the need for deaf individuals to rely on vision to simultaneously monitor their environment and focus on a specific task. This dual demand on attentional resources might limit the resources available for performing visual tasks such as the CPT ( Smith et al., 1998 ; Quittner et al., 2004 ).

Normally, phasic alerting is primarily dependent on the auditory system. Therefore, in adults, it would be reasonable to expect that adaptive mechanisms could lead to a heightened state of alert generated by visual cues, as demonstrated in the experiment conducted by Prasad et al. (2022) .

The overall advantage observed in spatial exogenous orienting in deaf adults appears to be attributable to covert orienting rather than overt orienting/ eye movements ( Prasad et al., 2015 ; Brazão et al., 2021 ; Prasad et al., 2022 ). This supports the notion of an adaptive alteration in the visual attention system in deaf individuals. This adaptation enables them to monitor the environment since they are able to efficiently shift their attentional focus across the visual field towards important stimuli and also disengage from them more rapidly.

The mechanisms governing orienting of attention or eye movements have been shown to be more dependent on endogenous attention, which could explain why the differences between deaf and full hearing individuals do not extend to the results of these tasks ( Zangrossi et al., 2021 ; Celli et al., 2022 ). Endogenous orienting does not differ between deaf and typical hearing adults, whether measured by visual search ( Heimler et al., 2015a ) or spatial orienting paradigms using central cues ( Heimler et al., 2015b ; Bonmassar et al., 2021 ; Li et al., 2022 ). One explanation for this result is that endogenous orienting of attention requires voluntary control of attention (top-down), while exogenous attention is an involuntary mechanism (bottom-up), as some results indicated that deaf individuals could have worse executive control, possibly explaining the lack of differences in these tasks ( Li et al., 2022 ). However, as we have found in this review, deficits in executive control are not common in adults or native signers, contrary to the results found in orienting. Another possible explanation for this discrepancy is that this function does not show differences since it is not inherently adaptative. In contrast, the improvements observed in exogenous orienting could stem from the need to monitor environmental changes using only the visual system, without the support of the auditory system. On the other hand, attention shifts due to endogenous attention could be distracting for deaf individuals required to maintain a strong focus on hands and facial expressions during conversations.

Regarding executive function, no differences were found in a typical flanker task ( Holmer et al., 2020 ). However, when distractors were placed in the periphery instead of the centre, deaf individuals showed poorer performance compared to their hearing peers ( Chen et al., 2010 ). These contradictory results seem to support the hypothesis that the observed performance deficits in conflict tasks with central targets may not necessarily be due to deficits in executive attention. Instead, these findings could be due to the further allocation of attentional resources towards distractors in comparison to hearing individuals. This explanation is further supported when these results are compared to those of the UFOV tasks, where both targets and distractors are located in the periphery. In these tasks, deaf individuals tend to have an advantage ( Dye et al., 2016 ; Samar and Berger, 2017 ). However, the findings of Hauthal et al. (2012) could indicate an adaptive change specifically in the processing of faces. These results suggest that the performance of signers without CI in executive attention tasks depends on the position of the target, which can be explained by the further allocation of attention towards the periphery. An alternative interpretation of these findings is that deaf adults may develop an advantage in the ventral attention network (VAN). The VAN is responsible for reflexive bottom-up attentional mechanisms and has been associated with exogenous orienting and phasic alerting This could potentially explain the observed benefits in both functions among deaf adults. In contrast, the dorsal attention network (DAN) governs voluntary or top-down attentional mechanisms and has been linked to endogenous orienting, tonic alerting, and executive functioning ( Corbetta and Shulman, 2002 ; Rueda et al., 2023 ). Apart from tonic alerting, it appears that deaf adults may not experience performance deficits relative to typical hearing controls in this pathway.

4.3 Findings of comparisons between deaf and hearing children

In children, the differences between deaf and typical hearing individuals vary according to age, suggesting that middle childhood is an important period of development for visual attention. Our review found that deaf children show worse scores in CPTs, which is argued as being indicative of a deficit in tonic alerting. However, contrary to this notion, Hoffman et al. (2018) found no differences in performance block by block between deaf and hearing children. This suggests that tonic alerting or vigilance may not be affected, but the difference in performance is due to the division of labor, as mentioned previously. Furthermore, the poor performance during these tasks was characterized by high commission errors ( Yucel and Derim, 2008 ; Hoffman et al., 2018 ), which could be interpreted as poor inhibition or impulsivity. These findings have been replicated with other paradigms that measure response inhibition, such as the Go/No Go or Simon tasks ( Figueras et al., 2008 ; Botting et al., 2017 ; Hall et al., 2018 ).

The results reported by Daza and Phillips-Silver (2013) , indicating higher phasic alerting and faster exogenous orienting, could potentially suggest a benefit due to the lack of auditory stimulation. However, these results have not been directly compared with those of hearing children. We must also consider that the differences in endogenous attention found by Pavani et al. (2019) can only be interpreted in the context of gaze cues, since there is evidence that other (non-gaze) directional cues rely on different processes ( Heimler et al., 2015b ). Consequently, there is insufficient experimental data on orienting in deaf children in comparison to their hearing counterparts, which prevents us from drawing any firm conclusions in this regard.

Concerning executive attention, discrepancies between the results of Dye and Hauser (2014) and Merchán et al. (2022) and those of Daza González et al. (2021) could be due to differences in the sample, specifically in terms of age, since the latter study focused on children aged 9 to 10 years. As observed in adults, deaf children show no difference in UFOV task performance between the ages of 7 and 10 years. In fact, their performance surpasses that of their hearing peers between the ages of 11 and 17 ( Dye et al., 2009 ; Dye and Bavelier, 2010 ). This discrepancy in performance might manifest as a reduced ability to ignore distractors when they are at the periphery and the target is in the centre of the visual field. Notably, this difference disappears when the target is also positioned in the periphery, supporting the hypothesis that attentional resources are allocated toward the periphery.

In general, we can conclude that, as expected, the findings have revealed improved performance of deaf individuals in tasks related to covert exogenous orienting, with limited impact on endogenous orienting in adults. However, deaf individuals show poorer execution of tasks involving tonic alertness and executive attention, except when the target is presented peripherally. These results are consistent with much of the clinical literature in deaf individuals ( Barker et al., 2009 ) and support the integrative hypothesis suggesting a deficiency in the temporal distribution of attention and an enhancement in spatial distribution ( Dye and Bavelier, 2010 ). Finally, from the perspective of the attention network model, our study highlights the need to further explore phasic alerting. Currently, there is a gap in research exploring differences in exogenous and endogenous orienting between deaf and full hearing children and a lack of studies investigating the endogenous orienting network in deaf adults.

4.4 Development of attention network functions in deaf children

Regarding our objective of characterizing the development of attentional networks in middle childhood within the deaf population, several conclusions can be drawn. However, we must consider the need for further research in this area, particularly through longitudinal studies.

Our findings indicate that tonic alertness continues to develop from ages 6 to 13 in both deaf and typical hearing children ( Dye and Hauser, 2014 ; Dye and Terhune-Cotter, 2023 ). This aligns with previous research on typical hearing children using the same task, which showed a specific development ceiling at 10 years old ( Betts et al., 2006 ). However, it appears that deaf individuals do not reach the levels observed in typical hearing adults, at least those who are not native signers ( Bharadwaj et al., 2020 ).

The elemental operations of moving and engaging improve between the ages of 6 and 7 in deaf children ( Daza and Phillips-Silver, 2013 ). In comparison to hearing children, our results suggest that orienting networks continue to develop during middle childhood in deaf individuals, whereas in their hearing counterparts, this development tends to plateau at around 6 years old ( Rueda et al., 2004 ; Pozuelos et al., 2014 ; Federico et al., 2017 ). Notably, this development in deaf individuals appears to extend into adulthood, providing them with an advantage over typical hearing adults. Interestingly, when measuring electrophysiological brain activity through evoked potentials, improvements in visual attention related to saliency processing and orienting of attention have been observed as early as 3 years of age. These measures demonstrate improvement during the early years in deaf children, indicating early and differential development of these components of attention ( Campbell and Sharma, 2016 ; de Schonen et al., 2018 ; Gabr et al., 2022 ; Corina et al., 2024 ).

Finally, executive attention seems to improve between 7 and 9 years of age in deaf children. Dye and Hauser (2014) found that deaf signers without CI reach the same levels of performance between 9 and 13 years old. However, Daza González et al. (2021) found no differences among children aged 9–10, while Merchán et al. (2022) observed worse performance in a sample of 7–10 years old. These findings are consistent with those reported in studies of typical hearing children, suggesting that difficulties found in this aspect of the attention network cannot be solely attributed to late development ( Rueda et al., 2004 ; Pozuelos et al., 2014 ; Federico et al., 2017 ). When comparing deaf and hearing adults, it is plausible that deaf individuals continue to show development in exogenous orienting during early childhood, eventually achieving better performance than their hearing counterparts ( Bottari et al., 2012 ; Prasad et al., 2015 ). In adulthood, deaf signers without CI reach similar levels in executive attention when central targets are present ( Chen et al., 2010 ; Holmer et al., 2020 ). However, differences in tonic alertness may persist into adulthood ( Parasnis et al., 2003 ; Kronenberger et al., 2013 ).

4.5 Effects of the communication system and the use of cochlear implants

In most studies, the use of sign language is associated with the absence of a CI. It is important to recognize the clear distinction between culturally deaf people who communicate mainly in sign language within deaf communities and those who have received CI along with speech therapy. The latter group has experienced some level of auditory input and uses a language that is less reliant on visual cues.

In adults, there are no studies on tonic alertness involving deaf signers without CI. However, age at CI implantation does not seem to have an impact on CPT performance ( Kronenberger et al., 2013 ; Bharadwaj et al., 2020 ). While no differences were observed between deaf signers without CI and full hearing children ( Dye and Hauser, 2014 ), differences have been found in oral-speaking deaf children with CI ( Yucel and Derim, 2008 ; Hoffman et al., 2018 ). Additionally, Daza and Phillips-Silver (2013) found differences in tonic alertness between oral speaking deaf children with CI and deaf signers without CI in favor of the former. Dye and Terhune-Cotter (2023) found that while the English language was a strong predictor of better sustained attention, ASL proficiency was a more accurate predictor of response inhibition.

Generally speaking, these findings suggest a consistent trend toward poorer performance on tonic alerting tasks in oral speaking deaf individuals. Notably, the lack of an effect of age of implantation in adults raises the possibility that early language acquisition does not influence these outcomes. Regarding exogenous orienting, it is evident that elementary operations of orienting such as moving and engaging are enhanced in deaf signers without CI compared to oral speaking deaf individuals with CI ( Daza and Phillips-Silver, 2013 ). Additionally, the advantage observed in executive attention towards peripheral targets in adults appears to be more prevalent among deaf signers without CI ( Samar and Berger, 2017 ), while in children these improvements have also been found in deaf signers without CI ( Dye et al., 2009 ).

These findings align with the main hypothesis put forward to explain differences in performance on tasks that measure different executive functions in deaf people and could also be applied to these results, that is, worse performance can be attributed to late acquisition of language ( Hall et al., 2017 , 2018 ; Merchán et al., 2022 ). This explanation has commonly been invoked when attempting to explain performance on executive function tasks, but as observed in this review, tonic alertness also appears to be affected. However, an adaptive form of development is evident when executive attention is directed toward the periphery in deaf signers without CI who lack auditory stimulation and have delayed acquisition of language ( Dye et al., 2009 ; Samar and Berger, 2017 ). Unfortunately, there is insufficient evidence to conclusively establish the impact of these variables on phasic alertness, endogenous orienting, and executive attention.

5 Conclusion

In summary, there are notable gaps in the literature regarding the functions of visual attention networks, specifically in the alerting network functions in adults, phasic alerting, and both orienting networks in children. Current evidence suggests that deaf adults show poorer performance during CPTs, but this might not necessarily be attributed to deficits in tonic alerting. Phasic alerting, on the other hand, appears to confer advantages in deaf adults. Exogenous orienting shows enhancements, whereas endogenous orienting does not. Additionally, differences in executive attention are evident, particularly depending on the peripheral placement of the distractors. In children, the evidence reveals similar patterns of results, with the exception that difficulties in executive attention are observed before the ages of 9 or 10.

Regarding individual differences in language delay and the use of CI, it seems that benefits in exogenous orienting are more frequent in deaf individuals without CI and users of sign language while language abilities appear to be a good predictor of difficulties in executive attention. This understanding contributes to the growing body of knowledge in the field, emphasizing the need for further research to bridge the identified gaps and refine our comprehension of the intricate development of visual attention networks in the deaf population.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

NG: Writing – original draft, Methodology, Investigation. JP-S: Supervision, Conceptualization, Writing – review & editing. MD: Writing – original draft, Supervision, Writing – review & editing, Funding acquisition, Conceptualization.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by a grant PID2019-111454RB-I00/AEI/10.13039/501100011033 from Spanish Ministry of Science and Innovation—Spanish State Research Agency, to the last author.

Conflict of interest

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

Publisher’s note

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Keywords: deaf, children, attention, hearing, orienting, review methodology, investigation

Citation: Gioiosa Maurno N, Phillips-Silver J and Daza González MT (2024) Research of visual attention networks in deaf individuals: a systematic review. Front. Psychol . 15:1369941. doi: 10.3389/fpsyg.2024.1369941

Received: 13 January 2024; Accepted: 22 April 2024; Published: 09 May 2024.

Reviewed by:

Copyright © 2024 Gioiosa Maurno, Phillips-Silver and Daza González. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: María Teresa Daza González, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Open access
Published: 16 May 2024

Promoting equality, diversity and inclusion in research and funding: reflections from a digital manufacturing research network

Oliver J. Fisher 1 ,
Debra Fearnshaw ORCID: orcid.org/0000-0002-6498-9888 2 ,
Nicholas J. Watson 3 ,
Peter Green 4 ,
Fiona Charnley 5 ,
Duncan McFarlane 6 &
Sarah Sharples 2

Research Integrity and Peer Review volume 9 , Article number: 5 ( 2024 ) Cite this article

Metrics details

Equal, diverse, and inclusive teams lead to higher productivity, creativity, and greater problem-solving ability resulting in more impactful research. However, there is a gap between equality, diversity, and inclusion (EDI) research and practices to create an inclusive research culture. Research networks are vital to the research ecosystem, creating valuable opportunities for researchers to develop their partnerships with both academics and industrialists, progress their careers, and enable new areas of scientific discovery. A feature of a network is the provision of funding to support feasibility studies – an opportunity to develop new concepts or ideas, as well as to ‘fail fast’ in a supportive environment. The work of networks can address inequalities through equitable allocation of funding and proactive consideration of inclusion in all of their activities.

This study proposes a strategy to embed EDI within research network activities and funding review processes. This paper evaluates 21 planned mitigations introduced to address known inequalities within research events and how funding is awarded. EDI data were collected from researchers engaging in a digital manufacturing network activities and funding calls to measure the impact of the proposed method.

Quantitative analysis indicates that the network’s approach was successful in creating a more ethnically diverse network, engaging with early career researchers, and supporting researchers with care responsibilities. However, more work is required to create a gender balance across the network activities and ensure the representation of academics who declare a disability. Preliminary findings suggest the network’s anonymous funding review process has helped address inequalities in funding award rates for women and those with care responsibilities, more data are required to validate these observations and understand the impact of different interventions individually and in combination.

Conclusions

In summary, this study offers compelling evidence regarding the efficacy of a research network's approach in advancing EDI within research and funding. The network hopes that these findings will inform broader efforts to promote EDI in research and funding and that researchers, funders, and other stakeholders will be encouraged to adopt evidence-based strategies for advancing this important goal.

Peer Review reports

Introduction

Achieving equality, diversity, and inclusion (EDI) is an underpinning contributor to human rights, civilisation and society-wide responsibility [ 1 ]. Furthermore, promoting and embedding EDI within research environments is essential to make the advancements required to meet today’s research challenges [ 2 ]. This is evidenced by equal, diverse and inclusive teams leading to higher productivity, creativity and greater problem-solving ability [ 3 ], which increases the scientific impact of research outputs and researchers [ 4 ]. However, there remains a gap between EDI research and the everyday implementation of inclusive practices to achieve change [ 5 ]. This paper presents and reflects on the EDI measures trialled by the UK Engineering and Physical Sciences Research Council (EPSRC) funded digital manufacturing research network, Connected Everything (grant number: EP/S036113/1) [ 6 ]. The EPSRC is a UK research council that funds engineering and physical sciences research. By sharing these reflections, this work aims to contribute to the wider effort of creating an inclusive research culture. The perceptions of equality, diversity, and inclusion may vary among individuals. For the scope of this study, the following definitions are adopted:

Equality: Equality is about ensuring that every individual has an equal opportunity to make the most of their lives and talents. No one should have poorer life chances because of the way they were born, where they come from, what they believe, or whether they have a disability.

Diversity: Diversity concerns understanding that each individual is unique, recognising our differences, and exploring these differences in a safe, positive, and nurturing way to value each other as individuals.

Inclusion: Inclusion is an effort and practice in which groups or individuals with different backgrounds are culturally and socially accepted, welcomed and treated equally. This concerns treating each person as an individual, making them feel valued, and supported and being respectful of who they are.

Research networks have varied goals, but a common purpose is to create new interdisciplinary research communities, by fostering interactions between researchers and appropriate scientific, technological and industrial groups. These networks aim to offer valuable career progression opportunities for researchers, through access to research funding, forming academic and industrial collaborations at network events, personal and professional development, and research dissemination. However, feedback from a 2021 survey of 19 UK research networks, suggests that these research networks are not always diverse, and whilst on the face of it they seem inclusive, they are perceived as less inclusive by minority groups (including non-males, those with disabilities, and ethnic minority respondents) [ 7 ]. The exclusivity of these networks further exacerbates the inequality within the academic community as it prevents certain groups from being able to engage with all aspects of network activities.

Research investigating the causes of inequality and exclusivity has identified several suggestions to make research culture more inclusive, including improving diverse representation within event programmes and panels [ 8 , 9 ]; ensuring events are accessible to all [ 10 ]; providing personalised resources and training to build capacity and increase engagement [ 11 ]; educating institutions and funders to understand and address the barriers to research [ 12 ]; and increasing diversity in peer review and funding panels [ 13 ]. Universities, research institutions and research funding bodies are increasingly taking responsibility to ensure the health of the research and innovation system and to foster inclusion. For example, the EPSRC has set out their own ‘Expectation for EDI’ to promote the formation of a diverse and inclusive research culture [ 14 ]. To drive change, there is an emphasis on the importance of measuring diversity and links to measured outcomes to benchmark future studies on how interventions affect diversity [ 5 ]. Further, collecting and sharing EDI data can also drive aspirations, provide a target for actions, and allow institutions to consider common issues. However, there is a lack of available data regarding the impact of EDI practices on diversity that presents an obstacle, impeding the realisation of these benefits and hampering progress in addressing common issues and fostering diversity and inclusion [ 5 ].

Funding acquisition is important to an academic’s career progression, yet funding may often be awarded in ways that feel unequal and/or non-transparent. The importance of funding in academic career progression means that, if credit for obtaining funding is not recognised appropriately, careers can be damaged, and, as a result of the lack of recognition for those who have been involved in successful research, funding bodies may not have a complete picture of the research community, and are unable to deliver the best value for money [ 15 ]. Awarding funding is often a key research network activity and an area where networks can have a positive impact on the wider research community. It is therefore important that practices are established to embed EDI consideration within the funding process and to ensure that network funding is awarded without bias. Recommendations from the literature to make the funding award process fairer include: ensuring a diverse funding panel; funders instituting reviewer anti-bias training; anonymous review; and/or automatic adjustments to correct for known biases [ 16 ]. In the UK, the government organisation UK Research and Innovation (UKRI), tasked with overseeing research and innovation funding, has pledged to publish data to enhance transparency. This initiative aims to furnish an evidence base for designing interventions and evaluating their efficacy. While the data show some positive signs (e.g., the award rates for male and female PI applicants were equal at 29% in 2020–21), Ottoline Leyser (UKRI Chief Executive) highlights the ‘persistent pernicious disparities for under-represented groups in applying for and winning research funding’ [ 17 ]. This suggests that a more radical approach to rethinking the traditional funding review process may be required.

This paper describes the approach taken by the ‘Connected Everything’ EPSRC-funded Network to embed EDI in all aspects of its research funding process, and evaluates the impact of this ambition, leading to recommendations for embedding EDI in research funding allocation.

Connected everything’s equality diversity and inclusion strategy

Connected Everything aims to create a multidisciplinary community of researchers and industrialists to address key challenges associated with the future of digital manufacturing. The network is managed by an investigator team who are responsible for the strategic planning and, working with the network manager, to oversee the delivery of key activities. The network was first funded between 2016–2019 (grant number: EP/P001246/1) and was awarded a second grant (grant number: EP/S036113/1). The network activities are based around three goals: building partnerships, developing leadership and accelerating impact.

The Connected Everything network represents a broad range of disciplines, including manufacturing, computer science, cybersecurity, engineering, human factors, business, sociology, innovation and design. Some of the subject areas, such as Computer Science and Engineering, tend to be male-dominated (e.g., in 2021/22, a total of 185,42 higher education student enrolments in engineering & technology subjects was broken down as 20.5% Female and 79.5% Male [ 18 ]). The networks also face challenges in terms of accessibility for people with care responsibilities and disabilities. In 2019, Connected Everything committed to embedding EDI in all its network activities and published a guiding principle and goals for improving EDI (see Additional file 1 ). When designing the processes to deliver the second iteration of Connected Everything, the team identified several sources of potential bias/exclusion which have the potential to impact engagement with the network. Based on these identified factors, a series of mitigation interventions were implemented and are outlined in Table 1 .

Connected everything anonymous review process

A key Connected Everything activity is the funding of feasibility studies to enable cross-disciplinary, foresight, speculative and risky early-stage research, with a focus on low technology-readiness levels. Awards are made via a short, written application followed by a pitch to a multidisciplinary diverse panel including representatives from industry. Six- to twelve-month-long projects are funded to a maximum value of £60,000.

The current peer-review process used by funders may reveal the applicants’ identities to the reviewer. This can introduce dilemmas to the reviewer regarding (a) deciding whether to rely exclusively on information present within the application or search for additional information about the applicants and (b) whether or not to account for institutional prestige [ 34 ]. Knowing an applicant’s identity can bias the assessment of the proposal, but by focusing the assessment on the science rather than the researcher, equality is more frequently achieved between award rates (i.e., the proportion of successful applications) [ 15 ]. To progress Connected Everything’s commitment to EDI, the project team created a 2-stage review process, where the applicants’ identity was kept anonymous during the peer review stage. This anonymous process, which is outlined in Fig. 1 , was created for the feasibility study funding calls in 2019 and used for subsequent funding calls.

Connected Everything’s anonymous review process [EDI: Equality, diversity, and inclusion]

To facilitate the anonymous review process, the proposal was submitted in two parts: part A the research idea and part B the capability-to-deliver statement. All proposals were first anonymously reviewed by a random selection of two members from the Connected Everything executive group, which is a diverse group of digital manufacturing experts and peers from academia, industry and research institutions that provide guidance and leadership on Connected Everything activities. The reviewers rated the proposals against the selection criteria (see Additional file 1 , Table 1) and provided overall comments alongside a recommendation on whether or not the applicant should be invited to the panel pitch. This information was summarised and shared with a moderation sift panel, made up of a minimum of two Connected Everything investigators and a minimum of one member of the executive group, that tensioned the reviewers’ comments (i.e. comments and evaluations provided by the peer reviewers are carefully considered and weighed against each other) and ultimately decided which proposals to invite to the panel. This tension process included using the identifying information to ensure the applicants did have the capability to deliver the project. If this remained unclear, the applicants were asked to confirm expertise in an area the moderation sift panel thought was key or asked to bring in additional expertise to the project team during the panel pitch.

During stage two the applicants were invited to pitch their research idea to a panel of experts who were selected to reflect the diversity of the community. The proposals, including applicants’ identities, were shared with the panel at least two weeks ahead of the panel. Individual panel members completed a summary sheet at the end of the pitch session to record how well the proposal met the selection criteria (see Additional file 1 , Table 1). Panel members did not discuss their funding decision until all the pitches had been completed. A panel chair oversaw the process but did not declare their opinion on a specific feasibility study unless the panel could not agree on an outcome. The panel and panel chair were reminded to consider ways to manage their unconscious bias during the selection process.

Due to the positive response received regarding the anonymous review process, Connected Everything extended its use when reviewing other funded activities. As these awards were for smaller grant values (~ £5,000), it was decided that no panel pitch was required, and the researcher’s identity was kept anonymous for the entire process.

Data collection and analysis methods

Data collection.

Equality, diversity and inclusion data were voluntarily collected from applicants for Connected Everything research funding and from participants who won scholarships to attend Connected Everything funded activities. Responses to the EDI data requests were collected from nine Connected Everything coordinated activities between 2019 and 2022. Data requests were sent after the applicant had applied for Connected Everything funding or had attended a Connected Everything funded activity. All data requests were completed voluntarily, with reassurance given that completion of the data requested in no way affected their application. In total 260 responses were received, of which the three feasibility study calls comprised 56.2% of the total responses received. Overall, there was a 73.8% response rate.

To understand the diversity of participants engaging with Connected Everything activities and funding, the data requests asked for details of specific diversity characteristics: gender, transgender, disability, ethnicity, age, and care responsibilities. Although sex and gender are terms that are often used interchangeably, they are two different concepts. To clarify, the definitions used by the UK government describe sex as a set of biological attributes that is generally limited to male or female, and typically attributed to individuals at birth. In contrast, gender identity is a social construction related to behaviours and attributes, and is self-determined based on a person’s internal perception, identification and experience. Transgender is a term used to describe people whose gender identity is not the same as the sex they were registered at birth. Respondents were first asked to identify their gender and then whether their gender was different from their birth sex.

For this study, respondents were asked to (voluntarily) self-declare whether they consider themselves to be disabled or not. Ethnicity within the data requests was based on the 2011 census classification system. When reporting ethnicity data, this study followed the AdvanceHE example to aggregate the census categories into six groups to enable benchmarking against the available academic ethnicity data. AdvanceHE is a UK charity that works to improve the higher education system for staff, students and society. However, it was acknowledged that there were limitations with this grouping, including the assumption that minority ethnic staff or students are a homogenous group [ 16 ]. Therefore, this study made sure to breakdown these groups during the discussion of the results. The six groups are:

Asian: Asian/Asian British: Indian, Pakistani, Bangladeshi, and any other Asian background;

Black: Black/African/Caribbean/Black British: African, Caribbean, and any other Black/African/Caribbean background;

Other ethnic backgrounds, including Arab.

White: all white ethnic groups.

Benchmarking data

Published data from the Higher Education Statistics Agency [ 26 ] (a UK organisation responsible for collecting, analysing, and disseminating data related to higher education institutions and students), UKRI funding data [ 19 , 35 ] and 2011 census data [ 36 ] were used to benchmark the EDI data collected within this study. The responses to the data collected were compared to the engineering and technology cluster of academic disciplines, as this is most represented by Connected Everything’s main funded EPSRC. The Higher Education Statistics Agency defines the engineering and technology cluster as including the following subject areas: general engineering; chemical engineering; mineral, metallurgy & materials engineering; civil engineering; electrical, electronic & computer engineering; mechanical, aero & production engineering and; IT, systems sciences & computer software engineering [ 37 ].

When assessing the equality in funding award rates, previous studies have focused on analysing the success rates of only the principal investigators [ 15 , 16 , 38 ]; however, Connected Everything recognised that writing research proposals is a collaborative task, so requested diversity data from the whole research team. The average of the last six years of published principal investigator and co-investigator diversity data for UKRI and EPSRC funding awards (2015–2021) was used to benchmark the Connected Everything funding data [ 35 ]. The UKRI and EPSRC funding review process includes a peer review stage followed by panel pitch and assessment stage; however, the applicant's track record is assessed during the peer review stage, unlike the Connected Everything review process.

The data collected have been used to evaluate the success of the planned migrations to address EDI factors affecting the higher education research ecosystem, as outlined in Table 1 (" Connected Everything’s Equality Diversity and Inclusion Strategy " Section).

Dominance of small number of research-intensive universities receiving funding from network

The dominance of a small number of research-intensive universities receiving funding from a network can have implications for the field of research, including: the unequal distribution of resources; a lack of diversity of research, limited collaboration opportunities; and impact on innovation and progress. Analysis of published EPSRC funding data between 2015 and 2021 [ 19 ], shows that the funding has been predominately (74.1%, 95% CI [71.%, 76.9%] out of £3.98 billion) awarded to Russell Group universities. The Russell Group is a self-selected association of 24 research-intensive universities (out of the 174 universities) in the UK, established in 1994. Evaluation of the universities that received Connected Everything feasibility study funding between 2016–2019, shows that Connected Everything awarded just over half (54.6%, 95% CI [25.1%, 84.0%] out of 11 awards) to Russell Group universities. Figure 2 shows that the Connected Everything funding awarded to Russell Group universities reduced to 44.4%, 95% CI [12.0%, 76.9%] of 9 awards between 2019–2022.

A comparison of funding awarded by EPSRC (total = £3.98 billion) across Russell Group universities and non-Russell Group universities, alongside the allocations for Connected Everything I (total = £660 k) and Connected Everything II (total = £540 k)

Dominance of successful applications from men

The percentage point difference between the award rates of researchers who identified as female, those who declare a disability, or identified as ethnic minority applicants and carers and their respective counterparts have been plotted in Fig. 3 . Bars to the right of the axis mean that the award rate of the female/declared-disability/ethnic-minority/carer applicants is greater than that of male/non- disability/white/not carer applicants.

Percentage point (PP) differences in award rate by funding provider for gender, disability status, ethnicity and care responsibilities (data not collected by UKRI and EPSRC [ 35 ]). The total number of applicants for each funder are as follows: Connected Everything = 146, EPSRC = 37,960, and UKRI = 140,135. *The numbers of applicants were too small (< 5) to enable a meaningful discussion

Figure 3 (A) shows that between 2015 and 2021 research team applicants who identified as male had a higher award rate than those who identified as female when applying for EPSRC and wider UKRI research council funding. Connected Everything funding applicants who identified as female achieved a higher award rate (19.4%, 95% CI [6.5%, 32.4%] out of 146) compared to male applicants (15.6%, 95% CI [8.8%, 22.4%] out of 146). These data suggest that biases have been reduced by the Connected Everything review process and other mitigation strategies (e.g., visible gender diversity in panel pitch members and publishing CE principal and goals to demonstrate commitment to equality and fairness). This finding aligns with an earlier study that found gender bias during the peer review process, resulting in female investigators receiving less favourable evaluations than their male counterparts [ 15 ].

Over-representation of people identifying as male in engineering and technology academic community

Figure 4 shows the response to the gender question, with 24.2%, 95% CI [19.0%, 29.4%] of 260 responses identifying as female. This aligns with the average for the engineering and technology cluster (21.4%, 95% CI [20.9%, 21.9%] female of 27,740 academic staff), which includes subject areas representative of our main funder, EPSRC [ 22 ]. We also sought to understand the representation of transgender researchers within the network. However, following the rounding policy outlined by UK Government statistics policies and procedures [ 39 ], the number of responses that identified as a different sex to birth was too low (< 5) to enable a meaningful discussion.

Gender question responses from a total of 260 respondents

Dominance of successful applications from white academics

Figure 3 (C) shows that researchers with a minority ethnicity consistently have a lower award rate than white researchers when applying for EPSRC and UKRI funding. Similarly, the results in Fig. 3 (C) indicate that white researchers are more successful (8.0% percentage point, 95% CI [-8.6%, 24.6%]) when applying for Connected Everything funding. These results indicate that more measures should be implemented to support the ethnic minority researchers applying for Connected Everything funding, as well as sense checking there is no unconscious bias in any of the Connected Everything funding processes. The breakdown of the ethnicity diversity of applicants at different stages of the Connected Everything review process (i.e. all applications, applicants invited to panel pitch and awarded feasibility studies) has been plotted in Fig. 5 to help identify where more support is needed. Figure 5 shows an increase in the proportion of white researchers from 54%, 95% CI [45.4%, 61.8%] of all 146 applicants to 66%, 95% CI [52.8%, 79.1%] of the 50 researchers invited to the panel pitch. This suggests that stage 1 of the Connected Everything review process (anonymous review of written applications) may favour white applicants and/or introduce unconscious bias into the process.

Ethnicity questions responses from different stages during the Connected Everything anonymous review process. The total number of applicants is 146, with 50 at the panel stage and 23 ultimately awarded

Under-representation of those from black or minority ethnic backgrounds

Connected Everything appears to have a wide range of ethnic diversity, as shown in Fig. 6 . The ethnicities Asian (18.3%, 95% CI [13.6%, 23.0%]), Black (5.1%, 95% CI [2.4%, 7.7%]), Chinese (12.5%, 95% CI [8.4%, 16.5%]), mixed (3.5%, 95% CI [1.3%, 5.7%]) and other (7.8%, 95% CI [4.5%, 11.1%]) have a higher representation among the 260 individuals engaging with network’s activities, in contrast to both the engineering and technology academic community and the wider UK population. When separating these groups into the original ethnic diversity answers, it becomes apparent that there is no engagement with ‘Black or Black British: Caribbean’, ‘Mixed: White and Black Caribbean’ or ‘Mixed: White and Asian’ researchers within Connected Everything activities. The lack of engagement with researchers from a Caribbean heritage is systemic of a lack of representation within the UK research landscape [ 25 ].

Ethnicity question responses from a total of 260 respondents compared to distribution of the 13,085 UK engineering and technology (E&T) academic staff [ 22 ] and 56 million people recorded in the UK 2011 census data [ 36 ]

Under-representation of disabilities, chronic conditions, invisible illnesses and neurodiversity in funded activities and events.

Figure 7 (A) shows that 5.7%, 95% CI [2.4%, 8.9%] of 194 responses declared a disability. This is higher than the average of engineering and technology academics that identify as disabled (3.4%, 95% CI [3.2%, 3.7%] of 27,730 academics). Between Jan-March 2022, 9.0 million people of working age (16–64) within the UK were identified as disabled by the Office for National Statistics [ 40 ], which is 21% of the working age population [ 27 ]. Considering these statistics, there is a stark under-representation of disabilities, chronic conditions, invisible illnesses and neurodiversity amongst engineering and technology academic staff and those engaging in Connected Everything activities.

Responses to A Disability and B Care responsibilities questions colected from a total of 194 respondents

Between 2015 and 2020 academics that declared a disability have been less successful than academics without a disability in attracting UKRI and EPSRC funding, as shown in Fig. 3 (B). While Fig. 3 (B) shows that those who declare a disability have a higher Connected Everything funding award rate, the number of applicants who declared a disability was too small (< 5) to enable a meaningful discussion regarding this result.

Under-representation of those with care responsibilities in funded activities and events

In response to the care responsibilities question, Fig. 7 (B) shows that 27.3%, 95% CI [21.1%, 33.6%] of 194 respondents identified as carers, which is higher than the 6% of adults estimated to be providing informal care across the UK in a UK Government survey of the 2020/2021 financial year [ 41 ]. However, the ‘informal care’ definition used by the 2021 survey includes unpaid care to a friend or family member needing support, perhaps due to illness, older age, disability, a mental health condition or addiction [ 41 ]. The Connected Everything survey included care responsibilities across the spectrum of care that includes partners, children, other relatives, pets, friends and kin. It is important to consider a wide spectrum of care responsibilities, as key academic events, such as conferences, have previously been demonstrably exclusionary sites for academics with care responsibilities [ 42 ]. Breakdown analysis of the responses to care responsibilities by gender in Fig. 8 reveals that 37.8%, 95% CI [25.3%, 50.3%] of 58 women respondents reported care responsibilities, compared to 22.6%, 95% CI [61.1%, 76.7%] of 136 men respondents. Our findings reinforce similar studies that conclude the burden of care falls disproportionately on female academics [ 43 ].

Responses to care responsibilities when grouped by A 136 males and B 58 females

Figure 3 (D) shows that researchers with careering responsibilities applying for Connected Everything funding have a higher award rate than those researchers applying without care responsibilities. These results suggest that the Connected Everything review process is supportive of researchers with care responsibilities, who have faced barriers in other areas of academia.

Reduced opportunities for ECRs

Early-career researchers (ECRs) represent the transition stage between starting a PhD and senior academic positions. EPSRC defines an ECR as someone who is either within eight years of their PhD award, or equivalent professional training or within six years of their first academic appointment [ 44 ]. These periods exclude any career break, for example, due to family care; health reasons; and reasons related to COVID-19 such as home schooling or increased teaching load. The median age for starting a PhD in the UK is 24 to 25, while PhDs usually last between three and four years [ 45 ]. Therefore, these data would imply that the EPSRC median age of ECRs is between 27 and 37 years. It should be noted, however, that this definition is not ideal and excludes ECRs who may have started their research career later in life.

Connected Everything aims to support ECRs via measures that include mentoring support, workshops, summer schools and podcasts. Figure 9 shows a greater representation of researchers engaging with Connected Everything activities that are aged between 30–44 (62.4%, 95% CI [55.6%, 69.2%] of 194 respondents) when compared to the wider engineering and technology academic community (43.7%, 95% CI [43.1%, 44.3%] of 27,780 academics) and UK population (26.9%, 95% CI [26.9%, 26.9%]).

Age question responses from a total of 194 respondents compared to distribution of the 27,780 UK engineering and technology (E&T) academic staff [ 22 ] and 56 million people recorded in the UK 2011 census data [ 36 ]

High competition for funding has a greater impact on ECRs

Figure 10 shows that the largest age bracket applying for and winning Connected Everything funding is 31–45, whereas 72%, CI 95% [70.1%, 74.5%] of 12,075 researchers awarded EPSRC grants between 2015 and 2021 were 40 years or older. These results suggest that measures introduced by Connected Everything has been successful at providing funding opportunities for researchers who are likely to be early-mid career stage.

Age of researchers at applicant and awarded funding stages for A Connected Everything between 2019–2022 (total of 146 applicants and 23 awarded) and B EPSRC funding between 2015–2021 [ 35 ] (total of 35,780 applicants and 12,075 awarded)

The results of this paper provide insights into the impact that Connected Everything’s planned mitigations have had on promoting equality, diversity, and inclusion (EDI) in research and funding. Collecting EDI data from individuals who engage with network activities and apply for research funding enabled an evaluation of whether these mitigations have been successful in achieving the intended outcomes outlined at the start of the study, as summarised in Table 2 .

The results in Table 2 indicate that Connected Everything’s approach to EDI has helped achieve the intended outcome to improve representation of women, ECRs, those with a declared disability and black/minority ethnic backgrounds engaging with network events when compared to the engineering and technology academic community. In addition, the network has helped raise awareness of the high presence of researchers with care responsibilities at network events, which can help to track progress towards making future events inclusive and accessible towards these carers. The data highlights two areas for improvement: (1) ensuring a gender balance; and (2) increasing representation of those with declared disabilities. Both these discrepancies are indicative of the wider imbalances and underrepresentation of these groups in the engineering and technology academic community [ 26 ], yet represent areas where networks can strive to make a difference. Possible strategies include: using targeted outreach; promoting greater representation of these groups in event speakers; and going further to create a welcoming and inclusive environment. One barrier that can disproportionately affect women researchers is the need to balance care responsibilities with attending network events [ 46 ]. This was reflected in the Connected Everything data that reported 37.8%, 95% CI [25.3%, 50.3%] of women engaging with network activities had care responsibilities, compared to 22.6%, 95% CI [61.1%, 76.7%] of men. Providing accommodations such as on-site childcare, flexible scheduling, or virtual attendance options can therefore help to promote inclusivity and allow more women researchers to attend.

Only 5.7%, 95% CI [2.4%, 8.9%] of responses engaging with Connected Everything declared a disability, which is higher than the engineering and technology academic community (3.4%, 95% CI [3.2%, 3.7%]) [ 26 ], but unrepresentative of the wider UK population. It has been suggested that academics can be uncomfortable when declaring disabilities because scholarly contributions and institutional citizenship are so prized that they feel they cannot be honest about their issues or health concerns and keep them secret [ 47 ]. In research networks, it is important to be mindful of this hidden group within higher education and ensure that measures are put in place to make the network’s activities inclusive to all. Future considerations for accommodations to improve research events inclusivity include: improving physical accessibility of events; providing assistive technology such as screen readers, audio descriptions, and captioning can help individuals with visual or hearing impairments to access and participate; providing sign language interpreters; offering flexible scheduling options; and the provision of quiet rooms, written materials in accessible formats, and support staff trained to work with individuals with cognitive disabilities.

Connected Everything introduced measures (e.g., anonymised reviewing process, Q&A sessions before funding calls, inclusive design of panel pitch) to help address inequalities in how funding is awarded. Table 2 shows success in reducing the dominance of researchers who identify as male and research-intensive universities in winning research funding and that researchers with care responsibilities were more successful at winning funding than those without care responsibilities. The data revealed that the proposed measures were unable to address the inequality in award rates between white and ethnic minority researchers, which is an area to look to improve. The inequality appears to occur during the anonymous review stage, with a greater proportion of white researchers being invited to panel. Recommendations to make the review process fairer include: ensuring greater diversity of reviewers; reviewer anti-bias training; and automatic adjustments to correct for known biases in writing style [ 16 , 32 ].

When reflecting on the development of a strategy to embed EDI throughout the network, Connected Everything has learned several key lessons that may benefit other networks undergoing a similar activity. These include:

EDI is never ‘done’: There is a constant need to review approaches to EDI to ensure they remain relevant to the network community. Connected Everything could review its principles to include the concept of justice in its approach to diversity and inclusion. The concept of justice concerning EDI refers to the removal of systematic barriers that stop fair and equitable distribution of resources and opportunities among all members of society, regardless of their individual characteristics or backgrounds. The principles and subsequent actions could be reviewed against the EDI expectations [ 14 ], paying particular attention to areas where barriers may still be present. For example, shifting from welcoming people into existing structures and culture to creating new structures and culture together, with specific emphasis on decision or advisory mechanisms within the network. This activity could lend itself to focusing more on tailored support to overcome barriers, thus achieving equity, if it is not within the control of the network to remove the barrier itself (justice).

Widen diversity categories: By collecting data on a broad range of characteristics, we can identify and address disparities and biases that might otherwise be overlooked. A weakness of this dataset is that ignores the experience of those with intersectional identities, across race, ethnicity, gender, class, disability and/ or LGBTQI. The Wellcome Trust noted how little was known about the socio-economic background of scientists and researchers [ 48 ].

Collect data on whole research teams: For the first two calls for feasibility study funding, Connected Everything only asked the Principal Investigator to voluntarily provide their data. We realised that this was a limited approach and, in the third call, asked for the data regarding the whole research team to be shared anonymously. Furthermore, we do not currently measure the diversity of our event speakers, panellists or reviewers. Collecting these data in the future will help to ensure the network is accountable and will ensure that all groups are represented during our activities and in the funding decision-making process.

High response rate: Previous surveys measuring network diversity (e.g., [ 7 ]) have struggled to get responses when surveying their memberships; whereas, this study achieved a response rate of 73.8%. We attribute this high response rate to sending EDI data requests on the point of contact with the network (e.g., on submitting funding proposals or after attending network events), rather than trying to survey the entire network membership at anyone point in time.

Improve administration: The administration associated with collecting EDI data requires a commitment to transparency, inclusivity, and continuous improvement. For example, during the first feasibility funding call, Connected Everything made it clear that the review process would be anonymous, but the application form was not in separate documents. This made anonymising the application forms extremely time-consuming. For the subsequent calls, separate documents were created – Part A for identifying information (Principal Investigator contact details, Project Team and Industry collaborators) and Part B for the research idea.

Accepting that this can be uncomfortable: Trying to improve EDI can be uncomfortable because it often requires challenging our assumptions, biases, and existing systems and structures. However, it is essential if we want to make real progress towards equity and inclusivity. Creating processes to support embedding EDI takes time and Connected Everything has found it is rare to get it right the first time. Connected Everything is sharing its learning as widely as possible both to support others in their approaches and continue our learning as we reflect on how to continually improve, even when it is challenging.

Enabling individual engagement with EDI: During this work, Connected Everything recognised that methods for engaging with such EDI issues in research design and delivery are lacking. Connected Everything, with support from the Future Food Beacon of Excellence at the University of Nottingham, set out to develop a card-based tool [ 49 ] to help researchers and stakeholders identify questions around how their work may promote equity and increase inclusion or have a negative impact towards one or more protected groups and how this can be overcome. The results of this have been shared at conference presentations [ 50 ] and will be published later.

While this study provides insights into how EDI can be improved in research network activities and funding processes, it is essential to acknowledge several limitations that may impact the interpretation of the findings.

Sample size and generalisability: A total of 260 responses were received, which may not be representative of our overall network of 500 + members. Nevertheless, this data provides a sense of the current diversity engaging in Connected Everything activities and funding opportunities, which we can compare with other available data to steer action to further diversify the network.

Handling of missing data: Out of the 260 responses, 66 data points were missing for questions regarding age, disability, and caring responsibilities. These questions were mistakenly omitted from a Connected Everything summer school survey, contributing to 62 missing data points. While we assumed the remainer of missing data to be at random during analysis, it's important to acknowledge it could be related to other factors, potentially introducing bias into our results.

Emphasis on quantitative data: The study relies on using quantitative data to evaluate the impact of the EDI measures introduced by Connected Everything. However, relying solely on quantitative metrics may overlook nuanced aspects of EDI that cannot be easily quantified. For example, EDI encompasses multifaceted issues influenced by historical, cultural, and contextual factors. These nuances may not be fully captured by numbers alone. In addition, some EDI efforts may not yield immediate measurable outcomes but still contribute to a more inclusive environment.

Diversity and inclusion are not synonymous: The study proposes 21 measures to contribute towards creating an equal, diverse and inclusive research culture and collects diversity data to measure the impact of these measures. However, while diversity is simpler to monitor, increasing diversity alone does not guarantee equality or inclusion. Even with diverse research groups, individuals from underrepresented groups may still face barriers, microaggressions, or exclusion.

Balancing anonymity and rigour in grant reviews:The proposed anonymous review process proposed by Connected Everything removes personal and organisational details from the research ideas under reviewer evaluation. However, there exists a possibility that a reviewer could discern the identity of the grant applicant based on the research idea. Reviewers are expected to be subject matter experts in the field relevant to the grant proposal they are evaluating. Given the specialised nature of scientific research, it is conceivable that a well-known applicant could be identified through the specifics of the work, the methodologies employed, and even the writing style.

Expanding gender identity options: A limitation of this study emerged from the restricted gender options (male, female, other, prefer not to say) provided to respondents when answering the gender identity question. This limitation reflects the context of data collection in 2018, a time when diversity monitoring guidance was still limited. As our understanding of gender identity evolves beyond binary definitions, future data collection efforts should embrace a more expansive and inclusive approach, recognising the diverse spectrum of gender identities.

In conclusion, this study provides evidence of the effectiveness of a research network's approach to promoting equality, diversity, and inclusion (EDI) in research and funding. By collecting EDI data from individuals who engage with network activities and apply for research funding, this study has shown that the network's initiatives have had a positive impact on representation and fairness in the funding process. Specifically, the analysis reveals that the network is successful at engaging with ECRs, and those with care responsibilities and has a diverse range of ethnicities represented at Connected Everything events. Additionally, the network activities have a more equal gender balance and greater representation of researchers with disabilities when compared to the engineering and technology academic community, though there is still an underrepresentation of these groups compared to the national population.

Connected Everything introduced measures to help address inequalities in how funding is awarded. The measures introduced helped reduce the dominance of researchers who identified as male and research-intensive universities in winning research funding. Additionally, researchers with care responsibilities were more successful at winning funding than those without care responsibilities. However, inequality persisted with white researchers achieving higher award rates than those from ethnic minority backgrounds. Recommendations to make the review process fairer include: ensuring greater diversity of reviewers; reviewer anti-bias training; and automatic adjustments to correct for known biases in writing style.

Connected Everything’s approach to embedding EDI in network activities has already been shared widely with other EPSRC-funded networks and Hubs (e.g. the UKRI Circular Economy Hub and the UK Acoustics Network Plus). The network hopes that these findings will inform broader efforts to promote EDI in research and funding and that researchers, funders, and other stakeholders will be encouraged to adopt evidence-based strategies for advancing this important goal.

Availability of data and materials

The data collected was anonymously, however, it may be possible to identify an individual by combining specific records of the data request form data. Therefore, the study data has been presented in aggregate form to protect the confidential of individuals and the data utilised in this study cannot be made openly accessible due to ethical obligations to protect the privacy and confidentiality of the data providers.

Abbreviations

Early career researcher

Equality, diversity and inclusion

Engineering physical sciences research council

UK research and innovation

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Acknowledgements

The authors would like to acknowledge the support Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/S036113/1], Connected Everything II: Accelerating Digital Manufacturing Research Collaboration and Innovation. The authors would also like to gratefully acknowledge the Connected Everything Executive Group for their contribution towards developing Connected Everything’s equality, diversity and inclusion strategy.

This work was supported by the Engineering and Physical Sciences Research Council (EPSRC) [grant number EP/S036113/1].

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Oliver J. Fisher

Human Factors Research Group, Faculty of Engineering, University of Nottingham, University Park, Nottingham, UK

Debra Fearnshaw & Sarah Sharples

School of Food Science and Nutrition, University of Leeds, Leeds, UK

Nicholas J. Watson

School of Engineering, University of Liverpool, Liverpool, UK

Peter Green

Centre for Circular Economy, University of Exeter, Exeter, UK

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Institute for Manufacturing, University of Cambridge, Cambridge, UK

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OJF analysed and interpreted the data, and was the lead author in writing and revising the manuscript. DF led the data acquisition and supported the interpretation of the data. DF was also a major contributor to the design of the equality diversity and inclusion (EDI) strategy proposed in this work. NJW supported the design of the EDI strategy and was a major contributor in reviewing and revising the manuscript. PG supported the design of the EDI strategy, and was a major contributor in reviewing and revising the manuscript. FC supported the design of the EDI strategy and the interpretation of the data. DM supported the design of the EDI strategy. SS led the development EDI strategy proposed in this work, and was a major contributor in data interpretation and reviewing and revising the manuscript. All authors read and approved the final manuscript.

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Correspondence to Debra Fearnshaw .

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Fisher, O.J., Fearnshaw, D., Watson, N.J. et al. Promoting equality, diversity and inclusion in research and funding: reflections from a digital manufacturing research network. Res Integr Peer Rev 9 , 5 (2024). https://doi.org/10.1186/s41073-024-00144-w

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Allosteric coupling asymmetry mediates paradoxical activation of BRAF by type II inhibitors

Damien M Rasmussen
Manny M Semonis
Joseph T Greene
Joseph M Muretta
Andrew R Thompson
Silvia Toledo Ramos
David D Thomas
William CK Pomerantz
Tanya S Freedman

Department of Pharmacology, University of Minnesota, United States ;
Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, United States ;
Department of Chemistry, University of Minnesota, United States ;
Center for Immunology, University of Minnesota, United States ;
Masonic Cancer Center, University of Minnesota, United States ;
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Nicholas M Levinson
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Reviewer #1 (Public Review):

Reviewer #2 (public review):, author response.

Amy H Andreotti
Iowa State University, United States

The authors quantitatively describe the complex binding equilibria of BRAF and its inhibitors resulting in some cases in the paradoxical activation of BRAF dimer when bound to ATP competitive inhibitors. The authors use a biophysical tour de force involving FRET binding assays, NMR, kinase activity assays, and DEER spectroscopy.

The strengths of the study are the beautifully conducted assays that allow for a thorough characterization of the allostery in this complex system. Additionally, the use of F-NMR and DEER spectroscopy provides important insights into the details of the process.

The resulting model for binding of inhibitors and dimerization (Figure 4) is very helpful.

Weaknesses:

This is a complex system and its communication is inherently challenging. It might be of interest to the broader readership to understand the implications of the model for drug development and therapy.

This manuscript uses FRET, 19F-NMR, and DEER/EPR solution measurements to examine the allosteric effects of a panel of BRAF inhibitors (BRAFi). These include first-generation aC-out BRAFi, and more recent Type I and Type II aC-in inhibitors. Intermolecular FRET measurements quantify Kd for BRAF dimerization and inhibitor binding to the first and second subunits. Distinct patterns are found between aC-in BRAFi, where Type I BRAFi binds equally well to the first and second subunits within dimeric BRAF. In contrast, Type II BRAFi shows stronger affinity for the first subunit and weaker affinity for the second subunit, an effect named "allosteric asymmetry". Allosteric asymmetry has the potential for Type II inhibitors to promote dimerization while favoring occupancy of only one subunit (BBD form), leading to the enrichment of an active dimer.

Measurements of in vitro BRAF kinase activity correlate amazingly well with the calculated amounts of the half-site-inhibited BBD forms with Type II inhibitors. This suggests that the allosteric asymmetry mechanism explains paradoxical activation by this class of inhibitors. DEER/EPR measurements further examine the positioning of helix aC. They show systematic outward movement of aC with Type II inhibitors, relative to the aC-in state with Type I inhibitors, and further show that helix aC adopts multiple states and is therefore dynamic in apo BRAF. This makes a strong case that negative cooperativity between sites in the BRAF dimer can account for paradoxical kinase activation by Type II inhibitors by creating a half-site-occupied homodimer, BBD. In contrast, Type I inhibitors and aC-out inhibitors do not fit this model, and are therefore proposed to be explained by previously proposed models involving negative allostery between subunits in BRAF-CRAF heterodimers, RAS priming, and transactivation.

This study integrates orthogonal spectroscopic and kinetic strategies to characterize BRAF dynamics and determine how it impacts inhibitor allostery. The unique combination of approaches presented in this study represents a road map for future work in the important area of protein kinase dynamics. The work represents a worthy contribution not only to the field of BRAF regulation but to protein kinases in general.

Some questions remain regarding the proposed model for Type II inhibitors and its comparison to Type I and aC-out inhibitors that would be useful to clarify. Specifically, it would be helpful to address whether the activation of BRAF by Type II inhibitors, while strongly correlated with BBD model predictions in vitro, also depends on CRAF via BRAF-CRAF in cells and therefore overlaps with the mechanisms of paradoxical activation by Type I and aC-out inhibitors.

We would like to thank the reviewers for their helpful comments. We note that both reviews are strongly supportive with comments including, “a biophysical tour de force” (rev #1), “the study is exemplary” (rev #2), and “represents a roadmap for future work” (rev #2). Below we respond to each reviewer comment.

Reviewer #1 This study provides a detailed and quantitative description of the allosteric mechanisms resulting in the paradoxical activation of BRAF kinase dimers by certain kinase inhibitors. The findings provide a much needed quantiative basis for this phenomenon and may lay the foundation for future drug development efforts aimed at the important cancer target BRAF. The study builds on very evidence obtained by multiple independent biophysical methods. Summary: The authors quantitatively describe the complex binding equilibria of BRAF and its inhibitors resulting in some cases in the paradoxical activation of BRAF dimer when bound to ATP competitive inhibitors. The authors use a biophysical tour de force involving FRET binding assays, NMR, kinase activity assays and DEER spectroscopy.

We are gratified by the reviewer’s supportive summary.

Strengths: The strengths of the study are the beautifully conducted assays that allow for a thorough characterization of the allostery in this complex system. Additionally, the use of F-NMR and DEER spectroscopy provide important insights into the details of the process.The resulting model for binding of inhibitors and dimerization (Fig.4) is very helpful. Weaknesses: This is a complex system and its communication is inherently challenging. It might be of interest to the broader readership to understand the implications of the model for drug development and therapy.

We agree with the reviewer that this is a complicated system. With regard to inhibitor development, a key insight is that designing aC-in state inhibitors that avoid paradoxical activation may be non-trivial because these molecules not only induce dimers but also tend to bind the second dimer subunit more weakly than the first, due to allosteric asymmetry and/or inherently different affinities for each RAF isoform. We feel the full implications for future therapeutic development are an extensive topic that is beyond the scope of our work, which is focused on the properties of current inhibitors.

Recommendations for the author: The experimental work, analysis and resulting model are excellent. I had some difficulty following the complex model in some instances and it may be useful to review the description of the model and see whether it can be made more palatable to the broader readership.I think it would be useful to discuss the model presented in reference 40 (Kholodenko) and to compare it to the presented model here.

We regret any confusion with regards to the nature of the model. Our analysis was built upon the model developed by Boris Kholodenko as reported in his 2015 Cell Reports paper. This formed the theoretical framework that combined with our experimental data allowed us to parameterize this model to obtain experimental values for the equilibrium constants and allosteric coupling factors.

Reviewer #2 This manuscript combines elegant biophysical solution measurements to address paradoxical kinase activation by Type II BRAF inhibitors. The novel findings challenge prevailing models, through experiments that are rigorous and carefully controlled. The study is exemplary in the breadth of strategies it uses to address protein kinase dynamics and inhibitor allostery. Summary: This manuscript uses FRET, 19F-NMR and DEER/EPR solution measurements to examine the allosteric effects of a panel of BRAF inhibitors (BRAFi). These include first-generation aC-out BRAFi, and more recent Type I and Type II aC-in inhibitors. Intermolecular FRET measurements quantify Kd for BRAF dimerization and inhibitor binding to the first and second subunits. Distinct patterns are found between aC-in BRAFi, where Type I BRAFi bind equally well to the first and second subunits within dimeric BRAF. In contrast, Type II BRAFi show stronger affinity for the first subunit and weaker affinity for the second subunit, an effect named "allosteric asymmetry". Allosteric asymmetry has the potential for Type II inhibitors to promote dimerization while favoring occupancy of only one subunit (BBD form), leading to enrichment of an active dimer. Measurements of in vitro BRAF kinase activity correlate amazingly well with the calculated amounts of the half site-inhibited BBD forms with Type II inhibitors. This suggests that the allosteric asymmetry mechanism explains paradoxical activation by this class of inhibitors. DEER/EPR measurements further examine the positioning of helix aC. They show systematic outward movement of aC with Type II inhibitors, relative to the aC-in state with Type I inhibitors, and further show that helix aC adopts multiple states and is therefore dynamic in apo BRAF. This makes a strong case that negative cooperativity between sites in the BRAF dimer can account for paradoxical kinase activation by Type II inhibitors by creating a half site-occupied homodimer, BBD. In contrast, Type I inhibitors and aC-out inhibitors do not fit this model, and are therefore proposed to be explained by previous proposed models involving negative allostery between subunits in BRAF-CRAF heterodimers, RAS priming, and transactivation. Strengths: This study integrates orthogonal spectroscopic and kinetic strategies to characterize BRAF dynamics and determine how it impacts inhibitor allostery. The unique combination of approaches presented in this study represents a road map for future work in the important area of protein kinase dynamics. The work represents a worthy contribution not only to the field of BRAF regulation but protein kinases in general. Weaknesses: Some questions remain regarding the proposed model for Type II inhibitors and its comparison to Type I and aC-out inhibitors that would be useful to clarify. Specifically, it would be helpful to address whether the activation of BRAF by Type II inhibitors, while strongly correlated with BBD model predictions in vitro, also depends on CRAF via BRAF-CRAF in cells and therefore overlaps with the mechanisms of paradoxical activation by Type I and aC-out inhibitors.

We agree with the reviewer that this is a worthy question to be pursued. However, given the substantial experimental effort required for such an endeavor, and the highly supportive nature of the reviewer comments, including that “This is a strong manuscript that I feel is well above the bar for publication”, we believe this effort is more appropriate for a future study.

This is a strong manuscript that I feel is well above the bar for publication. Nevertheless, it is recommended that the authors consider addressing the following points in order to support their major conclusions. (1) Fig 3D shows similar effects of Type II and Type I inhibitors in the biphasic increase of cellular pMEK/pERK. From this, the authors argue that Type II inhibitors are explained by negative allostery in the BRAF homodimer (based on Fig 2E), while Type I inhibitors are not. But it seems possible that despite the terrific correlation between BBD and BRAF kinase activities measured in vitro, CRAF is still important to explain pathway activation in cells. It also seems conceivable that the calculated %BBD between different Type II inhibitors may not correlate as well with their effects on pathway activation in cells. These possibilities should be addressed.

We agree with the reviewer that it is likely that CRAF contributes to paradoxical activation by type II inhibitors in cells. It is also likely that other cellular factors such as RAS-priming and membrane recruitment play a role in activation. However, we note that for the type II inhibitors there is good agreement between the biophysical predictions and the concentration regimes in which activation is observed in cells, suggesting that these predictions are capturing a key part of the activation process that occurs in cells.

(2) In Fig 2A, is it possible to report the activity of dimeric BRAF-WT in the absence of inhibitor? This would help confirm that the maximal activity measured after titrating inhibitor is indeed consistent with the predicted %BBD population, which would be expected to have half of the specific activity of BB.

In principle, it is possible to determine the catalytic activity of apo dimers (BB) by combining our model predictions for the concentration of BB dimers and our activity measurements. However, because the activity assays are performed at nanomolar kinase concentrations, whereas the baseline dimerization affinity of BRAF is in the micromolar range, the observed activity of apo BRAF arises from a small subpopulation of dimers (on the order of 4 percent under the conditions of our experiments) and is therefore difficult to define accurately. As a result, we deemed it more suitable to compare our results to published activity measurements derived from 14-3-3-activated dimers which should represent fully dimerized BRAF. This analysis, as reported in Figure 2E, suggests that the BBD activity is approximately half of that of BB.

(3) The 19F-NMR experiments make a good case for broadening of the helix aC signal in the BRAF dimer. From this, the study proposes that after inhibitor binds one subunit, the second unoccupied subunit retains dynamics. It would be useful to address this experimentally, if possible. For example, can the 19F-NMR signal be measured in the presence of inhibitor, to support the prediction that the unoccupied subunit is indeed dynamic and samples multiple conformations as in apo BRAF?

We agree with the reviewer that it would be interesting to determine the dynamic response of BRAF to inhibitor binding. However, this is a challenging undertaking due to the biochemical heterogeneity that occurs at sub saturating inhibitor concentrations. For example, at any given inhibitor concentration, BRAF exists as a mixture of monomers, apo dimers, dimers with one inhibitor molecule, and dimers with two inhibitor molecules bound. This makes it challenging to relate the 19F NMR signal to a single biochemical state. Addressing this would require a substantial experimental effort that we feel is beyond the scope of this study.

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BMC Psychology

SYSTEMATIC REVIEW article

1 Introduction

1.2 The integrative hypothesis

1.3 The attention networks model

1.4 Objectives

2.1 Search strategy

2.2 Selection criteria

2.3 Data extraction and quality evaluation

3.1 Frequency of studies and tasks used

3.1.1 The alerting network

3.1.2 The orienting network

3.1.3 The executive attention network

3.2 Comparisons between deaf and hearing adults

3.3 Development of attention networks and comparison between deaf and full hearing children

4 Discussion

4.2 Results of comparisons between deaf and hearing adults

4.3 Findings of comparisons between deaf and hearing children

4.4 Development of attention network functions in deaf children

4.5 Effects of the communication system and the use of cochlear implants

5 Conclusion

Data availability statement

Author contributions

Conflict of interest