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CHAPTER 2 The Abstract and Introduction

At or near the beginning of most papers you will find an Abstract and an Introduction.

THE ABSTRACT

If the title of an article doesn't give you a clear enough idea of what it's about, then most papers reporting primary research data start with an Abstract – a brief summary of the whole paper that appears immediately below the title.

The purpose of this brief summary is to help the reader decide if they want to go on to read the paper in detail, by outlining the content of the research and its main findings. A good Abstract should help the reader decide – if this study has been well conducted, then is it one about which I would be interested enough to read further?

Some journals require authors to provide structured Abstracts – using headings equivalent to those that appear in the main text. A typical example is shown in Figure 2.1, from a study of a day treatment programme for patients with eating disorders. Some Abstracts are unstructured and simply give a brief narrative account of the accompanying paper as in Figure 2.2, from a qualitative study on the attitudes of young male offenders to fatherhood. The decision about which style of Abstract to use is determined not by the author, but by the journal.

Figure 2.1 An example of a structured Abstract – this one from a trial of two treatment programmes for patients with eating disorders.

Source: From Kong (2005) with permission from John Wiley & Sons.

Figure 2.2 An unstructured Abstract accompanied by a list of Keywords indicating the article's content.

Source: From Buston (2010), © 2010, with permission from Elsevier.

A list of Keywords may accompany the Abstract, if the journal requires it. Their purpose is to assist readers who are searching for articles on particular topics. For such a list the words may come from a standard source decided by the journal or they may be chosen by the authors themselves.

THE INTRODUCTION

After the Abstract comes an introductory section. Its aim is to provide some background information that makes it clear why the study described in the paper has been undertaken. The general topic area of the paper may be very familiar, but even so (perhaps especially so) the authors will probably give some summary of its importance, possibly along the lines of:

 Is it clinically important? Is it about a symptom that affects quality of life or causes major treatment difficulties?

 Is there a public health importance? Is it about an illness that represents a big burden for the community – in terms of chronic handicap, or costs to health or social services?

 Is the interest theoretical? Will further study help us to understand the causes of a condition or its consequences?

Figure 2.3 shows the Introduction to a study which examined the effect of two ways of presenting information to women who were making decisions about antenatal testing.

Figure 2.3 Explaining the background to a research study.

Source: From Graham et al. (2000), © 2000, with permission from BMJ Publishing Group Ltd.

These questions will normally be discussed by reference to existing evidence. The Introduction to a paper is not the place to look for a comprehensive literature review, and introductory sections in most papers are brief, but there are one or two pointers to help you decide if the evidence is being presented in a fair and unbiased way:

 Is there reference to a systematic review (see Chapters 10 and 11)? Or if not, to a search strategy which the authors used to identify relevant evidence? For an example, see Figure 2.4, taken from a study of the association between birthweight and adult blood pressure.

 Is the evidence mainly from the authors' own group or do the authors quote a range of evidence, even if it is not in support of their own views?

Figure 2.4 Introduction explaining the rationale for the study.

Source: Reproduced from: Shanahan et al. (2019).

 Many clinical studies are carried out because the evidence is ambiguous or contradictory. Is there a dilemma which is posed by the evidence and is it clearly spelled out in the Introduction?

Generally speaking, the justification for a new study is that the existing evidence is unsatisfactory and a typical Introduction summarizes why, as in Figure 2.4 from a study on the use of social media to post about self‐harm. The commonest justifications for new research are that:

 Different studies have come to different conclusions about the topic and it isn't possible to come to an answer without new work.

 The evidence cannot be applied in the setting being considered by the authors. For example, good evidence may cease to be of value simply because it is old – trials showing the benefit of treatment may no longer be useful if a disorder changes so that its sensitivity to treatment changes. Similarly, evidence from one part of the world cannot always be applied freely elsewhere.

 The evidence may be incomplete. For example, we may know that rates of smoking are increasing among young women but we don't know why.

 The evidence may be of poor quality.

If these elements of the Introduction are well presented, then it should be clear what the paper is about and why the authors have chosen to conduct the work that they have. Armed with this background briefing, you can now move on to check the specific objectives of the authors' work (see Chapter 3).

ETHICAL CONSIDERATIONS

Nearly all studies in healthcare that involve contact with people will require ethical approval. What that means is that the researchers will have had to submit their proposals to a panel of experts, such as a local research ethics committee, who decide whether the project is ethical or not. For example, the risks of any research should be outweighed by its benefits and participants should have been given the opportunity to participate or not as they wished, without their decision influencing their medical care.

Most authors will indicate that their study has been approved by the appropriate body governing research ethics – usually either in the Methods section or the Acknowledgements. Increasingly, authors will mention any particular ethical dilemmas raised by their research either in the Introduction or the Discussion of their paper. Where there are particular questions raised by a study, the authors may expand upon them (including, for example, details of the information given to participants and the way in which consent was obtained).

Certain types of research cause particular ethical concerns. For example, young children, or those with cognitive impairment or learning disability, or patients who are unconscious, cannot give consent to participate in research that nonetheless asks extremely important questions about clinical care. In these situations, researchers may undertake research with ethical approval, provided certain criteria are met (see Figure 2.5 from a study of a weight management intervention in adults with a learning disability).

Figure 2.5 Ethical considerations in a study involving adults with a learning disability.

Source: Reproduced from Harris et al. (2017).