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How to Write an Abstract | Steps & Examples

Published on February 28, 2019 by Shona McCombes . Revised on July 18, 2023 by Eoghan Ryan.

An abstract is a short summary of a longer work (such as a thesis ,  dissertation or research paper ). The abstract concisely reports the aims and outcomes of your research, so that readers know exactly what your paper is about.

Although the structure may vary slightly depending on your discipline, your abstract should describe the purpose of your work, the methods you’ve used, and the conclusions you’ve drawn.

One common way to structure your abstract is to use the IMRaD structure. This stands for:

• Introduction

Abstracts are usually around 100–300 words, but there’s often a strict word limit, so make sure to check the relevant requirements.

In a dissertation or thesis , include the abstract on a separate page, after the title page and acknowledgements but before the table of contents .

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Table of contents

Abstract example, when to write an abstract, step 1: introduction, step 2: methods, step 3: results, step 4: discussion, tips for writing an abstract, other interesting articles, frequently asked questions about abstracts.

Hover over the different parts of the abstract to see how it is constructed.

This paper examines the role of silent movies as a mode of shared experience in the US during the early twentieth century. At this time, high immigration rates resulted in a significant percentage of non-English-speaking citizens. These immigrants faced numerous economic and social obstacles, including exclusion from public entertainment and modes of discourse (newspapers, theater, radio).

Incorporating evidence from reviews, personal correspondence, and diaries, this study demonstrates that silent films were an affordable and inclusive source of entertainment. It argues for the accessible economic and representational nature of early cinema. These concerns are particularly evident in the low price of admission and in the democratic nature of the actors’ exaggerated gestures, which allowed the plots and action to be easily grasped by a diverse audience despite language barriers.

Keywords: silent movies, immigration, public discourse, entertainment, early cinema, language barriers.

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You will almost always have to include an abstract when:

• Completing a thesis or dissertation
• Submitting a research paper to an academic journal
• Writing a book or research proposal
• Applying for research grants

It’s easiest to write your abstract last, right before the proofreading stage, because it’s a summary of the work you’ve already done. Your abstract should:

• Be a self-contained text, not an excerpt from your paper
• Be fully understandable on its own
• Reflect the structure of your larger work

Start by clearly defining the purpose of your research. What practical or theoretical problem does the research respond to, or what research question did you aim to answer?

You can include some brief context on the social or academic relevance of your dissertation topic , but don’t go into detailed background information. If your abstract uses specialized terms that would be unfamiliar to the average academic reader or that have various different meanings, give a concise definition.

After identifying the problem, state the objective of your research. Use verbs like “investigate,” “test,” “analyze,” or “evaluate” to describe exactly what you set out to do.

This part of the abstract can be written in the present or past simple tense  but should never refer to the future, as the research is already complete.

• This study will investigate the relationship between coffee consumption and productivity.
• This study investigates the relationship between coffee consumption and productivity.

Next, indicate the research methods that you used to answer your question. This part should be a straightforward description of what you did in one or two sentences. It is usually written in the past simple tense, as it refers to completed actions.

• Structured interviews will be conducted with 25 participants.
• Structured interviews were conducted with 25 participants.

Don’t evaluate validity or obstacles here — the goal is not to give an account of the methodology’s strengths and weaknesses, but to give the reader a quick insight into the overall approach and procedures you used.

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Next, summarize the main research results . This part of the abstract can be in the present or past simple tense.

• Our analysis has shown a strong correlation between coffee consumption and productivity.
• Our analysis shows a strong correlation between coffee consumption and productivity.
• Our analysis showed a strong correlation between coffee consumption and productivity.

Depending on how long and complex your research is, you may not be able to include all results here. Try to highlight only the most important findings that will allow the reader to understand your conclusions.

Finally, you should discuss the main conclusions of your research : what is your answer to the problem or question? The reader should finish with a clear understanding of the central point that your research has proved or argued. Conclusions are usually written in the present simple tense.

• We concluded that coffee consumption increases productivity.
• We conclude that coffee consumption increases productivity.

If there are important limitations to your research (for example, related to your sample size or methods), you should mention them briefly in the abstract. This allows the reader to accurately assess the credibility and generalizability of your research.

If your aim was to solve a practical problem, your discussion might include recommendations for implementation. If relevant, you can briefly make suggestions for further research.

If your paper will be published, you might have to add a list of keywords at the end of the abstract. These keywords should reference the most important elements of the research to help potential readers find your paper during their own literature searches.

Be aware that some publication manuals, such as APA Style , have specific formatting requirements for these keywords.

It can be a real challenge to condense your whole work into just a couple of hundred words, but the abstract will be the first (and sometimes only) part that people read, so it’s important to get it right. These strategies can help you get started.

Read other abstracts

The best way to learn the conventions of writing an abstract in your discipline is to read other people’s. You probably already read lots of journal article abstracts while conducting your literature review —try using them as a framework for structure and style.

You can also find lots of dissertation abstract examples in thesis and dissertation databases .

Reverse outline

Not all abstracts will contain precisely the same elements. For longer works, you can write your abstract through a process of reverse outlining.

For each chapter or section, list keywords and draft one to two sentences that summarize the central point or argument. This will give you a framework of your abstract’s structure. Next, revise the sentences to make connections and show how the argument develops.

Write clearly and concisely

A good abstract is short but impactful, so make sure every word counts. Each sentence should clearly communicate one main point.

To keep your abstract or summary short and clear:

• Avoid passive sentences: Passive constructions are often unnecessarily long. You can easily make them shorter and clearer by using the active voice.
• Avoid long sentences: Substitute longer expressions for concise expressions or single words (e.g., “In order to” for “To”).
• Avoid obscure jargon: The abstract should be understandable to readers who are not familiar with your topic.
• Avoid repetition and filler words: Replace nouns with pronouns when possible and eliminate unnecessary words.
• Avoid detailed descriptions: An abstract is not expected to provide detailed definitions, background information, or discussions of other scholars’ work. Instead, include this information in the body of your thesis or paper.

If you’re struggling to edit down to the required length, you can get help from expert editors with Scribbr’s professional proofreading services or use the paraphrasing tool .

Check your formatting

If you are writing a thesis or dissertation or submitting to a journal, there are often specific formatting requirements for the abstract—make sure to check the guidelines and format your work correctly. For APA research papers you can follow the APA abstract format .

Checklist: Abstract

The word count is within the required length, or a maximum of one page.

The abstract appears after the title page and acknowledgements and before the table of contents .

I have clearly stated my research problem and objectives.

I have briefly described my methodology .

I have summarized the most important results .

I have stated my main conclusions .

I have mentioned any important limitations and recommendations.

The abstract can be understood by someone without prior knowledge of the topic.

You've written a great abstract! Use the other checklists to continue improving your thesis or dissertation.

If you want to know more about AI for academic writing, AI tools, or research bias, make sure to check out some of our other articles with explanations and examples or go directly to our tools!

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An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

• To help potential readers determine the relevance of your paper for their own research.
• To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

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

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

Avoid citing sources in your abstract . There are two reasons for this:

• The abstract should focus on your original research, not on the work of others.
• The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

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

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Writing an Abstract for Your Research Paper

Definition and Purpose of Abstracts

An abstract is a short summary of your (published or unpublished) research paper, usually about a paragraph (c. 6-7 sentences, 150-250 words) long. A well-written abstract serves multiple purposes:

• an abstract lets readers get the gist or essence of your paper or article quickly, in order to decide whether to read the full paper;
• an abstract prepares readers to follow the detailed information, analyses, and arguments in your full paper;
• and, later, an abstract helps readers remember key points from your paper.

It’s also worth remembering that search engines and bibliographic databases use abstracts, as well as the title, to identify key terms for indexing your published paper. So what you include in your abstract and in your title are crucial for helping other researchers find your paper or article.

If you are writing an abstract for a course paper, your professor may give you specific guidelines for what to include and how to organize your abstract. Similarly, academic journals often have specific requirements for abstracts. So in addition to following the advice on this page, you should be sure to look for and follow any guidelines from the course or journal you’re writing for.

The Contents of an Abstract

Abstracts contain most of the following kinds of information in brief form. The body of your paper will, of course, develop and explain these ideas much more fully. As you will see in the samples below, the proportion of your abstract that you devote to each kind of information—and the sequence of that information—will vary, depending on the nature and genre of the paper that you are summarizing in your abstract. And in some cases, some of this information is implied, rather than stated explicitly. The Publication Manual of the American Psychological Association , which is widely used in the social sciences, gives specific guidelines for what to include in the abstract for different kinds of papers—for empirical studies, literature reviews or meta-analyses, theoretical papers, methodological papers, and case studies.

Here are the typical kinds of information found in most abstracts:

• the context or background information for your research; the general topic under study; the specific topic of your research
• the central questions or statement of the problem your research addresses
• what’s already known about this question, what previous research has done or shown
• the main reason(s) , the exigency, the rationale , the goals for your research—Why is it important to address these questions? Are you, for example, examining a new topic? Why is that topic worth examining? Are you filling a gap in previous research? Applying new methods to take a fresh look at existing ideas or data? Resolving a dispute within the literature in your field? . . .
• your research and/or analytical methods
• your main findings , results , or arguments
• the significance or implications of your findings or arguments.

Your abstract should be intelligible on its own, without a reader’s having to read your entire paper. And in an abstract, you usually do not cite references—most of your abstract will describe what you have studied in your research and what you have found and what you argue in your paper. In the body of your paper, you will cite the specific literature that informs your research.

When to Write Your Abstract

Although you might be tempted to write your abstract first because it will appear as the very first part of your paper, it’s a good idea to wait to write your abstract until after you’ve drafted your full paper, so that you know what you’re summarizing.

What follows are some sample abstracts in published papers or articles, all written by faculty at UW-Madison who come from a variety of disciplines. We have annotated these samples to help you see the work that these authors are doing within their abstracts.

Choosing Verb Tenses within Your Abstract

The social science sample (Sample 1) below uses the present tense to describe general facts and interpretations that have been and are currently true, including the prevailing explanation for the social phenomenon under study. That abstract also uses the present tense to describe the methods, the findings, the arguments, and the implications of the findings from their new research study. The authors use the past tense to describe previous research.

The humanities sample (Sample 2) below uses the past tense to describe completed events in the past (the texts created in the pulp fiction industry in the 1970s and 80s) and uses the present tense to describe what is happening in those texts, to explain the significance or meaning of those texts, and to describe the arguments presented in the article.

The science samples (Samples 3 and 4) below use the past tense to describe what previous research studies have done and the research the authors have conducted, the methods they have followed, and what they have found. In their rationale or justification for their research (what remains to be done), they use the present tense. They also use the present tense to introduce their study (in Sample 3, “Here we report . . .”) and to explain the significance of their study (In Sample 3, This reprogramming . . . “provides a scalable cell source for. . .”).

Sample Abstract 1

From the social sciences.

Reporting new findings about the reasons for increasing economic homogamy among spouses

Gonalons-Pons, Pilar, and Christine R. Schwartz. “Trends in Economic Homogamy: Changes in Assortative Mating or the Division of Labor in Marriage?” Demography , vol. 54, no. 3, 2017, pp. 985-1005.

Sample Abstract 2

From the humanities.

Analyzing underground pulp fiction publications in Tanzania, this article makes an argument about the cultural significance of those publications

Emily Callaci. “Street Textuality: Socialism, Masculinity, and Urban Belonging in Tanzania’s Pulp Fiction Publishing Industry, 1975-1985.” Comparative Studies in Society and History , vol. 59, no. 1, 2017, pp. 183-210.

Sample Abstract/Summary 3

From the sciences.

Reporting a new method for reprogramming adult mouse fibroblasts into induced cardiac progenitor cells

Lalit, Pratik A., Max R. Salick, Daryl O. Nelson, Jayne M. Squirrell, Christina M. Shafer, Neel G. Patel, Imaan Saeed, Eric G. Schmuck, Yogananda S. Markandeya, Rachel Wong, Martin R. Lea, Kevin W. Eliceiri, Timothy A. Hacker, Wendy C. Crone, Michael Kyba, Daniel J. Garry, Ron Stewart, James A. Thomson, Karen M. Downs, Gary E. Lyons, and Timothy J. Kamp. “Lineage Reprogramming of Fibroblasts into Proliferative Induced Cardiac Progenitor Cells by Defined Factors.” Cell Stem Cell , vol. 18, 2016, pp. 354-367.

Sample Abstract 4, a Structured Abstract

Reporting results about the effectiveness of antibiotic therapy in managing acute bacterial sinusitis, from a rigorously controlled study

Note: This journal requires authors to organize their abstract into four specific sections, with strict word limits. Because the headings for this structured abstract are self-explanatory, we have chosen not to add annotations to this sample abstract.

Wald, Ellen R., David Nash, and Jens Eickhoff. “Effectiveness of Amoxicillin/Clavulanate Potassium in the Treatment of Acute Bacterial Sinusitis in Children.” Pediatrics , vol. 124, no. 1, 2009, pp. 9-15.

“OBJECTIVE: The role of antibiotic therapy in managing acute bacterial sinusitis (ABS) in children is controversial. The purpose of this study was to determine the effectiveness of high-dose amoxicillin/potassium clavulanate in the treatment of children diagnosed with ABS.

METHODS : This was a randomized, double-blind, placebo-controlled study. Children 1 to 10 years of age with a clinical presentation compatible with ABS were eligible for participation. Patients were stratified according to age (<6 or ≥6 years) and clinical severity and randomly assigned to receive either amoxicillin (90 mg/kg) with potassium clavulanate (6.4 mg/kg) or placebo. A symptom survey was performed on days 0, 1, 2, 3, 5, 7, 10, 20, and 30. Patients were examined on day 14. Children’s conditions were rated as cured, improved, or failed according to scoring rules.

RESULTS: Two thousand one hundred thirty-five children with respiratory complaints were screened for enrollment; 139 (6.5%) had ABS. Fifty-eight patients were enrolled, and 56 were randomly assigned. The mean age was 6630 months. Fifty (89%) patients presented with persistent symptoms, and 6 (11%) presented with nonpersistent symptoms. In 24 (43%) children, the illness was classified as mild, whereas in the remaining 32 (57%) children it was severe. Of the 28 children who received the antibiotic, 14 (50%) were cured, 4 (14%) were improved, 4(14%) experienced treatment failure, and 6 (21%) withdrew. Of the 28children who received placebo, 4 (14%) were cured, 5 (18%) improved, and 19 (68%) experienced treatment failure. Children receiving the antibiotic were more likely to be cured (50% vs 14%) and less likely to have treatment failure (14% vs 68%) than children receiving the placebo.

CONCLUSIONS : ABS is a common complication of viral upper respiratory infections. Amoxicillin/potassium clavulanate results in significantly more cures and fewer failures than placebo, according to parental report of time to resolution.” (9)

Some Excellent Advice about Writing Abstracts for Basic Science Research Papers, by Professor Adriano Aguzzi from the Institute of Neuropathology at the University of Zurich:

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How to Write an Abstract (With Examples)

By Sarah Oakley

Table of Contents

What is an abstract in a paper, how long should an abstract be, 5 steps for writing an abstract, examples of an abstract, how prowritingaid can help you write an abstract.

If you are writing a scientific research paper or a book proposal, you need to know how to write an abstract, which summarizes the contents of the paper or book.

When researchers are looking for peer-reviewed papers to use in their studies, the first place they will check is the abstract to see if it applies to their work. Therefore, your abstract is one of the most important parts of your entire paper.

In this article, we’ll explain what an abstract is, what it should include, and how to write one.

An abstract is a concise summary of the details within a report. Some abstracts give more details than others, but the main things you’ll be talking about are why you conducted the research, what you did, and what the results show.

When a reader is deciding whether to read your paper completely, they will first look at the abstract. You need to be concise in your abstract and give the reader the most important information so they can determine if they want to read the whole paper.

Remember that an abstract is the last thing you’ll want to write for the research paper because it directly references parts of the report. If you haven’t written the report, you won’t know what to include in your abstract.

If you are writing a paper for a journal or an assignment, the publication or academic institution might have specific formatting rules for how long your abstract should be. However, if they don’t, most abstracts are between 150 and 300 words long.

A short word count means your writing has to be precise and without filler words or phrases. Once you’ve written a first draft, you can always use an editing tool, such as ProWritingAid, to identify areas where you can reduce words and increase readability.

If your abstract is over the word limit, and you’ve edited it but still can’t figure out how to reduce it further, your abstract might include some things that aren’t needed. Here’s a list of three elements you can remove from your abstract:

Discussion : You don’t need to go into detail about the findings of your research because your reader will find your discussion within the paper.

Definition of terms : Your readers are interested the field you are writing about, so they are likely to understand the terms you are using. If not, they can always look them up. Your readers do not expect you to give a definition of terms in your abstract.

References and citations : You can mention there have been studies that support or have inspired your research, but you do not need to give details as the reader will find them in your bibliography.

Good writing = better grades

ProWritingAid will help you improve the style, strength, and clarity of all your assignments.

If you’ve never written an abstract before, and you’re wondering how to write an abstract, we’ve got some steps for you to follow. It’s best to start with planning your abstract, so we’ve outlined the details you need to include in your plan before you write.

Remember to consider your audience when you’re planning and writing your abstract. They are likely to skim read your abstract, so you want to be sure your abstract delivers all the information they’re expecting to see at key points.

1. What Should an Abstract Include?

Abstracts have a lot of information to cover in a short number of words, so it’s important to know what to include. There are three elements that need to be present in your abstract:

Your context is the background for where your research sits within your field of study. You should briefly mention any previous scientific papers or experiments that have led to your hypothesis and how research develops in those studies.

Your hypothesis is your prediction of what your study will show. As you are writing your abstract after you have conducted your research, you should still include your hypothesis in your abstract because it shows the motivation for your paper.

Throughout your abstract, you also need to include keywords and phrases that will help researchers to find your article in the databases they’re searching. Make sure the keywords are specific to your field of study and the subject you’re reporting on, otherwise your article might not reach the relevant audience.

2. Can You Use First Person in an Abstract?

You might think that first person is too informal for a research paper, but it’s not. Historically, writers of academic reports avoided writing in first person to uphold the formality standards of the time. However, first person is more accepted in research papers in modern times.

If you’re still unsure whether to write in first person for your abstract, refer to any style guide rules imposed by the journal you’re writing for or your teachers if you are writing an assignment.

3. Abstract Structure

Some scientific journals have strict rules on how to structure an abstract, so it’s best to check those first. If you don’t have any style rules to follow, try using the IMRaD structure, which stands for Introduction, Methodology, Results, and Discussion.

Following the IMRaD structure, start with an introduction. The amount of background information you should include depends on your specific research area. Adding a broad overview gives you less room to include other details. Remember to include your hypothesis in this section.

The next part of your abstract should cover your methodology. Try to include the following details if they apply to your study:

What type of research was conducted?

How were the test subjects sampled?

What were the sample sizes?

What was done to each group?

How long was the experiment?

How was data recorded and interpreted?

Following the methodology, include a sentence or two about the results, which is where your reader will determine if your research supports or contradicts their own investigations.

The results are also where most people will want to find out what your outcomes were, even if they are just mildly interested in your research area. You should be specific about all the details but as concise as possible.

The last few sentences are your conclusion. It needs to explain how your findings affect the context and whether your hypothesis was correct. Include the primary take-home message, additional findings of importance, and perspective. Also explain whether there is scope for further research into the subject of your report.

Your conclusion should be honest and give the reader the ultimate message that your research shows. Readers trust the conclusion, so make sure you’re not fabricating the results of your research. Some readers won’t read your entire paper, but this section will tell them if it’s worth them referencing it in their own study.

4. How to Start an Abstract

The first line of your abstract should give your reader the context of your report by providing background information. You can use this sentence to imply the motivation for your research.

You don’t need to use a hook phrase or device in your first sentence to grab the reader’s attention. Your reader will look to establish relevance quickly, so readability and clarity are more important than trying to persuade the reader to read on.

5. How to Format an Abstract

Most abstracts use the same formatting rules, which help the reader identify the abstract so they know where to look for it.

Here’s a list of formatting guidelines for writing an abstract:

Stick to one paragraph

Use block formatting with no indentation at the beginning

Put your abstract straight after the title and acknowledgements pages

Use present or past tense, not future tense

There are two primary types of abstract you could write for your paper—descriptive and informative.

An informative abstract is the most common, and they follow the structure mentioned previously. They are longer than descriptive abstracts because they cover more details.

Descriptive abstracts differ from informative abstracts, as they don’t include as much discussion or detail. The word count for a descriptive abstract is between 50 and 150 words.

Here is an example of an informative abstract:

A growing trend exists for authors to employ a more informal writing style that uses “we” in academic writing to acknowledge one’s stance and engagement. However, few studies have compared the ways in which the first-person pronoun “we” is used in the abstracts and conclusions of empirical papers. To address this lacuna in the literature, this study conducted a systematic corpus analysis of the use of “we” in the abstracts and conclusions of 400 articles collected from eight leading electrical and electronic (EE) engineering journals. The abstracts and conclusions were extracted to form two subcorpora, and an integrated framework was applied to analyze and seek to explain how we-clusters and we-collocations were employed. Results revealed whether authors’ use of first-person pronouns partially depends on a journal policy. The trend of using “we” showed that a yearly increase occurred in the frequency of “we” in EE journal papers, as well as the existence of three “we-use” types in the article conclusions and abstracts: exclusive, inclusive, and ambiguous. Other possible “we-use” alternatives such as “I” and other personal pronouns were used very rarely—if at all—in either section. These findings also suggest that the present tense was used more in article abstracts, but the present perfect tense was the most preferred tense in article conclusions. Both research and pedagogical implications are proffered and critically discussed.

Wang, S., Tseng, W.-T., & Johanson, R. (2021). To We or Not to We: Corpus-Based Research on First-Person Pronoun Use in Abstracts and Conclusions. SAGE Open, 11(2).

Here is an example of a descriptive abstract:

From the 1850s to the present, considerable criminological attention has focused on the development of theoretically-significant systems for classifying crime. This article reviews and attempts to evaluate a number of these efforts, and we conclude that further work on this basic task is needed. The latter part of the article explicates a conceptual foundation for a crime pattern classification system, and offers a preliminary taxonomy of crime.

Farr, K. A., & Gibbons, D. C. (1990). Observations on the Development of Crime Categories. International Journal of Offender Therapy and Comparative Criminology, 34(3), 223–237.

If you want to ensure your abstract is grammatically correct and easy to read, you can use ProWritingAid to edit it. The software integrates with Microsoft Word, Google Docs, and most web browsers, so you can make the most of it wherever you’re writing your paper.

Before you edit with ProWritingAid, make sure the suggestions you are seeing are relevant for your document by changing the document type to “Abstract” within the Academic writing style section.

You can use the Readability report to check your abstract for places to improve the clarity of your writing. Some suggestions might show you where to remove words, which is great if you’re over your word count.

We hope the five steps and examples we’ve provided help you write a great abstract for your research paper.

Sarah Oakley

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Abstract Writing: A Step-by-Step Guide With Tips & Examples

Table of Contents

Introduction

Abstracts of research papers have always played an essential role in describing your research concisely and clearly to researchers and editors of journals, enticing them to continue reading. However, with the widespread availability of scientific databases, the need to write a convincing abstract is more crucial now than during the time of paper-bound manuscripts.

Abstracts serve to "sell" your research and can be compared with your "executive outline" of a resume or, rather, a formal summary of the critical aspects of your work. Also, it can be the "gist" of your study. Since most educational research is done online, it's a sign that you have a shorter time for impressing your readers, and have more competition from other abstracts that are available to be read.

The APCI (Academic Publishing and Conferences International) articulates 12 issues or points considered during the final approval process for conferences & journals and emphasises the importance of writing an abstract that checks all these boxes (12 points). Since it's the only opportunity you have to captivate your readers, you must invest time and effort in creating an abstract that accurately reflects the critical points of your research.

With that in mind, let’s head over to understand and discover the core concept and guidelines to create a substantial abstract. Also, learn how to organise the ideas or plots into an effective abstract that will be awe-inspiring to the readers you want to reach.

What is Abstract? Definition and Overview

The word "Abstract' is derived from Latin abstractus meaning "drawn off." This etymological meaning also applies to art movements as well as music, like abstract expressionism. In this context, it refers to the revealing of the artist's intention.

Based on this, you can determine the meaning of an abstract: A condensed research summary. It must be self-contained and independent of the body of the research. However, it should outline the subject, the strategies used to study the problem, and the methods implemented to attain the outcomes. The specific elements of the study differ based on the area of study; however, together, it must be a succinct summary of the entire research paper.

Abstracts are typically written at the end of the paper, even though it serves as a prologue. In general, the abstract must be in a position to:

• Describe the paper.
• Identify the problem or the issue at hand.
• Explain to the reader the research process, the results you came up with, and what conclusion you've reached using these results.
• Include keywords to guide your strategy and the content.

Furthermore, the abstract you submit should not reflect upon any of  the following elements:

• Examine, analyse or defend the paper or your opinion.
• What you want to study, achieve or discover.
• Be redundant or irrelevant.

After reading an abstract, your audience should understand the reason - what the research was about in the first place, what the study has revealed and how it can be utilised or can be used to benefit others. You can understand the importance of abstract by knowing the fact that the abstract is the most frequently read portion of any research paper. In simpler terms, it should contain all the main points of the research paper.

What is the Purpose of an Abstract?

Abstracts are typically an essential requirement for research papers; however, it's not an obligation to preserve traditional reasons without any purpose. Abstracts allow readers to scan the text to determine whether it is relevant to their research or studies. The abstract allows other researchers to decide if your research paper can provide them with some additional information. A good abstract paves the interest of the audience to pore through your entire paper to find the content or context they're searching for.

Abstract writing is essential for indexing, as well. The Digital Repository of academic papers makes use of abstracts to index the entire content of academic research papers. Like meta descriptions in the regular Google outcomes, abstracts must include keywords that help researchers locate what they seek.

Types of Abstract

Informative and Descriptive are two kinds of abstracts often used in scientific writing.

A descriptive abstract gives readers an outline of the author's main points in their study. The reader can determine if they want to stick to the research work, based on their interest in the topic. An abstract that is descriptive is similar to the contents table of books, however, the format of an abstract depicts complete sentences encapsulated in one paragraph. It is unfortunate that the abstract can't be used as a substitute for reading a piece of writing because it's just an overview, which omits readers from getting an entire view. Also, it cannot be a way to fill in the gaps the reader may have after reading this kind of abstract since it does not contain crucial information needed to evaluate the article.

To conclude, a descriptive abstract is:

• A simple summary of the task, just summarises the work, but some researchers think it is much more of an outline
• Typically, the length is approximately 100 words. It is too short when compared to an informative abstract.
• A brief explanation but doesn't provide the reader with the complete information they need;
• An overview that omits conclusions and results

An informative abstract is a comprehensive outline of the research. There are times when people rely on the abstract as an information source. And the reason is why it is crucial to provide entire data of particular research. A well-written, informative abstract could be a good substitute for the remainder of the paper on its own.

A well-written abstract typically follows a particular style. The author begins by providing the identifying information, backed by citations and other identifiers of the papers. Then, the major elements are summarised to make the reader aware of the study. It is followed by the methodology and all-important findings from the study. The conclusion then presents study results and ends the abstract with a comprehensive summary.

In a nutshell, an informative abstract:

• Has a length that can vary, based on the subject, but is not longer than 300 words.
• Contains all the content-like methods and intentions
• Offers evidence and possible recommendations.

Informative Abstracts are more frequent than descriptive abstracts because of their extensive content and linkage to the topic specifically. You should select different types of abstracts to papers based on their length: informative abstracts for extended and more complex abstracts and descriptive ones for simpler and shorter research papers.

What are the Characteristics of a Good Abstract?

• A good abstract clearly defines the goals and purposes of the study.
• It should clearly describe the research methodology with a primary focus on data gathering, processing, and subsequent analysis.
• A good abstract should provide specific research findings.
• It presents the principal conclusions of the systematic study.
• It should be concise, clear, and relevant to the field of study.
• A well-designed abstract should be unifying and coherent.
• It is easy to grasp and free of technical jargon.
• It is written impartially and objectively.

What are the various sections of an ideal Abstract?

By now, you must have gained some concrete idea of the essential elements that your abstract needs to convey . Accordingly, the information is broken down into six key sections of the abstract, which include:

An Introduction or Background

Research methodology, objectives and goals, limitations.

Let's go over them in detail.

The introduction, also known as background, is the most concise part of your abstract. Ideally, it comprises a couple of sentences. Some researchers only write one sentence to introduce their abstract. The idea behind this is to guide readers through the key factors that led to your study.

It's understandable that this information might seem difficult to explain in a couple of sentences. For example, think about the following two questions like the background of your study:

• What is currently available about the subject with respect to the paper being discussed?
• What isn't understood about this issue? (This is the subject of your research)

While writing the abstract’s introduction, make sure that it is not lengthy. Because if it crosses the word limit, it may eat up the words meant to be used for providing other key information.

Research methodology is where you describe the theories and techniques you used in your research. It is recommended that you describe what you have done and the method you used to get your thorough investigation results. Certainly, it is the second-longest paragraph in the abstract.

In the research methodology section, it is essential to mention the kind of research you conducted; for instance, qualitative research or quantitative research (this will guide your research methodology too) . If you've conducted quantitative research, your abstract should contain information like the sample size, data collection method, sampling techniques, and duration of the study. Likewise, your abstract should reflect observational data, opinions, questionnaires (especially the non-numerical data) if you work on qualitative research.

The research objectives and goals speak about what you intend to accomplish with your research. The majority of research projects focus on the long-term effects of a project, and the goals focus on the immediate, short-term outcomes of the research. It is possible to summarise both in just multiple sentences.

In stating your objectives and goals, you give readers a picture of the scope of the study, its depth and the direction your research ultimately follows. Your readers can evaluate the results of your research against the goals and stated objectives to determine if you have achieved the goal of your research.

In the end, your readers are more attracted by the results you've obtained through your study. Therefore, you must take the time to explain each relevant result and explain how they impact your research. The results section exists as the longest in your abstract, and nothing should diminish its reach or quality.

One of the most important things you should adhere to is to spell out details and figures on the results of your research.

Instead of making a vague assertion such as, "We noticed that response rates varied greatly between respondents with high incomes and those with low incomes", Try these: "The response rate was higher for high-income respondents than those with lower incomes (59 30 percent vs. 30 percent in both cases; P<0.01)."

You're likely to encounter certain obstacles during your research. It could have been during data collection or even during conducting the sample . Whatever the issue, it's essential to inform your readers about them and their effects on the research.

Research limitations offer an opportunity to suggest further and deep research. If, for instance, you were forced to change for convenient sampling and snowball samples because of difficulties in reaching well-suited research participants, then you should mention this reason when you write your research abstract. In addition, a lack of prior studies on the subject could hinder your research.

Your conclusion should include the same number of sentences to wrap the abstract as the introduction. The majority of researchers offer an idea of the consequences of their research in this case.

Your conclusion should include three essential components:

• A significant take-home message.
• Corresponding important findings.
• The Interpretation.

Even though the conclusion of your abstract needs to be brief, it can have an enormous influence on the way that readers view your research. Therefore, make use of this section to reinforce the central message from your research. Be sure that your statements reflect the actual results and the methods you used to conduct your research.

Good Abstract Examples

Abstract example #1.

Children’s consumption behavior in response to food product placements in movies.

The abstract:

"Almost all research into the effects of brand placements on children has focused on the brand's attitudes or behavior intentions. Based on the significant differences between attitudes and behavioral intentions on one hand and actual behavior on the other hand, this study examines the impact of placements by brands on children's eating habits. Children aged 6-14 years old were shown an excerpt from the popular film Alvin and the Chipmunks and were shown places for the item Cheese Balls. Three different versions were developed with no placements, one with moderately frequent placements and the third with the highest frequency of placement. The results revealed that exposure to high-frequency places had a profound effect on snack consumption, however, there was no impact on consumer attitudes towards brands or products. The effects were not dependent on the age of the children. These findings are of major importance to researchers studying consumer behavior as well as nutrition experts as well as policy regulators."

Abstract Example #2

Social comparisons on social media: The impact of Facebook on young women’s body image concerns and mood. The abstract:

"The research conducted in this study investigated the effects of Facebook use on women's moods and body image if the effects are different from an internet-based fashion journal and if the appearance comparison tendencies moderate one or more of these effects. Participants who were female ( N = 112) were randomly allocated to spend 10 minutes exploring their Facebook account or a magazine's website or an appearance neutral control website prior to completing state assessments of body dissatisfaction, mood, and differences in appearance (weight-related and facial hair, face, and skin). Participants also completed a test of the tendency to compare appearances. The participants who used Facebook were reported to be more depressed than those who stayed on the control site. In addition, women who have the tendency to compare appearances reported more facial, hair and skin-related issues following Facebook exposure than when they were exposed to the control site. Due to its popularity it is imperative to conduct more research to understand the effect that Facebook affects the way people view themselves."

Abstract Example #3

The Relationship Between Cell Phone Use and Academic Performance in a Sample of U.S. College Students

"The cellphone is always present on campuses of colleges and is often utilised in situations in which learning takes place. The study examined the connection between the use of cell phones and the actual grades point average (GPA) after adjusting for predictors that are known to be a factor. In the end 536 students in the undergraduate program from 82 self-reported majors of an enormous, public institution were studied. Hierarchical analysis ( R 2 = .449) showed that use of mobile phones is significantly ( p < .001) and negative (b equal to -.164) connected to the actual college GPA, after taking into account factors such as demographics, self-efficacy in self-regulated learning, self-efficacy to improve academic performance, and the actual high school GPA that were all important predictors ( p < .05). Therefore, after adjusting for other known predictors increasing cell phone usage was associated with lower academic performance. While more research is required to determine the mechanisms behind these results, they suggest the need to educate teachers and students to the possible academic risks that are associated with high-frequency mobile phone usage."

Quick tips on writing a good abstract

There exists a common dilemma among early age researchers whether to write the abstract at first or last? However, it's recommended to compose your abstract when you've completed the research since you'll have all the information to give to your readers. You can, however, write a draft at the beginning of your research and add in any gaps later.

If you find abstract writing a herculean task, here are the few tips to help you with it:

1. Always develop a framework to support your abstract

Before writing, ensure you create a clear outline for your abstract. Divide it into sections and draw the primary and supporting elements in each one. You can include keywords and a few sentences that convey the essence of your message.

2. Review Other Abstracts

Abstracts are among the most frequently used research documents, and thousands of them were written in the past. Therefore, prior to writing yours, take a look at some examples from other abstracts. There are plenty of examples of abstracts for dissertations in the dissertation and thesis databases.

3. Avoid Jargon To the Maximum

When you write your abstract, focus on simplicity over formality. You should  write in simple language, and avoid excessive filler words or ambiguous sentences. Keep in mind that your abstract must be readable to those who aren't acquainted with your subject.

4. Focus on Your Research

It's a given fact that the abstract you write should be about your research and the findings you've made. It is not the right time to mention secondary and primary data sources unless it's absolutely required.

Conclusion: How to Structure an Interesting Abstract?

Abstracts are a short outline of your essay. However, it's among the most important, if not the most important. The process of writing an abstract is not straightforward. A few early-age researchers tend to begin by writing it, thinking they are doing it to "tease" the next step (the document itself). However, it is better to treat it as a spoiler.

The simple, concise style of the abstract lends itself to a well-written and well-investigated study. If your research paper doesn't provide definitive results, or the goal of your research is questioned, so will the abstract. Thus, only write your abstract after witnessing your findings and put your findings in the context of a larger scenario.

The process of writing an abstract can be daunting, but with these guidelines, you will succeed. The most efficient method of writing an excellent abstract is to centre the primary points of your abstract, including the research question and goals methods, as well as key results.

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Writing an abstract - a six point checklist (with samples)

Posted in: abstract , dissertations

The abstract is a vital part of any research paper. It is the shop front for your work, and the first stop for your reader. It should provide a clear and succinct summary of your study, and encourage your readers to read more. An effective abstract, therefore should answer the following questions:

• Why did you do this study or project?
• What did you do and how?
• What did you find?
• What do your findings mean?

So here's our run down of the key elements of a well-written abstract.

• Size - A succinct and well written abstract should be between approximately 100- 250 words.
• Background - An effective abstract usually includes some scene-setting information which might include what is already known about the subject, related to the paper in question (a few short sentences).
• Purpose  - The abstract should also set out the purpose of your research, in other words, what is not known about the subject and hence what the study intended to examine (or what the paper seeks to present).
• Methods - The methods section should contain enough information to enable the reader to understand what was done, and how. It should include brief details of the research design, sample size, duration of study, and so on.
• Results - The results section is the most important part of the abstract. This is because readers who skim an abstract do so to learn about the findings of the study. The results section should therefore contain as much detail about the findings as the journal word count permits.
• Conclusion - This section should contain the most important take-home message of the study, expressed in a few precisely worded sentences. Usually, the finding highlighted here relates to the primary outcomes of the study. However, other important or unexpected findings should also be mentioned. It is also customary, but not essential, to express an opinion about the theoretical or practical implications of the findings, or the importance of their findings for the field. Thus, the conclusions may contain three elements:
• The primary take-home message.
• Any additional findings of importance.
• Implications for future studies.

Example Abstract 2: Engineering Development and validation of a three-dimensional finite element model of the pelvic bone.

Abstract from: Dalstra, M., Huiskes, R. and Van Erning, L., 1995. Development and validation of a three-dimensional finite element model of the pelvic bone. Journal of biomechanical engineering, 117(3), pp.272-278.

And finally...  A word on abstract types and styles

Abstract types can differ according to subject discipline. You need to determine therefore which type of abstract you should include with your paper. Here are two of the most common types with examples.

Informative Abstract

The majority of abstracts are informative. While they still do not critique or evaluate a work, they do more than describe it. A good informative abstract acts as a surrogate for the work itself. That is, the researcher presents and explains all the main arguments and the important results and evidence in the paper. An informative abstract includes the information that can be found in a descriptive abstract [purpose, methods, scope] but it also includes the results and conclusions of the research and the recommendations of the author. The length varies according to discipline, but an informative abstract is usually no more than 300 words in length.

Descriptive Abstract A descriptive abstract indicates the type of information found in the work. It makes no judgements about the work, nor does it provide results or conclusions of the research. It does incorporate key words found in the text and may include the purpose, methods, and scope of the research. Essentially, the descriptive abstract only describes the work being summarised. Some researchers consider it an outline of the work, rather than a summary. Descriptive abstracts are usually very short, 100 words or less.

Adapted from Andrade C. How to write a good abstract for a scientific paper or conference presentation. Indian J Psychiatry. 2011 Apr;53(2):172-5. doi: 10.4103/0019-5545.82558. PMID: 21772657; PMCID: PMC3136027 .

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Organizing Your Social Sciences Research Paper

• 3. The Abstract
• Purpose of Guide
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An abstract summarizes, usually in one paragraph of 300 words or less, the major aspects of the entire paper in a prescribed sequence that includes: 1) the overall purpose of the study and the research problem(s) you investigated; 2) the basic design of the study; 3) major findings or trends found as a result of your analysis; and, 4) a brief summary of your interpretations and conclusions.

Writing an Abstract. The Writing Center. Clarion University, 2009; Writing an Abstract for Your Research Paper. The Writing Center, University of Wisconsin, Madison; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-first Century . Oxford, UK: Chandos Publishing, 2010;

Importance of a Good Abstract

Sometimes your professor will ask you to include an abstract, or general summary of your work, with your research paper. The abstract allows you to elaborate upon each major aspect of the paper and helps readers decide whether they want to read the rest of the paper. Therefore, enough key information [e.g., summary results, observations, trends, etc.] must be included to make the abstract useful to someone who may want to examine your work.

How do you know when you have enough information in your abstract? A simple rule-of-thumb is to imagine that you are another researcher doing a similar study. Then ask yourself: if your abstract was the only part of the paper you could access, would you be happy with the amount of information presented there? Does it tell the whole story about your study? If the answer is "no" then the abstract likely needs to be revised.

Farkas, David K. “A Scheme for Understanding and Writing Summaries.” Technical Communication 67 (August 2020): 45-60;  How to Write a Research Abstract. Office of Undergraduate Research. University of Kentucky; Staiger, David L. “What Today’s Students Need to Know about Writing Abstracts.” International Journal of Business Communication January 3 (1966): 29-33; Swales, John M. and Christine B. Feak. Abstracts and the Writing of Abstracts . Ann Arbor, MI: University of Michigan Press, 2009.

Structure and Writing Style

I.  Types of Abstracts

To begin, you need to determine which type of abstract you should include with your paper. There are four general types.

Critical Abstract A critical abstract provides, in addition to describing main findings and information, a judgment or comment about the study’s validity, reliability, or completeness. The researcher evaluates the paper and often compares it with other works on the same subject. Critical abstracts are generally 400-500 words in length due to the additional interpretive commentary. These types of abstracts are used infrequently.

Descriptive Abstract A descriptive abstract indicates the type of information found in the work. It makes no judgments about the work, nor does it provide results or conclusions of the research. It does incorporate key words found in the text and may include the purpose, methods, and scope of the research. Essentially, the descriptive abstract only describes the work being summarized. Some researchers consider it an outline of the work, rather than a summary. Descriptive abstracts are usually very short, 100 words or less. Informative Abstract The majority of abstracts are informative. While they still do not critique or evaluate a work, they do more than describe it. A good informative abstract acts as a surrogate for the work itself. That is, the researcher presents and explains all the main arguments and the important results and evidence in the paper. An informative abstract includes the information that can be found in a descriptive abstract [purpose, methods, scope] but it also includes the results and conclusions of the research and the recommendations of the author. The length varies according to discipline, but an informative abstract is usually no more than 300 words in length.

Highlight Abstract A highlight abstract is specifically written to attract the reader’s attention to the study. No pretense is made of there being either a balanced or complete picture of the paper and, in fact, incomplete and leading remarks may be used to spark the reader’s interest. In that a highlight abstract cannot stand independent of its associated article, it is not a true abstract and, therefore, rarely used in academic writing.

II.  Writing Style

Use the active voice when possible , but note that much of your abstract may require passive sentence constructions. Regardless, write your abstract using concise, but complete, sentences. Get to the point quickly and always use the past tense because you are reporting on a study that has been completed.

Abstracts should be formatted as a single paragraph in a block format and with no paragraph indentations. In most cases, the abstract page immediately follows the title page. Do not number the page. Rules set forth in writing manual vary but, in general, you should center the word "Abstract" at the top of the page with double spacing between the heading and the abstract. The final sentences of an abstract concisely summarize your study’s conclusions, implications, or applications to practice and, if appropriate, can be followed by a statement about the need for additional research revealed from the findings.

Composing Your Abstract

Although it is the first section of your paper, the abstract should be written last since it will summarize the contents of your entire paper. A good strategy to begin composing your abstract is to take whole sentences or key phrases from each section of the paper and put them in a sequence that summarizes the contents. Then revise or add connecting phrases or words to make the narrative flow clearly and smoothly. Note that statistical findings should be reported parenthetically [i.e., written in parentheses].

Before handing in your final paper, check to make sure that the information in the abstract completely agrees with what you have written in the paper. Think of the abstract as a sequential set of complete sentences describing the most crucial information using the fewest necessary words. The abstract SHOULD NOT contain:

• A catchy introductory phrase, provocative quote, or other device to grab the reader's attention,
• Lengthy background or contextual information,
• Redundant phrases, unnecessary adverbs and adjectives, and repetitive information;
• Acronyms or abbreviations,
• References to other literature [say something like, "current research shows that..." or "studies have indicated..."],
• Using ellipticals [i.e., ending with "..."] or incomplete sentences,
• Jargon or terms that may be confusing to the reader,
• Citations to other works, and
• Any sort of image, illustration, figure, or table, or references to them.

Abstract. Writing Center. University of Kansas; Abstract. The Structure, Format, Content, and Style of a Journal-Style Scientific Paper. Department of Biology. Bates College; Abstracts. The Writing Center. University of North Carolina; Borko, Harold and Seymour Chatman. "Criteria for Acceptable Abstracts: A Survey of Abstracters' Instructions." American Documentation 14 (April 1963): 149-160; Abstracts. The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Hartley, James and Lucy Betts. "Common Weaknesses in Traditional Abstracts in the Social Sciences." Journal of the American Society for Information Science and Technology 60 (October 2009): 2010-2018; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-first Century. Oxford, UK: Chandos Publishing, 2010; Procter, Margaret. The Abstract. University College Writing Centre. University of Toronto; Riordan, Laura. “Mastering the Art of Abstracts.” The Journal of the American Osteopathic Association 115 (January 2015 ): 41-47; Writing Report Abstracts. The Writing Lab and The OWL. Purdue University; Writing Abstracts. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Koltay, Tibor. Abstracts and Abstracting: A Genre and Set of Skills for the Twenty-First Century . Oxford, UK: 2010; Writing an Abstract for Your Research Paper. The Writing Center, University of Wisconsin, Madison.

Writing Tip

Never Cite Just the Abstract!

Citing to just a journal article's abstract does not confirm for the reader that you have conducted a thorough or reliable review of the literature. If the full-text is not available, go to the USC Libraries main page and enter the title of the article [NOT the title of the journal]. If the Libraries have a subscription to the journal, the article should appear with a link to the full-text or to the journal publisher page where you can get the article. If the article does not appear, try searching Google Scholar using the link on the USC Libraries main page. If you still can't find the article after doing this, contact a librarian or you can request it from our free i nterlibrary loan and document delivery service .

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How to write an abstract

What is an abstract?

General format of an abstract, the content of an abstract, abstract example, abstract style guides, frequently asked questions about writing an abstract, related articles.

An abstract is a summary of the main contents of a paper.

The abstract is the first glimpse that readers get of the content of a research paper. It can influence the popularity of a paper, as a well-written one will attract readers, and a poorly-written one will drive them away.

➡️ Different types of papers may require distinct abstract styles. Visit our guide on the different types of research papers to learn more.

Tip: Always wait until you’ve written your entire paper before you write the abstract.

Before you actually start writing an abstract, make sure to follow these steps:

• Read other papers : find papers with similar topics, or similar methodologies, simply to have an idea of how others have written their abstracts. Notice which points they decided to include, and how in depth they described them.
• Double check the journal requirements : always make sure to review the journal guidelines to format your paper accordingly. Usually, they also specify abstract's formats.
• Write the abstract after you finish writing the paper : you can only write an abstract once you finish writing the whole paper. This way you can include all important aspects, such as scope, methodology, and conclusion.

➡️ Read more about  what is a research methodology?

The general format of an abstract includes the following features:

• Between 150-300 words .
• An independent page , after the title page and before the table of contents.
• Concise summary including the aim of the research, methodology , and conclusion .
• Keywords describing the content.

As mentioned before, an abstract is a text that summarizes the main points of a research. Here is a break down of each element that should be included in an abstract:

• Purpose : every abstract should start by describing the main purpose or aim of the research.
• Methods : as a second point, the methodology carried out should be explained.
• Results : then, a concise summary of the results should be included.
• Conclusion : finally, a short outline of the general outcome of the research should be given.
• Keywords : along with the abstract, specific words and phrases related to the topics discussed in the research should be added. These words are usually around five, but the number can vary depending on the journal's guidelines.

This abstract, taken from ScienceDirect , illustrates the ideal structure of an abstract. It has 155 words, it's concise, and it clearly shows the division of elements necessary to write a successful abstract.

This paper explores the implicit assumption in the growing body of literature that social media usage is fundamentally different in business-to-business (B2B) companies than in the extant business-to-consumer (B2C) literature. Sashi's (2012) customer engagement cycle is utilized to compare organizational practices in relation to social media marketing in B2B, B2C, Mixed B2B/B2C and B2B2C business models. Utilizing 449 responses to an exploratory panel based survey instrument, we clearly identify differences in social media usage and its perceived importance as a communications channel. In particular we identify distinct differences in the relationship between social media importance and the perceived effectiveness of social media marketing across business models. Our results indicate that B2B social media usage is distinct from B2C, Mixed and B2B2C business model approaches. Specifically B2B organizational members perceive social media to have a lower overall effectiveness as a channel and identify it as less important for relationship oriented usage than other business models.

The exact format of an abstract depends on the citation style you implement. Whether it’s a well-known style (like APA, IEEE, etc.) or a journal's style, each format has its own guidelines, so make sure you know which style you are using before writing your abstract.

APA is one of the most commonly used styles to format an abstract. Therefore, we created a guide with exact instructions on how to write an abstract in APA style, and a template to download:

📕 APA abstract page: format and template

Additionally, you will find below an IEEE and ASA abstract guide by Purdue Online Writing Lab :

📗 IEEE General Format - Abstract

📘 ASA Manuscript Formatting - Abstract

No. You should always write an abstract once you finish writing the whole paper. This way you can include all important aspects of the paper, such as scope, methodology, and conclusion.

The length of an abstract depends on the formatting style of the paper. For example, APA style calls for 150 to 250 words. Generally, you need between 150-300 words.

No. An abstract has an independent section after the title page and before the table of contents, and should not be included in the table of contents.

Take a look at APA abstract page: format and template for exact details on how to format an abstract in APA style.

You can access any paper through Google Scholar or any other search engine; pick a paper and read the abstract. Abstracts are always freely available to read.

How to Write a Scientific Abstract for Your Research Article | Parts of a Research Article

How-to-write-a-scientific-abstract.

Karen McKee, Scientist

January 21, 2022

One of the most important parts of a scientific research article is the abstract. Why? Because they act like advertisements for your paper. Successful authors put substantial effort into crafting their abstracts as it is often the only section of a paper that is read! And will determine whether a reader decides to continue. In the case of a conference paper, the abstract will determine whether it is accepted or not for presentation to colleagues. Conference organizers and journal editors and reviewers pay close attention to the abstract because it is a good predictor of the quality of the paper or talk. A poorly written abstract says the author is inexperienced or doesn’t care about quality.

What is the purpose of a scientific abstract?

Essentially, an abstract should reflect all the parts of your research paper, including yourself, but in shortened form. In other words, a person reading only your abstract should be able to:

• understand why you conducted the study
• how you conducted it
• what you found,
• and why your work is important.

In general, avoid the novice’s cut-and-paste approach when crafting your abstract and instead write a unique, standalone summary. Although inclusion of data is acceptable, report only those numbers that represent the most important information. Some authors include citations or URLs in their abstracts, but many journals discourage or prohibit such additions. Be sure to stay within the word limit, which most journals and conferences set for abstracts. Use Wiley Author Services to find the best journal for publication of your paper and understand their submission process for more details.  

Let’s now consider how to write an abstract. Some journals or conferences provide a template that specifies four or five sections, e.g., Background or Aim, Question, Methods, Results, and Conclusions. If so, then follow those instructions. If not, then the four-part structure provided below will serve as a basic guideline. If you follow this formula, your abstract will be well organized and will contain all the essential elements. There are four main parts in which you need to answer the following questions:

How to Write an Abstract

1. what problem did you study and why is it important.

Here, you want to provide some background to the study, the motivation behind the study, and/or the specific question or hypothesis you addressed. You may be able to set the stage with only one or two sentences, but sometimes it takes a longer description. You’ll have to use your best judgment here as to how much to say in this first section.

2. What methods did you use to study the problem?

Next, you want to give an overview of your methods. Was it a field study or a laboratory experiment? What experimental treatments were applied? Generally, you want to keep the methods section brief unless it is the focus of the paper.

3. What were your key findings?

When describing your results, strive to focus on the main finding(s) and list no more than two or three points. Also, avoid ambiguous or imprecise wording, which is a common mistake found in conference abstracts written before the data have been completely collected or analyzed. If your data are incomplete or still being analyzed, you are not ready to present your paper.

4. What did you conclude based on these findings and what are the broader implications?

The conclusions section is where you want to drive home the broader implications of your study. What is new or innovative about the findings? How do your findings affect the field of study? Are there any applications? In writing this section, however, don’t state sweeping generalizations unsupported by the data or say that insights “will be discussed”.

What other considerations should I take when writing my abstract?

Search Engine Optimization (SEO), which means including keywords people are likely to use when looking for papers on your topic . In addition to including such terms in the title and keyword field of your paper, you want to repeat those terms contextually throughout the abstract. Such repetition is used by search engines to rank an online document. By optimizing your abstract for discovery by search engines, you can raise the ranking of your paper in a search and make it easier for colleagues to find.

Some journals are now encouraging or requiring “enhanced abstracts” such as  graphical abstracts  or  video abstracts . Although such abstracts include additional visual components, the same basic guidelines I’ve covered in this post still apply. All good abstracts recapitulate the paper and contain the four key parts listed above.

Writing good abstracts is not an art, but a learned skill. Developing such a skill takes practice. Here is an exercise to help you develop this skill. Pick a scientific article in your field. Read the paper with the abstract covered. Then try to write an abstract based on your reading. Compare your abstract to the author’s. Repeat until you feel confident. If you’ve not yet published a paper, this exercise will help you hone the skills necessary to write a concise and informative abstract.

If you would like to view a presentation that summarizes the points in this post and uses a published abstract to illustrate, see  this link.

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• How to Write an Abstract | Steps & Examples

How to Write an Abstract | Steps & Examples

Published on 1 March 2019 by Shona McCombes . Revised on 10 October 2022 by Eoghan Ryan.

An abstract is a short summary of a longer work (such as a dissertation or research paper ). The abstract concisely reports the aims and outcomes of your research, so that readers know exactly what your paper is about.

Although the structure may vary slightly depending on your discipline, your abstract should describe the purpose of your work, the methods you’ve used, and the conclusions you’ve drawn.

One common way to structure your abstract is to use the IMRaD structure. This stands for:

• Introduction

Abstracts are usually around 100–300 words, but there’s often a strict word limit, so make sure to check the relevant requirements.

In a dissertation or thesis , include the abstract on a separate page, after the title page and acknowledgements but before the table of contents .

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Table of contents

Abstract example, when to write an abstract, step 1: introduction, step 2: methods, step 3: results, step 4: discussion, tips for writing an abstract, frequently asked questions about abstracts.

Hover over the different parts of the abstract to see how it is constructed.

This paper examines the role of silent movies as a mode of shared experience in the UK during the early twentieth century. At this time, high immigration rates resulted in a significant percentage of non-English-speaking citizens. These immigrants faced numerous economic and social obstacles, including exclusion from public entertainment and modes of discourse (newspapers, theater, radio).

Incorporating evidence from reviews, personal correspondence, and diaries, this study demonstrates that silent films were an affordable and inclusive source of entertainment. It argues for the accessible economic and representational nature of early cinema. These concerns are particularly evident in the low price of admission and in the democratic nature of the actors’ exaggerated gestures, which allowed the plots and action to be easily grasped by a diverse audience despite language barriers.

Keywords: silent movies, immigration, public discourse, entertainment, early cinema, language barriers.

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You will almost always have to include an abstract when:

• Completing a thesis or dissertation
• Submitting a research paper to an academic journal
• Writing a book proposal
• Applying for research grants

It’s easiest to write your abstract last, because it’s a summary of the work you’ve already done. Your abstract should:

• Be a self-contained text, not an excerpt from your paper
• Be fully understandable on its own
• Reflect the structure of your larger work

Start by clearly defining the purpose of your research. What practical or theoretical problem does the research respond to, or what research question did you aim to answer?

You can include some brief context on the social or academic relevance of your topic, but don’t go into detailed background information. If your abstract uses specialised terms that would be unfamiliar to the average academic reader or that have various different meanings, give a concise definition.

After identifying the problem, state the objective of your research. Use verbs like “investigate,” “test,” “analyse,” or “evaluate” to describe exactly what you set out to do.

This part of the abstract can be written in the present or past simple tense  but should never refer to the future, as the research is already complete.

• This study will investigate the relationship between coffee consumption and productivity.
• This study investigates the relationship between coffee consumption and productivity.

Next, indicate the research methods that you used to answer your question. This part should be a straightforward description of what you did in one or two sentences. It is usually written in the past simple tense, as it refers to completed actions.

• Structured interviews will be conducted with 25 participants.
• Structured interviews were conducted with 25 participants.

Don’t evaluate validity or obstacles here — the goal is not to give an account of the methodology’s strengths and weaknesses, but to give the reader a quick insight into the overall approach and procedures you used.

Next, summarise the main research results . This part of the abstract can be in the present or past simple tense.

• Our analysis has shown a strong correlation between coffee consumption and productivity.
• Our analysis shows a strong correlation between coffee consumption and productivity.
• Our analysis showed a strong correlation between coffee consumption and productivity.

Depending on how long and complex your research is, you may not be able to include all results here. Try to highlight only the most important findings that will allow the reader to understand your conclusions.

Finally, you should discuss the main conclusions of your research : what is your answer to the problem or question? The reader should finish with a clear understanding of the central point that your research has proved or argued. Conclusions are usually written in the present simple tense.

• We concluded that coffee consumption increases productivity.
• We conclude that coffee consumption increases productivity.

If there are important limitations to your research (for example, related to your sample size or methods), you should mention them briefly in the abstract. This allows the reader to accurately assess the credibility and generalisability of your research.

If your aim was to solve a practical problem, your discussion might include recommendations for implementation. If relevant, you can briefly make suggestions for further research.

If your paper will be published, you might have to add a list of keywords at the end of the abstract. These keywords should reference the most important elements of the research to help potential readers find your paper during their own literature searches.

Be aware that some publication manuals, such as APA Style , have specific formatting requirements for these keywords.

It can be a real challenge to condense your whole work into just a couple of hundred words, but the abstract will be the first (and sometimes only) part that people read, so it’s important to get it right. These strategies can help you get started.

Read other abstracts

The best way to learn the conventions of writing an abstract in your discipline is to read other people’s. You probably already read lots of journal article abstracts while conducting your literature review —try using them as a framework for structure and style.

You can also find lots of dissertation abstract examples in thesis and dissertation databases .

Reverse outline

Not all abstracts will contain precisely the same elements. For longer works, you can write your abstract through a process of reverse outlining.

For each chapter or section, list keywords and draft one to two sentences that summarise the central point or argument. This will give you a framework of your abstract’s structure. Next, revise the sentences to make connections and show how the argument develops.

Write clearly and concisely

A good abstract is short but impactful, so make sure every word counts. Each sentence should clearly communicate one main point.

To keep your abstract or summary short and clear:

• Avoid passive sentences: Passive constructions are often unnecessarily long. You can easily make them shorter and clearer by using the active voice.
• Avoid long sentences: Substitute longer expressions for concise expressions or single words (e.g., “In order to” for “To”).
• Avoid obscure jargon: The abstract should be understandable to readers who are not familiar with your topic.
• Avoid repetition and filler words: Replace nouns with pronouns when possible and eliminate unnecessary words.
• Avoid detailed descriptions: An abstract is not expected to provide detailed definitions, background information, or discussions of other scholars’ work. Instead, include this information in the body of your thesis or paper.

If you’re struggling to edit down to the required length, you can get help from expert editors with Scribbr’s professional proofreading services .

Check your formatting

If you are writing a thesis or dissertation or submitting to a journal, there are often specific formatting requirements for the abstract—make sure to check the guidelines and format your work correctly. For APA research papers you can follow the APA abstract format .

Checklist: Abstract

The word count is within the required length, or a maximum of one page.

The abstract appears after the title page and acknowledgements and before the table of contents .

I have clearly stated my research problem and objectives.

I have briefly described my methodology .

I have summarized the most important results .

I have stated my main conclusions .

I have mentioned any important limitations and recommendations.

The abstract can be understood by someone without prior knowledge of the topic.

You've written a great abstract! Use the other checklists to continue improving your thesis or dissertation.

An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

• To help potential readers determine the relevance of your paper for their own research.
• To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarises the contents of your paper.

An abstract for a thesis or dissertation is usually around 150–300 words. There’s often a strict word limit, so make sure to check your university’s requirements.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis or paper.

Avoid citing sources in your abstract . There are two reasons for this:

• The abstract should focus on your original research, not on the work of others.
• The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

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

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Writing an Abstract

What is an abstract.

An abstract is a summary of your paper and/or research project. It is NOT an introduction to your paper; rather, it should highlight your major points, explain why your work is important, describe how you researched your problem, and offer your conclusions. Typically, an abstract should be approximately 250-300 words. 

How do I prepare an abstract?

Review the components of an abstract.

The exact content of your abstract will depend on the status of your project, disciplinary norms, and feedback from your mentor; however, it should include several of the components listed below: 

• Problem:  What is the central problem or question you investigated? 
• Context: Provide brief background to place your project into context. Explain previous studies, concepts, or theoretical or critical frameworks relevant to your research (i.e., what’s already known or has been done on this topic). 
• Purpose: Outline how your work is contributing to the existing knowledge or is addressing gaps within your field (i.e., why this area of research is important and what’s the rationale for your work). 
• Hypothesis: What prediction(s) did you make based on your research question? 
• Methods: Describe the important methods you used to perform your research or evidence you examined. 
• Results: What are the major results, findings or arguments of the research project?  
• Interpretation: How do your results relate back to your central problem? 
• Implications: Why are your results important? What can we learn from them? 

Understand the structure of an abstract

Once you are familiar with the key components of an abstract, the next step is to understand how to organize these elements effectively. The composition of your abstract can also take different forms depending on the type of research and the conventions of your specific discipline. Below are common structures for projects in STEM fields and in the humanities suggested by The Writing Center . 

For STEM and experimental projects

• Objective/Goal/Significance (Why did you do it or why did it need to be done? Why is this question important/worth asking?) 
• Methods/Approach (What did you do? How did you attempt to answer this question?) 
• Results (What did you find/expect to find? What did the research reveal?) 
• Conclusions (What did you learn?) 

For humanities projects

(Version 1)

• Background (What’s the importance of your topic?) 
• Thesis (What argument or claim are you making?) 
• Theoretical Approach (if applicable) 
• Conclusion 

(Version 2)

• Background (Existing conversation, contribution of research) 

Consider your audience

For the purposes of the symposium, the wording of an abstract should be understandable to a well-read, interdisciplinary audience. Specialized terms should be either defined or avoided. 

Consult additional resources

• Creating an Abstract resource from  WUSTL University Libraries  
• How to construct a  Nature summary paragraph  (biological and biomedical sciences) 
• Abstract Guide  from the American Psychological Association 
• Writing an Abstract for Your Research Paper  from the University of Wisconsin Writing Center 
• View students’ abstracts from last year’s Fall and Spring Undergraduate Research Symposia 

Get help and feedback

Share your abstract with your mentor well in advance of the deadline to receive their input. Your abstract must have the approval of your research mentor or advisor. 

In addition you may wish to make an appointment  with The Writing Center at any stage of the abstract writing process.  

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Abstract for Research Proposal: Types and How to Write It

by  Antony W

June 26, 2024

An abstract in a research proposal summarizes the main aspect of the assignment in a given sequence in 300 words or less. It highlights the purpose of the study, the research problem, design of the study, findings, summary of your interpretations and conclusions.

For what it’s worth, the abstract of your research proposal should give a clear and concise elaboration of the major aspects of an issue you’ve investigated.

In this guide, you’ll learn how to write an abstract for any research proposal. We’ll look at why an abstract is important, the types of abstracts, writing style, and what to avoid when it comes to writing an abstract for your research proposal.

Types of Abstracts for a Research Proposal

There are four types of abstracts that you can write for a research proposal :

• Critical abstract
• Descriptive abstract
• Informative abstract
• Highlight abstract

1. Critical abstract

A critical abstract in a research proposal describes the primary findings and gives a solid judgment on the validity, completeness, and reliability of the study. It’s your responsibility as a researcher to evaluate your work and then compare it with already existing work on the same subject.

Because a critical abstract includes an additional commentary, it tends to longer. Often, the length falls between 400 and 500 words. However, do keep in mind that this type of an abstract is very are, which means your instructor may never ask you to write a critical abstract for your research proposal.

2. Highlight Abstract

A highlight abstract is a piece of writing that can’t stand independent of its associated document. It uses incomplete and leading remarks, with the primary goal of grabbing the attention of the reader to the study.

Professors have made it clear that a highlight abstract is not by itself a true abstract to use in a research proposal. Since it cannot stand on its away separate from the associated article, it’s unlikely that your teacher will ask you to use it in academic writing.

3. Descriptive abstract

A descriptive abstract gives a short description of the research proposal. It may include purpose, method, and the scope of the research, and it’s often 100 words or less in length. Some people consider it to be an outline of the research proposal rather than an actual abstract for the document.

While a descriptive abstract describes the type of information a reader will find in a research proposal, it neither critics the work nor provides results and conclusion of the study.

4. Informative Abstract

Many abstracts in academic writing are informative. They don’t analyze the study or investigation that you propose, but they explain a research project in a way that they can stand independently. In other words, an informative abstract gives an explanation for the main arguments, evidence, and significant results.

In addition to featuring purpose, method, and scope, an informative abstract also include the results, conclusion, as well as the recommendation of the author. As for the length, an informative abstract should not be more than 300 words.

How to Write an Abstract for a Research Proposal

Of the four type of abstracts that we’ve discussed above, an informative abstract is what you’ll need to write in your research proposal. Writing an abstract for a research proposal isn’t difficult at all. You only need to know what to write and how to write it, and you’re good to get started.

1. Write in Active Voice

First, use active voice when writing an abstract for your research proposal. However, this doesn’t mean you should avoid passive voice in entirety. If you find that some sentences can’t make sense unless with passive sentence construction, feel free to bend this rule somewhat.

Second, make sure your sentences are concise and complete. Refrain from using ambiguous words. Keep the language simple instead.

Lastly, never use present or future tense to write an abstract for a research proposal. You’re reporting a study that you’ve already conducted and therefore writing in past sense makes the most sense.

Your abstract should come immediately after the title page. Write in block format without paragraph indentations. The abstract should not be more than 300 words long and the page should not have a number. The word “Abstract” in your research proposal should be center aligned in the page, unless otherwise stated.

In addition to these formatting rules, the last sentence of your abstract should summarize the application to practice or the conclusions of your study. In the case where it seems appropriate, you might want follow this by statement that suggests a need for additional research.

3. Time to Write the Abstract

There are no hard rules on when to write an abstract for a research proposal. Some students choose to write the section first while others choose to write it last. We strongly recommend that you write the abstract last because it’s a summary of the whole paper. You can also write it in the beginning if you’ve already outlined your draft and know what you want to talk about even before you start writing.

Your informative abstract is subject to frequent changes as you work on your paper, and that holds whether you write the section first or last. Be flexible and tweak this part of the assignment as necessary. Also, make sure you report statistical findings in parentheses.

Read abstract to be sure the summary of the study agrees with what you’ve written in your proposal. As we mentioned earlier, this section is subject to change depending on the direction your research takes. So make sure you identify and correct any anomalies if any.

Mistakes to Avoid When Writing an Abstract for Research Proposal

To wind up this guide, here are some of the most common mistakes that you should avoid when writing an abstract for your research proposal:

• Avoid giving a lengthy background
• Don’t include citations to other people’s work
• An abstract shouldn’t include a table, figure, image, or any kind of illustration
• Don’t include terms that are difficult to understand

About the author 

Antony W is a professional writer and coach at Help for Assessment. He spends countless hours every day researching and writing great content filled with expert advice on how to write engaging essays, research papers, and assignments.

Disparities in Sentencing: Creating a "Benchcard" on Brain Development to Incorporate Neuroscience Research

LSU Law Journal for Social Justice & Policy, Vol. 4, p.23, 2024

Suffolk University Law School Research Paper No. 24-11

31 Pages Posted: 19 Aug 2024

Stevie Leahy

Suffolk University Law School

Date Written: August 16, 2024

This article explores the disparities in juvenile sentencing across the United States, with a focus on the implications of the Supreme Court's decision in Jones v. Mississippi (2021) and the importance of incorporating neuroscience research into legal decisions. It highlights how different jurisdictions handle juvenile life without parole (JLWOP) sentences, leading to significant inconsistencies based on geography. The article advocates for the development of a “benchcard” that would guide judges in making informed decisions by integrating the latest scientific understanding of brain development, particularly concerning individuals up to age 25. By examining the evolution of legal protections for juveniles and the role of the prison industrial complex, the article argues for a more equitable legal approach that considers the developmental differences of young offenders.

Suggested Citation: Suggested Citation

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Suffolk university law school ( email ).

120 Tremont Street Boston, MA 02108-4977 United States

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• Volume 33, Issue 9
• Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis
• Article Text
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• Rebecca Payne 1 ,
• Aileen Clarke 1 ,
• Nadia Swann 1 ,
• Jackie van Dael 1 ,
• Natassia Brenman 1 ,
• Rebecca Rosen 2 ,
• Adam Mackridge 3 ,
• Lucy Moore 1 ,
• Asli Kalin 1 ,
• Emma Ladds 1 ,
• Nina Hemmings 2 ,
• Sarah Rybczynska-Bunt 4 ,
• Stuart Faulkner 1 ,
• Isabel Hanson 1 ,
• Sophie Spitters 5 ,
• http://orcid.org/0000-0002-7758-8493 Sietse Wieringa 1 , 6 ,
• Francesca H Dakin 1 ,
• Sara E Shaw 1 ,
• Joseph Wherton 1 ,
• Richard Byng 4 ,
• Laiba Husain 1 ,
• http://orcid.org/0000-0003-2369-8088 Trisha Greenhalgh 1
• 1 Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
• 2 Nuffield Trust , London , UK
• 3 Betsi Cadwaladr University Health Board , Bangor , UK
• 4 Peninsula Schools of Medicine and Dentistry , University of Plymouth , Plymouth , UK
• 5 Wolfson Institute of Population Health , Queen Mary University of London , London , UK
• 6 Sustainable Health Unit , University of Oslo , Oslo , Norway
• Correspondence to Professor Trisha Greenhalgh; trish.greenhalgh{at}phc.ox.ac.uk

Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.

Setting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021–2023.

Methods Multimethod qualitative study. We explored causes of real safety incidents retrospectively (‘Safety I’ analysis). In a prospective longitudinal study, we used interviews and ethnographic observation to produce individual, organisational and system-level explanations for why safety and near-miss incidents (rarely) occurred and why they did not occur more often (‘Safety II’ analysis). Data were analysed thematically. An interpretive synthesis of why safety incidents occur, and why they do not occur more often, was refined following member checking with safety experts and lived experience experts.

Results Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances. These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating seemed especially vulnerable. General practices were facing resource constraints, understaffing and high demand. Triage and care pathways were complex, hard to navigate and involved multiple staff. In this context, patient safety often depended on individual staff taking initiative, speaking up or personalising solutions.

Conclusion While safety incidents are extremely rare in remote primary care, deaths and serious harms have resulted. We offer suggestions for patient, staff and system-level mitigations.

• Primary care
• Diagnostic errors
• Safety culture
• Qualitative research
• Prehospital care

Data availability statement

Data are available upon reasonable request. Details of real safety incidents are not available for patient confidentiality reasons. Requests for data on other aspects of the study from other researchers will be considered.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjqs-2023-016674

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Safety incidents are extremely rare in primary care but they do happen. Concerns have been raised about the safety of remote triage and remote consultations.

WHAT THIS STUDY ADDS

Rare safety incidents (involving death or serious harm) in remote encounters can be traced back to various clinical, communicative, technical and logistical causes. Telephone and video encounters in general practice are occurring in a high-risk (extremely busy and sometimes understaffed) context in which remote workflows may not be optimised. Front-line staff use creativity and judgement to help make care safer.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

As remote modalities become mainstreamed in primary care, staff should be trained in the upstream causes of safety incidents and how they can be mitigated. The subtle and creative ways in which front-line staff already contribute to safety culture should be recognised and supported.

Introduction

In early 2020, remote triage and remote consultations (together, ‘remote encounters’), in which the patient is in a different physical location from the clinician or support staff member, were rapidly expanded as a safety measure in many countries because they eliminated the risk of transmitting COVID-19. 1–4 But by mid-2021, remote encounters had begun to be depicted as potentially unsafe because they had come to be associated with stories of patient harm, including avoidable deaths and missed cancers. 5–8

Providing triage and clinical care remotely is sometimes depicted as a partial solution to the system pressures facing primary healthcare in many countries, 9–11 including rising levels of need or demand, the ongoing impact of the COVID-19 pandemic and workforce challenges (especially short-term or longer-term understaffing). In this context, remote encounters may be an important component of a mixed-modality health service when used appropriately alongside in-person contacts. 12 13 But this begs the question of what ‘appropriate’ and ‘safe’ use of remote modalities in a primary care context is. Safety incidents (defined as ‘any unintended or unexpected incident which could have, or did, lead to harm for one or more patients receiving healthcare 14 ’) are extremely rare in primary healthcare consultations generally, 15 16 in-hours general practice telephone triage 17 and out-of-hours primary care. 18 But the recent widespread expansion of remote triage and remote consulting in primary care means that a wider range of patients and conditions are managed remotely, making it imperative to re-examine where the risks lie.

Theoretical approaches to safety in healthcare fall broadly into two traditions. 19 ‘Safety I’ studies focus on what went wrong. Incident reports are analysed to identify ‘root causes’ and ‘safety gaps’, and recommendations are made to reduce the chance that further similar incidents will happen in the future. 20 Such studies, undertaken in isolation, tend to lead to a tightening of rules, procedures and protocols. ‘Safety II’ studies focus on why, most of the time, things do not go wrong. Ethnography and other qualitative methods are employed to study how humans respond creatively to unique and unforeseen situations, thereby preventing safety incidents most of the time. 19 Such studies tend to show that actions which achieve safety are highly context specific, may entail judiciously breaking the rules and require human qualities such as courage, initiative and adaptability. 21 Few previous studies have combined both approaches.

In this study, we aimed to use Safety I methods to learn why safety incidents occur (although rarely) in remote primary care encounters and also apply Safety II methods to examine the kinds of creative actions taken by front-line staff that contribute to a safety culture and thereby prevent such incidents.

Study design and origins

Multimethod qualitative study across UK, including incident analysis, longitudinal ethnography and national stakeholder interviews.

The idea for this safety study began during a longitudinal ethnographic study of 12 general practices across England, Scotland and Wales as they introduced (and, in some cases, subsequently withdrew) various remote and digital modalities. Practices were selected for maximum diversity in geographical location, population served and digital maturity and followed from mid-2021 to end 2023 using staff and patient interviews and in-person ethnographic visits. The study protocol, 22 baseline findings 23 and a training needs analysis 24 have been published. To provide context for our ethnography, we interviewed a sample of national stakeholders in remote and digital primary care, including out-of-hours providers running telephone-led services, and held four online multistakeholder workshops, one of which was on the theme of safety, for policymakers, clinicians, patients and other parties. Early data from this detailed qualitative work revealed staff and patient concerns about the safety of remote encounters but no actual examples of harm.

To explore the safety theme further, we decided to take a dual approach. First, following Safety I methodology for the study of rare harms, 20 we set out to identify and analyse a sample of safety incidents involving remote encounters. These were sourced from arm’s-length bodies (NHS England, NHS Resolution, Healthcare Safety Investigation Branch) and providers of healthcare at scale (health boards, integrated care systems and telephone advice services), since our own small sample had not identified any of these rare occurrences. Second, we extended our longitudinal ethnographic design to more explicitly incorporate Safety II methodology, 19 allowing us to examine safety culture and safety practices in our 12 participating general practices, especially the adaptive work done by staff to avert potential safety incidents.

Data sources and management

Table 1 summarises the data sources.

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Summary of data sources

The Safety I dataset (rows 2-5) consisted of 95 specific incident reports, including complaints submitted to the main arm’s-length NHS body in England, NHS England, between 2020 and 2023 (n=69), closed indemnity claims that had been submitted to a national indemnity body, NHS Resolution, between 2015 and 2023 (n=16), reports from an urgent care telephone service in Wales (NHS 111 Wales) between 2020 and 2023 (n=6) and a report on an investigation of telephone advice during the COVID-19 crisis between 2020 and 2022 7 (n=4). These 95 incidents were organised using Microsoft Excel spreadsheets.

The Safety II dataset (rows 6-10) consisted of extracts from fieldnotes, workshop transcripts and interviews collected over 2 years, stored and coded on NVivo qualitative software. These were identified by searching for text words and codes (e.g. ‘risk’, ‘safety’, ‘incident’) and by asking researchers-in-residence, who were closely familiar with practices, to highlight safety incidents involving harm and examples of safety-conscious work practices. This dataset included over 100 formal interviews and numerous on-the-job interviews with practice staff, plus interviews with a sample of 10 GP (general practitioner) trainers and 10 GP trainees (penultimate row of table 1 ) and with six clinical safety experts identified through purposive sampling from government, arm’s-length bodies and health boards (bottom row of table 1 ).

Data analysis

We analysed incident reports, interview data and ethnographic fieldnotes using thematic analysis as described by Braun and Clarke. 25 These authors define a theme as an important, broad pattern in a set of qualitative data, which can (where necessary) be further refined using coding.

Themes in the incident dataset were identified by five steps. First, two researchers (both medically qualified) read each source repeatedly to gain familiarity. Second, those researchers worked independently using Braun and Clarke’s criterion (‘whether it captures something important in relation to the overall research question’—p 82 25 ) to identify themes. Third, they discussed their initial interpretations with each other and resolved differences through discussion. Fourth, they extracted evidence from the data sources to illustrate and refine each theme. Finally, they presented their list of themes along with illustrative examples to the wider team. Cases used to illustrate themes were systematically fictionalised by changing age, randomly allocating gender and altering clinical details. 26 For example, an acute appendicitis could be changed to acute diverticulitis if the issue was a missed acute abdomen.

These safety themes were then used to sensitise us to seek relevant (confirming and disconfirming) material from our ethnographic and interview datasets. For example, the theme ‘poor communication’ (and subthemes such as ‘failure to seek further clarification’ within this) promoted us to look for examples in our stakeholder interviews of poor communication offered as a cause of safety incidents and examples in our ethnographic notes of good communication (including someone seeking clarification). We used these wider data to add nuance to the initial list of themes.

As a final sense-checking step, the draft findings from this study were shown to each of the six safety experts in our sample and refined in the light of their comments (in some cases, for example, they considered the case to have been overfictionalised, thereby losing key clinical messages; they also gave additional examples to illustrate some of the themes we had identified, which underlined the importance of those themes).

Overview of dataset

The dataset ( table 1 ) consisted of 95 incident reports (see fictionalised examples in box 1 ), plus approximately 400 pages of extracts from interviews, ethnographic fieldnotes and workshop discussions, including situated safety practices (see examples in box 2 ), plus strategic insights relating to policy, organisation and planning of services. Notably, almost all incidents related to telephone calls.

Examples of safety incidents involving death or serious harm in remote encounters

All these cases have been systematically fictionalised as explained in the text.

Case 1 (death)

A woman in her 70s experiencing sudden breathlessness called her GP (general practitioner) surgery. The receptionist answered the phone and informed her that she would place her on the doctor’s list for an emergency call-back. The receptionist was distracted by a patient in the waiting room and did not do so. The patient deteriorated and died at home that afternoon.—NHS Resolution case, pre-2020

Case 2 (death)

An elderly woman contacted her GP after a telephone contact with the out-of-hours service, where constipation had been diagnosed. The GP prescribed laxatives without seeing the patient. The patient self-presented to the emergency department (ED) the following day in obstruction secondary to an incarcerated hernia and died in the operating theatre.—NHS Resolution case, pre-2020

Case 3 (risk to vulnerable patients)

A daughter complained that her elderly father was unable to access his GP surgery as he could not navigate the online triage system. When he phoned the surgery directly, he was directed back to the online system and told to get a relative to complete the form for him.—Complaint to NHS England, 2021

Case 4 (harm)

A woman in her first pregnancy at 28 weeks’ gestation experiencing urinary incontinence called NHS 111. She was taken down by a ‘urinary problems’ algorithm. Both the call handler and the subsequent clinician failed to recognise that she had experienced premature rupture of membranes. She later presented to the maternity department in active labour, and the opportunity to give early steroids to the premature infant was missed.—NHS Resolution case, pre-2020

Case 5 (death)

A doctor called about a 16-year-old girl with lethargy, shaking, fever and poor oral intake who had been unwell for 5 days. The doctor spoke to her older sister and advised that the child had likely glandular fever and should rest. When the parents arrived home, they called an ambulance but the child died of sepsis in the ED.—NHS Resolution case, pre-2020

Case 6 (death)

A 40-year-old woman, 6 weeks after caesarean section, contacted her GP due to shortness of breath, increased heart rate and dry cough. She was advised to get a COVID test and to dial 111 if she developed a productive cough, fever or pain. The following day she collapsed and died at home. The postmortem revealed a large pulmonary embolus. On reviewing the case, her GP surgery felt that had she been seen face to face, her oxygen saturations would have been measured and may have led to suspicion of the diagnosis.—NHS Resolution case, 2020

Case 7 (death)

A son complained that his father with diabetes and chronic kidney disease did not receive any in-person appointments over a period of 1 year. His father went on to die following a leg amputation arising from a complication of his diabetes.—Complaint to NHS England, 2021

Case 8 (death)

A 73-year-old diabetic woman with throat pain and fatigue called the surgery. She was diagnosed with a viral illness and given self-care advice. Over the next few days, she developed worsening breathlessness and was advised to do a COVID test and was given a pulse oximeter. She was found dead at home 4 days later. Postmortem found a blocked coronary artery and a large amount of pulmonary oedema. The cause of death was myocardial infarction and heart failure.—NHS Resolution case, pre-2020

Case 9 (harm)

A patient with a history of successfully treated cervical cancer developed vaginal bleeding. A diagnosis of fibroids was made and the patient received routine care by telephone over the next few months until a scan revealed a local recurrence of the original cancer.—Complaint to NHS England, 2020

Case 10 (death)

A 65-year-old female smoker with chronic cough and breathlessness presented to her GP. She was diagnosed with chronic obstructive pulmonary disease (COPD) and monitored via telephone. She did not respond to inhalers or antibiotics but continued to receive telephone monitoring without further investigation. Her symptoms continued to worsen and she called an ambulance. In the ED, she was diagnosed with heart failure and died soon after.—Complaint to NHS England, 2021

Case 11 (harm)

A 30-year-old woman presented with intermittent episodes of severe dysuria over a period of 2 years. She was given repeated courses of antibiotics but no urine was sent for culture and she was not examined. After 4 months of symptoms, she saw a private GP and was diagnosed with genital herpes.—Complaint to NHS England, 2021

Case 12 (harm)

There were repeated telephone consultations about a baby whose parents were concerned that the child was having a funny colour when feeding or crying. The 6-week check was done by telephone and at no stage was the child seen in person. Photos were sent in, but the child’s dark skin colour meant that cyanosis was not easily apparent to the reviewing clinician. The child was subsequently admitted by emergency ambulance where a significant congenital cardiac abnormality was found.—Complaint to NHS England, 2020 1

Case 13 (harm)

A 35-year-old woman in her third trimester of pregnancy had a telephone appointment with her GP about a breast lump. She was informed that this was likely due to antenatal breast changes and was not offered an in-person appointment. She attended after delivery and was referred to a breast clinic where a cancer was diagnosed.—Complaint to NHS England, 2020

Case 14 (harm)

A 63-year-old woman with a variety of physical symptoms including diarrhoea, hip girdle pain, palpitations, light-headedness and insomnia called her surgery on multiple occasions. She was told her symptoms were likely due to anxiety, but was diagnosed with stage 4 ovarian cancer and died soon after.—Complaint to NHS England, 2021

Case 15 (death)

A man with COPD with worsening shortness of breath called his GP surgery. The staff asked him if it was an emergency, and when the patient said no, scheduled him for 2 weeks later. The patient died before the appointment.—Complaint to NHS England, 2021

Examples of safety practices

Case 16 (safety incident averted by switching to video call for a sick child)

‘I’ve remembered one father that called up. Really didn’t seem to be too concerned. And was very much under-playing it and then when I did a video call, you know this child… had intercostal recession… looked really, really poorly. And it was quite scary actually that, you know, you’d had the conversation and if you’d just listened to what Dad was saying, actually, you probably wouldn’t be concerned.’—GP (general practitioner) interview 2022

Case 17 (‘red flag’ spotted by support staff member)

A receptionist was processing routine ‘administrative’ encounters sent in by patients using AccuRx (text messaging software). She became concerned about a sick note renewal request from a patient with a mental health condition. The free text included a reference to feeling suicidal, so the receptionist moved the request to the ‘red’ (urgent call-back) list. In interviews with staff, it became apparent that there had recently been heated discussion in the practice about whether support staff were adding ‘too many’ patients to the red list. After discussing cases, the doctors concluded that it should be them, not the support staff, who should absorb the risk in uncertain cases. The receptionist said that they had been told: ‘if in doubt, put it down as urgent and then the duty doctor can make a decision.’—Ethnographic fieldnotes from general practice 2023

Case 18 (‘check-in’ phone call added on busy day)

A duty doctor was working through a very busy Monday morning ‘urgent’ list. One patient had acute abdominal pain, which would normally have triggered an in-person appointment, but there were no slots and hard decisions were being made. This patient had had the pain already for a week, so the doctor judged that the general rule of in-person examination could probably be over-ridden. But instead of simply allocating to a call-back, the doctor asked a support staff member to phone the patient, ask ‘are you OK to wait until tomorrow?’ and offer basic safety-netting advice.—Ethnographic fieldnotes from general practice 2023

Case 19 (receptionist advocating on behalf of ‘angry’ walk-in patient)

A young Afghan man with limited English walked into a GP surgery on a very busy day, ignoring the prevailing policy of ‘total triage’ (make contact by phone or online in the first instance). He indicated that he wanted a same-day in-person appointment for a problem he perceived as urgent. A heated exchange occurred with the first receptionist, and the patient accused her of ‘racism’. A second receptionist of non-white ethnicity herself noted the man’s distress and suspected that there may indeed be an urgent problem. She asked the first receptionist to leave the scene, saying she wanted to ‘have a chat’ with the patient (‘the colour of my skin probably calmed him down more than anything’). Through talking to the patient and looking through his record, she ascertained that he had an acute infection that likely needed prompt attention. She tried to ‘bend the rules’ and persuade the duty doctor to see the patient, conveying the clinical information but deliberately omitting the altercation. But the first receptionist complained to the doctor (‘he called us racists’) and the doctor decided that the patient would not therefore be offered a same-day appointment. The second receptionist challenged the doctor (‘that’s not a reason to block him from getting care’). At this point, the patient cried and the second receptionist also became upset (‘this must be serious, you know’). On this occasion, despite her advocacy the patient was not given an immediate appointment.—Ethnographic fieldnotes from general practice 2022

Case 20 (long-term condition nurse visits ‘unengaged’ patients at home)

An advanced nurse practitioner talks of two older patients, each with a long-term condition, who are ‘unengaged’ and lacking a telephone. In this practice, all long-term condition reviews are routinely done by phone. She reflects that some people ‘choose not to have avenues of communication’ (ie, are deliberately not contactable), and that there may be reasons for this (‘maybe health anxiety or just old’). She has, on occasion, ‘turned up’ unannounced at the patient’s home and asked to come in and do the review, including bloods and other tests. She reflects that while most patients engage well with the service, ‘half my job is these patients who don’t engage very well.’—Ethnographic fieldnotes from digitally advanced general practice 2022

Case 21 (doctor over-riding patient’s request for telephone prescribing)

A GP trainee described a case of a 53-year-old first-generation immigrant from Pakistan, a known smoker with hypertension and diabetes. He had booked a telephone call for vomiting and sinus pain. There was no interpreter available but the man spoke some English. He said he had awoken in the night with pain in his sinuses and vomiting. All he wanted was painkillers for his sinuses. The story did not quite make sense, and the man ‘sounded unwell’. The GP told him he needed to come in and be examined. The patient initially resisted but was persuaded to come in. When the GP went to call him in, the man was visibly unwell and lying down in the waiting room. When seen in person, he admitted to shoulder pain. The GP sent him to accident and emergency (A&E) where a myocardial infarction was diagnosed.—Trainee interview 2023

Below, we describe the main themes that were evident in the safety incidents: a challenging organisational and system context, poor communication compounded by remote modalities, limited clinical information, patient and carer burden and inadequate training. Many safety incidents illustrated multiple themes—for example, poor communication and failures of clinical assessment or judgement and patient complexity and system pressures. In the detailed findings below, we illustrate why safety incidents occasionally occur and why they are usually avoided.

The context for remote consultations: system and operational challenges

Introduction of remote triage and expansion of remote consultations in UK primary care occurred at a time of unprecedented system stress (an understaffed and chronically under-resourced primary care sector, attempting to cope with a pandemic). 23 Many organisations had insufficient telephone lines or call handlers, so patients struggled to access services (eg, half of all calls to the emergency COVID-19 telephone service in March 2020 were never answered 7 ). Most remote consultations were by telephone. 27

Our safety incident dataset included examples of technically complex access routes which patients found difficult or impossible to navigate (case 3 in box 1 ) and which required non-clinical staff to make clinical or clinically related judgements (cases 4 and 15). Our ethnographic dataset contained examples of inflexible application of triage rules (eg, no face-to-face consultation unless the patient had already had a telephone call), though in other practices these rules could be over-ridden by staff using their judgement or asking colleagues. Some practices had a high rate of failed telephone call-backs (patient unobtainable).

High demand, staff shortages and high turnover of clinical and support staff made the context for remote encounters inherently risky. Several incidents were linked to a busy staff member becoming distracted (case 1). Telephone consultations, which tend to be shorter, were sometimes used in the hope of improving efficiency. Some safety incidents suggested perfunctory and transactional telephone consultations, with flawed decisions made on the basis of incomplete information (eg, case 2).

Many practices had shifted—at least to some extent—from a demand-driven system (in which every request for an appointment was met) to a capacity-driven one (in which, if a set capacity was exceeded, patients were advised to seek care elsewhere), though the latter was often used flexibly rather than rigidly with an expectation that some patients would be ‘squeezed in’. In some practices, capacity limits had been introduced to respond to escalation of demand linked to overuse of triage templates (eg, to inquire about minor symptoms).

As a result of task redistribution and new staff roles, a single episode of care for one problem often involved multiple encounters or tasks distributed among clinical and non-clinical staff (often in different locations and sometimes also across in-hours and out-of-hours providers). Capacity constraints in onward services placed pressure on primary care to manage risk in the community, leading in some cases to failure to escalate care appropriately (case 6).

Some safety incidents were linked to organisational routines that had not adapted sufficiently to remote—for example, a prescription might be issued but (for various reasons) it could not be transmitted electronically to the pharmacy. Certain urgent referrals were delayed if the consultation occurred remotely (a referral for suspected colon cancer, for example, would not be accepted without a faecal immunochemical test).

Training, supervising and inducting staff was more difficult when many were working remotely. If teams saw each other less frequently, relationship-building encounters and ‘corridor’ conversations were reduced, with knock-on impacts for individual and team learning and patient care. Those supervising trainees or allied professionals reported loss of non-verbal cues (eg, more difficult to assess how confident or distressed the trainee was).

Clinical and support staff regularly used initiative and situated judgement to compensate for an overall lack of system resilience ( box 1 ). Many practices had introduced additional safety measures such as lists of patients who, while not obviously urgent, needed timely review by a clinician. Case 17 illustrates how a rule of thumb ‘if in doubt, put it down as urgent’ was introduced and then applied to avert a potentially serious mental health outcome. Case 18 illustrates how, in the context of insufficient in-person slots to accommodate all high-risk cases, a unique safety-netting measure was customised for a patient.

Poor communication is compounded by remote modalities

Because sense data (eg, sight, touch, smell) are missing, 28 remote consultations rely heavily on the history. Many safety incidents were characterised by insufficient or inaccurate information for various reasons. Sometimes (cases 2, 5, 6, 8, 9, 10 and 11), the telephone consultation was too short to do justice to the problem; the clinician asked few or no questions to build rapport, obtain a full history, probe the patient’s answers for additional detail, confirm or exclude associated symptoms and inquire about comorbidities and medication. Video provided some visual cues but these were often limited to head and shoulders, and photographs were sometimes of poor quality.

Cases 2, 4, 5 and 9 illustrate the dangers of relying on information provided by a third party (another staff member or a relative). A key omission (eg, in case 5) was failing to ask why the patient was unable to come to the phone or answer questions directly.

Some remote triage conversations were conducted using an inappropriate algorithm. In case 4, for example, the call handler accepted a pregnant patient’s assumption that leaking fluid was urine when the problem was actually ruptured membranes. The wrong pathway was selected; vital questions remained unasked; and a skewed history was passed to (and accepted by) the clinician. In case 8, the patient’s complaint of ‘throat’ pain was taken literally and led to ‘viral illness’ advice, overlooking a myocardial infarction.

The cases in box 2 illustrate how staff compensated for communication challenges. In case 16, a GP plays a hunch that a father’s account of his child’s asthma may be inaccurate and converts a phone encounter to video, revealing the child’s respiratory distress. In case 19 (an in-person encounter but relevant because the altercation occurs partly because remote triage is the default modality), one receptionist correctly surmises that the patient’s angry demeanour may indicate urgency and uses her initiative and interpersonal skills to obtain additional clinical information. In case 20, a long-term condition nurse develops a labour-intensive workaround to overcome her elderly patients’ ‘lack of engagement’. More generally, we observed numerous examples of staff using both formal tools (eg, see ‘red list’ in case 17) and informal measures (eg, corridor chats) to pass on what they believed to be crucial information.

Remote consulting can provide limited clinical information

Cases 2 and 4–14 all describe serious conditions including congenital cyanotic heart disease, pulmonary oedema, sepsis, cancer and diabetic foot which would likely have been readily diagnosed with an in-person examination. While patients often uploaded still images of skin lesions, these were not always of sufficient quality to make a confident diagnosis.

Several safety incidents involved clinicians assuming that a diagnosis made on a remote consultation was definitive rather than provisional. Especially when subsequent consultations were remote, such errors could become ingrained, leading to diagnostic overshadowing and missed or delayed diagnosis (cases 2, 8, 9, 10, 11 and 13). Patients with pre-existing conditions (especially if multiple or progressive), the very young and the elderly were particularly difficult to assess by telephone (cases 1, 2, 8, 10, 12 and 16). Clinical conditions difficult to assess remotely included possible cardiac pain (case 8), acute abdomen (case 2), breathing difficulties (cases 1, 6 and 10), vague and generalised symptoms (cases 5 and 14) and symptoms which progressed despite treatment (cases 9, 10 and 11). All these categories came up repeatedly in interviews and workshops as clinically risky.

Subtle aspects of the consultation which may have contributed to safety incidents in a telephone consultation included the inability to fully appraise the patient’s overall health and well-being (including indicators relevant to mental health such as affect, eye contact, personal hygiene and evidence of self-harm), general demeanour, level of agitation and concern, and clues such as walking speed and gait (cases 2, 5, 6, 7, 8, 10, 12 and 14). Our interviews included stories of missed cases of new-onset frailty and dementia in elderly patients assessed by telephone.

In most practices we studied, most long-term condition management was undertaken by telephone. This may be appropriate (and indeed welcome) when the patient is well and confident and a physical examination is not needed. But diabetes reviews, for example, require foot examination. Case 7 describes the deterioration and death of a patient with diabetes whose routine check-ups had been entirely by telephone. We also heard stories of delayed diagnosis of new diabetes in children when an initial telephone assessment failed to pick up lethargy, weight loss and smell of ketones, and point-of-care tests of blood or urine were not possible.

Nurses observed that remote consultations limit opportunities for demonstrating or checking the patient’s technique in using a device for monitoring or treating their condition such as an inhaler, oximeter or blood pressure machine.

Safety netting was inadequate in many remote safety incidents, even when provided by a clinician (cases 2, 5, 6, 8, 10, 12 and 13) but especially when conveyed by a non-clinician (case 15). Expert interviewees identified that making life-changing diagnoses remotely and starting patients on long-term medication without an in-person appointment was also risky.

Our ethnographic data showed that various measures were used to compensate for limited clinical information, including converting a phone consultation to video (case 16), asking the patient if they felt they could wait until an in-person slot was available (case 18), visiting the patient at home (case 20) and enacting a ‘if the history doesn’t make sense, bring the patient in for an in-person assessment’ rule of thumb (case 21). Out-of-hours providers added examples of rules of thumb that their services had developed over years of providing remote services, including ‘see a child face-to-face if the parent rings back’, ‘be cautious about third-party histories’, ‘visit a palliative care patient before starting a syringe driver’ and ‘do not assess abdominal pain remotely’.

Remote modalities place additional burdens on patients and carers

Given the greater importance of the history in remote consultations, patients who lacked the ability to communicate and respond in line with clinicians’ expectations were at a significant disadvantage. Several safety incidents were linked to patients’ limited fluency in the language and culture of the clinician or to specific vulnerabilities such as learning disability, cognitive impairment, hearing impairment or neurodiversity. Those with complex medical histories and comorbidities, and those with inadequate technical set-up and skills (case 3), faced additional challenges.

In many practices, in-person appointments were strictly limited according to more or less rigid triage criteria. Some patients were unable to answer the question ‘is this an emergency?’ correctly, leading to their condition being deprioritised (case 15). Some had learnt to ‘game’ the triage system (eg, online templates 29 ) by adapting their story to obtain the in-person appointment they felt they needed. This could create distrust and lead to inaccurate information on the patient record.

Our ethnographic dataset contained many examples of clinical and support staff using initiative to compensate for vulnerable patients’ inability or unwillingness to take on the additional burden of remote modalities (cases 19 and 20 in Box 2 30 31 ).

Training for remote encounters is often inadequate

Safety incidents highlighted various training needs for support staff members (eg, customer care skills, risks of making clinical judgements) and clinicians (eg, limitations of different modalities, risks of diagnostic overshadowing). Whereas out-of-hours providers gave thorough training to novice GPs (covering such things as attentiveness, rapport building, history taking, probing, attending to contextual cues and safety netting) in telephone consultations, 32–34 many in-hours clinicians had never been formally taught to consult by telephone. Case 17 illustrates how on-the-job training based on acknowledgement of contextual pressures and judicious use of rules of thumb may be very effective in averting safety incidents.

Statement of principal findings

An important overall finding from this study is that examples of deaths or serious harms associated with remote encounters in primary care were extremely rare, amounting to fewer than 100 despite an extensive search going back several years.

Analysis of these 95 safety incidents, drawn from multiple complementary sources, along with rich qualitative data from ethnography, interviews and workshops has clarified where the key risks lie in remote primary care. Remote triage and consultations expanded rapidly in the context of the COVID-19 crisis; they were occurring in the context of resource constraints, understaffing and high demand. Triage and care pathways were complex, multilayered and hard to navigate; some involved distributed work among multiple clinical and non-clinical staff. In some cases, multiple remote encounters preceded (and delayed) a needed in-person assessment.

In this high-risk context, safety incidents involving death or serious harm were rare, but those that occurred were characterised by a combination of inappropriate choice of modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate clinical pathway (eg, wrong algorithm) and failure to take account of social circumstances. These led to missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex or multiple pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues and failure to respond to previous treatment, and those who (for any reason) had difficulty communicating, seemed particularly at risk.

Strengths and limitations of the study

The main strength of this study was that it combined the largest Safety I study undertaken to date of safety incidents in remote primary care (using datasets which have not previously been tapped for research), with a large, UK-wide ethnographic Safety II analysis of general practice as well as stakeholder interviews and workshops. Limitations of the safety incident sample (see final column in table 1 ) include that it was skewed towards very rare cases of death and serious harm, with relatively few opportunities for learning that did not result in serious harm. Most sources were retrospective and may have suffered from biases in documentation and recall. We also failed to obtain examples of safeguarding incidents (which would likely turn up in social care audits). While all cases involved a remote modality (or a patient who would not or could not use one), it is impossible to definitively attribute the harm to that modality.

Comparison with existing literature

This study has affirmed previous findings that processes, workflows and training in in-hours general practice have not adapted adequately to the booking, delivery and follow-up of remote consultations. 24 35 36 Safety issues can arise, for example, from how the remote consultation interfaces with other key practice routines (eg, for making urgent referrals for possible cancer). The sheer complexity and fragmentation of much remote and digital work underscores the findings from a systematic review of the importance of relational coordination (defined as ‘a mutually reinforcing process of communicating and relating for the purpose of task integration ’ (p 3) 37 ) and psychological safety (defined as ‘people’s perceptions of the consequences of taking interpersonal risks in a particular context such as a workplace ’ (p 23) 38 ) in building organisational resilience and assuring safety.

The additional workload and complexity associated with running remote appointments alongside in-person ones is cognitively demanding for staff and requires additional skills for which not all are adequately trained. 24 39 40 We have written separately about the loss of traditional continuity of care as primary care services become digitised, 41–43 and about the unmet training needs of both clinical and support staff for managing remote and digital encounters. 24

Our findings also resonate with research showing that remote modalities can interfere with communicative tasks such as rapport building, establishing a therapeutic relationship and identifying non-verbal cues such as tearfulness 35 36 44 ; that remote consultations tend to be shorter and feature less discussion, information gathering and safety netting 45–48 ; and that clinical assessment in remote encounters may be challenging, 27 49 50 especially when physical examination is needed. 35 36 51 These factors may rarely contribute to incorrect or delayed diagnoses, underestimation of the seriousness or urgency of a case, and failure to identify a deteriorating trajectory. 35 36 52–54

Even when systems seem adequate, patients may struggle to navigate them. 23 30 31 This finding aligns with an important recent review of cognitive load theory in the context of remote and digital health services: because such services are more cognitively demanding for patients, they may widen inequities of access. 55 Some patients lack navigating and negotiating skills, access to key technologies 13 36 or confidence in using them. 30 35 The remote encounter may require the patient to have a sophisticated understanding of access and cross-referral pathways, interpret their own symptoms (including making judgements about severity and urgency), obtain and use self-monitoring technologies (such as a blood pressure machine or oximeter) and convey these data in medically meaningful ways (eg, by completing algorithmic triage forms or via a telephone conversation). 30 56 Furthermore, the remote environment may afford fewer opportunities for holistically evaluating, supporting or safeguarding the vulnerable patient, leading to widening inequities. 13 35 57 Previous work has also shown that patients with pre-existing illness, complex comorbidities or high-risk states, 58 59 language non-concordance, 13 35 inability to describe their symptoms (eg, due to autism 60 ), extremes of age 61 and those with low health or system literacy 30 are more difficult to assess remotely.

Lessons for safer care

Many of the contributory factors to safety incidents in remote encounters have been suggested previously, 35 36 and align broadly with factors that explain safety incidents more generally. 53 62 63 This new study has systematically traced how upstream factors may, very rarely, combine to contribute to avoidable human tragedies—and also how primary care teams develop local safety practices and cultures to help avoid them. Our study provides some important messages for practices and policymakers.

First, remote encounters in general practice are mostly occurring in a system designed for in-person encounters, so processes and workflows may work less well.

Second, because the remote encounter depends more on history taking and dialogue, verbal communication is even more mission critical. Working remotely under system pressures and optimising verbal communication should both be priorities for staff training.

Third, the remote environment may increase existing inequities as patients’ various vulnerabilities (eg, extremes of age, poverty, language and literacy barriers, comorbidities) make remote communication and assessment more difficult. Our study has revealed impressive efforts from staff to overcome these inequities on an individual basis; some of these workarounds may become normalised and increase efficiency, but others are labour intensive and not scalable.

A final message from this study is that clinical assessment provides less information when a physical examination (and even a basic visual overview) is not possible. Hence, the remote consultation has a higher degree of inherent uncertainty. Even when processes have been optimised (eg, using high-quality triage to allocate modality), but especially when they have not, diagnoses and assessments of severity or urgency should be treated as more provisional and revisited accordingly. We have given examples in the Results section of how local adaptation and rule breaking bring flexibility into the system and may become normalised over time, leading to the creation of locally understood ‘rules of thumb’ which increase safety.

Overall, these findings underscore the need to share learning and develop guidance about the drivers of risk, how these play out in different kinds of remote encounters and how to develop and strengthen Safety II approaches to mitigate those risks. Table 2 shows proposed mitigations at staff, process and system levels, as well as a preliminary list of suggestions for patients, which could be refined with patient input using codesign methods. 64

Reducing safety incidents in remote primary care

Unanswered questions and future research

This study has helped explain where the key risks lie in remote primary care encounters, which in our dataset were almost all by telephone. It has revealed examples of how front-line staff create and maintain a safety culture, thereby helping to prevent such incidents. We suggest four key avenues for further research. First, additional ethnographic studies in general practice might extend these findings and focus on specific subquestions (eg, how practices identify, capture and learn from near-miss incidents). Second, ethnographic studies of out-of-hours services, which are mostly telephone by default, may reveal additional elements of safety culture from which in-hours general practice could learn. Third, the rise in asynchronous e-consultations (in which patients complete an online template and receive a response by email) raises questions about the safety of this new modality which could be explored in mixed-methods studies including quantitative analysis of what kinds of conditions these consultations cover and qualitative analysis of the content and dynamics of the interaction. Finally, our findings suggest that the safety of new clinically related ‘assistant’ roles in general practice should be urgently evaluated, especially when such staff are undertaking remote assessment or remote triage.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Ethical approval was granted by the East Midlands—Leicester South Research Ethics Committee and UK Health Research Authority (September 2021, 21/EM/0170 and subsequent amendments). Access to the NHS Resolution dataset was obtained by secondment of the RP via honorary employment contract, where she worked with staff to de-identify and fictionalise relevant cases. The Remote by Default 2 study (referenced in main text) was co-designed by patients and lay people; it includes a diverse patient panel. Oversight was provided by an independent external advisory group with a lay chair and patient representation. A person with lived experience of a healthcare safety incident (NS) is a co-author on this paper and provided input to data analysis and writing up, especially the recommendations for patients in table 2 .

Acknowledgments

We thank the participating organisations for cooperating with this study and giving permission to use fictionalised safety incidents. We thank the participants in the ethnographic study (patients, practice staff, policymakers, other informants) who gave generously of their time and members of the study advisory group.

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X @dakinfrancesca, @trishgreenhalgh

Contributors RP led the Safety I analysis with support from AC. The Safety II analysis was part of a wider ethnographic study led by TG and SS, on which all other authors undertook fieldwork and contributed data. TG and RP wrote the paper, with all other authors contributing refinements. All authors checked and approved the final manuscript. RP is guarantor.

Funding Funding was from NIHR HS&DR (grant number 132807) (Remote by Default 2 study) and NIHR School for Primary Care Research (grant number 594) (ModCons study), plus an NIHR In-Practice Fellowship for RP.

Competing interests RP was National Professional Advisor, Care Quality Commission 2017–2022, where her role included investigation of safety issues.

Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

• Editorial Examining telehealth through the Institute of Medicine quality domains: unanswered questions and research agenda Timothy C Guetterman Lorraine R Buis BMJ Quality & Safety 2024; 33 552-555 Published Online First: 09 May 2024. doi: 10.1136/bmjqs-2023-016872

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