1.1 The Research Report and Its Parts

Each lesson in this course has produced a piece of a study, from the question in Lesson 2 to the first analyses in Lesson 11. A study is finished only when someone else can read what was done and what was found. This lesson teaches that writing, following the Cedar Valley team as it drafts its report.

Most empirical reports in the health sciences follow a structure called IMRaD: Introduction, Methods, Results and Discussion. Many health journals call the introduction the background, and this lesson uses that term. The background answers why the study was needed and what it asked. The methods answer what was done, with whom and how the data were analyzed. The results answer what was found, and the discussion answers what the findings mean, how far they can be trusted and what should follow. A title, an abstract and a reference list surround these four parts.

IMRaD is often drawn as an hourglass. The background starts with a broad problem and narrows to one question, the methods and results stay narrow because they describe one study, and the discussion widens again toward the literature and practice. The shape tells you where a sentence belongs: a general claim about loneliness belongs at the top of the background or the end of the discussion, and a percentage from your survey belongs in the results.

The table below gives a working word budget for a short report of about 2,000 words, such as a report to a health authority. The proportions are a starting point; a study with a complicated design will need a longer methods section, and a short report may combine some subsections.

The abstract

The abstract is a short summary of the whole report, often limited to about 250 to 300 words, and many readers will read it in place of the report. Most health journals ask for a structured abstract, with headings that follow IMRaD: background (or objective), methods, results and conclusions. Because the abstract summarizes the finished report, it is written last, and every number in it must match the results section. STROBE item 1 asks for an informative and balanced summary of what was done and what was found (von Elm et al., 2007). Systematic reviews use a separate checklist, PRISMA 2020 for Abstracts, which HSCI 241 Lesson 12 Section 1.2 describes. The example below shows the Cedar Valley abstract, written after the rest of the report and using the numbers that later sections of this lesson report.

1.2 What a Background Section Must Do

A background section is an argument that the study's question was worth asking. A background that lists facts about a topic without reaching a question leaves the reader unsure why the study exists, while one that moves step by step from a problem to a question makes the rest of the report easy to follow.

The linguist John Swales (1990) found that most research article introductions make three rhetorical moves, which he called the CARS model (Create a Research Space). The writer first establishes a territory by showing that the topic matters, then establishes a niche by showing that something about it is unknown or contested, and finally occupies the niche by stating what the present study did. The moves give you a structure to check a draft against.

A practical way to plan the moves is a funnel with four layers: the problem and why it matters, what is already known, what is not yet known (the research gap), and the question and aims. Each layer is narrower than the one above it and leads to the next.

1.3 Synthesis Rather Than Summary

The most common weakness in student background sections is the study-by-study summary, in which each sentence describes one paper and the reader is left to work out how the studies relate to the question. A synthesis organizes the literature by idea: each paragraph opens with a claim, gives the evidence from several sources and ends by connecting the claim to the study. Compare the two versions below, which use the same three sources.

A synthesis matrix makes synthesis easier to write. It is a table in which each row is a source and each column is a feature you want to compare, such as the population, the design, the main finding and how you will use the source. When the matrix is complete, you read down the columns to find the patterns that become your paragraphs. Lesson 2 described how to find three to five key papers for a question; the matrix is where you record what they say. The Cedar Valley team's matrix began as follows.

1.4 Stating the Gap and the Question

The gap is the hinge of the background, where the writer turns from what others have done to what this study does. Naming the kind of gap helps you write it precisely. A population gap means a question has been studied elsewhere but not in your group or setting. A question gap means a relationship has not been examined. A conflict gap means studies disagree. A methods gap means earlier studies used a measure or design that limits what they can show. A perspective gap means a group's experience has not been described in its own words, which is often the gap a qualitative strand fills.

A gap statement must be supported by the reading you have actually done. "No study has ever examined this" is a claim that only a systematic search could support, and systematic searching is taught in HSCI 241. Write the gap in terms you can defend, such as "We did not find a published estimate of loneliness for this region." For a regional health authority, a local gap of this kind is often the one that matters most.

The background ends with a one-sentence aim and the questions, which should match the gap and use the same wording that the methods and results use later. For a mixed-methods study, state both the quantitative and the qualitative question. Lesson 2 wrote them in PECO and SPIDER form; in the report they become full sentences.

1.5 Paraphrasing, Quoting and Citing as You Write

Most of a background section is paraphrase: a source's idea restated in your own words and sentence structure, with a citation. Direct quotations are used sparingly, usually when exact wording matters, such as a definition in a policy document. Patchwriting, which keeps a source's sentence structure and swaps a few words, is a form of plagiarism even with a citation. A safe habit is to read a passage, close it, write the idea from memory and check the result against the source.

Cite every source as you draft, because adding citations afterwards is the most common way to lose track of where an idea came from. Section 4 shows how to format citations in APA 7 style and how Zotero inserts them as you write.

2.1 What the Methods Section Is For

The methods section serves two readers. One wants to judge whether the findings can be trusted and needs to know who took part, how they were found, how each variable was measured and how the data were analyzed. The other wants to repeat or compare the study and needs enough detail to do so. Both are served by specific text that names the instrument, gives the number invited and the number who took part, states any cut-off and names the analytic approach.

Methods are written in the past tense under subheadings, which help readers find information and help you check that nothing is missing. The order below is common, although journals vary. Much of the section records decisions made earlier in this course.

2.2 Writing Each Part: The Cedar Valley Methods

The tabs below show the Cedar Valley team's draft methods. Numbers beyond the shared case description are illustrative and are used consistently through this lesson.

2.3 Reporting Guidelines

A reporting guideline is a checklist of the information that a report of a particular kind of study should contain, developed by groups of methodologists, journal editors and researchers. They grew out of repeated findings that published studies left out information readers needed. The statistician Douglas Altman (1994) argued that poor design and reporting were widespread in medical research, and he later helped to found the EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research), an international initiative that maintains a searchable library of reporting guidelines.

Authors use a guideline in two ways. While planning and collecting data, the checklist tells you what you will need to record, such as the number of people who declined or the duration of each interview. While writing, you work through the checklist item by item and note the page or section where each item is reported. Many journals ask authors to submit the completed checklist with the manuscript. A complete checklist shows that a study has been reported fully. The quality of the design is a separate judgement, which HSCI 230 teaches, and the STROBE authors state that their checklist was written to guide reporting and should be kept separate from quality assessment (Vandenbroucke et al., 2007).

STROBE for observational studies

STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) is the reporting guideline for the three main observational designs: cohort, case-control and cross-sectional studies (von Elm et al., 2007). Its checklist has 22 items arranged in the order of a report, from the title and abstract through the introduction, methods, results and discussion to funding. A companion explanation and elaboration paper gives the reasoning and an example for each item (Vandenbroucke et al., 2007). The methods items are the ones students most often miss, and the table below shows where the Cedar Valley draft reports each of them.

Because the Cedar Valley study uses linked administrative data, the team also consulted RECORD (the REporting of studies Conducted using Observational Routinely-collected health Data), an extension of STROBE that adds items about the databases used, how records were linked and how the quality of the linkage was checked (Benchimol et al., 2015). Lesson 9 described linkage error, and RECORD is where a report states how it was assessed.

COREQ and SRQR for qualitative studies

COREQ (the Consolidated Criteria for Reporting Qualitative Research) is a 32-item checklist for studies that use interviews and focus groups (Tong et al., 2007). Its items are grouped into three domains, and the accordion below lists what each domain asks for. SRQR (the Standards for Reporting Qualitative Research) is a 21-item checklist that applies to qualitative research of any design, including ethnography and document analysis (O'Brien et al., 2014). SRQR asks authors to state their qualitative approach and research paradigm, the characteristics and reflexivity of the researchers, and the techniques used to enhance trustworthiness. The two overlap a great deal; COREQ suits a report like Cedar Valley's that rests on interviews and focus groups.

Reporting a mixed-methods study

A mixed-methods report has to satisfy the reader of each strand and explain how the strands were combined. In practice, authors report the quantitative strand against STROBE, the qualitative strand against COREQ or SRQR, and the integration against GRAMMS (Good Reporting of A Mixed Methods Study), which asks for the justification for using mixed methods, the design, each strand's methods and the point at which integration occurred (O'Cathain et al., 2008). A short report often goes out without formal checklists, and working through the relevant items is still the most reliable way to find gaps in a draft.

3.1 What Goes in a Results Section

The results section reports what was found, in the order of the questions set out in the background, and leaves interpretation to the discussion. It usually opens with the flow of participants, which STROBE asks for as item 13: the Cedar Valley team writes that of 5,250 adults selected, 5,040 received an invitation and 1,600 completed the survey (31.7 percent), that 1,312 respondents (82.0 percent) consented to linkage, and that 1,303 of them were linked. It then describes the participants, reports the quantitative findings and presents the qualitative themes, and in a mixed-methods report it closes with the integrated findings.

Tables and text divide the work. A table holds the full set of numbers or themes in a form that readers can scan and check. The text tells the reader what to notice, citing the table by number and quoting only the key figures. Text that repeats every number in a table wastes words, and a table that is never mentioned in the text leaves the reader unsure why it is there. Figures are a third option for showing patterns, and HSCI 410 Lesson 6 teaches how to produce them. This section concentrates on tables, which almost every report needs.

3.2 The Anatomy of an APA Table

APA 7 style gives every table the same parts. The table number appears in bold above the table. The title appears one line below the number, in italic title case, and states what the table shows. The column headings name each column and give the sample size or units where needed, and the left-hand column, called the stub, holds the row labels. The body holds the data. Horizontal rules separate the headings from the body and close the table, and APA style uses no vertical rules. The note below the table begins with the word Note in italics and explains abbreviations, measures and anything else a reader needs to understand the table without reading the text.

3.3 Table 1: Describing the Participants

The first table in most quantitative reports describes the participants, and it is so standard that researchers simply call it the Table 1. It lets readers judge who the findings apply to and compare the groups being studied. Lesson 11 showed how to produce the numbers for a Table 1, using the Canadian Social Connection Survey; the work here is presenting such numbers well. The Cedar Valley Table 1 below, from the fictional study, describes all respondents and compares those classed as lonely with those who were not.

Several design decisions are visible in this table. Categorical variables are reported as counts with column percentages, so each column describes one group. Age, which is roughly symmetric, is summarized with a mean and standard deviation, while the number of chronic conditions, which is skewed by a few people with many conditions, is summarized with a median and interquartile range (Lesson 11 explains the choice). Binary variables such as living alone take a single row, because the other category is implied. Missing values for self-rated health are shown as their own row, so that the percentages remain honest about the denominator. The table contains no significance tests: its purpose is description, and the STROBE explanation and elaboration paper advises against significance tests in descriptive tables (Vandenbroucke et al., 2007). Measures of association and confidence intervals belong to later courses in the series.

The text that accompanies Table 1 picks out a few comparisons: "Compared with other respondents, those classed as lonely were older on average (mean age 77.1 years compared with 75.4 years), more often lived alone (54.1 percent compared with 32.8 percent) and more often rated their health as fair or poor (36.0 percent compared with 18.8 percent; Table 1)."

HSCI 410 Lesson 2 Section 3 adds the epidemiological conventions for a Table 1, including stratification by exposure and the use of standardized differences in place of p-values.

3.4 Cross-Tabulation

A cross-tabulation (or contingency table) shows how the categories of one variable are distributed across the categories of another. When one variable is the exposure and the other the outcome, the usual layout puts the exposure in the rows and reports row percentages, so that each row shows the percentage of that exposure group with the outcome. Table 2 answers the Cedar Valley PECO question descriptively.

The accompanying sentence reports the comparison with its numerators and denominators: "Among respondents classed as lonely, 28.0 percent (82 of 293) had at least one emergency department visit in the following 12 months, compared with 19.0 percent (192 of 1,010) of other respondents (Table 2)." The results section stops there. Whether the difference reflects loneliness itself, poorer health among lonely respondents or something else is a question for the discussion, and later courses teach the measures and adjusted analyses that address it.

3.5 Qualitative Results: Themes With Exemplar Quotes

Qualitative results are usually reported in text, organized by theme, with each theme described, interpreted and illustrated with quotations. A summary table helps readers see all the themes at once. A good theme name states a meaning ("Transportation decides who you see"), while a topic label ("Transportation") only names an area of the interview. An exemplar quotation is a short passage chosen because it shows the theme clearly; good practice draws quotations from several participants, keeps them brief and labels each with a participant code. In small communities, a combination of town, age and occupation can identify someone, so the Cedar Valley team reports only gender and decade of age. Some qualitative traditions discourage counting how many participants contributed to a theme, because a theme's importance does not depend on its frequency, and the team follows that convention. The quotations below are invented for this fictional study.

3.6 The Mixed-Methods Joint Display

A joint display is a table or figure that places quantitative and qualitative findings side by side so that readers can see how they relate (Guetterman et al., 2015). Each row is a domain that both strands addressed. The final column records the meta-inference, the conclusion drawn from the two strands together, and classifies the fit between them. Fetters et al. (2013) describe three kinds of fit: confirmation, when the strands agree; expansion, when one strand adds something the other could not show; and discordance, when they disagree. Discordance is a finding in its own right, and it often points to the next question.

4.1 The Discussion Section

The discussion turns the hourglass outward again. It tells the reader what the findings mean, how far they can be trusted and what should follow. Most discussions make five moves in order: they restate the main findings as answers to the study questions, compare them with earlier research, offer explanations (including alternatives), set out strengths and limitations, and close with implications and a conclusion. The discussion should introduce no new results, and every comparison with earlier work needs a citation.

4.2 Writing Limitations

Every study has limitations, and readers trust a report more when its authors describe them clearly. A useful limitation has four parts: it names the problem, explains how the problem could have affected the findings (and in which direction, if that can be judged), says what the team did to reduce it, and states what it means for interpretation. A list of generic phrases such as "the sample size was small" does none of this.

Language should match the strength of the evidence. Observational findings are written as associations, qualitative findings are written as what participants described, and recommendations are proportionate to what the study can show. The process of choosing these words is often called hedging.

4.3 APA 7 Citation and Formatting

HSCI 207 uses the style of the Publication Manual of the American Psychological Association, seventh edition, known as APA 7 (American Psychological Association, 2020). APA is an author-date style: each in-text citation gives the author's surname and the year, and points to a full entry in the reference list at the end of the paper. A parenthetical citation puts both in parentheses at the end of the clause; a narrative citation makes the author part of the sentence, with the year in parentheses.

The reference list starts on a new page under the heading References, in bold and centred. Entries are double-spaced, have a hanging indent of 0.5 inch (the first line starts at the margin and later lines are indented), and are listed alphabetically by the first author's surname. Every in-text citation has an entry, and every entry is cited. Each entry answers four questions in order: who (author), when (date), what (title) and where (source). The tabs show the pattern for the three source types you will use most. The Cedar Valley Health Authority and Cedar Valley Seniors' Network examples are fictional, and their URLs use the reserved example.org domain.

For the paper itself, APA 7 student papers use a title page (title, author, department and university, course, instructor and due date), page numbers in the top right corner, one-inch margins, double spacing and a readable font such as 12-point Times New Roman or 11-point Calibri, Arial or Georgia. Level 1 headings (for example, Methods, Results and Discussion) are centred, bold and in title case; Level 2 headings are flush left, bold and in title case; Level 3 headings are flush left, bold, italic and in title case. Tables may appear in the text after they are first mentioned or on separate pages after the references.

Disclosing AI assistance

Many journals and institutions ask authors to state whether they used generative artificial intelligence (AI) tools in preparing a report. A disclosure statement names the tool and its version, says when and for what purpose it was used, and explains how its output was checked. Editing limited to spelling and grammar generally need not be reported, although journal policies vary. Publication-ethics guidance does not allow an AI tool to be listed as an author, because a tool cannot take responsibility for the work, so the authors remain responsible for every sentence and citation. A statement for a short report can take this form: “We used [tool name and version] on [dates] to [purpose, for example suggesting shorter wording for the discussion]. We checked all output against our data and sources, revised it, and take full responsibility for the content of this report.” HSCI 241 Lesson 6 Section 3.6 gives a fuller template for evidence syntheses, and HSCI 241 Lesson 12 Section 1.5 shows where a review reports its use of AI.

4.4 Reference Management With Zotero

A reference manager stores the details of your sources, inserts citations as you write and builds the reference list in the style you choose. In a survey of students in a later course in this series, about two thirds reported that they had never used one, so this section starts from the beginning. HSCI 207 uses Zotero, which is free and open source and runs on Windows, macOS and Linux; Mendeley and EndNote work in similar ways. The steps below take about half an hour the first time.

4.5 Reviewing a Draft and Responding to Reviewers

Before a report is published or sent to its readers, other people read it critically. In peer review, an editor asks researchers in the field to judge a manuscript, and the authors revise it in response. The same two skills, reviewing a draft against stated criteria and responding to a reviewer’s comments, apply when colleagues read each other’s drafts inside a research team. HSCI 230 Lesson 1 Section 3 (Research Integrity and Reform) describes peer review as an institution and its limits.

A criterion-based review

A useful review judges the draft against stated criteria. The criteria can come from the parts of this lesson: whether the background ends with a gap and questions that match it, whether the methods report what the relevant reporting guideline asks for, whether each table can stand alone and is cited in the text, and whether the discussion uses language matched to the evidence and states specific limitations. For each criterion, the reviewer says what the draft does, locates any problem, explains why it matters to a reader and suggests a change. Comments are numbered so that the authors can answer each one, and major comments, which affect the conclusions, are separated from minor ones, such as an abbreviation missing from a table note. A reviewer comments on the work and its reporting, keeps a professional tone, and treats the manuscript as confidential.

Responding to reviewers

Authors answer every comment in a response to reviewers, usually a table or letter in which each comment is copied in full and followed by the authors’ reply and the exact change, with its location in the revised report. When the authors agree, they describe the change and quote the new text. When they disagree, they explain why with evidence and, where possible, still clarify the report so that other readers do not raise the same point. The revised report marks the changes, for example with tracked changes, so that the editor and reviewers can find them. The table below shows three comments that a member of the Cedar Valley advisory group and a colleague of Dr. Hart might make on an earlier draft of the report, with the team’s responses.

A response that answers every comment, quotes each change and gives its location lets the reviewer check the revision quickly. Replies such as “Done”, or arguments that leave the report unchanged, leave the reviewer to search the manuscript and often lead to a second round of the same comments.

Bringing It All Together

A study becomes useful when someone else can read it, judge it and act on it. This lesson followed the Cedar Valley team as it turned its data into a report. The background built an argument from the literature to a defensible local gap and two questions, using synthesis to group the evidence by idea. The methods recorded the decisions made over the course of the study with enough detail for a reader to judge and repeat them, checked against STROBE and RECORD for the linked survey strand and against COREQ or SRQR for the interviews and focus groups.

The results presented the participants in a Table 1, compared emergency department visits by loneliness status in a cross-tabulation with row percentages, summarized four themes with exemplar quotations that protect participants in small communities, and brought the strands together in a joint display that classified each pair of findings as confirmation, expansion or discordance. The discussion interpreted those findings with language matched to the evidence and described limitations by naming each problem, its likely effect, what was done and what it means. APA 7 and Zotero tie the report to its sources accurately and consistently.

The final reflection asks you to plan the main parts of a short report for a new study, drawing on all four sections of this lesson.

Final Knowledge Assessment

This glossary defines the terms, reporting guidelines, tools and people introduced in this lesson on writing up research.