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How to Discuss the Significance of Your Research

• 6-minute read
• 10th April 2023

Introduction

Research papers can be a real headache for college students . As a student, your research needs to be credible enough to support your thesis statement. You must also ensure you’ve discussed the literature review, findings, and results.

However, it’s also important to discuss the significance of your research . Your potential audience will care deeply about this. It will also help you conduct your research. By knowing the impact of your research, you’ll understand what important questions to answer.

If you’d like to know more about the impact of your research, read on! We’ll talk about why it’s important and how to discuss it in your paper.

What Is the Significance of Research?

This is the potential impact of your research on the field of study. It includes contributions from new knowledge from the research and those who would benefit from it. You should present this before conducting research, so you need to be aware of current issues associated with the thesis before discussing the significance of the research.

Why Does the Significance of Research Matter?

Potential readers need to know why your research is worth pursuing. Discussing the significance of research answers the following questions:

●  Why should people read your research paper ?

●  How will your research contribute to the current knowledge related to your topic?

●  What potential impact will it have on the community and professionals in the field?

Not including the significance of research in your paper would be like a knight trying to fight a dragon without weapons.

Where Do I Discuss the Significance of Research in My Paper?

As previously mentioned, the significance of research comes before you conduct it. Therefore, you should discuss the significance of your research in the Introduction section. Your reader should know the problem statement and hypothesis beforehand.

Steps to Discussing the Significance of Your Research

Discussing the significance of research might seem like a loaded question, so we’ve outlined some steps to help you tackle it.

Step 1: The Research Problem

The problem statement can reveal clues about the outcome of your research. Your research should provide answers to the problem, which is beneficial to all those concerned. For example, imagine the problem statement is, “To what extent do elementary and high school teachers believe cyberbullying affects student performance?”

Learning teachers’ opinions on the effects of cyberbullying on student performance could result in the following:

●  Increased public awareness of cyberbullying in elementary and high schools

●  Teachers’ perceptions of cyberbullying negatively affecting student performance

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●  Whether cyberbullying is more prevalent in elementary or high schools

The research problem will steer your research in the right direction, so it’s best to start with the problem statement.

Step 2: Existing Literature in the Field

Think about current information on your topic, and then find out what information is missing. Are there any areas that haven’t been explored? Your research should add new information to the literature, so be sure to state this in your discussion. You’ll need to know the current literature on your topic anyway, as this is part of your literature review section .

Step 3: Your Research’s Impact on Society

Inform your readers about the impact on society your research could have on it. For example, in the study about teachers’ opinions on cyberbullying, you could mention that your research will educate the community about teachers’ perceptions of cyberbullying as it affects student performance. As a result, the community will know how many teachers believe cyberbullying affects student performance.

You can also mention specific individuals and institutions that would benefit from your study. In the example of cyberbullying, you might indicate that school principals and superintendents would benefit from your research.

Step 4: Future Studies in the Field

Next, discuss how the significance of your research will benefit future studies, which is especially helpful for future researchers in your field. In the example of cyberbullying affecting student performance, your research could provide further opportunities to assess teacher perceptions of cyberbullying and its effects on students from larger populations. This prepares future researchers for data collection and analysis.

Discussing the significance of your research may sound daunting when you haven’t conducted it yet. However, an audience might not read your paper if they don’t know the significance of the research. By focusing on the problem statement and the research benefits to society and future studies, you can convince your audience of the value of your research.

Remember that everything you write doesn’t have to be set in stone. You can go back and tweak the significance of your research after conducting it. At first, you might only include general contributions of your study, but as you research, your contributions will become more specific.

You should have a solid understanding of your topic in general, its associated problems, and the literature review before tackling the significance of your research. However, you’re not trying to prove your thesis statement at this point. The significance of research just convinces the audience that your study is worth reading.

Finally, we always recommend seeking help from your research advisor whenever you’re struggling with ideas. For a more visual idea of how to discuss the significance of your research, we suggest checking out this video .

1. Do I need to do my research before discussing its significance?

No, you’re discussing the significance of your research before you conduct it. However, you should be knowledgeable about your topic and the related literature.

2. Is the significance of research the same as its implications?

No, the research implications are potential questions from your study that justify further exploration, which comes after conducting the research.

 3. Discussing the significance of research seems overwhelming. Where should I start?

We recommend the problem statement as a starting point, which reveals clues to the potential outcome of your research.

4. How can I get feedback on my discussion of the significance of my research?

Our proofreading experts can help. They’ll check your writing for grammar, punctuation errors, spelling, and concision. Submit a 500-word document for free today!

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The Savvy Scientist

Experiences of a London PhD student and beyond

What is the Significance of a Study? Examples and Guide

If you’re reading this post you’re probably wondering: what is the significance of a study?

No matter where you’re at with a piece of research, it is a good idea to think about the potential significance of your work. And sometimes you’ll have to explicitly write a statement of significance in your papers, it addition to it forming part of your thesis.

In this post I’ll cover what the significance of a study is, how to measure it, how to describe it with examples and add in some of my own experiences having now worked in research for over nine years.

If you’re reading this because you’re writing up your first paper, welcome! You may also like my how-to guide for all aspects of writing your first research paper .

Looking for guidance on writing the statement of significance for a paper or thesis? Click here to skip straight to that section.

What is the Significance of a Study?

For research papers, theses or dissertations it’s common to explicitly write a section describing the significance of the study. We’ll come onto what to include in that section in just a moment.

However the significance of a study can actually refer to several different things.

Working our way from the most technical to the broadest, depending on the context, the significance of a study may refer to:

• Within your study: Statistical significance. Can we trust the findings?
• Wider research field: Research significance. How does your study progress the field?
• Commercial / economic significance: Could there be business opportunities for your findings?
• Societal significance: What impact could your study have on the wider society.
• And probably other domain-specific significance!

We’ll shortly cover each of them in turn, including how they’re measured and some examples for each type of study significance.

But first, let’s touch on why you should consider the significance of your research at an early stage.

Why Care About the Significance of a Study?

No matter what is motivating you to carry out your research, it is sensible to think about the potential significance of your work. In the broadest sense this asks, how does the study contribute to the world?

After all, for many people research is only worth doing if it will result in some expected significance. For the vast majority of us our studies won’t be significant enough to reach the evening news, but most studies will help to enhance knowledge in a particular field and when research has at least some significance it makes for a far more fulfilling longterm pursuit.

Furthermore, a lot of us are carrying out research funded by the public. It therefore makes sense to keep an eye on what benefits the work could bring to the wider community.

Often in research you’ll come to a crossroads where you must decide which path of research to pursue. Thinking about the potential benefits of a strand of research can be useful for deciding how to spend your time, money and resources.

It’s worth noting though, that not all research activities have to work towards obvious significance. This is especially true while you’re a PhD student, where you’re figuring out what you enjoy and may simply be looking for an opportunity to learn a new skill.

However, if you’re trying to decide between two potential projects, it can be useful to weigh up the potential significance of each.

Let’s now dive into the different types of significance, starting with research significance.

Research Significance

What is the research significance of a study.

Unless someone specifies which type of significance they’re referring to, it is fair to assume that they want to know about the research significance of your study.

Research significance describes how your work has contributed to the field, how it could inform future studies and progress research.

Where should I write about my study’s significance in my thesis?

Typically you should write about your study’s significance in the Introduction and Conclusions sections of your thesis.

It’s important to mention it in the Introduction so that the relevance of your work and the potential impact and benefits it could have on the field are immediately apparent. Explaining why your work matters will help to engage readers (and examiners!) early on.

It’s also a good idea to detail the study’s significance in your Conclusions section. This adds weight to your findings and helps explain what your study contributes to the field.

On occasion you may also choose to include a brief description in your Abstract.

What is expected when submitting an article to a journal

It is common for journals to request a statement of significance, although this can sometimes be called other things such as:

• Impact statement
• Significance statement
• Advances in knowledge section

Here is one such example of what is expected:

Impact Statement:  An Impact Statement is required for all submissions.  Your impact statement will be evaluated by the Editor-in-Chief, Global Editors, and appropriate Associate Editor. For your manuscript to receive full review, the editors must be convinced that it is an important advance in for the field. The Impact Statement is not a restating of the abstract. It should address the following: Why is the work submitted important to the field? How does the work submitted advance the field? What new information does this work impart to the field? How does this new information impact the field? Experimental Biology and Medicine journal, author guidelines

Typically the impact statement will be shorter than the Abstract, around 150 words.

Defining the study’s significance is helpful not just for the impact statement (if the journal asks for one) but also for building a more compelling argument throughout your submission. For instance, usually you’ll start the Discussion section of a paper by highlighting the research significance of your work. You’ll also include a short description in your Abstract too.

How to describe the research significance of a study, with examples

Whether you’re writing a thesis or a journal article, the approach to writing about the significance of a study are broadly the same.

I’d therefore suggest using the questions above as a starting point to base your statements on.

• Why is the work submitted important to the field?
• How does the work submitted advance the field?
• What new information does this work impart to the field?
• How does this new information impact the field?

Answer those questions and you’ll have a much clearer idea of the research significance of your work.

When describing it, try to clearly state what is novel about your study’s contribution to the literature. Then go on to discuss what impact it could have on progressing the field along with recommendations for future work.

Potential sentence starters

If you’re not sure where to start, why not set a 10 minute timer and have a go at trying to finish a few of the following sentences. Not sure on what to put? Have a chat to your supervisor or lab mates and they may be able to suggest some ideas.

• This study is important to the field because…
• These findings advance the field by…
• Our results highlight the importance of…
• Our discoveries impact the field by…

Now you’ve had a go let’s have a look at some real life examples.

Statement of significance examples

A statement of significance / impact:

Impact Statement This review highlights the historical development of the concept of “ideal protein” that began in the 1950s and 1980s for poultry and swine diets, respectively, and the major conceptual deficiencies of the long-standing concept of “ideal protein” in animal nutrition based on recent advances in amino acid (AA) metabolism and functions. Nutritionists should move beyond the “ideal protein” concept to consider optimum ratios and amounts of all proteinogenic AAs in animal foods and, in the case of carnivores, also taurine. This will help formulate effective low-protein diets for livestock, poultry, and fish, while sustaining global animal production. Because they are not only species of agricultural importance, but also useful models to study the biology and diseases of humans as well as companion (e.g. dogs and cats), zoo, and extinct animals in the world, our work applies to a more general readership than the nutritionists and producers of farm animals. Wu G, Li P. The “ideal protein” concept is not ideal in animal nutrition.  Experimental Biology and Medicine . 2022;247(13):1191-1201. doi: 10.1177/15353702221082658

And the same type of section but this time called “Advances in knowledge”:

Advances in knowledge: According to the MY-RADs criteria, size measurements of focal lesions in MRI are now of relevance for response assessment in patients with monoclonal plasma cell disorders. Size changes of 1 or 2 mm are frequently observed due to uncertainty of the measurement only, while the actual focal lesion has not undergone any biological change. Size changes of at least 6 mm or more in  T 1  weighted or  T 2  weighted short tau inversion recovery sequences occur in only 5% or less of cases when the focal lesion has not undergone any biological change. Wennmann M, Grözinger M, Weru V, et al. Test-retest, inter- and intra-rater reproducibility of size measurements of focal bone marrow lesions in MRI in patients with multiple myeloma [published online ahead of print, 2023 Apr 12].  Br J Radiol . 2023;20220745. doi: 10.1259/bjr.20220745

Other examples of research significance

Moving beyond the formal statement of significance, here is how you can describe research significance more broadly within your paper.

Describing research impact in an Abstract of a paper:

Three-dimensional visualisation and quantification of the chondrocyte population within articular cartilage can be achieved across a field of view of several millimetres using laboratory-based micro-CT. The ability to map chondrocytes in 3D opens possibilities for research in fields from skeletal development through to medical device design and treatment of cartilage degeneration. Conclusions section of the abstract in my first paper .

In the Discussion section of a paper:

We report for the utility of a standard laboratory micro-CT scanner to visualise and quantify features of the chondrocyte population within intact articular cartilage in 3D. This study represents a complimentary addition to the growing body of evidence supporting the non-destructive imaging of the constituents of articular cartilage. This offers researchers the opportunity to image chondrocyte distributions in 3D without specialised synchrotron equipment, enabling investigations such as chondrocyte morphology across grades of cartilage damage, 3D strain mapping techniques such as digital volume correlation to evaluate mechanical properties  in situ , and models for 3D finite element analysis  in silico  simulations. This enables an objective quantification of chondrocyte distribution and morphology in three dimensions allowing greater insight for investigations into studies of cartilage development, degeneration and repair. One such application of our method, is as a means to provide a 3D pattern in the cartilage which, when combined with digital volume correlation, could determine 3D strain gradient measurements enabling potential treatment and repair of cartilage degeneration. Moreover, the method proposed here will allow evaluation of cartilage implanted with tissue engineered scaffolds designed to promote chondral repair, providing valuable insight into the induced regenerative process. The Discussion section of the paper is laced with references to research significance.

How is longer term research significance measured?

Looking beyond writing impact statements within papers, sometimes you’ll want to quantify the long term research significance of your work. For instance when applying for jobs.

The most obvious measure of a study’s long term research significance is the number of citations it receives from future publications. The thinking is that a study which receives more citations will have had more research impact, and therefore significance , than a study which received less citations. Citations can give a broad indication of how useful the work is to other researchers but citations aren’t really a good measure of significance.

Bear in mind that us researchers can be lazy folks and sometimes are simply looking to cite the first paper which backs up one of our claims. You can find studies which receive a lot of citations simply for packaging up the obvious in a form which can be easily found and referenced, for instance by having a catchy or optimised title.

Likewise, research activity varies wildly between fields. Therefore a certain study may have had a big impact on a particular field but receive a modest number of citations, simply because not many other researchers are working in the field.

Nevertheless, citations are a standard measure of significance and for better or worse it remains impressive for someone to be the first author of a publication receiving lots of citations.

Other measures for the research significance of a study include:

• Accolades: best paper awards at conferences, thesis awards, “most downloaded” titles for articles, press coverage.
• How much follow-on research the study creates. For instance, part of my PhD involved a novel material initially developed by another PhD student in the lab. That PhD student’s research had unlocked lots of potential new studies and now lots of people in the group were using the same material and developing it for different applications. The initial study may not receive a high number of citations yet long term it generated a lot of research activity.

That covers research significance, but you’ll often want to consider other types of significance for your study and we’ll cover those next.

Statistical Significance

What is the statistical significance of a study.

Often as part of a study you’ll carry out statistical tests and then state the statistical significance of your findings: think p-values eg <0.05. It is useful to describe the outcome of these tests within your report or paper, to give a measure of statistical significance.

Effectively you are trying to show whether the performance of your innovation is actually better than a control or baseline and not just chance. Statistical significance deserves a whole other post so I won’t go into a huge amount of depth here.

Things that make publication in  The BMJ  impossible or unlikely Internal validity/robustness of the study • It had insufficient statistical power, making interpretation difficult; • Lack of statistical power; The British Medical Journal’s guide for authors

Calculating statistical significance isn’t always necessary (or valid) for a study, such as if you have a very small number of samples, but it is a very common requirement for scientific articles.

Writing a journal article? Check the journal’s guide for authors to see what they expect. Generally if you have approximately five or more samples or replicates it makes sense to start thinking about statistical tests. Speak to your supervisor and lab mates for advice, and look at other published articles in your field.

How is statistical significance measured?

Statistical significance is quantified using p-values . Depending on your study design you’ll choose different statistical tests to compute the p-value.

A p-value of 0.05 is a common threshold value. The 0.05 means that there is a 1/20 chance that the difference in performance you’re reporting is just down to random chance.

• p-values above 0.05 mean that the result isn’t statistically significant enough to be trusted: it is too likely that the effect you’re showing is just luck.
• p-values less than or equal to 0.05 mean that the result is statistically significant. In other words: unlikely to just be chance, which is usually considered a good outcome.

Low p-values (eg p = 0.001) mean that it is highly unlikely to be random chance (1/1000 in the case of p = 0.001), therefore more statistically significant.

It is important to clarify that, although low p-values mean that your findings are statistically significant, it doesn’t automatically mean that the result is scientifically important. More on that in the next section on research significance.

How to describe the statistical significance of your study, with examples

In the first paper from my PhD I ran some statistical tests to see if different staining techniques (basically dyes) increased how well you could see cells in cow tissue using micro-CT scanning (a 3D imaging technique).

In your methods section you should mention the statistical tests you conducted and then in the results you will have statements such as:

Between mediums for the two scan protocols C/N [contrast to noise ratio] was greater for EtOH than the PBS in both scanning methods (both  p  < 0.0001) with mean differences of 1.243 (95% CI [confidence interval] 0.709 to 1.778) for absorption contrast and 6.231 (95% CI 5.772 to 6.690) for propagation contrast. … Two repeat propagation scans were taken of samples from the PTA-stained groups. No difference in mean C/N was found with either medium: PBS had a mean difference of 0.058 ( p  = 0.852, 95% CI -0.560 to 0.676), EtOH had a mean difference of 1.183 ( p  = 0.112, 95% CI 0.281 to 2.648). From the Results section of my first paper, available here . Square brackets added for this post to aid clarity.

From this text the reader can infer from the first paragraph that there was a statistically significant difference in using EtOH compared to PBS (really small p-value of <0.0001). However, from the second paragraph, the difference between two repeat scans was statistically insignificant for both PBS (p = 0.852) and EtOH (p = 0.112).

By conducting these statistical tests you have then earned your right to make bold statements, such as these from the discussion section:

Propagation phase-contrast increases the contrast of individual chondrocytes [cartilage cells] compared to using absorption contrast. From the Discussion section from the same paper.

Without statistical tests you have no evidence that your results are not just down to random chance.

Beyond describing the statistical significance of a study in the main body text of your work, you can also show it in your figures.

In figures such as bar charts you’ll often see asterisks to represent statistical significance, and “n.s.” to show differences between groups which are not statistically significant. Here is one such figure, with some subplots, from the same paper:

In this example an asterisk (*) between two bars represents p < 0.05. Two asterisks (**) represents p < 0.001 and three asterisks (***) represents p < 0.0001. This should always be stated in the caption of your figure since the values that each asterisk refers to can vary.

Now that we know if a study is showing statistically and research significance, let’s zoom out a little and consider the potential for commercial significance.

Commercial and Industrial Significance

What are commercial and industrial significance.

Moving beyond significance in relation to academia, your research may also have commercial or economic significance.

Simply put:

• Commercial significance: could the research be commercialised as a product or service? Perhaps the underlying technology described in your study could be licensed to a company or you could even start your own business using it.
• Industrial significance: more widely than just providing a product which could be sold, does your research provide insights which may affect a whole industry? Such as: revealing insights or issues with current practices, performance gains you don’t want to commercialise (e.g. solar power efficiency), providing suggested frameworks or improvements which could be employed industry-wide.

I’ve grouped these two together because there can certainly be overlap. For instance, perhaps your new technology could be commercialised whilst providing wider improvements for the whole industry.

Commercial and industrial significance are not relevant to most studies, so only write about it if you and your supervisor can think of reasonable routes to your work having an impact in these ways.

How are commercial and industrial significance measured?

Unlike statistical and research significances, the measures of commercial and industrial significance can be much more broad.

Here are some potential measures of significance:

Commercial significance:

• How much value does your technology bring to potential customers or users?
• How big is the potential market and how much revenue could the product potentially generate?
• Is the intellectual property protectable? i.e. patentable, or if not could the novelty be protected with trade secrets: if so publish your method with caution!
• If commercialised, could the product bring employment to a geographical area?

Industrial significance:

What impact could it have on the industry? For instance if you’re revealing an issue with something, such as unintended negative consequences of a drug , what does that mean for the industry and the public? This could be:

• Reduced overhead costs
• Better safety
• Faster production methods
• Improved scaleability

How to describe the commercial and industrial significance of a study, with examples

Commercial significance.

If your technology could be commercially viable, and you’ve got an interest in commercialising it yourself, it is likely that you and your university may not want to immediately publish the study in a journal.

You’ll probably want to consider routes to exploiting the technology and your university may have a “technology transfer” team to help researchers navigate the various options.

However, if instead of publishing a paper you’re submitting a thesis or dissertation then it can be useful to highlight the commercial significance of your work. In this instance you could include statements of commercial significance such as:

The measurement technology described in this study provides state of the art performance and could enable the development of low cost devices for aerospace applications. An example of commercial significance I invented for this post

Industrial significance

First, think about the industrial sectors who could benefit from the developments described in your study.

For example if you’re working to improve battery efficiency it is easy to think of how it could lead to performance gains for certain industries, like personal electronics or electric vehicles. In these instances you can describe the industrial significance relatively easily, based off your findings.

For example:

By utilising abundant materials in the described battery fabrication process we provide a framework for battery manufacturers to reduce dependence on rare earth components. Again, an invented example

For other technologies there may well be industrial applications but they are less immediately obvious and applicable. In these scenarios the best you can do is to simply reframe your research significance statement in terms of potential commercial applications in a broad way.

As a reminder: not all studies should address industrial significance, so don’t try to invent applications just for the sake of it!

Societal Significance

What is the societal significance of a study.

The most broad category of significance is the societal impact which could stem from it.

If you’re working in an applied field it may be quite easy to see a route for your research to impact society. For others, the route to societal significance may be less immediate or clear.

Studies can help with big issues facing society such as:

• Medical applications : vaccines, surgical implants, drugs, improving patient safety. For instance this medical device and drug combination I worked on which has a very direct route to societal significance.
• Political significance : Your research may provide insights which could contribute towards potential changes in policy or better understanding of issues facing society.
• Public health : for instance COVID-19 transmission and related decisions.
• Climate change : mitigation such as more efficient solar panels and lower cost battery solutions, and studying required adaptation efforts and technologies. Also, better understanding around related societal issues, for instance this study on the effects of temperature on hate speech.

How is societal significance measured?

Societal significance at a high level can be quantified by the size of its potential societal effect. Just like a lab risk assessment, you can think of it in terms of probability (or how many people it could help) and impact magnitude.

Societal impact = How many people it could help x the magnitude of the impact

Think about how widely applicable the findings are: for instance does it affect only certain people? Then think about the potential size of the impact: what kind of difference could it make to those people?

Between these two metrics you can get a pretty good overview of the potential societal significance of your research study.

How to describe the societal significance of a study, with examples

Quite often the broad societal significance of your study is what you’re setting the scene for in your Introduction. In addition to describing the existing literature, it is common to for the study’s motivation to touch on its wider impact for society.

For those of us working in healthcare research it is usually pretty easy to see a path towards societal significance.

Our CLOUT model has state-of-the-art performance in mortality prediction, surpassing other competitive NN models and a logistic regression model … Our results show that the risk factors identified by the CLOUT model agree with physicians’ assessment, suggesting that CLOUT could be used in real-world clinicalsettings. Our results strongly support that CLOUT may be a useful tool to generate clinical prediction models, especially among hospitalized and critically ill patient populations. Learning Latent Space Representations to Predict Patient Outcomes: Model Development and Validation

In other domains the societal significance may either take longer or be more indirect, meaning that it can be more difficult to describe the societal impact.

Even so, here are some examples I’ve found from studies in non-healthcare domains:

We examined food waste as an initial investigation and test of this methodology, and there is clear potential for the examination of not only other policy texts related to food waste (e.g., liability protection, tax incentives, etc.; Broad Leib et al., 2020) but related to sustainable fishing (Worm et al., 2006) and energy use (Hawken, 2017). These other areas are of obvious relevance to climate change… AI-Based Text Analysis for Evaluating Food Waste Policies

The continued development of state-of-the art NLP tools tailored to climate policy will allow climate researchers and policy makers to extract meaningful information from this growing body of text, to monitor trends over time and administrative units, and to identify potential policy improvements. BERT Classification of Paris Agreement Climate Action Plans

Top Tips For Identifying & Writing About the Significance of Your Study

• Writing a thesis? Describe the significance of your study in the Introduction and the Conclusion .
• Submitting a paper? Read the journal’s guidelines. If you’re writing a statement of significance for a journal, make sure you read any guidance they give for what they’re expecting.
• Take a step back from your research and consider your study’s main contributions.
• Read previously published studies in your field . Use this for inspiration and ideas on how to describe the significance of your own study
• Discuss the study with your supervisor and potential co-authors or collaborators and brainstorm potential types of significance for it.

Now you’ve finished reading up on the significance of a study you may also like my how-to guide for all aspects of writing your first research paper .

Writing an academic journal paper

I hope that you’ve learned something useful from this article about the significance of a study. If you have any more research-related questions let me know, I’m here to help.

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How To Write a Significance Statement for Your Research

A significance statement is an essential part of a research paper. It explains the importance and relevance of the study to the academic community and the world at large. To write a compelling significance statement, identify the research problem, explain why it is significant, provide evidence of its importance, and highlight its potential impact on future research, policy, or practice. A well-crafted significance statement should effectively communicate the value of the research to readers and help them understand why it matters.

Updated on May 4, 2023

A significance statement is a clearly stated, non-technical paragraph that explains why your research matters. It’s central in making the public aware of and gaining support for your research.

Write it in jargon-free language that a reader from any field can understand. Well-crafted, easily readable significance statements can improve your chances for citation and impact and make it easier for readers outside your field to find and understand your work.

Read on for more details on what a significance statement is, how it can enhance the impact of your research, and, of course, how to write one.

What is a significance statement in research?

A significance statement answers the question: How will your research advance scientific knowledge and impact society at large (as well as specific populations)? 

You might also see it called a “Significance of the study” statement. Some professional organizations in the STEM sciences and social sciences now recommended that journals in their disciplines make such statements a standard feature of each published article. Funding agencies also consider “significance” a key criterion for their awards.

Read some examples of significance statements from the Proceedings of the National Academy of Sciences (PNAS) here .

Depending upon the specific journal or funding agency’s requirements, your statement may be around 100 words and answer these questions:

1. What’s the purpose of this research?

2. What are its key findings?

3. Why do they matter?

4. Who benefits from the research results?

Readers will want to know: “What is interesting or important about this research?” Keep asking yourself that question.

Where to place the significance statement in your manuscript

Most journals ask you to place the significance statement before or after the abstract, so check with each journal’s guide. 

This article is focused on the formal significance statement, even though you’ll naturally highlight your project’s significance elsewhere in your manuscript. (In the introduction, you’ll set out your research aims, and in the conclusion, you’ll explain the potential applications of your research and recommend areas for future research. You’re building an overall case for the value of your work.)

Developing the significance statement

The main steps in planning and developing your statement are to assess the gaps to which your study contributes, and then define your work’s implications and impact.

Identify what gaps your study fills and what it contributes

Your literature review was a big part of how you planned your study. To develop your research aims and objectives, you identified gaps or unanswered questions in the preceding research and designed your study to address them.

Go back to that lit review and look at those gaps again. Review your research proposal to refresh your memory. Ask:

• How have my research findings advanced knowledge or provided notable new insights?
• How has my research helped to prove (or disprove) a hypothesis or answer a research question?
• Why are those results important?

Consider your study’s potential impact at two levels: 

• What contribution does my research make to my field?
• How does it specifically contribute to knowledge; that is, who will benefit the most from it?

Define the implications and potential impact

As you make notes, keep the reasons in mind for why you are writing this statement. Whom will it impact, and why?

The first audience for your significance statement will be journal reviewers when you submit your article for publishing. Many journals require one for manuscript submissions. Study the author’s guide of your desired journal to see its criteria ( here’s an example ). Peer reviewers who can clearly understand the value of your research will be more likely to recommend publication. 

Second, when you apply for funding, your significance statement will help justify why your research deserves a grant from a funding agency . The U.S. National Institutes of Health (NIH), for example, wants to see that a project will “exert a sustained, powerful influence on the research field(s) involved.” Clear, simple language is always valuable because not all reviewers will be specialists in your field.

Third, this concise statement about your study’s importance can affect how potential readers engage with your work. Science journalists and interested readers can promote and spread your work, enhancing your reputation and influence. Help them understand your work.

You’re now ready to express the importance of your research clearly and concisely. Time to start writing.

How to write a significance statement: Key elements 

When drafting your statement, focus on both the content and writing style.

• In terms of content, emphasize the importance, timeliness, and relevance of your research results. 
• Write the statement in plain, clear language rather than scientific or technical jargon. Your audience will include not just your fellow scientists but also non-specialists like journalists, funding reviewers, and members of the public. 

Follow the process we outline below to build a solid, well-crafted, and informative statement. 

Get started

Some suggested opening lines to help you get started might be:

• The implications of this study are… 
• Building upon previous contributions, our study moves the field forward because…
• Our study furthers previous understanding about…

Alternatively, you may start with a statement about the phenomenon you’re studying, leading to the problem statement.

Include these components

Next, draft some sentences that include the following elements. A good example, which we’ll use here, is a significance statement by Rogers et al. (2022) published in the Journal of Climate .

1. Briefly situate your research study in its larger context . Start by introducing the topic, leading to a problem statement. Here’s an example:

‘Heatwaves pose a major threat to human health, ecosystems, and human systems.”

2. State the research problem.

“Simultaneous heatwaves affecting multiple regions can exacerbate such threats. For example, multiple food-producing regions simultaneously undergoing heat-related crop damage could drive global food shortages.”

3. Tell what your study does to address it.

“We assess recent changes in the occurrence of simultaneous large heatwaves.”

4. Provide brief but powerful evidence to support the claims your statement is making , Use quantifiable terms rather than vague ones (e.g., instead of “This phenomenon is happening now more than ever,” see below how Rogers et al. (2022) explained it). This evidence intensifies and illustrates the problem more vividly:

“Such simultaneous heatwaves are 7 times more likely now than 40 years ago. They are also hotter and affect a larger area. Their increasing occurrence is mainly driven by warming baseline temperatures due to global heating, but changes in weather patterns contribute to disproportionate increases over parts of Europe, the eastern United States, and Asia.

5. Relate your study’s impact to the broader context , starting with its general significance to society—then, when possible, move to the particular as you name specific applications of your research findings. (Our example lacks this second level of application.) 

“Better understanding the drivers of weather pattern changes is therefore important for understanding future concurrent heatwave characteristics and their impacts.”

Refine your English

Don’t understate or overstate your findings – just make clear what your study contributes. When you have all the elements in place, review your draft to simplify and polish your language. Even better, get an expert AJE edit . Be sure to use “plain” language rather than academic jargon.

• Avoid acronyms, scientific jargon, and technical terms 
• Use active verbs in your sentence structure rather than passive voice (e.g., instead of “It was found that...”, use “We found...”)
• Make sentence structures short, easy to understand – readable
• Try to address only one idea in each sentence and keep sentences within 25 words (15 words is even better)
• Eliminate nonessential words and phrases (“fluff” and wordiness)

Enhance your significance statement’s impact

Always take time to review your draft multiple times. Make sure that you:

• Keep your language focused
• Provide evidence to support your claims
• Relate the significance to the broader research context in your field

After revising your significance statement, request feedback from a reading mentor about how to make it even clearer. If you’re not a native English speaker, seek help from a native-English-speaking colleague or use an editing service like AJE to make sure your work is at a native level.

Understanding the significance of your study

Your readers may have much less interest than you do in the specific details of your research methods and measures. Many readers will scan your article to learn how your findings might apply to them and their own research. 

Different types of significance

Your findings may have different types of significance, relevant to different populations or fields of study for different reasons. You can emphasize your work’s statistical, clinical, or practical significance. Editors or reviewers in the social sciences might also evaluate your work’s social or political significance.

Statistical significance means that the results are unlikely to have occurred randomly. Instead, it implies a true cause-and-effect relationship.

Clinical significance means that your findings are applicable for treating patients and improving quality of life.

Practical significance is when your research outcomes are meaningful to society at large, in the “real world.” Practical significance is usually measured by the study’s  effect size . Similarly, evaluators may attribute social or political significance to research that addresses “real and immediate” social problems.

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What is the Significance of the Study?

• By DiscoverPhDs
• August 25, 2020

• what the significance of the study means,
• why it’s important to include in your research work,
• where you would include it in your paper, thesis or dissertation,
• how you write one
• and finally an example of a well written section about the significance of the study.

What does Significance of the Study mean?

The significance of the study is a written statement that explains why your research was needed. It’s a justification of the importance of your work and impact it has on your research field, it’s contribution to new knowledge and how others will benefit from it.

Why is the Significance of the Study important?

The significance of the study, also known as the rationale of the study, is important to convey to the reader why the research work was important. This may be an academic reviewer assessing your manuscript under peer-review, an examiner reading your PhD thesis, a funder reading your grant application or another research group reading your published journal paper. Your academic writing should make clear to the reader what the significance of the research that you performed was, the contribution you made and the benefits of it.

How do you write the Significance of the Study?

When writing this section, first think about where the gaps in knowledge are in your research field. What are the areas that are poorly understood with little or no previously published literature? Or what topics have others previously published on that still require further work. This is often referred to as the problem statement.

The introduction section within the significance of the study should include you writing the problem statement and explaining to the reader where the gap in literature is.

Then think about the significance of your research and thesis study from two perspectives: (1) what is the general contribution of your research on your field and (2) what specific contribution have you made to the knowledge and who does this benefit the most.

For example, the gap in knowledge may be that the benefits of dumbbell exercises for patients recovering from a broken arm are not fully understood. You may have performed a study investigating the impact of dumbbell training in patients with fractures versus those that did not perform dumbbell exercises and shown there to be a benefit in their use. The broad significance of the study would be the improvement in the understanding of effective physiotherapy methods. Your specific contribution has been to show a significant improvement in the rate of recovery in patients with broken arms when performing certain dumbbell exercise routines.

This statement should be no more than 500 words in length when written for a thesis. Within a research paper, the statement should be shorter and around 200 words at most.

Significance of the Study: An example

Building on the above hypothetical academic study, the following is an example of a full statement of the significance of the study for you to consider when writing your own. Keep in mind though that there’s no single way of writing the perfect significance statement and it may well depend on the subject area and the study content.

Here’s another example to help demonstrate how a significance of the study can also be applied to non-technical fields:

The significance of this research lies in its potential to inform clinical practices and patient counseling. By understanding the psychological outcomes associated with non-surgical facial aesthetics, practitioners can better guide their patients in making informed decisions about their treatment plans. Additionally, this study contributes to the body of academic knowledge by providing empirical evidence on the effects of these cosmetic procedures, which have been largely anecdotal up to this point.

The statement of the significance of the study is used by students and researchers in academic writing to convey the importance of the research performed; this section is written at the end of the introduction and should describe the specific contribution made and who it benefits.

Need to write a list of abbreviations for a thesis or dissertation? Read our post to find out where they go, what to include and how to format them.

Starting your PhD can feel like a daunting, exciting and special time. They’ll be so much to think about – here are a few tips to help you get started.

Multistage sampling is a more complex form of cluster sampling for obtaining sample populations. Learn their pros and cons and how to undertake them.

Join thousands of other students and stay up to date with the latest PhD programmes, funding opportunities and advice.

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The unit of analysis refers to the main parameter that you’re investigating in your research project or study.

The purpose of research is to enhance society by advancing knowledge through developing scientific theories, concepts and ideas – find out more on what this involves.

Kai is a PhD student at Imperial College London. His research centres around sample efficiency, transfer learning and interpretability for deep reinforcement learning.​

Dr Manning gained his PhD in Chemical Engineering from the University of Sheffield in 2019. He is now a postdoc researcher studying molecular simulations on nanomaterials at the University of Bath.

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How To Write Significance of the Study (With Examples) 

Whether you’re writing a research paper or thesis, a portion called Significance of the Study ensures your readers understand the impact of your work. Learn how to effectively write this vital part of your research paper or thesis through our detailed steps, guidelines, and examples.

Related: How to Write a Concept Paper for Academic Research

Table of Contents

What is the significance of the study.

The Significance of the Study presents the importance of your research. It allows you to prove the study’s impact on your field of research, the new knowledge it contributes, and the people who will benefit from it.

Related: How To Write Scope and Delimitation of a Research Paper (With Examples)

Where Should I Put the Significance of the Study?

The Significance of the Study is part of the first chapter or the Introduction. It comes after the research’s rationale, problem statement, and hypothesis.

Related: How to Make Conceptual Framework (with Examples and Templates)

Why Should I Include the Significance of the Study?

The purpose of the Significance of the Study is to give you space to explain to your readers how exactly your research will be contributing to the literature of the field you are studying 1 . It’s where you explain why your research is worth conducting and its significance to the community, the people, and various institutions.

How To Write Significance of the Study: 5 Steps

Below are the steps and guidelines for writing your research’s Significance of the Study.

1. Use Your Research Problem as a Starting Point

Your problem statement can provide clues to your research study’s outcome and who will benefit from it 2 .

Ask yourself, “How will the answers to my research problem be beneficial?”. In this manner, you will know how valuable it is to conduct your study. 

Let’s say your research problem is “What is the level of effectiveness of the lemongrass (Cymbopogon citratus) in lowering the blood glucose level of Swiss mice (Mus musculus)?”

Discovering a positive correlation between the use of lemongrass and lower blood glucose level may lead to the following results:

• Increased public understanding of the plant’s medical properties;
• Higher appreciation of the importance of lemongrass  by the community;
• Adoption of lemongrass tea as a cheap, readily available, and natural remedy to lower their blood glucose level.

Once you’ve zeroed in on the general benefits of your study, it’s time to break it down into specific beneficiaries.

2. State How Your Research Will Contribute to the Existing Literature in the Field

Think of the things that were not explored by previous studies. Then, write how your research tackles those unexplored areas. Through this, you can convince your readers that you are studying something new and adding value to the field.

3. Explain How Your Research Will Benefit Society

In this part, tell how your research will impact society. Think of how the results of your study will change something in your community. 

For example, in the study about using lemongrass tea to lower blood glucose levels, you may indicate that through your research, the community will realize the significance of lemongrass and other herbal plants. As a result, the community will be encouraged to promote the cultivation and use of medicinal plants.

4. Mention the Specific Persons or Institutions Who Will Benefit From Your Study

Using the same example above, you may indicate that this research’s results will benefit those seeking an alternative supplement to prevent high blood glucose levels.

5. Indicate How Your Study May Help Future Studies in the Field

You must also specifically indicate how your research will be part of the literature of your field and how it will benefit future researchers. In our example above, you may indicate that through the data and analysis your research will provide, future researchers may explore other capabilities of herbal plants in preventing different diseases.

Tips and Warnings

• Think ahead . By visualizing your study in its complete form, it will be easier for you to connect the dots and identify the beneficiaries of your research.
• Write concisely. Make it straightforward, clear, and easy to understand so that the readers will appreciate the benefits of your research. Avoid making it too long and wordy.
• Go from general to specific . Like an inverted pyramid, you start from above by discussing the general contribution of your study and become more specific as you go along. For instance, if your research is about the effect of remote learning setup on the mental health of college students of a specific university , you may start by discussing the benefits of the research to society, to the educational institution, to the learning facilitators, and finally, to the students.
• Seek help . For example, you may ask your research adviser for insights on how your research may contribute to the existing literature. If you ask the right questions, your research adviser can point you in the right direction.
• Revise, revise, revise. Be ready to apply necessary changes to your research on the fly. Unexpected things require adaptability, whether it’s the respondents or variables involved in your study. There’s always room for improvement, so never assume your work is done until you have reached the finish line.

Significance of the Study Examples

This section presents examples of the Significance of the Study using the steps and guidelines presented above.

Example 1: STEM-Related Research

Research Topic: Level of Effectiveness of the Lemongrass ( Cymbopogon citratus ) Tea in Lowering the Blood Glucose Level of Swiss Mice ( Mus musculus ).

Significance of the Study .

This research will provide new insights into the medicinal benefit of lemongrass ( Cymbopogon citratus ), specifically on its hypoglycemic ability.

Through this research, the community will further realize promoting medicinal plants, especially lemongrass, as a preventive measure against various diseases. People and medical institutions may also consider lemongrass tea as an alternative supplement against hyperglycemia. 

Moreover, the analysis presented in this study will convey valuable information for future research exploring the medicinal benefits of lemongrass and other medicinal plants.  

Example 2: Business and Management-Related Research

Research Topic: A Comparative Analysis of Traditional and Social Media Marketing of Small Clothing Enterprises.

Significance of the Study:

By comparing the two marketing strategies presented by this research, there will be an expansion on the current understanding of the firms on these marketing strategies in terms of cost, acceptability, and sustainability. This study presents these marketing strategies for small clothing enterprises, giving them insights into which method is more appropriate and valuable for them. 

Specifically, this research will benefit start-up clothing enterprises in deciding which marketing strategy they should employ. Long-time clothing enterprises may also consider the result of this research to review their current marketing strategy.

Furthermore, a detailed presentation on the comparison of the marketing strategies involved in this research may serve as a tool for further studies to innovate the current method employed in the clothing Industry.

Example 3: Social Science -Related Research.

Research Topic:  Divide Et Impera : An Overview of How the Divide-and-Conquer Strategy Prevailed on Philippine Political History.

Significance of the Study :

Through the comprehensive exploration of this study on Philippine political history, the influence of the Divide et Impera, or political decentralization, on the political discernment across the history of the Philippines will be unraveled, emphasized, and scrutinized. Moreover, this research will elucidate how this principle prevailed until the current political theatre of the Philippines.

In this regard, this study will give awareness to society on how this principle might affect the current political context. Moreover, through the analysis made by this study, political entities and institutions will have a new approach to how to deal with this principle by learning about its influence in the past.

In addition, the overview presented in this research will push for new paradigms, which will be helpful for future discussion of the Divide et Impera principle and may lead to a more in-depth analysis.

Example 4: Humanities-Related Research

Research Topic: Effectiveness of Meditation on Reducing the Anxiety Levels of College Students.

Significance of the Study: 

This research will provide new perspectives in approaching anxiety issues of college students through meditation. 

Specifically, this research will benefit the following:

 Community – this study spreads awareness on recognizing anxiety as a mental health concern and how meditation can be a valuable approach to alleviating it.

Academic Institutions and Administrators – through this research, educational institutions and administrators may promote programs and advocacies regarding meditation to help students deal with their anxiety issues.

Mental health advocates – the result of this research will provide valuable information for the advocates to further their campaign on spreading awareness on dealing with various mental health issues, including anxiety, and how to stop stigmatizing those with mental health disorders.

Parents – this research may convince parents to consider programs involving meditation that may help the students deal with their anxiety issues.

Students will benefit directly from this research as its findings may encourage them to consider meditation to lower anxiety levels.

Future researchers – this study covers information involving meditation as an approach to reducing anxiety levels. Thus, the result of this study can be used for future discussions on the capabilities of meditation in alleviating other mental health concerns.

Frequently Asked Questions

1. what is the difference between the significance of the study and the rationale of the study.

Both aim to justify the conduct of the research. However, the Significance of the Study focuses on the specific benefits of your research in the field, society, and various people and institutions. On the other hand, the Rationale of the Study gives context on why the researcher initiated the conduct of the study.

Let’s take the research about the Effectiveness of Meditation in Reducing Anxiety Levels of College Students as an example. Suppose you are writing about the Significance of the Study. In that case, you must explain how your research will help society, the academic institution, and students deal with anxiety issues through meditation. Meanwhile, for the Rationale of the Study, you may state that due to the prevalence of anxiety attacks among college students, you’ve decided to make it the focal point of your research work.

2. What is the difference between Justification and the Significance of the Study?

In Justification, you express the logical reasoning behind the conduct of the study. On the other hand, the Significance of the Study aims to present to your readers the specific benefits your research will contribute to the field you are studying, community, people, and institutions.

Suppose again that your research is about the Effectiveness of Meditation in Reducing the Anxiety Levels of College Students. Suppose you are writing the Significance of the Study. In that case, you may state that your research will provide new insights and evidence regarding meditation’s ability to reduce college students’ anxiety levels. Meanwhile, you may note in the Justification that studies are saying how people used meditation in dealing with their mental health concerns. You may also indicate how meditation is a feasible approach to managing anxiety using the analysis presented by previous literature.

3. How should I start my research’s Significance of the Study section?

– This research will contribute… – The findings of this research… – This study aims to… – This study will provide… – Through the analysis presented in this study… – This study will benefit…

Moreover, you may start the Significance of the Study by elaborating on the contribution of your research in the field you are studying.

4. What is the difference between the Purpose of the Study and the Significance of the Study?

The Purpose of the Study focuses on why your research was conducted, while the Significance of the Study tells how the results of your research will benefit anyone.

Suppose your research is about the Effectiveness of Lemongrass Tea in Lowering the Blood Glucose Level of Swiss Mice . You may include in your Significance of the Study that the research results will provide new information and analysis on the medical ability of lemongrass to solve hyperglycemia. Meanwhile, you may include in your Purpose of the Study that your research wants to provide a cheaper and natural way to lower blood glucose levels since commercial supplements are expensive.

5. What is the Significance of the Study in Tagalog?

In Filipino research, the Significance of the Study is referred to as Kahalagahan ng Pag-aaral.

• Draft your Significance of the Study. Retrieved 18 April 2021, from http://dissertationedd.usc.edu/draft-your-significance-of-the-study.html
• Regoniel, P. (2015). Two Tips on How to Write the Significance of the Study. Retrieved 18 April 2021, from https://simplyeducate.me/2015/02/09/significance-of-the-study/

Written by Jewel Kyle Fabula

in Career and Education , Juander How

Jewel Kyle Fabula

Jewel Kyle Fabula is a Bachelor of Science in Economics student at the University of the Philippines Diliman. His passion for learning mathematics developed as he competed in some mathematics competitions during his Junior High School years. He loves cats, playing video games, and listening to music.

Browse all articles written by Jewel Kyle Fabula

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• USC Libraries
• Research Guides

Organizing Your Social Sciences Research Paper

• The Research Problem/Question
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
• Extending the Timeliness of a Topic Idea
• Academic Writing Style
• Applying Critical Thinking
• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

A research problem is a definite or clear expression [statement] about an area of concern, a condition to be improved upon, a difficulty to be eliminated, or a troubling question that exists in scholarly literature, in theory, or within existing practice that points to a need for meaningful understanding and deliberate investigation. A research problem does not state how to do something, offer a vague or broad proposition, or present a value question. In the social and behavioral sciences, studies are most often framed around examining a problem that needs to be understood and resolved in order to improve society and the human condition.

Bryman, Alan. “The Research Question in Social Research: What is its Role?” International Journal of Social Research Methodology 10 (2007): 5-20; Guba, Egon G., and Yvonna S. Lincoln. “Competing Paradigms in Qualitative Research.” In Handbook of Qualitative Research . Norman K. Denzin and Yvonna S. Lincoln, editors. (Thousand Oaks, CA: Sage, 1994), pp. 105-117; Pardede, Parlindungan. “Identifying and Formulating the Research Problem." Research in ELT: Module 4 (October 2018): 1-13; Li, Yanmei, and Sumei Zhang. "Identifying the Research Problem." In Applied Research Methods in Urban and Regional Planning . (Cham, Switzerland: Springer International Publishing, 2022), pp. 13-21.

Importance of...

The purpose of a problem statement is to:

• Introduce the reader to the importance of the topic being studied . The reader is oriented to the significance of the study.
• Anchors the research questions, hypotheses, or assumptions to follow . It offers a concise statement about the purpose of your paper.
• Place the topic into a particular context that defines the parameters of what is to be investigated.
• Provide the framework for reporting the results and indicates what is probably necessary to conduct the study and explain how the findings will present this information.

In the social sciences, the research problem establishes the means by which you must answer the "So What?" question. This declarative question refers to a research problem surviving the relevancy test [the quality of a measurement procedure that provides repeatability and accuracy]. Note that answering the "So What?" question requires a commitment on your part to not only show that you have reviewed the literature, but that you have thoroughly considered the significance of the research problem and its implications applied to creating new knowledge and understanding or informing practice.

To survive the "So What" question, problem statements should possess the following attributes:

• Clarity and precision [a well-written statement does not make sweeping generalizations and irresponsible pronouncements; it also does include unspecific determinates like "very" or "giant"],
• Demonstrate a researchable topic or issue [i.e., feasibility of conducting the study is based upon access to information that can be effectively acquired, gathered, interpreted, synthesized, and understood],
• Identification of what would be studied, while avoiding the use of value-laden words and terms,
• Identification of an overarching question or small set of questions accompanied by key factors or variables,
• Identification of key concepts and terms,
• Articulation of the study's conceptual boundaries or parameters or limitations,
• Some generalizability in regards to applicability and bringing results into general use,
• Conveyance of the study's importance, benefits, and justification [i.e., regardless of the type of research, it is important to demonstrate that the research is not trivial],
• Does not have unnecessary jargon or overly complex sentence constructions; and,
• Conveyance of more than the mere gathering of descriptive data providing only a snapshot of the issue or phenomenon under investigation.

Bryman, Alan. “The Research Question in Social Research: What is its Role?” International Journal of Social Research Methodology 10 (2007): 5-20; Brown, Perry J., Allen Dyer, and Ross S. Whaley. "Recreation Research—So What?" Journal of Leisure Research 5 (1973): 16-24; Castellanos, Susie. Critical Writing and Thinking. The Writing Center. Dean of the College. Brown University; Ellis, Timothy J. and Yair Levy Nova. "Framework of Problem-Based Research: A Guide for Novice Researchers on the Development of a Research-Worthy Problem." Informing Science: the International Journal of an Emerging Transdiscipline 11 (2008); Thesis and Purpose Statements. The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Thesis Statements. The Writing Center. University of North Carolina; Tips and Examples for Writing Thesis Statements. The Writing Lab and The OWL. Purdue University; Selwyn, Neil. "‘So What?’…A Question that Every Journal Article Needs to Answer." Learning, Media, and Technology 39 (2014): 1-5; Shoket, Mohd. "Research Problem: Identification and Formulation." International Journal of Research 1 (May 2014): 512-518.

Structure and Writing Style

I.  Types and Content

There are four general conceptualizations of a research problem in the social sciences:

• Casuist Research Problem -- this type of problem relates to the determination of right and wrong in questions of conduct or conscience by analyzing moral dilemmas through the application of general rules and the careful distinction of special cases.
• Difference Research Problem -- typically asks the question, “Is there a difference between two or more groups or treatments?” This type of problem statement is used when the researcher compares or contrasts two or more phenomena. This a common approach to defining a problem in the clinical social sciences or behavioral sciences.
• Descriptive Research Problem -- typically asks the question, "what is...?" with the underlying purpose to describe the significance of a situation, state, or existence of a specific phenomenon. This problem is often associated with revealing hidden or understudied issues.
• Relational Research Problem -- suggests a relationship of some sort between two or more variables to be investigated. The underlying purpose is to investigate specific qualities or characteristics that may be connected in some way.

A problem statement in the social sciences should contain :

• A lead-in that helps ensure the reader will maintain interest over the study,
• A declaration of originality [e.g., mentioning a knowledge void or a lack of clarity about a topic that will be revealed in the literature review of prior research],
• An indication of the central focus of the study [establishing the boundaries of analysis], and
• An explanation of the study's significance or the benefits to be derived from investigating the research problem.

NOTE :   A statement describing the research problem of your paper should not be viewed as a thesis statement that you may be familiar with from high school. Given the content listed above, a description of the research problem is usually a short paragraph in length.

II.  Sources of Problems for Investigation

The identification of a problem to study can be challenging, not because there's a lack of issues that could be investigated, but due to the challenge of formulating an academically relevant and researchable problem which is unique and does not simply duplicate the work of others. To facilitate how you might select a problem from which to build a research study, consider these sources of inspiration:

Deductions from Theory This relates to deductions made from social philosophy or generalizations embodied in life and in society that the researcher is familiar with. These deductions from human behavior are then placed within an empirical frame of reference through research. From a theory, the researcher can formulate a research problem or hypothesis stating the expected findings in certain empirical situations. The research asks the question: “What relationship between variables will be observed if theory aptly summarizes the state of affairs?” One can then design and carry out a systematic investigation to assess whether empirical data confirm or reject the hypothesis, and hence, the theory.

Interdisciplinary Perspectives Identifying a problem that forms the basis for a research study can come from academic movements and scholarship originating in disciplines outside of your primary area of study. This can be an intellectually stimulating exercise. A review of pertinent literature should include examining research from related disciplines that can reveal new avenues of exploration and analysis. An interdisciplinary approach to selecting a research problem offers an opportunity to construct a more comprehensive understanding of a very complex issue that any single discipline may be able to provide.

Interviewing Practitioners The identification of research problems about particular topics can arise from formal interviews or informal discussions with practitioners who provide insight into new directions for future research and how to make research findings more relevant to practice. Discussions with experts in the field, such as, teachers, social workers, health care providers, lawyers, business leaders, etc., offers the chance to identify practical, “real world” problems that may be understudied or ignored within academic circles. This approach also provides some practical knowledge which may help in the process of designing and conducting your study.

Personal Experience Don't undervalue your everyday experiences or encounters as worthwhile problems for investigation. Think critically about your own experiences and/or frustrations with an issue facing society or related to your community, your neighborhood, your family, or your personal life. This can be derived, for example, from deliberate observations of certain relationships for which there is no clear explanation or witnessing an event that appears harmful to a person or group or that is out of the ordinary.

Relevant Literature The selection of a research problem can be derived from a thorough review of pertinent research associated with your overall area of interest. This may reveal where gaps exist in understanding a topic or where an issue has been understudied. Research may be conducted to: 1) fill such gaps in knowledge; 2) evaluate if the methodologies employed in prior studies can be adapted to solve other problems; or, 3) determine if a similar study could be conducted in a different subject area or applied in a different context or to different study sample [i.e., different setting or different group of people]. Also, authors frequently conclude their studies by noting implications for further research; read the conclusion of pertinent studies because statements about further research can be a valuable source for identifying new problems to investigate. The fact that a researcher has identified a topic worthy of further exploration validates the fact it is worth pursuing.

III.  What Makes a Good Research Statement?

A good problem statement begins by introducing the broad area in which your research is centered, gradually leading the reader to the more specific issues you are investigating. The statement need not be lengthy, but a good research problem should incorporate the following features:

1.  Compelling Topic The problem chosen should be one that motivates you to address it but simple curiosity is not a good enough reason to pursue a research study because this does not indicate significance. The problem that you choose to explore must be important to you, but it must also be viewed as important by your readers and to a the larger academic and/or social community that could be impacted by the results of your study. 2.  Supports Multiple Perspectives The problem must be phrased in a way that avoids dichotomies and instead supports the generation and exploration of multiple perspectives. A general rule of thumb in the social sciences is that a good research problem is one that would generate a variety of viewpoints from a composite audience made up of reasonable people. 3.  Researchability This isn't a real word but it represents an important aspect of creating a good research statement. It seems a bit obvious, but you don't want to find yourself in the midst of investigating a complex research project and realize that you don't have enough prior research to draw from for your analysis. There's nothing inherently wrong with original research, but you must choose research problems that can be supported, in some way, by the resources available to you. If you are not sure if something is researchable, don't assume that it isn't if you don't find information right away--seek help from a librarian !

NOTE:   Do not confuse a research problem with a research topic. A topic is something to read and obtain information about, whereas a problem is something to be solved or framed as a question raised for inquiry, consideration, or solution, or explained as a source of perplexity, distress, or vexation. In short, a research topic is something to be understood; a research problem is something that needs to be investigated.

IV.  Asking Analytical Questions about the Research Problem

Research problems in the social and behavioral sciences are often analyzed around critical questions that must be investigated. These questions can be explicitly listed in the introduction [i.e., "This study addresses three research questions about women's psychological recovery from domestic abuse in multi-generational home settings..."], or, the questions are implied in the text as specific areas of study related to the research problem. Explicitly listing your research questions at the end of your introduction can help in designing a clear roadmap of what you plan to address in your study, whereas, implicitly integrating them into the text of the introduction allows you to create a more compelling narrative around the key issues under investigation. Either approach is appropriate.

The number of questions you attempt to address should be based on the complexity of the problem you are investigating and what areas of inquiry you find most critical to study. Practical considerations, such as, the length of the paper you are writing or the availability of resources to analyze the issue can also factor in how many questions to ask. In general, however, there should be no more than four research questions underpinning a single research problem.

Given this, well-developed analytical questions can focus on any of the following:

• Highlights a genuine dilemma, area of ambiguity, or point of confusion about a topic open to interpretation by your readers;
• Yields an answer that is unexpected and not obvious rather than inevitable and self-evident;
• Provokes meaningful thought or discussion;
• Raises the visibility of the key ideas or concepts that may be understudied or hidden;
• Suggests the need for complex analysis or argument rather than a basic description or summary; and,
• Offers a specific path of inquiry that avoids eliciting generalizations about the problem.

NOTE:   Questions of how and why concerning a research problem often require more analysis than questions about who, what, where, and when. You should still ask yourself these latter questions, however. Thinking introspectively about the who, what, where, and when of a research problem can help ensure that you have thoroughly considered all aspects of the problem under investigation and helps define the scope of the study in relation to the problem.

V.  Mistakes to Avoid

Beware of circular reasoning! Do not state the research problem as simply the absence of the thing you are suggesting. For example, if you propose the following, "The problem in this community is that there is no hospital," this only leads to a research problem where:

• The need is for a hospital
• The objective is to create a hospital
• The method is to plan for building a hospital, and
• The evaluation is to measure if there is a hospital or not.

This is an example of a research problem that fails the "So What?" test . In this example, the problem does not reveal the relevance of why you are investigating the fact there is no hospital in the community [e.g., perhaps there's a hospital in the community ten miles away]; it does not elucidate the significance of why one should study the fact there is no hospital in the community [e.g., that hospital in the community ten miles away has no emergency room]; the research problem does not offer an intellectual pathway towards adding new knowledge or clarifying prior knowledge [e.g., the county in which there is no hospital already conducted a study about the need for a hospital, but it was conducted ten years ago]; and, the problem does not offer meaningful outcomes that lead to recommendations that can be generalized for other situations or that could suggest areas for further research [e.g., the challenges of building a new hospital serves as a case study for other communities].

Alvesson, Mats and Jörgen Sandberg. “Generating Research Questions Through Problematization.” Academy of Management Review 36 (April 2011): 247-271 ; Choosing and Refining Topics. Writing@CSU. Colorado State University; D'Souza, Victor S. "Use of Induction and Deduction in Research in Social Sciences: An Illustration." Journal of the Indian Law Institute 24 (1982): 655-661; Ellis, Timothy J. and Yair Levy Nova. "Framework of Problem-Based Research: A Guide for Novice Researchers on the Development of a Research-Worthy Problem." Informing Science: the International Journal of an Emerging Transdiscipline 11 (2008); How to Write a Research Question. The Writing Center. George Mason University; Invention: Developing a Thesis Statement. The Reading/Writing Center. Hunter College; Problem Statements PowerPoint Presentation. The Writing Lab and The OWL. Purdue University; Procter, Margaret. Using Thesis Statements. University College Writing Centre. University of Toronto; Shoket, Mohd. "Research Problem: Identification and Formulation." International Journal of Research 1 (May 2014): 512-518; Trochim, William M.K. Problem Formulation. Research Methods Knowledge Base. 2006; Thesis and Purpose Statements. The Writer’s Handbook. Writing Center. University of Wisconsin, Madison; Thesis Statements. The Writing Center. University of North Carolina; Tips and Examples for Writing Thesis Statements. The Writing Lab and The OWL. Purdue University; Pardede, Parlindungan. “Identifying and Formulating the Research Problem." Research in ELT: Module 4 (October 2018): 1-13; Walk, Kerry. Asking an Analytical Question. [Class handout or worksheet]. Princeton University; White, Patrick. Developing Research Questions: A Guide for Social Scientists . New York: Palgrave McMillan, 2009; Li, Yanmei, and Sumei Zhang. "Identifying the Research Problem." In Applied Research Methods in Urban and Regional Planning . (Cham, Switzerland: Springer International Publishing, 2022), pp. 13-21.

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Evans D, Coad J, Cottrell K, et al. Public involvement in research: assessing impact through a realist evaluation. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.36.)

Public involvement in research: assessing impact through a realist evaluation.

Chapter 9 conclusions and recommendations for future research.

• How well have we achieved our original aim and objectives?

The initially stated overarching aim of this research was to identify the contextual factors and mechanisms that are regularly associated with effective and cost-effective public involvement in research. While recognising the limitations of our analysis, we believe we have largely achieved this in our revised theory of public involvement in research set out in Chapter 8 . We have developed and tested this theory of public involvement in research in eight diverse case studies; this has highlighted important contextual factors, in particular PI leadership, which had not previously been prominent in the literature. We have identified how this critical contextual factor shapes key mechanisms of public involvement, including the identification of a senior lead for involvement, resource allocation for involvement and facilitation of research partners. These mechanisms then lead to specific outcomes in improving the quality of research, notably recruitment strategies and materials and data collection tools and methods. We have identified a ‘virtuous circle’ of feedback to research partners on their contribution leading to their improved confidence and motivation, which facilitates their continued contribution. Following feedback from the HS&DR Board on our original application we did not seek to assess the cost-effectiveness of different mechanisms of public involvement but we did cost the different types of public involvement as discussed in Chapter 7 . A key finding is that many research projects undercost public involvement.

In our original proposal we emphasised our desire to include case studies involving young people and families with children in the research process. We recruited two studies involving parents of young children aged under 5 years, and two projects involving ‘older’ young people in the 18- to 25-years age group. We recognise that in doing this we missed studies involving children and young people aged under 18 years; in principle we would have liked to have included studies involving such children and young people, but, given the resources at our disposal and the additional resource, ethical and governance issues this would have entailed, we regretfully concluded that this would not be feasible for our study. In terms of the four studies with parental and young persons’ involvement that we did include, we have not done a separate analysis of their data, but the themes emerging from those case studies were consistent with our other case studies and contributed to our overall analysis.

In terms of the initial objectives, we successfully recruited the sample of eight diverse case studies and collected and analysed data from them (objective 1). As intended, we identified the outcomes of involvement from multiple stakeholders‘ perspectives, although we did not get as many research partners‘ perspectives as we would have liked – see limitations below (objective 2). It was more difficult than expected to track the impact of public involvement from project inception through to completion (objective 3), as all of our projects turned out to have longer time scales than our own. Even to track involvement over a stage of a case study research project proved difficult, as the research usually did not fall into neatly staged time periods and one study had no involvement activity over the study period.

Nevertheless, we were able to track seven of the eight case studies prospectively and in real time over time periods of up to 9 months, giving us an unusual window on involvement processes that have previously mainly been observed retrospectively. We were successful in comparing the contextual factors, mechanisms and outcomes associated with public involvement from different stakeholders‘ perspectives and costing the different mechanisms for public involvement (objective 4). We only partly achieved our final objective of undertaking a consensus exercise among stakeholders to assess the merits of the realist evaluation approach and our approach to the measurement and valuation of economic costs of public involvement in research (objective 5). A final consensus event was held, where very useful discussion and amendment of our theory of public involvement took place, and the economic approach was discussed and helpfully critiqued by participants. However, as our earlier discussions developed more fully than expected, we decided to let them continue rather than interrupt them in order to run the final exercise to assess the merits of the realist evaluation approach. We did, however, test our analysis with all our case study participants by sending a draft of this final report for comment. We received a number of helpful comments and corrections but no disagreement with our overall analysis.

• What were the limitations of our study?

Realist evaluation is a relatively new approach and we recognise that there were a number of limitations to our study. We sought to follow the approach recommended by Pawson, but we acknowledge that we were not always able to do so. In particular, our theory of public involvement in research evolved over time and initially was not as tightly framed in terms of a testable hypothesis as Pawson recommends. In his latest book Pawson strongly recommends that outcomes should be measured with quantitative data, 17 but we did not do so; we were not aware of the existence of quantitative data or tools that would enable us to collect such data to answer our research questions. Even in terms of qualitative data, we did not capture as much information on outcomes as we initially envisaged. There were several reasons for this. The most important was that capturing outcomes in public involvement is easier the more operational the focus of involvement, and more difficult the more strategic the involvement. Thus, it was relatively easy to see the impact of a patient panel on the redesign of a recruitment leaflet but harder to capture the impact of research partners in a multidisciplinary team discussion of research design.

We also found it was sometimes more difficult to engage research partners as participants in our research than researchers or research managers. On reflection this is not surprising. Research partners are generally motivated to take part in research relevant to their lived experience of a health condition or situation, whereas our research was quite detached from their lived experience; in addition people had many constraints on their time, so getting involved in our research as well as their own was likely to be a burden too far for some. Researchers clearly also face significant time pressures but they had a more direct interest in our research, as they are obliged to engage with public involvement to satisfy research funders such as the NIHR. Moreover, researchers were being paid by their employers for their time during interviews with us, while research partners were not paid by us and usually not paid by their research teams. Whatever the reasons, we had less response from research partners than researchers or research managers, particularly for the third round of data collection; thus we have fewer data on outcomes from research partners‘ perspectives and we need to be aware of a possible selection bias towards more engaged research partners. Such a bias could have implications for our findings; for example payment might have been a more important motivating factor for less engaged advisory group members.

There were a number of practical difficulties we encountered. One challenge was when to recruit the case studies. We recruited four of our eight case studies prior to the full application, but this was more than 1 year before our project started and 15 months or more before data collection began. In this intervening period, we found that the time scales of some of the case studies were no longer ideal for our project and we faced the choice of whether to continue with them, although this timing was not ideal, or seek at a late moment to recruit alternative ones. One of our case studies ultimately undertook no involvement activity over the study period, so we obtained fewer data from it, and it contributed relatively little to our analysis. Similarly, one of the four case studies we recruited later experienced some delays itself in beginning and so we had a more limited period for data collection than initially envisaged. Research governance approvals took much longer than expected, particularly as we had to take three of our research partners, who were going to collect data within NHS projects, through the research passport process, which essentially truncated our data collection period from 1 year to 9 months. Even if we had had the full year initially envisaged for data collection, our conclusion with hindsight was that this was insufficiently long. To compare initial plans and intentions for involvement with the reality of what actually happened required a longer time period than a year for most of our case studies.

In the light of the importance we have placed on the commitment of PIs, there is an issue of potential selection bias in the recruitment of our sample. As our sampling strategy explicitly involved a networking approach to PIs of projects where we thought some significant public involvement was taking place, we were likely (as we did) to recruit enthusiasts and, at worst, those non-committed who were at least open to the potential value of public involvement. There were, unsurprisingly, no highly sceptical PIs in our sample. We have no data therefore on how public involvement may work in research where the PI is sceptical but may feel compelled to undertake involvement because of funder requirements or other factors.

• What would we do differently next time?

If we were to design this study again, there are a number of changes we would make. Most importantly we would go for a longer time period to be able to capture involvement through the whole research process from initial design through to dissemination. We would seek to recruit far more potential case studies in principle, so that we had greater choice of which to proceed with once our study began in earnest. We would include case studies from the application stage to capture the important early involvement of research partners in the initial design period. It might be preferable to research a smaller number of case studies, allowing a more in-depth ethnographic approach. Although challenging, it would be very informative to seek to sample sceptical PIs. This might require a brief screening exercise of a larger group of PIs on their attitudes to and experience of public involvement.

The economic evaluation was challenging in a number of ways, particularly in seeking to obtain completed resource logs from case study research partners. Having a 2-week data collection period was also problematic in a field such as public involvement, where activity may be very episodic and infrequent. Thus, collecting economic data alongside other case study data in a more integrated way, and particularly with interviews and more ethnographic observation of case study activities, might be advantageous. The new budgeting tool developed by INVOLVE and the MHRN may provide a useful resource for future economic evaluations. 23

We have learned much from the involvement of research partners in our research team and, although many aspects of our approach worked well, there are some things we would do differently in future. Even though we included substantial resources for research partner involvement in all aspects of our study, we underestimated how time-consuming such full involvement would be. We were perhaps overambitious in trying to ensure such full involvement with the number of research partners and the number and complexity of the case studies. We were also perhaps naive in expecting all the research partners to play the same role in the team; different research partners came with different experiences and skills, and, like most of our case studies, we might have been better to be less prescriptive and allow the roles to develop more organically within the project.

• Implications for research practice and funding

If one of the objectives of R&D policy is to increase the extent and effectiveness of public involvement in research, then a key implication of this research is the importance of influencing PIs to value public involvement in research or to delegate to other senior colleagues in leading on involvement in their research. Training is unlikely to be the key mechanism here; senior researchers are much more likely to be influenced by peers or by their personal experience of the benefits of public involvement. Early career researchers may be shaped by training but again peer learning and culture may be more influential. For those researchers sceptical or agnostic about public involvement, the requirement of funders is a key factor that is likely to make them engage with the involvement agenda. Therefore, funders need to scrutinise the track record of research teams on public involvement to ascertain whether there is any evidence of commitment or leadership on involvement.

One of the findings of the economic analysis was that PIs have consistently underestimated the costs of public involvement in their grant applications. Clearly the field will benefit from the guidance and budgeting tool recently disseminated by MHRN and INVOLVE. It was also notable that there was a degree of variation in the real costs of public involvement and that effective involvement is not necessarily costly. Different models of involvement incur different costs and researchers need to be made aware of the costs and benefits of these different options.

One methodological lesson we learned was the impact that conducting this research had on some participants’ reflection on the impact of public involvement. Particularly for research staff, the questions we asked sometimes made them reflect upon what they were doing and change aspects of their approach to involvement. Thus, the more the NIHR and other funders can build reporting, audit and other forms of evaluation on the impact of public involvement directly into their processes with PIs, the more likely such questioning might stimulate similar reflection.

• Recommendations for further research

There are a number of gaps in our knowledge around public involvement in research that follow from our findings, and would benefit from further research, including realist evaluation to extend and further test the theory we have developed here:

• In-depth exploration of how PIs become committed to public involvement and how to influence agnostic or sceptical PIs would be very helpful. Further research might compare, for example, training with peer-influencing strategies in engendering PI commitment. Research could explore the leadership role of other research team members, including research partners, and how collective leadership might support effective public involvement.
• More methodological work is needed on how to robustly capture the impact and outcomes of public involvement in research (building as well on the PiiAF work of Popay et al. 51 ), including further economic analysis and exploration of impact when research partners are integral to research teams.
• Research to develop approaches and carry out a full cost–benefit analysis of public involvement in research would be beneficial. Although methodologically challenging, it would be very useful to conduct some longer-term studies which sought to quantify the impact of public involvement on such key indicators as participant recruitment and retention in clinical trials.
• It would also be helpful to capture qualitatively the experiences and perspectives of research partners who have had mixed or negative experiences, since they may be less likely than enthusiasts to volunteer to participate in studies of involvement in research such as ours. Similarly, further research might explore the (relatively rare) experiences of marginalised and seldom-heard groups involved in research.
• Payment for public involvement in research remains a contested issue with strongly held positions for and against; it would be helpful to further explore the value research partners and researchers place on payment and its effectiveness for enhancing involvement in and impact on research.
• A final relatively narrow but important question that we identified after data collection had finished is: what is the impact of the long periods of relative non-involvement following initial periods of more intense involvement for research partners in some types of research, particularly clinical trials?

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• Cite this Page Evans D, Coad J, Cottrell K, et al. Public involvement in research: assessing impact through a realist evaluation. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.36.) Chapter 9, Conclusions and recommendations for future research.
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• Published: 17 May 2024

Assessing the status quo of international employees’ adjustment research, 1990–2022: a review and future research agenda

• Irma Baneviciene 1 ,
• Maike Andresen 2 &
• Vilmante Kumpikaite-Valiuniene 3  

Humanities and Social Sciences Communications volume  11 , Article number:  633 ( 2024 ) Cite this article

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• Business and management
• Politics and international relations

This study aims to comprehensively review scientific journal articles related to the adjustment of international employees within the management and business domain from 1990 to 2022. The study seeks to identify trends and patterns in research topics and to propose a future research agenda. To achieve this, we analysed 222 articles from the Web of Science Core Collection database through two main steps: (1) a bibliometric analysis to track the field’s evolution over time and (2) a content analysis of abstracts to examine covered topics and pinpoint research gaps. Our findings indicate that the theory surrounding the adjustment of international employees is still in the process of maturation, with several potential areas for future research emerging. The analysis reveals that factors influencing adjustment are the most extensively researched for assigned expatriates, leaving other international employees relatively under-researched. Moreover, quantitative research emerged as the most prevalent methodological approach among the included studies. Most study samples predominantly consisted of individuals moving between Asia, Europe, and North America, underscoring the significance of Africa—characterised by substantial migration flows within the region—as a focal point for future adjustment research. Moreover, individual-, organisation-, and country-related antecedents of international employees’ anticipatory and in-country adjustments were analysed to present conclusions for future research. This study supplements the domains of international human resource management and international business by identifying research priorities concerning the adjustment of international employees and outlining an agenda for further research.

Introduction

Economic globalisation facilitates the movement of people, capital, goods, and ideas across borders, leading to a significant rise in international mobility among the workforce, a trend that is of global relevance (Duan et al. 2021 ). According to the International Organisation for Migration (IOM UN Migration 2022 ), the global population of international migrants reached approximately 281 million in 2020, representing 3.6% of the world’s population. This figure marks a significant increase from previous years, with 128 million more international migrants than in 1990 and over three times the number reported in 1970 (IOM UN Migration 2022 ). The adjustment of these individuals to new countries and organisations varies depending on factors such as language barriers, geopolitical dynamics, cultural differences, and familial status. Therefore, research into working people’s international mobility and adjustment has gained much attention from researchers worldwide.

A review of previous studies on adjustment highlights a predominant focus on cross-cultural issues, including the development of adjustment over time, the influence of prior international experience, cross-cultural training, and intercultural learning (Chenyang 2022 ; Morris et al. 2014 ; Nam et al. 2014 ; Takeuchi and Chen, 2013 ). Additionally, numerous antecedents of expatriate adjustment have been examined, such as personality traits, expatriate-local interactions, family dynamics, and organisational factors (Van Bakel 2019 ; Dang et al. 2022 ; Harari et al. 2018 ; Haslberger and Brewster 2008 ; Kang and Shen 2018 ; Takeuchi 2010 ). Similarly, studies by Hajro et al. ( 2019 ), Schudey et al. ( 2012 ), and Shen and Hall ( 2009 ) explored the influences of individual, organisational, and social variables on migrants’ acculturation, coping mechanisms and integration, as well as repatriate readjustment.

This review makes a unique contribution by focusing on the factors influencing the adjustment of different groups of international employees, namely expatriates and migrants. Through systematic literature mapping, it delineates the scope of existing research on adjustment, its evolution over time, and differences between employee groups. By aligning findings with macro-level migration data, the study identifies research gaps and priorities, which are crucial for enhancing our understanding of adjustment processes and informing future research directions. This unique approach aims to advance research on the adjustment of international employees (IE), thereby contributing to the existing body of knowledge on international human resource management and international business.

The literature reveals a plethora of definitions of IEs based on various factors such as mobility patterns, employment characteristics, education level, support availability, and planned duration of stay in a foreign country. However, these definitions often overlap, and authors tailor unique definitions to suit their research needs (Andresen et al. 2018 ). Common types of IEs include assigned expatriates, self-initiated expatriates (SIEs), sojourners, migrants, international business travellers, short-term assignees, rotational assignees, and international commuters, with SIEs, assigned expatriates, skilled migrants, and skilled immigrants being the most frequently discussed groups in the literature (Andresen et al. 2014 ; McNulty and Selmer 2017 ; Cerdin and Selmer 2014 ; McNulty and Brewster 2017 ).

The adjustment of IEs is multifaceted and varies depending on the type of IE and the circumstances surrounding their becoming IEs (Shaffer et al. 1999 ). According to Waxin and Panaccio ( 2005 ), the intercultural adjustment of expatriates is defined as a ratio of human psychological comfort and knowledge of a foreign culture. However, scholars have offered differing definitions of intercultural adjustment, with terms such as adjustment, adaptation, assimilation, acculturation, and integration often used interchangeably (Harrison et al. 2004 ). In this study, “adjustment” is the standard term to denote realigning one’s needs with new cultural demands after relocating to an unfamiliar cultural environment (Aycan 1997 ; Bhaskar-Shrinivas et al. 2005 ).

Against this backdrop, a hybrid literature review was conducted, combining bibliometric analysis and content analysis of scientific article abstracts published between 1990 and 2022. Generated systematic literature mapping aimed to (1) provide insights into the field’s evolution over time; (2) identify research trends, priorities, and critical areas; (3) pinpoint research gaps for future exploration.

This study contributes to adjustment theory in five key ways. Firstly, it highlights the need to refine the adjustment construct’s definition, conceptual landscape, nomological network, and causal mechanisms. Secondly, it underscores the importance of systematically identifying the boundary conditions of adjustment theory. Thirdly, it tracks evolutionary nuances to anticipate the trajectory of adjustment research. Fourthly, it identifies critical knowledge gaps to inform future research directions. Finally, recommendations for research methods are provided to facilitate the evolution of adjustment theory from an intermediate to a mature state.

The paper has been structured into four parts. The first part defines adjustment together with an overview of its most essential antecedents that can be identified in the literature. It expounds upon the methodology and strategy used in the study. The second part presents the findings of the bibliometric analysis that indicates general information such as publication year, country, and the research sample’s nationality. The third part covers the content analysis of the abstracts with the presentation of the covered themes and research areas. The final part then discusses the main results and limitations and outlines future research areas.

Theoretical background

The adjustment model proposed by Black et al. ( 1991 ) depicts the factors influencing adjustment and refers to the group of assigned expatriates. The authors differentiate between anticipatory and in-country adjustment, representing two stages of the expatriate cross-cultural adjustment process. Anticipatory adjustment, which occurs before the international relocation, is determined by individual factors, such as training and previous experience and organisational factors, such as selection mechanisms and criteria. It is assumed that individuals’ anticipatory adjustment, i.e., their preparation before they embark on the journey to the host country, will ease their adjustment abroad. Black et al. ( 1991 ) highlighted four influencing factors related to in-country adjustment, which takes place upon relocation to the destination country, that relate to the sphere of the individual (self-efficacy, relation skills, and perception skills), job (role clarity, role discretion, role novelty, role conflict), organisation (organisation culture novelty, social support, logistical help, socialisation tactics, socialisation content), and nonwork (culture novelty and family-spouse adjustment). The in-country adjustment process leads to different degrees of adjustment in terms of work, interaction , and general adjustment in the country of destination that can be measured.

Subsequent researchers delving into adjustment and extending the framework proposed by Black et al. ( 1991 ) revealed additional factors influencing anticipatory and in-country adjustment. For instance, Yijälä et al. ( 2012 ) investigated the anticipatory adjustment of highly skilled, self-initiated foreign employees, shedding light on specific challenges and strategies pertinent to this cohort. They differentiate between psychological , socio-psychological , and work-related anticipatory adjustment. Lett and Smith ( 2009 ) distinguished – analogous to Black et al. ( 1991 ) – pre-departure and in-country adjustment and highlight individual , organisational , job , and non-work factors that impact adjustment before and after moving to the destination country.

Ritchie et al. ( 2015 ) expanded on general adjustment following relocation by identifying additional precursors, including job satisfaction, team cohesion, and alignment with organisational values. Additionally, they advocate for the incorporation of control variables related to demographics and individual traits such as gender, family status, parental responsibilities, professional background, tenure, and linguistic abilities (Caligiuri et al. 1998 ; Canhilal et al. 2015 ; Chen 2010 ; Lee et al. 2014 ), a recommendation that subsequent scholars have adopted in their studies. Hippler et al. ( 2014 ) divided their scale into ten factors delineating various aspects or changes that may necessitate adjustment. These factors encompass aspects of the work environment, language proficiency, job or task attributes, recreational activities, urban setting, work-life balance, living accommodations, familial dynamics, local social connections, and communication with those remaining behind. This approach shows that work - related facets of IEs’ adjustment receive the least attention.

After reviewing the antecedents of adjustment proposed by different authors (e.g., Black et al. 1991 ; Caligiuri et al. 1998 ; Chen, 2010 ; Hippler et al. 2014 ; Lee et al. 2014 ; Lett and Smith, 2009 ; Ritchie et al. 2015 ), both similarities and some differences become apparent. Based on this overview, we group the antecedents of IEs’ adjustment (anticipatory and in-country) into the following main groups: individual-, organisation-, and country-related antecedents (see Fig. 1 ).

Model of factors influencing IE adjustment.

The study aims to achieve several objectives: firstly, to offer a comprehensive overview of the evolution of research within the adjustment field over time, including the types of international employees (IEs) whose adjustment is being researched, the terminology utilised to describe ‘adjustment’ in publications, and the research methodologies employed. Secondly, it seeks to identify trends in research topics, delineate research priorities, and highlight critical research areas. Lastly, the study aims to uncover research gaps that necessitate attention in future studies.

The methodology employed in our study, illustrated in Fig. 2 , follows an adapted systematic mapping approach proposed by Petersen et al. ( 2008 ). This approach enables the collation, description, and cataloguing of available evidence, as elucidated by James et al. ( 2016 ). By adopting this approach, we can provide a broad overview of a research field and identify the amount and type of research in this field (Petersen et al. 2008 ; Soaita et al. 2020 ), as elaborated upon in subsequent sections.

Study mapping process.

For analysis purposes, we utilised the Web of Science (WoS) Core Collection database, renowned as one of the premier platforms for scientific citation search, discovery, and analytical information (Li et al. 2018 ). Scholars frequently rely on this database for bibliometric analyses (Vlase and Lähdesmäki 2023 ). With its comprehensive coverage spanning articles from 1900 onwards (Chadegani et al. 2013 ), the WoS database provides a robust foundation for gaining insights into trends in academic research on IEs’ adjustment, a vital component of this study.

To conduct our literature search, we established specific inclusion criteria. We designated the base timeframe for the search period from 1990 to 2022 (July). Within the WoS platform, we focused on the management and business categories, representing the primary disciplines relevant to international employees’ adjustment. Articles were restricted to published in English, the predominant language for international collaboration.

We formulated search terms targeting IEs and an adjustment in identifying relevant articles. For the IE aspect, keywords such as immigrant, migrant, and expatriate were employed. Concerning adjustment, the terms adaptation, assimilation, acculturation, and integration were selected, aligning with the terminology outlined by Harrison et al. ( 2004 ) as synonymous with adjustment. The search terms were combined of the two search fields into a search string using “AND” to search the title, abstracts, or keywords of the articles, i.e. (immigra* OR migra* OR expatriat*) AND (adjust* OR adapt* OR assimilat* OR acculturat* OR integrat*). As an additional criterion, it was stipulated that one of the keywords related to adjustment must be present as an article keyword. Article keywords were meticulously chosen by authors to accurately encapsulate the essence of their paper (Emich et al. 2020 ; Zhang et al. 2016 ). Hence, if authors perceive their article as directly pertinent to adjustment, they are inclined to opt for the term as a keyword.

The search yielded a total of 444 articles. The abstracts of these articles were imported into the MAXQDA software, commonly used for qualitative and mixed methods research. Each abstract was meticulously reviewed to confirm its relevance to IE adjustment. In cases where abstracts lacked clarity and inclusion or exclusion was uncertain, the introduction or conclusion of the paper was consulted for clarification (Petersen et al. 2008 ). Out of the initial pool, 222 articles were identified as unrelated to IE adjustment, focusing instead on consumer acculturation’s impact on product selection, micromarketing issues regarding immigration and acculturation, and differences in labour and capital incomes between immigrants and natives. The final selection of the articles for the study consists of 222 articles.

A hybrid approach combining bibliometric analysis and structured review was adopted to analyse the data and achieve the research objectives, following the framework proposed by Paul and Criado ( 2020 ). Bibliometric analysis provided insights into the evolution of the field and trends in articles on adjustment and their prevalence concerning types of international employees published from 1990 to 2022. Concurrently, structured review techniques, including content analysis, were employed to identify research trends and uncover research gaps (Paul and Criado 2020 ). Content analysis systematically condenses extensive text into categories based on predefined coding rules, facilitating the identification of document trends and patterns (Stemler 2000 ), thus offering a systematic and objective means of describing and quantifying phenomena (Downe-Wamboldt, 1992 ).

The initial coding process involved 50 articles from the corpus of 222, conducted by one author and subsequently reviewed by other authors. The coding system was refined through discussions among the authors, ensuring consensus. Following this, the 50 initial abstracts were re-analysed, and all remaining abstracts were subjected to the established coding rules. (1) Main categories were created for all statistical data: publication year, research method, terminology of ‘adjustment’ used in the articles, country of research, nationality of participants, and type of IE. (2) Deductive categories of anticipatory and in-country adjustment were utilised to examine the antecedents of IE adjustment. Each category was further subdivided into individual-related, organisation-related, and country-related antecedents. Inductive codes were then defined for each identified antecedent and assigned to the deductive categories (refer to Table 1 for details).

All statistical data and specified antecedents underwent coding based on the abstracts. A total of 1522 coding instances were assigned. The total number of codings per category sometimes varied from the total number of articles in the corpus. This discrepancy occurred because not all articles included information relevant to every category, or multiple subcategories within an article were pertinent, resulting in multiple codings. For instance, if an article examined and assigned expatriates and self-initiated expatriates within its sample, two codings were recorded under the IE type category.

The interrelationships among the categories were analysed to identify prevalent themes and underlying patterns of connection.

General information

Field progression over time.

A total of 222 articles spanning from 1990 to 2022 were subjected to analysis (refer to Fig. 3 ). The distribution of articles across each year within this timeframe reveals distinct phases in the evolution of interest in IE adjustment research: before 1999, between 2000 and 2016, and from 2017 onwards. Before 1999, sporadic publications occurred every few years (a total of five), indicating budding interest in the field without establishing it as a full-fledged area of research. From 2000 to 2016, researchers consistently, albeit modestly, addressed IE adjustment, with the number of published articles gradually increasing from two per year to a maximum of 12 in specific years. Notably, since 2017, 27 years after the first publication on IE adjustment, the annual publication count has consistently reached 20 or more, albeit not every year. This sustained growth in publications within the management and business domains reflects rising scholarly interest in IE adjustment. Such findings affirm our initiative to delve into topic diversity, identify research gaps, and contribute to the future advancement of the field.

Number of articles on IE adjustment published per year, 1990–2022.

Types of IEs researched

Coding the type of IEs studied in the articles in the corpus generated 230 codings (see Fig. 4 ). Based on the terminology used in the abstracts by the researchers themselves to elucidate the types of IEs studied in each case, two subcategories of IEs were generated: (a) expatriates (assigned expatriates and self-initiated expatriates) and (b) migrants (migrant workers, immigrants, and skilled/qualified migrants).

Use of the different IE types to name the samples per year.

In comparison, a more significant proportion of articles concentrated on the expatriate cohort (197 articles) than the migrant cohort (33 articles). Specifically, assigned expatriates emerged as the most extensively studied subgroup within the expatriate cohort, with 165 articles dedicated to their adjustment consistently appearing in the scientific literature over the years. Notably, research on the adjustment of assigned expatriates commenced as early as 1990 and has steadily escalated since 2000. The period post-2017 witnessed a sustained and notable volume of articles on assigned expatriates, indicating continued scholarly interest in this area.

Conversely, a significantly smaller number of research publications delved into the adjustment of self-initiated expatriates (SIEs) (32 articles), albeit ranking as the second highest. Interestingly, the earliest article addressing the adjustment of SIEs only emerged in 2008. Although the number of articles SIEs has remained relatively low over the years, there was a notable surge in 2021 with nine articles. Nonetheless, research on SIEs has persisted since 2012, albeit in limited numbers.

The second cohort, migrants, was represented in 33 articles. Among these, the term “immigrant” was predominantly utilised in 20 articles to define the focus group of their research. Four articles specifically focussed on migrant workers, while nine underscored the high skills or qualifications of the migrants in their respective samples. Moreover, research on adjustment primarily concentrated on adjusting IEs to the host country, with no studies additionally analysing the reciprocal adjustment of locals to the cultural changes introduced by IEs.

To summarise, most adjustment research focuses on expatriates, particularly assigned expatriates, with a notable increase in articles over the years. Conversely, studies on all other groups have remained consistent, albeit low, levels. Furthermore, adjustment was predominantly explored unilaterally through the lens of IEs.

Adjustment terminology used

The terms adjustment, acculturation, assimilation, integration, and adaptation have been used to describe IEs’ successful settling in a new host country, new job, or community. Figure 5 shows the adjustment terms used in the scientific literature concerning a specific type of IE.

Use of terminology around “adjustment” according to IE types.

Assimilation is the least utilised term in the literature on IE adjustment, appearing in only two articles. Acculturation, integration, and adaptation were employed more frequently, with 13, 12, and 23 articles, respectively. However, the usage frequency of these terms pales compared to the predominant use of the term adjustment, which was featured in 174 articles.

Furthermore, we analysed the extent to which multiple terms were employed within individual article abstracts. While most authors consistently used only one term in their articles, a minority of articles (9) utilised four of the five adjustment terms in varying combinations. For instance, as the primary term, adjustment was paired with acculturation (1) and integration (1). Acculturation, as the primary term, was coupled with adjustment (1), assimilation (1), or integration (4). Assimilation, as the primary term, was combined with acculturation (1) and integration (2). Notably, the term adaptation was not used concurrently with the other terms. Integration was frequently interchanged with other terms within the same articles (7) (refer to Table 2 for details).

The analysis of bibliometric data also highlights variations in the predominant adjustment terms across different types of international employees. A comparison between expatriates and migrants reveals distinct patterns. Research articles concerning expatriates predominantly utilised the terms adjustment (160 [81.2%]) and adaptation (21 [10.7%]). Conversely, these terms were less prevalent in studies focusing on migrants, accounting for only 14 (42.4%) and 2 (6.1%) instances, respectively. Notably, the term assimilation was exclusively used in studies on migrants (2 instances), while integration (migrants: 10 [30.3%]; expatriates: 2 [1%]) and acculturation (migrants: 11 [33.3%]; expatriates: 7 [3.6%]) were employed more frequently in research related to migrants compared to expatriates.

Research methods

Table 3 presents the research methods outlined in the abstracts of the articles. These methods were categorised based on the research onion framework proposed by Saunders et al. ( 2009 ), distinguishing between methodological choice, time horizon, and strategy. Quantitative research emerged as the most frequently employed methodological choice (124 instances) in IE adjustment research, followed by qualitative research methods (38 instances) and mixed methods (11 instances), with a considerable margin between them. Concerning the time horizon of the research, only 11 articles with a longitudinal design were identified since 1990 in the domain of IE adjustment. Several unique features were observed regarding the research strategy, including case studies (2 instances) and secondary sources (7 instances). Notably, the methodological choice was listed in the abstracts of only 186 (84%) articles.

In summary, quantitative research predominated in both expatriate and migrant groups. However, studies on migrants exhibited a relatively higher proportion of qualitative methods. Additionally, there was slightly more variability in the research methods employed for expatriates than migrants.

Trends in research topics and critical research priorities

Host countries and nationality of participants.

Notably, 154 articles specified the country or countries where the research was conducted, while 96 articles indicated the nationality of the participants. Some articles opted to identify regions rather than specific countries (e.g., Asia or Africa) without providing details on the nationalities of the participants, leading to ambiguity regarding the participants’ origins and the research locations. The information extracted from the articles was categorised based on the type of international employee (IE) under study, as outlined in Table 4 .

Whenever available, the nationalities of the IE samples were classified according to geographic regions defined by the (United Nations 2022 ): Africa, Asia, Europe, Latin America and the Caribbean, North America, and Oceania. Analysis of the abstracts revealed that the samples predominantly comprised IEs from Asian (42 instances), European (24 instances), and North American (14 instances) origins. Conversely, IEs from Africa (1 instance), Latin America and the Caribbean (3 instances), and Oceania (2 instances) were less frequently examined in terms of adjustment. Among the focal regions, Chinese (17 instances), Japanese (12 instances), and American (12 instances) IEs were the most commonly studied. Notably, the Japanese IE group exclusively consisted of assigned expatriates.

A similar trend is observed concerning the host countries where international employees reside. Based on available data, the majority of research on IE adjustment focused on IEs living in Asia (93 instances), Europe (23 instances), and North America (18 instances), with significantly fewer studies conducted in regions such as Africa (8 instances), Latin America and the Caribbean (4 instances), and Oceania (8 instances). Examining individual countries, the data indicate that China (25 instances), Japan (10 instances), and the United States (13 instances) were the primary host countries for IE adjustment research. Among studies focusing on Japan or China as host countries, the articles predominantly referred to expatriates, particularly assigned expatriates (84% and 70%, respectively), rather than migrants.

Overall, the findings suggest that regions such as Africa, Latin America, the Caribbean, and Oceania, along with their nationals, were significantly underrepresented in research on IE adjustment.

Anticipatory adjustment of IEs

Anticipatory adjustment, comprising 34 studies, was most frequently examined in association with assigned expatriates (23 studies) (refer to Table 5 ). Anticipatory adjustment was not a significant focus in studies involving migrant IE groups (4 studies). The two primary factors explored concerning anticipatory adjustment were cross-cultural training to prepare assigned expatriates for their new roles during foreign assignments (9 studies) and previous international experience (11 studies, of which eight referred to assigned expatriates). Other factors, such as language proficiency, motivation to migrate, pre-departure expectations, organisational support and identification, recruitment/selection, and the host country environment, were only explored in limited studies.

In-country adjustment of IEs

Many studies have dealt with adjustment in the host country, which was named 238 times. Factors/antecedents were grouped into individual-, organisation- and country-related groups (refer to Table 6 ). Individual factors were researched most frequently (155), followed by organisational (95) and country-related (78) factors.

Out of individual factors, demographics such as gender and age were explored in 14 articles related to the expatriate group. Personal characteristics, including cultural competence, personality traits, and networks, were the most extensively researched aspect, with 105 studies dedicated to this area. Most of this research targeted assigned expatriates (79 studies), with relatively fewer studies focusing on SIEs and the broader migrant group (14 and 12 studies, respectively). Additionally, there were 22 articles focusing on spouse/family adjustment, examining how family dynamics impacted IE adjustment and considering factors such as support networks, personality traits, host country nationals, and language proficiency. Most of these articles (20 out of 22) were related to assigned expatriates. Individual work-related characteristics, such as organisational commitment, embeddedness, and job satisfaction, were also investigated in 14 studies, with all but two articles referencing the expatriate group.

Regarding organisational factors, particular attention was given to two areas: human resource strategy and management (including leadership, performance management, and organisational support), which were the focus of 35 studies, and employee relations (such as international teamwork, social support networks, and organisational socialisation), which were explored in 30 studies. Additionally, there were studies examining job-related factors (such as role clarity and workplace learning) and the role of the work environment in adjustment (including organisational culture and extrinsic motivation). Most of these articles primarily focused on assigned expatriates, with four-fifths of the articles on HR strategy and management related to this group.

Finally, concerning country-related factors , studies focused mainly on culture (cross-cultural training, cross-cultural communication, and cultural gap, novelty) (43), as well as networks (social support networks, spousal/family support, and host country nationals) (21) and the impact of the host country environment (culture, safety, location, leisure time, etc.) (14) on IE adjustment. Like the previously analysed groups, country-related factors influencing adjustment primarily concentrated on assigned expatriates (59 studies), potentially limiting the generalisation of adjustment patterns to other types of IEs.

In summary, individual, organisational, and country-related factors were predominantly examined through the lens of assigned expatriates. Regarding the distribution of topics by IE type, the analysis revealed that studies on assigned expatriates (49.8%) and SIEs (50%) primarily focused on individual factors. In contrast, most studies on the migrant group emphasised organisational antecedents (40.8%). Country-related factors received comparatively less attention across all IE types, with 24.5% of studies on assigned expatriates, 15.8% on SIEs, and 26.5% on the migrant group exploring these aspects.

By employing a hybrid analysis, which integrates partial bibliometric analysis and abstract content analysis of scientific articles published between 1990 and 2022, we accomplished two of our objectives: (1) furnishing comprehensive insights into the evolution of the field over time, and (2) identifying trends in research topics to grasp research priorities and essential research areas. In the subsequent sections, we will delve into our third objective, (3) uncovering research gaps that warrant attention in future research. Table 7 outlines the principal findings and a proposed research agenda, which we will elucidate below.

Research agenda

General information about the field progression over time indicates that the number of articles per year increased consistently, indicating that the field of IEs adjustment is of rising interest to management and business researchers. Nevertheless, as shown in the following, abstract content analysis of IE adjustment revealed several under-researched avenues for future research.

This analysis underscores a notable emphasis on expatriates in IE adjustment research, particularly assigned expatriates, which constituted approximately 72% of all articles. Conversely, other types of IEs remain relatively underexplored, aligning with previous research highlighting the dearth of scholarly attention on international career transitions for self-initiated IEs (Hajro et al. 2021 ; Yijälä et al. 2012 ; Zikic et al. 2010 ). Given the likelihood of SIEs and migrants receiving less or no support from their employers during relocation and in the host country, they may encounter distinct and potentially heightened adjustment challenges (Brewster et al. 2017 ). Given the escalating global prevalence of SIEs (Collings et al. 2010 ), the limited coverage of 32 articles on the adjustment of this specific group underscores a critical need for further research.

Moreover, standardising terminology for IE types could enhance the development of adjustment research and improve precision. Notably, the term “immigrant” lacks a robust definition compared to terms like “assigned expatriate,” “self-initiated expatriate,” or “skilled migrant.” Consequently, the ambiguity surrounding the delineation of these groups hampers the comparability of research findings. Future studies would benefit from clearly describing the characteristics of the group(s) under investigation, regardless of the label used. Additionally, given the varied definitions of IEs, more comparative research across two or more IE types is warranted to ascertain whether and how they adjust differently to host country circumstances and the underlying reasons.

Finally, regarding sample perspectives, all studies in the corpus exclusively focused on the adjustment of IEs, who typically represent a minority in the host country, to a foreign culture. However, the adjustment of locals to newcomers and the influences they bring from their home countries, which may affect various aspects of local life, warrant a more thorough examination in future research.

Adjustment Terms

As 76% of articles used the term ‘adjustment,’ it might be concluded that this term is the most acceptable for scientists to use in conjunction with IE adjustment. Adaptation (22) was mainly used in connection with expatriates (91%) and – as the only term – and not along with other terms. Interestingly, many publications on adaptation (totalling 19) primarily focused on cross-cultural processes. Although these adaptation studies explicitly employed “adaptation” in their abstracts, they frequently cited sources with synonymous terms in their full text. For instance, three adaptation studies directly referenced acculturation literature sources (e.g., Berry et al. 1988 ) in the complete text, avoiding the explicit use of “acculturation.” Similarly, seven adaptation articles drew on references from the adjustment literature (J. S. Black and Stephens 1989 ; Lazarova et al. 2010 ) as the theoretical foundation for their adaptation research, without employing the term “adjustment” in the full text. In nine articles, the terms “adaptation” and “adjustment” were used interchangeably within the full text (Jyoti and Kour, 2017 ; Zhang et al. 2021 ). Given that conventional literature searches involve seeking relevant texts in databases based on titles, abstracts, and keywords, there exists a risk of parallel development between adaptation research and other adjustment research despite their overlapping content. Thus, future adaptation research should aim to demonstrate the scientific value of the terminological distinction between adaptation and other forms of adjustment. If this distinction is justified, it is crucial to clearly define and delineate these terms or refer to synonymous adjustment terms through cross-references in abstracts or keywords.

Moreover, the bibliometric analysis unveiled variations in dominant adjustment terms across different IE types. When comparing expatriates and migrants, research articles on expatriates predominantly employed the terms “adjustment” and “adaptation,” these terms were notably less utilised for the migrant groups. However, from a content perspective, both terms are equally pertinent and applicable to both groups. This underscores the need for a comprehensive assessment of literature covering both expatriate and migrant IE types, emphasising the importance of scientific exchange between these two research streams in the future.

Research Methods

The limited range of research methods employed in the study is noteworthy. Of the abstracts analysed, 124 indicated quantitative research methods, whereas 38 indicated qualitative methods. Interestingly, while quantitative methods were used across expatriate and migrant groups, qualitative research methods were comparatively more prevalent in studies focusing on migrant groups, albeit in smaller numbers overall. Existing research offers tentative explanations for adjustment; however, adjustment theory remains in a nascent stage, as evidenced by recent efforts at scale redevelopment (Hippler et al. 2014 ), the varied terminology used (Harrison et al. 2004 ), and calls for more significant consideration of context (Szabó 2022 ). Therefore, adjustment theory is currently classified as an intermediate theory. Although research questions permit the formulation of testable hypotheses, the adjustment construct remains preliminary. To achieve methodological congruence, a hybrid approach combining quantitative and qualitative methods is recommended (Edmondson and McManus 2007 ). Quantitative research enables testing associations between variables, while qualitative research facilitates elaboration on phenomena, explanations, and illumination of adjustment constructs and relationships. Incorporating more qualitative research would provide deeper insights into the individual experiences of IEs, given that expatriation/migration is inherently unique. Furthermore, latent class analyses could offer a person-centred perspective on adjustment, exploring different adjustment strategies individuals adopt and their characteristics and antecedents (Morris et al. 2015 ).

The chosen time horizon also reveals explicit limitations in current research practices. Only 5% of the articles indicated the use of a longitudinal design. Given that adjustment is a dynamic process (Banai, 2022 ; Hippler et al. 2015 ), the field could benefit from more longitudinal studies to understand its temporal development, success factors, and obstacles. A broader range of research methods is desirable to address diverse research questions (Sam and Ward 2021 ). Particularly in research on migrants’ adjustment, future studies should strive for more significant methodological variance, as differences in IE types do not inherently dictate differences in research methodology.

Countries of Destination and Sample Nationalities

IEs relocating to and originating from Asia, Europe, and North America were the most researched groups in studies related to IE adjustment. Compared to the absolute number of migrants, which is highest in the destination regions of Europe (87 million), Asia (86 million), and North America (59 million) (IOM UN Migration 2022 ), the host countries in the articles on which the analyses are based reflected the distribution well. Conversely, an analysis of the increase in migration flows from 2000 to 2020 shows that the regions Asia ( + 37 million), Europe ( + 30 million), North America ( + 18 million), and Africa ( + 10 million) (IOM UN Migration, 2022 ) are of the highest relevance. However, the fewest adjustment studies have been conducted in the regions of Africa, as well as Latin America, the Caribbean, and Oceania so far. In particular, the hitherto scarcely explored region of Africa, characterised by a high proportion of migration flow within the region and not across regions as applies to other regions (IOM UN Migration 2022 ), assumes great significance for future adjustment research. Many scholars posit that adjusting to a host culture that is culturally very different proves more difficult for IEs (Li et al. 2013 ; Varela and Gatlin-Watts, 2014 ). However, Selmer ( 2007 ) presents evidence suggesting that adjusting to a similar host culture can be as challenging as adjusting to a different one. Consequently, there should be a focus on the nuances of intraregional migration and adjustment, particularly in Africa.

Based on the information in the article abstracts, the most extensively researched destination countries for IEs were the United States, China, and Japan. Despite the United States being the primary destination for international migrants since 1970 (IOM UN Migration 2022 ), Germany, the second top destination for migrants (IOM UN Migration, 2022 ), was notably underrepresented in the corpus, with only three articles. Similarly, countries like Saudi Arabia (0), Russia (0), the UAE (5), the United Kingdom (5), and France (2) which rank among the countries with the highest migrant populations globally (IOM UN Migration 2022 ; UN DESA, 2022 ), were also underrepresented in adjustment studies. Furthermore, according to the OECD ( 2017 ), Switzerland, Australia, and New Zealand have foreign-born individuals comprising over 20% of their total employment. Nevertheless, research articles on IE adjustment in these destination countries numbered only 2, 6, and 2, respectively. Although Asia is witnessing significant growth in migrants, the proportion of international migrants in the population remains relatively low (1.8%; IOM UN Migration, 2022 ). Historically regarded as a highly homogeneous society with limited global mobility (Andresen et al. 2020 ; Sugimoto, 2014 ), Japan was unexpectedly one of the most studied destination countries for IE adjustment, highlighting the relevance of research in exploring adjustment dynamics in such unique contexts.

Concerning nationality , data indicates that over 40 per cent of all international migrants globally in 2020 hailed from Asia, predominantly from countries like India, China, Bangladesh, Pakistan, the Philippines, and Afghanistan (IOM UN Migration 2022 ). Mexico and Russia are among the largest emigration countries worldwide (UN DESA, 2022 ). However, these regions were scarcely represented in the nationalities studied in the adjustment articles analysed. Despite numerous studies focusing on Chinese IEs (17), other countries were either underrepresented (e.g., the Philippines, 2) or not represented at all (e.g., India, Bangladesh, Pakistan, Afghanistan) in the sampled articles.

Moreover, it is noteworthy that three of the ten GLOBE cultural clusters (House et al. 2004 ) accounted for approximately four-fifths of the destination countries (Confucian Asia, Southern Asia, Anglo) and nationalities (Confucian Asia, Latin Europe, Anglo) studied, with studies based on samples from other cultural clusters such as the Middle East, Sub-Saharan Africa, Latin America, or Eastern Europe being the exception. Future research should systematically examine the combination of nationality and host country to understand the impact of cultural attractiveness on adjustment. While cultural distance measures highlight challenges and losses from cross-cultural interaction, cultural attractiveness focuses on the potential gains from such interaction, even in culturally disparate contexts (Li et al. 2017 ). IEs from countries who perceive the cultural practices of their host country as more valuable than their own may feel attracted to the host country’s cultural practices, which could positively impact their adjustment (Li et al. 2017 ).

To summarise, data accessibility rather than content criteria may have primarily influenced the selection of nationalities and destination countries/regions in previous research. While focusing on countries with high migrant populations and significant migrant inflows may help identify facilitating factors, expanding the scope to include countries with different conditions can help identify equally important barriers. For instance, in countries with few IEs, more personal initiative is required for adjustment, as there are fewer fellow IEs to provide support, and interactions with the native population may be less familiar (Andresen et al. 2020 ). Given that adjustment processes are influenced by social systems that create inequities across individuals and groups, future research should systematically consider the social conditions in different cultures and how these inequities affect IEs’ ability to achieve positive outcomes (Szabó 2022 ). This necessitates a more deliberate sampling approach for destination countries/regions and the nationality of IEs, including “exceptional” destinations and nationalities, and examining the combination of nationality and host country attractiveness in future studies.

Research Themes

Most studies on anticipatory adjustment (68%) focused on assigned expatriates, which is understandable given their affiliation with the same company. Assigned expatriates typically receive support from their organisation before their assignment, facilitating their anticipatory adjustment. However, it is worth noting that all other types of international employees also engage in planning before relocating to another country. Therefore, they will likely undergo some form of individual anticipatory adjustment that could impact their adjustment abroad. Despite this, only seven articles explored the anticipatory adjustment of SIEs, and four studies examined the migrant group. Since SIEs and other migrants typically do not receive financial support from their employers for relocation, studying their anticipatory adjustment could benefit both receiving companies and countries. Hence, there is a need for more research on the anticipatory adjustment of all types of international employees beyond assigned expatriates.

Antecedents of in-country adjustment for international employees were categorised into individual, organisational, and country-level factors. However, some antecedents, such as networks, host country nationals, host country language proficiency, or person-organisation fit, could be attributed to multiple levels depending on the researcher’s perspective. For example, social support networks may not solely be “work-related” at work, even within the workplace environment. Individuals often form close networks with co-workers from various departments based on non-work-related factors like shared interests. Therefore, the impact of these adjustment antecedents on international employee adjustment may extend beyond the organisational level. This highlights the need for research that examines antecedents affecting multiple levels (individual, organisation, country) and stages of international employee adjustment.

Only 14 articles investigated how demographics might affect international employee adjustment; one emphasised the age of international employees, and 13 examined gender (with four focusing on women and seven comparing men with women). It is important to note that no articles addressed adjustment related to transgender or other genders. The lack of understanding regarding how international employees’ demographics or the host country’s environment influence adjustment could lead to poor decision-making and negative consequences for businesses, such as decreased motivation among international employees and disruptions in interactions with customers, suppliers, and colleagues abroad (Olsen and Martins 2009 ). This highlights the need for more research on the effects of international employees’ demographics and the host country’s demographics on adjustment.

A phenomenon not previously explored in existing studies is remote adjustment, which refers to the adjustment process experienced by workers with indirect and often temporary intercultural contact with individuals in geographically separated cultures. This indirect contact occurs virtually through the Internet, where IEs build social networks and seek support. Research by Canhilal et al. ( 2022 ) indicates that these virtual networks and Internet-based support significantly influence IE adjustment.

The concept of remote adjustment may have been particularly accelerated by the COVID-19 pandemic, which brought about widespread changes in workplaces worldwide, especially in technologically advanced countries. With the shift to online work replacing traditional face-to-face interactions, there has been a surge in virtual assignments and international remote work arrangements. As a result, an increasing number of IEs are navigating adjustment challenges in virtual environments. Given the growing prevalence of virtual work arrangements, exploring the adjustment experiences of virtual IEs, particularly in the context of information technologies, becomes essential in the post-COVID era. Understanding how remote adjustment unfolds and identifying effective strategies for supporting virtual IEs will benefit employers and international employees.

Theoretical contributions

To demonstrate the significance of this hybrid review in enriching the adjustment literature, we refer to Mukherjee et al. ( 2022 ) systematisation for delineating the critical pathways to making theoretical contributions. Within theoretical contributions (as outlined by Whetten, 1989 ), our examination reveals that prevailing adjustment research predominantly addresses fundamental theoretical questions. These inquiries encompass defining the adjustment construct, identifying the contributing factors to pre- and post-relocation adjustment phases (the conceptual landscape), delineating the interconnections among these factors (nomological network), and elucidating the underlying causal mechanisms (Mukherjee et al. 2022 ). Whereby the model of Black et al. ( 1991 ) plays a vital role in conceptualising international adjustment as both multifaceted (work and general adjustments together with interactions with host-country nationals) and time-related (anticipatory and in-country adjustments).

A primary theoretical contribution emanating from our analysis is the recognition that while the model proposed by Black et al. ( 1991 ) remains prominent, adjustment research also incorporates other theoretical constructs (such as acculturation, integration, and adaptation, albeit infrequently assimilation), which are often used synonymously. Consequently, regarding construct definition, a pressing need exists for either consolidation or precise demarcation of these constructs. A comprehensive comparison of literature concerning expatriates and migrants, as detailed in the research agenda mentioned earlier, holds promise for theoretically refining the conceptual landscape, nomological network, and causal mechanisms (Mukherjee et al. 2022 ).

Secondly, by delineating knowledge clusters or primary themes in adjustment research (Mukherjee et al. 2022 ), our analysis underscores the underexplored boundaries of adjustment theory, particularly temporal and contextual factors. These boundary conditions encompass discerning variances in adjustment predicated on the identity of the individuals undergoing adjustment (types of IEs, locals), the geographical locations involved (countries of origin and destination), and the timing of adjustment (anticipatory and in-country phases). Studies on expatriation and migration have explored distinct boundary conditions, but the findings need to be synthesised to inform future research on adjustment. Statistical data has revealed that the sampled populations are not fully representative, highlighting some research gaps that must be addressed. It is essential to compare the findings in the context of the “where” boundary condition to understand the topic better.

Thirdly, our systematic analysis underscores elevated researcher interest despite the increasing productivity in IE adjustment research over time by tracing evolutionary nuances to understand the trajectory of adjustment research (Mukherjee et al. 2022 ). However, a notable trend emerges wherein most research has predominantly focused on assigned expatriates, with all other IE categories receiving considerably less scholarly attention. This discrepancy highlights the imperative for a more equitable distribution of research focus across diverse IE cohorts to foster a comprehensive understanding of adjustment phenomena.

The fourth theoretical contribution centres on identifying significant knowledge gaps within adjustment research. Addressing these gaps necessitates a heightened focus on several areas in future studies. Specifically, increased attention should be given to anticipatory adjustment, particularly for migrants but encompassing all types of IEs. Additionally, there should be a more concentrated examination of in-country adjustment, specifically emphasising migrants and various country-related factors such as the cultural appeal of the home versus the host country, economic considerations, and political dynamics. Expanding the scope to include a broader range of countries of origin and destination, demographic variables, remote adjustment, and locals’ attitudes towards IEs’ adjustment or even their adjustment to them is essential.

The theoretical insights gleaned from systematic mapping highlight the necessity for future studies to adopt research methodologies that facilitate the evolution of adjustment theory from an intermediate to a mature stage, advocating for a hybrid research approach.

These findings contribute significantly to international human resource management and business, emphasising the need for additional research involving SIEs and migrants. Given the global rise in their numbers, particularly in less-explored countries and adjustment factors, such research has the potential to deepen our comprehension of the adjustment phenomenon.

Limitations and implications for research

The study is subject to several limitations that warrant acknowledgement. A methodological constraint is inherent in bibliometric analysis, as it primarily involves categorising and organising extensive bibliometric data (Andersen 2019 ). Although the supplementary content analysis of abstracts in this hybrid review offers additional insights into the state of research, it remains somewhat superficial. Future researchers are encouraged to delve deeper into relevant publications to facilitate a more nuanced differentiation of their research questions based on the research fields identified in this review.

Secondly, a limitation arises from our focus on business and management. The selection of articles inherently reflects a somewhat homogeneous perspective on IE adjustment research, with the organisational context typically foregrounded in these studies. Publications in sociology, economics, or psychology could offer additional insights into IE adjustment, such as those related to the macroeconomic context (sociology, economics) or individual antecedents, such as memory and identity (psychology).

Thirdly, our exploration was confined to the WoS database, inevitably influencing the articles. While it is generally acknowledged that there is a significant overlap in content indexed between WoS and Scopus (Pranckutė 2021 ), Donthu et al. ( 2021 ) advocate for selecting “one appropriate database to mitigate the need for that consolidation” (p. 293) and the associated risks of errors, a search in Scopus or Dimensions databases could have broadened the scope, considering they encompass journals not included in WoS.

Fourthly, our study’s search was restricted to English-language articles. Including articles in various languages would introduce research from diverse nations, fostering the exchange of research insights.

Conclusions

Based on a comprehensive review spanning 32 years of theory and research on adjustment, it is evident that studies concerning IE adjustment have seen a remarkable increase over this period. To advance adjustment theory and research further, future research should be deliberate in two key aspects: research design, incorporating purposeful sampling across demographics, types of IE, nationality, and destination countries, and methodological alignment through a hybrid approach that integrates qualitative and quantitative methods; and research focus, involving systematic selection and analysis of host countries alongside their social, political, and technological contexts, comparison of IE adjustment with that of local populations, examination of pre-departure and in-country adjustment among various IE types, and tracking adjustment over time, including remote settings. This proposed research agenda is extensive and essential for progressing intermediate adjustment theory towards maturity.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

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Baneviciene, I., Andresen, M. & Kumpikaite-Valiuniene, V. Assessing the status quo of international employees’ adjustment research, 1990–2022: a review and future research agenda. Humanit Soc Sci Commun 11 , 633 (2024). https://doi.org/10.1057/s41599-024-03098-y

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Social Cognitive and Addiction Neuroscience Lab at the University of Iowa

Research in the scanlab.

Research projects in the UIOWA Social Cognitive and Addiction Neuroscience Lab generally focus on one of the following areas:

The role of cognitive control in social behavior

Effects of alcohol on cognitive control 

Individual differences in neurobiologically based risks for addiction, primarily alcohol use disorder

Effects of incidental stimulus exposure on cognition and behavior (i.e., priming effects). 

The common theme around which these lines of work are integrated is the interplay between salience (i.e., motivational significance) and cognitive control (see Inzlicht, Bartholow, & Hirsch, 2015 ).

Salience, Cognitive Control, and Social Behavior

The interaction of salience and cognitive control is an enduring area of interest in the SCANlab, going back to Dr. Bartholow’s undergraduate days. In his undergraduate senior honors thesis, Dr. Bartholow found that participants asked to read résumés later recalled more gender-inconsistent information about job candidates. This general theme carried through to Dr. Bartholow’s dissertation research, in which he used event-related brain potentials (ERPs) to examine the neurocognitive consequences of expectancy violations. In that study, expectancy-violating behaviors elicited a larger P3-like positivity in the ERP and were recalled better compared to expectancy-consistent behaviors ( Bartholow et al., 2001 , 2003 ). Back then, we interpreted this effect as evidence for context updating (the dominant P3 theory at the time). As theoretical understanding of the P3 has evolved, we now believe this finding reflects the fact that unexpected information is salient, prompting engagement of controlled processing (see Nieuwenhuis et al., 2005 ).

Our research has been heavily influenced by cognitive neuroscience models of the structure of information processing, especially the continuous flow model ( Coles et al., 1985 ; Eriksen & Schultz, 1979) and various conflict monitoring theories (e.g., Botvinick et al., 2001 ; Shenhav et al., 2016 ). In essence, these models posit (a) that information about a stimulus accumulates gradually as processing unfolds, and (b) as a consequence, various stimulus properties or contextual features can energize multiple, often competing responses simultaneously, leading to a need to engage cognitive control to maintain adequate performance. This set of basic principles has influenced much of our research across numerous domains of interest (see Bartholow, 2010 ).

Applied to social cognition, these models imply that responses often classified as “automatic” (e.g., measures of implicit attitudes) might be influenced by control. We first tested this idea in the context of a racial categorization task in which faces were flanked by stereotype-relevant words ( Bartholow & Dickter, 2008 ). In two experiments, we found that race categorizations were faster when faces appeared with stereotype-congruent versus –incongruent words, especially when stereotype-congruent trials were more probable. Further, the ERP data showed that that this effect was not due to differences in the evaluative categorization of the faces (P3 latency), but instead reflected increased response conflict (N2 amplitude) due to partial activation of competing responses (lateralized readiness potential; LRP) on stereotype-incongruent trials. A more recent, multisite investigation (funded by the National Science Foundation ) extended this work by testing the role of executive cognitive function (EF) in the expression of implicit bias. Participants (N = 485) completed a battery of EF measures and, a week later, a battery of implicit bias measures. As predicted, we found that expression of implicit race bias was heavily influenced by individual differences in EF ability ( Ito et al., 2015 ). Specifically, the extent to which bias expression reflected automatic processes was reduced as a function of increases in general EF ability.

Another study demonstrating the role of conflict and control in “implicit” social cognition was designed to identify the locus of the affective congruency effect ( Bartholow et al., 2009 ), wherein people are faster to categorize the valence of a target if it is preceded by a valence-congruent (vs. incongruent) prime. This finding traditionally has been explained in terms of automatic spreading of activation in working memory (e.g., Fazio et al., 1986 ). By measuring ERPs while participants completed a standard evaluative priming task, we showed (a) that incongruent targets elicit response conflict; (b) that the degree of this conflict varies along with the probability of congruent targets, such that (c) when incongruent targets are highly probable, congruent targets elicit more conflict (also see Bartholow et al., 2005 ); and (d) that this conflict is localized to response generation processes, not stimulus evaluation.

Salience, Cognitive Control, and Alcohol

Drinking alcohol is inherently a social behavior. Alcohol commonly is consumed in social settings, possibly because it facilitates social bonding and group cohesion ( Sayette et al., 2012 ). Many of the most devastating negative consequences of alcohol use and chronic heavy drinking also occur in the social domain. Theorists have long posited that alcohol’s deleterious effects on social behavior stem from impaired cognitive control. Several of our experiments have shown evidence consistent with this idea, in that alcohol increases expression of race bias due to its impairment of control-related processes ( Bartholow et al., 2006 , 2012 ).

But exactly how does this occur? One answer, we believe, is that alcohol reduces the salience of events, such as a control failure (i.e., an error), that normally spur efforts at increased control. Interestingly, we found ( Bartholow et al., 2012 ) that alcohol does not reduce awareness of errors, as others had suggested ( Ridderinkhof et al., 2002 ), but rather reduces the salience or motivational significance of errors. This, in turn, hinders typical efforts at post-error control adjustment. Later work further indicated that alcohol’s control-impairing effects are limited to situations in which control has already failed, and that recovery of control following errors takes much longer when people are drunk ( Bailey et al., 2014 ). Thus, the adverse consequences people often experience when intoxicated might stem from alcohol’s dampening of the typical “affect alarm,” seated in the brain’s salience network (anterior insula and dorsal anterior cingulate cortex), which alerts us when control is failing and needs to be bolstered ( Inzlicht et al., 2015 ).

Incidental Stimulus Exposure Effects

A fundamental tenet of social psychology is that situational factors strongly affect behavior. Despite recent controversies related to some specific effects, we remain interested in the power of priming, or incidental stimulus exposure, to demonstrate this basic premise. We have studied priming effects in numerous domains, including studies showing that exposure to alcohol-related images or words can elicit behaviors often associated with alcohol consumption, such as aggression and general disinhibition.

Based on the idea that exposure to stimuli increases accessibility of relevant mental content ( Higgins, 2011 ), we reasoned that seeing alcohol-related stimuli might not only bring to mind thoughts linked in memory with alcohol, but also might instigate behaviors that often result from alcohol consumption. As an initial test of this idea, in the guise of a study on advertising effectiveness we randomly assigned participants to view magazine ads for alcoholic beverages or for other grocery items and asked them to rate the ads on various dimensions. Next, we asked participants if they would help us pilot test material for a future study on impression formation by reading a paragraph describing a person and rating him on various traits, including hostility. We reasoned that the common association between alcohol and aggression might lead to a sort of hostile perception bias when evaluating this individual. As predicted, participants who had seen ads for alcohol rated the individual as more hostile than did participants who had seen ads for other products, and this effect was larger among people who had endorsed (weeks previously) the notion that alcohol increases aggression ( Bartholow & Heinz, 2006 ). Subsequently, this finding has been extended to participants’ own aggression in verbal ( Friedman et al., 2007 ) and physical domains ( Pedersen et al., 2014 ), and has been replicated in other labs (e.g., Bègue et al., 2009 ; Subra et al., 2010 ).

Of course, aggression is not the only behavior commonly assumed to increase with alcohol. Hence, we have tested whether this basic phenomenon extends into other behavioral domains, and found similar effects with social disinhibition ( Freeman et al., 2010 ), tension-reduction (Friedman et al., 2007), race bias ( Stepanova et al., 2012 , 2018 a, 2018 b), and risky decision-making (Carter et al., in prep.). Additionally, it could be that participants are savvy enough to recognize the hypotheses in studies of this kind when alcohol-related stimuli are presented overtly (i.e., experimental demand). Thus, we have also tested the generality of the effect by varying alcohol cue exposure procedures, including the use of so-called “sub-optimal” exposures (i.e., when prime stimuli are presented too quickly to be consciously recognized). Here again, similar effects have emerged (e.g., Friedman et al., 2007; Loersch & Bartholow, 2011 ; Pedersen et al., 2014).

Taken together, these findings highlight the power of situational cues to affect behavior in theoretically meaningful ways. On a practical level, they point to the conclusion that alcohol can affect social behavior even when it is not consumed, suggesting, ironically, that even nondrinkers can experience its effects.

Aberrant Salience and Control as Risk Factors for Addiction

Salience is central to a prominent theory of addiction known as incentive sensitization theory (IST; e.g., Robinson & Berridge, 1993 ). Briefly, IST posits that, through use of addictive drugs, including alcohol, people learn to pair the rewarding feelings they experience (relaxation, stimulation) with various cues present during drug use. Eventually, repeated pairing of drug-related cues with reward leads those cues to take on the rewarding properties of the drug itself. That is, the cues become infused with incentive salience, triggering craving, approach and consummatory behavior.

Research has shown critical individual differences in vulnerability to attributing incentive salience to drug cues, and that vulnerable individuals are at much higher risk for addiction. Moreover, combining incentive sensitization with poor cognitive control (e.g., during a drinking episode) makes for a “potentially disastrous combination” ( Robinson & Berridge, 2003 , p. 44). To date, IST has been tested primarily in preclinical animal models. Part of our work aims to translate IST to a human model.

In a number of studies over the past decade, we have discovered that a low sensitivity to the effects of alcohol (i.e., needing more drinks to feel alcohol’s effects), known to be a potent risk factor for alcoholism, is associated with heightened incentive salience for alcohol cues. Compared with their higher-sensitivity (HS) peers, among low-sensitivity (LS) drinkers alcohol-related cues (a) elicit much larger neurophysiological responses ( Bartholow et al., 2007 , 2010 ; Fleming & Bartholow, in prep.); (b) capture selective attention ( Shin et al., 2010 ); (c) trigger approach-motivated behavior ( Fleming & Bartholow, 2014 ); (d) produce response conflict when relevant behaviors must be inhibited or overridden by alternative responses ( Bailey & Bartholow, 2016 ; Fleming & Bartholow, 2014), and (e) elicit greater feelings of craving (Fleming & Bartholow, in prep.; Piasecki et al., 2017 ; Trela et al., in press). These findings suggest that LS could be a human phenotype related to sign-tracking , a conditioned response reflecting susceptibility to incentive sensitization and addiction ( Robinson et al., 2014 ).

Recently, our lab has conducted two major projects designed to examine how the incentive salience of alcohol-related cues is associated with underage drinking. One such project, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01-AA020970 ), examined the extent to which pairing beer brands with major U.S. universities enhances the incentive salience of those brands for underage students. Major brewers routinely associate their brands with U.S. universities through direct marketing and by advertising during university-related programming (e.g., college sports). We tested whether affiliating a beer brand with students’ university increases the incentive salience of the brand, and whether individual differences in the magnitude of this effect predict changes in underage students’ alcohol use. We found (a) that P3 amplitude elicited by a beer brand increased when that brand was affiliated with students’ university, either in a contrived laboratory task or by ads presented during university-related sports broadcasts; (b) that stronger personal identification with the university increased this effect; and (c) that variability in this effect predicted changes in alcohol use over one month, controlling for baseline levels of use ( Bartholow et al., 2018 ).

A current project, also funded by the NIAAA ( R01-AA025451 ), aims to connect multiple laboratory-based measures of the incentive salience of alcohol-related cues to underage drinkers’ reports of craving, alcohol use, and alcohol-related consequences as they occur in their natural environments. This project will help us to better understand the extent to which changes in drinking lead to changes in alcohol sensitivity and to corresponding changes in the incentive salience of alcohol-related cues.

Managing boundaries for well-being: a study of work-nonwork balance crafting during the COVID-19 pandemic

• Open access
• Published: 17 May 2024

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• Sophie E. Brogle 1 ,
• Philipp Kerksieck   ORCID: orcid.org/0000-0001-5327-3668 1 ,
• Georg F. Bauer   ORCID: orcid.org/0000-0003-0232-8141 1 &
• Anja I. Morstatt   ORCID: orcid.org/0000-0001-6223-9939 1  

In the wake of the COVID-19 pandemic, the boundaries between the work and nonwork domain have rapidly blurred, presenting employees with new challenges and potentially heightening interference of the work with the nonwork domain (work-home interference, WHI) and vice versa (home-work interference, HWI). To counteract these interferences, employees can apply work-nonwork balance crafting (WNBC), referring to proactive efforts for balancing both life domains by targeting the permeability of the boundary between them. Employees may focus their crafting on the boundary toward the work domain (WNBC-work) or the non-work domain (WNBC-nonwork), e.g., shielding each domain from negative spillover from the other. This study aims to investigate the longitudinal associations of WNBC with health outcomes during the COVID-19 pandemic. We hypothesized that individuals who exhibited more such crafting behaviors at the onset of the pandemic would experience higher mental well-being and work engagement at later points in the COVID-19 pandemic, mediated by lower WHI and HWI. We surveyed N  = 2,171 German-speaking employees from Germany, Austria, and Switzerland at three time points during 2020. Structural equation model results indicate that only WNBC-work is longitudinally negatively associated with reduced HWI and positively associated with mental well-being and work engagement. Further, in our sample, only HWI is longitudinally associated with lower mental well-being. No indirect effect reaches significance. Our results underline the importance of WNBC in the work domain in the early phases of the COVID-19 pandemic. Future research should explore the nature of the direct links between WNBC and mental well-being and work engagement and consider alternative mediating processes, such as gain spirals. Lastly, our study underscores that supporting employees in crafting boundaries for well-being can be crucial, particularly during times of crisis.

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Introduction

The world was hit by the COVID-19 pandemic in March 2020, and governments worldwide aimed to contain the virus and prevent its spreading by inaugurating various measures, e.g., school closures, remote work, nationwide lockdowns (Hale et al., 2021 ; Rudolph et al., 2021 ). Since then, life for many employees has changed drastically, and the boundaries between work and nonwork have blurred increasingly (Cho, 2020 ; Vaziri et al., 2020 ). For many, their life domains clashed literally, as they were forced to work remotely, through which private and professional life occurred in the same physical space (Kaltiainen & Hakanen, 2023 ; Kniffin et al., 2021 ). For others, e.g., health workers or supermarket staff, a drastic increase in workload and increasingly straining mental and physical work conditions might have interfered with their capacities to deal with nonwork demands (Benfante et al., 2020 ). Such life domain conflicts are associated with adverse health consequences such as exhaustion (Reinke & Gerlach, 2022 ), but also reduced work engagement (Karatepe & Karadas, 2016 ) and impaired mental health (Yucel & Fan, 2019 ). For the time of the pandemic, a large study in the UK covering only a time frame until May 2020 indicated that mental health was negatively affected in this early phase (O’Connor et al., 2021 ). Thus, more knowledge on how life domain conflicts and impaired health unfolded throughout the pandemic is needed. Further, employees might have experienced the pandemic differentially, likely depending on their proactive and agentic efforts to deal with the pandemic (Demerouti & Bakker, 2022 ). Thus, the present study aims to examine how employees’ proactive crafting of the boundaries between work and non-work life domains is related to employee health during the COVID-19 crisis. We hypothesized that exhibiting more WNBC at the start of the pandemic would be associated with higher mental well-being and work engagement 8 months later, mediated by lower WHI and HWI.

Proactive behaviors, e.g., job crafting (Tims et al., 2012 ; Tims & Bakker, 2010 ; Wrzesniewski & Dutton, 2001 ), have been shown to play a relevant role in changing situations, e.g., organizational changes, and in maintaining work engagement (Petrou et al., 2018 ). Further, job crafting has been identified as a buffer to life domain conflicts (Lyu & Fan, 2022 ). However, the single life domain focus for crafting lacks breadth in understanding proactivity. The concept of job crafting has recently been transferred to the off-job domain (see literature on off-job crafting; Kujanpää et al., 2022 ) and further to the idea that the boundaries between life domains and, therefore, a balance between them can also be actively crafted (work nonwork balance crafting; WNBC) (Kerksieck et al., 2022 ). Due to the above-described shifting and blurring of work-nonwork boundaries during the COVID-19 crisis, WNBC, as a targeted, proactive strategy, is well suited to study how employees dealt with the clashing of life domains and how this is related to mental well-being and work engagement of employees during the first year of the global health crisis. Recent research indicates that there may be associations between crafting in different life domains, and that crafting is not limited to specific life domains but can also span across life domains (de Bloom et al., 2020 ; Demerouti et al., 2020 ). Consequently, WNBC itself focuses on the proactive crafting of said boundary and not, as other types of crafting, on crafting specific life domain characteristics with a focus on a single domain. We used a cross-lagged panel model approach with three waves, covering a period of 8 months during 2020. For the analysis, a structural equation model was specified, and the hypotheses were tested using path estimates. Our research model is depicted in Fig.  1 .

Our study makes two main contributions to research on the COVID-19 pandemic and crafting in general. First, our study captures a significant part of the first pandemic year and can shed light on long-term associations of proactive behaviors early in the pandemic. The beginning of the pandemic was a difficult time for most people. In many cases, workers faced a completely new situation, e.g., when affected by home office regulations (Tušl et al., 2021 ). However, by forming new routines and adapting behaviors to the novel needs caused by the pandemic and lockdown measures, people had a chance to influence their future experience of the pandemic (Chankasingh et al., 2022 ). By reviewing how WNBC at the pandemic onset is longitudinally linked with life domain conflicts and well-being, we provide knowledge on how to design early interventions supporting employees in their own crafting during future emergencies. For policymakers as well as organizations, this can increase future crisis preparedness.

Second, we add knowledge to WNBC research and, more specifically, whether life domain conflicts mediate between WNBC and well-being in both life domains, more specifically with mental well-being and work engagement. Previously, it was already demonstrated that WNBC is longitudinally linked with family role and job performance, job and life satisfaction, and work engagement (Kerksieck et al., 2022 ). However, the mechanisms still need to be clarified. Further, we closely examine domain-specific associations, which aids in understanding which domain focus might be more relevant in maintaining well-being over time. Those insights are highly significant for a more informed crisis management and can help organizations in supporting their employees to use bottom-up self-management crafting strategies to their benefit. This is important, since research on life-role interference during the pandemic has indicated the urgent need for proactive adjustments of roles employees fulfill at work and at home (Syrek et al., 2022 ). Furthermore, this knowledge about the role of WNBC will become ever more important even outside of the pandemic context, as the future of work will increasingly require the ability to deal with demands from the continuously intertwined work and nonwork domains (Caringal-Go et al., 2022 ; Mäkikangas et al., 2024 ; Rudolph et al., 2021 ).

Work-nonwork balance crafting as a buffer to life domain conflicts

Crafting generally describes self-initiated behaviors people undertake to shape or mold certain aspects of their lives according to their individual needs or preferences (Wrzesniewski & Dutton, 2001 ). Specifically, WNBC (Kerksieck et al., 2022 ) builds on this conceptualization and refers to proactive behaviors aiming to craft the boundaries between work and nonwork life according to individual needs (de Bloom et al., 2020 ). Other forms of crafting, e.g., job crafting (Tims et al., 2012 ; Wrzesniewski & Dutton, 2001 ) or off-job crafting (Kujanpää et al., 2022 ) show negative associations with stress experience (Ingusci et al., 2021 ) and burnout (Pijpker et al., 2022 ), among others.

WNBC efforts can focus on different life domains, resp. dimensions. For example, if someone tries hard to make time to take care of their remotely schooled children (due to the lockdown) while being strongly demanded by their work tasks, they focus on their private life and proactively ensure that they can meet their family obligations. Employees might be proactively setting clear time boundaries for work-related requests. In this way, the caring responsibilities in the nonwork life domain are prioritized. Work-related demands are dealt with after caring duties have been completed. In this way, crafting efforts are directed towards the employee’s nonwork life domain (WNBC-nonwork). On the other hand, employees might also proactively regulate a bad mood due to non-work reasons, e.g., increasingly demanding and stressful caring responsibilities due to COVID-19 measures, so that their work life is not affected. Their crafting efforts are then focused on the work life domain (WNBC-work). These two behaviors – protecting the work domain from the nonwork domain and vice versa – are not mutually exclusive and can take place simultaneously. Additionally, WNBC can occur as physical, relational, or cognitive crafting (Kerksieck et al., 2022 ). While theories on segmentation and integration are already well studied (Ashforth et al., 2000 ), they lack a nuanced perspective of how the boundary between life domains is created. WNBC suggests an active process whereby employees build their boundary from both sides: When guarding the work domain, they may prevent spillover from the non-work domain to the work domain, while still allowing a spillover from work to non-work, and vice versa. Therefore, WNBC offers a more comprehensive perspective that also allows for the prioritization of one domain. To summarize, WNBC refers to proactive behaviors aimed at balancing life domains – or managing life domain conflicts – and can be focused on the work or the nonwork domain.

Intensified life domain conflicts as consequence of pandemic working conditions

At the beginning of the pandemic, forced teleworking, increasing strain at work, and, for many, also increased care duties rapidly aggravated life domain conflicts. Both work-home interference (WHI) and home-work interference (HWI) (Kopelman et al., 1983 ) are indicators of a disturbed life domain balance, resulting in, i.e., life domain conflicts. When experiencing high WHI, an individual might not be able to fully enjoy the company of their family and friends because they worry about their work, which might be more demanding than usual due to the changed work form and workplace uncertainty during the pandemic. Whereas when experiencing high HWI, an individual might have issues focusing on work because they are preoccupied with worries about one of their family members being ill or struggling during the pandemic. Although the two constructs are conceptually separated due to the different directions of influence, they are related and can co-occur (Frone et al., 1992 ).

During the pivotal pandemic phase when first containment measures were put in place, we assume that the adoption and extent of WNBC practices varied among individuals and that WNBC potentially acted as a buffer against the escalation of life domain conflicts. Especially the beginning of the pandemic has been a crucial phase that set how employees experienced the subsequent course of the pandemic (Chankasingh et al., 2022 ). When crafting for the boundaries between the work and nonwork life, potentially a work-nonwork balance is created (Gravador & Teng-Calleja, 2018 ) and accompanied by lower conflicts between the two domains (both WHI and HWI), depending on the domain focus of the crafting.

Relationships between WNBC and life domain conflicts

We assume a life domain congruence in the association between WNBC and the life domain conflicts, such that WNBC with a focus on the nonwork domain is negatively associated with WHI, and WNBC with a focus on the work domain is negatively associated with HWI. Previous research found that high work demands, e.g., a high workload, predict WHI and high demands in the private domain predict HWI (Demerouti et al., 2004 ). In general, employees employing WNBC use different behaviors to prevent the potential for conflict between their work and private life domains. Employees focusing on WNBC in the nonwork domain, e.g., strategically distribute their work hours, thereby creating pockets of dedicated quality time with their family or partner. By orchestrating such intentional compartmentalization, WNBC minimizes the permeation of work-related stressors into the nonwork domain. Similarly, employees focus WNBC on the work domain, e.g., craft clashing domains, by actively planning their working days and fitting small time pockets to complete necessary private chores while ensuring that their work receives sufficient attention. Further, WNBC also captures employees’ behaviors to prevent negative affect spillover in the work or the nonwork domain to protect their resources and maintain their functioning in both life domains. This should in the long run reduce life domain conflicts as well.

Drawing a specific lens on the unfolding of the pandemic, we suggest that individuals who embraced WNBC strategies during the initial stages of the crisis were able to mitigate the aggravation of life domain conflicts. This proactive stance towards WNBC might have acted as a buffer against the rising challenges imposed by the pandemic. Consequently, as the pandemic unfolded, individuals who had actively engaged in higher levels of WNBC might have been better positioned to navigate subsequent challenges, leading to a diminished prevalence of life domain conflicts in their ongoing experiences compared to those who had engaged in comparatively less WNBC practices.

Based on the above literature review, we derive the following hypotheses:

H1.1: WNBC-nonwork at the pandemic onset (t1) is negatively associated with WHI in the middle of 2020 (t2).

H1.2: WNBC-work at the pandemic onset (t1) is negatively associated with HWI in the middle of 2020 (t2).

Life domain conflicts and impaired long-term mental well-being and work engagement

Experiencing life domain conflicts impairs health and well-being both in the short and long run (e.g., Karatepe & Karadas, 2016 ; Yucel & Fan, 2019 ). According to the Work-Home Resources Model (ten Brummelhuis & Bakker, 2012 ), chronic demands or life domain conflicts lead to a person having to constantly invest resources, which can lead to a depletion process over time. This continuous resource depletion (termed “loss spiral” in the Conservation of Resources Theory (COR; Hobfoll, 1989 ) is associated with negative consequences (e.g., Brosschot et al., 2006 ), including reduced work engagement (Halbesleben, 2010 ; Xanthopoulou et al., 2009 ).

Thus, we suggest that also during the COVID-19 pandemic, both types of life domain conflicts are negatively associated with subsequent mental well-being and work engagement, the health indicators of our study. Whether in pre-pandemic times or since the onset of the pandemic, whenever employees experience life domain conflicts, they need to invest resources to maintain their usual level of performance and to deal with the demands of their work and nonwork life, which further drains their resources and impairs their health.

First, we study how life domain conflicts are linked with mental well-being. The WHO defines mental well-being as a state ‘which allows individuals to realize their abilities, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their community’ (World Health Organization, 2001 , p. 1). It captures both aspects of satisfaction, positive affect, and psychological functioning (Ryan & Deci, 2001 ). As life domain conflicts have been linked with higher stress (Chapman et al., 1994 ), lower life satisfaction (Adams et al., 1996 ), and reduced general well-being (Grant-Vallone & Donaldson, 2001 ), we suggest that they predict reduced mental well-being as well.

H2.1: (a) HWI and (b) WHI in the middle of 2020 (t2) are negatively related to mental well-being at the end of 2020 (t3).

Second, we study how life domain conflicts are linked with work engagement. Work engagement can be defined as a positive, fulfilling state in which employees strive to actively use their personal resources to accomplish the work tasks at hand and perform well in the process (Schaufeli & Greenglass, 2001 ). Previous research has shown that life domain conflicts in both directions are negatively associated with work engagement (Karatepe & Karadas, 2016 ), both before and during the pandemic (Galanti et al., 2021 ). When private life interferes with work, e.g., due to additional care duties for stay-at-home children who had remote classes during the pandemic (Rieth & Hagemann, 2021 ), employees might have a more challenging time focusing on work, thereby limiting the experience of work engagement. However, work might also interfere with private life, e.g., due to forced teleworking, which might call employees to invest additional resources to maintain performance, increasing exhaustion in the long run. Accordingly, Kaltiainen and Hakaken ( 2023 ) report an indirect link between increased telework due to the pandemic and decreased work engagement via WHI. To conclude, we suggest that both types of life domain conflicts are associated with lower work engagement:

H2.2: (a) HWI and (b) WHI in the middle of 2020 (t2) are negatively related to work engagement at the end of 2020 (t3).

WNBC and subsequent mental well-being and work engagement

Finally, in this study, we also aim to study the long-term association between WNBC and both mental well-being and work engagement via reduced life domain conflicts. This adds depth to our understanding of how proactive behaviors early in the pandemic could be connected to long-term health and well-being. Notably, the direct link between WNBC and heightened work engagement has been substantiated in existing literature (Kerksieck et al., 2022 ). Our study examines a potential mechanism explaining this association by reviewing the life domain conflicts as mediators. Therefore, we link WNBC as a proactive and preventive strategy to the loss spiral between life domain conflicts and health and well-being. By its proactive nature, WNBC might preempt and neutralize potential conflicts that may arise in the context of the COVID-19 pandemic’s unique demands. In doing so, WNBC may counter the loss spiral and prevent the gradual depletion of personal resources occasioned by unaddressed life domain conflicts. In turn, WNBC potentially aids in preserving and potentially augmenting precious personal resources and maintaining health and well-being.

To conclude, we suggest the following hypotheses:

H3.1: WNBC-nonwork at the pandemic onset (t1) is indirectly positively related to (a) work engagement and (b) mental well-being at the end of 2020 (t3), mediated by WHI in the middle of 2020 (t2).

H3.2: WNBC-work at the pandemic onset (t1) is indirectly positively related to (a) work engagement and (b) mental well-being at the end of 2020 (t3), mediated by HWI in the middle of 2020 (t2).

Data collection and sample

For our study, we refer to three time points from a more extensive longitudinal panel data collection. The three survey waves cover the period from April 2020 to December 2020 (see Fig.  1 ). Participants were recruited via the market research provider Bilendi (formerly respondi; www.bilendi.de ). Inclusion criteria were a weekly working time of at least 20 h per week and being employed. The age ranged from 17 to 66 years ( M  = 46.9, SD  = 11.23), with 45.78% of the sample identifying as female. Participants came from Germany, Austria, or Switzerland. Sample sizes were 2,130 (wave 1), 1,633 (wave 2), and 1,178 (wave 3). In total, adjusted data points from 2,171 participants are available between waves 1 and 3, whereby participants who only took part in one wave were also included.

Research model. Note . H3.1 and H3.2 are mediation hypotheses whose sub-paths are shown in the model. For the constructs at t2 and t3, stability was controlled by including an autoregressive path from the previous wave, though not shown in the model. The nationwide Swiss lockdown due to the COVID-19 pandemic began on March 16 th , 2020 (Lockdown, 2021 )

Dropout analyses of those participants who only participated in wave 1 and not in waves 2 and 3 were performed (dropout: N  = 497). Mean differences in age ( M continuers = 47.71 years vs. M dropout = 44.02 years; t (764.15) = 6.1501, p  < .001) and life domain conflicts (WHI: M continuers = 1.85 vs. M dropout = 1.92; t (778.56) = -2.482, p  = .013; HWI: M continuers = 1.55 vs. M dropout = 1.62; t (778.32) = -2.684, p  = .007) were significant, indicating that the participants who dropped out after wave 1 were slightly younger and experienced higher life domain conflicts than the people who kept on participating in wave 2 and/or 3. In both cases, the group means were close to each other. There was no significant difference for gender and WNBC.

All measures were presented in German. In Table  1 , descriptive statistics and correlations between measures are presented.

• Work-nonwork balance crafting

WNBC was measured at wave 1 with 16 items of the Work-Nonwork Balance Crafting Scale (Kerksieck et al., 2022 ). The construct consists of two factors – crafting in the work and the nonwork domain. In the original scale, both factors contain all three crafting behaviors established (physical, relational, and cognitive/emotional). Example items are: ‘ If I must get personal chores done during working time, I make sure that my work won’t be negatively affected. ’ (WNBC-work) and ‘ I try hard to meet my private obligations, even if I’m demanded strongly by my work. ’ (WNBC-nonwork). The response format corresponds to a 5-point Likert scale (1 = ‘strongly disagree’ to 5 = ‘strongly agree’). Thus, a higher score indicated that respondents craft a less permeable boundary toward the focused domain, e.g., the work domain. In such a case, employees inhibit a spillover from, for example, negative emotions experienced outside of work to the work domain. The items were asked concerning the last four weeks. The original WNBC construct as a two-factor solution had a poor model fit (χ 2 (76) = 2055.731, p  < .001, CFI = 0.669, TLI = 0.602, RMSEA = 0.111, SRMR = 0.092). We suggest that the scale in its complete form is not fully applicable to participants’ situations at the onset of the pandemic. Therefore, the scale was shortened via an iterative, theory-based process based on the consensus of two raters (First and last author), and all authors agreed to the shortened version. We removed items referring to, e.g., physical crafting, vacations, and work goals, as during the pandemic, many employees worked from home, vacations were not possible, and we argue that work goals might not have been a priority in such uncertain times. For example, Kossek et al. ( 2021 ) identified in a qualitative study on women working in STEM jobs that they experienced substantial role demands associated with work and nonwork role sacrifice during the pandemic. Thus, adapting the original WNBC scale to represent the challenging and unique time more adequately at the onset of the pandemic resulted in a shortened scale of 8 items, four mirroring items for each of the two factors (see Appendix Table 3 ). Since each of the items that belong to a different crafting domain (e.g., work) share variance through a common crafting dimension (e.g., relational), four residual covariances for each of the mirroring items were added, resulting in a satisfactory model fit (χ 2 (15) = 99.859, p  < .001, CFI = 0.970, TLI = 0.944, RMSEA = 0.052, SRMR = 0.029). In allowing such residual covariances, we follow the approach taken by (Kerksieck et al., 2022 ) for the initial scale.

Home-work-interaction and work-home-interaction

HWI and WHI (Kopelman et al., 1983 ) were assessed at wave 1 (stability control) and wave 2 (mediators in research model) with four and eight items from the Survey Work-Home Interaction – NijmeGen (Geurts et al., 2005 ). Items were anchored on a 4-point Likert scale (0 = ‘never’ to 3 = ‘always’). An example item for HWI is: ‘ How often does it occur that problems with your spouse/family/friends affect your job performance? ’ and for WHI, an example item is: ‘ How often does it occur that you are irritable at home because your work is demanding? ’. The higher the score, the more respondents experienced an interference between the work and home life domains.

Mental well-being and work engagement

Mental well-being was assessed at wave 2 (stability control) and wave 3 (outcome in research model) with seven items from the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS; Tennant et al., 2007 ). The items refer to the last two weeks. An example item is: ‘ I felt optimistic about the future ’. The 5-point Likert scale ranges from 1 = ‘none of the time’ to 5 = ‘all of the time’, whereby a higher score indicated more mental well-being.

Work engagement was assessed at wave 2 (stability control) and wave 3 (outcome in research model) with nine items from the Utrecht Work Engagement Scale (UWES-9; Schaufeli et al., 2006 ). These include the three dimensions of vitality, dedication, and absorbedness. An example item is: ‘ At my work, I feel bursting with energy. ’ (dedication). The 7-point Likert scale ranges from 0 = ‘never’ to 6 = ‘always’, whereby a higher score reflects more work engagement.

Data analysis strategy

The data was prepared and analyzed with the open-source statistical program R Project (R Core Team, 2020 ) and the R package lavaan (Rosseel, 2012 ). First, the data was processed and checked to see if any cases needed to be excluded, e.g., due to unemployment at the time of the survey. Because four constructs were included in the model from two points, measurement invariance was analyzed for these constructs using confirmatory factor analyses (CFA) and following the common recommendations for longitudinal analyses (Putnick & Bornstein, 2016 ). As a minimum requirement, metric measurement invariance (equal factor structure and factor loadings) referring to equal factor loadings across time should hold in longitudinal models (Putnick & Bornstein, 2016 ). Model fit indices were accepted if close to recommended cut-off criteria, e.g., Root Mean Square Error of Approximation (RMSEA < 0.06) or Comparative Fit-Index (CFI ≥ 0.95) (Hu & Bentler, 1999 ). Furthermore, model comparison tests between the proposed measurement models against one-factor models were conducted for each wave. In the next step, the structural equation model was specified, and the hypotheses were tested using path estimates. Hypotheses 3.1a, 3.1b, 3.2a, and 3.2b, which predict a mediation effect, were also tested. Bootstrapping with 2,000 bootstraps was used as the calculation method, which, according to Hayes and Scharkow ( 2013 ), is the most suitable procedure for indirect effects. For missing values, the full information maximum likelihood method was used (Arbuckle et al., 1996 ). After the results of the hypothesized associations, post hoc analyses were conducted to investigate hypotheses that did not turn out as expected.

Before specifying the full research model, we examined whether assumptions of measurement invariance hold for those constructs for which we control for stability in the model. For WHI together with HWI, the model with metric measurement invariance indicated a good model fit (χ 2 (244) = 1238.667, p  < .001, CFI = 0.955, TLI = 0.949, RMSEA = 0.044, SRMR = 0.040). For mental well-being and work engagement, the models with residual measurement invariance (additionally equal item intercepts and residual variances) fit the data well and superior to less strict assumptions (mental well-being: χ 2 (75) = 831.135, p  < .001, CFI = 0.940, TLI = 0.927, RMSEA = 0.078, SRMR = 0.046; work engagement: χ 2 (151) = 705.050, p  < .001, CFI = 0.982, TLI = 0.982, RMSEA = 0.047, SRMR = 0.020). Our final model reaches a good fit as well (χ 2 (1955) = 9421.085, p  < .001, CFI = 0.897, TLI = 0.894, RMSEA = 0.042, SRMR = 0.076).

The direct and indirect effects of the research model are presented in Table  2 . First, we review the associations from WNBC to the life domain conflicts. The link between WNBC-work and HWI is significant ( b = -0.047, SE  = 0.021, p  = .024), but the link between WNBC-nonwork and WHI is not significant at a = 0.05 ( b  = 0.018, SE  = 0.025, p  = .465). Therefore, our results support H1.2, but not H1.1. Next, we review the associations of HWI and WHI with work engagement and mental well-being. Only the link between HWI and mental well-being is significant ( b = -0.154, SE  = 0.066, p  = .018), but all other hypothesized links are not significant (WHI to mental well-being: b  = 0.002, SE  = 0.045, p  = .959; HWI to work engagement: b = -0.181, SE  = 0.113, p  = .109; WHI to work engagement: b = -0.096, SE  = 0.083, p  = .250). Therefore, our results support H2.1a, but not H2.1b, H2.2a, or H2.2b. Lastly, we specified indirect effects from WNBC-work and -nonwork to work engagement and mental well-being via life domain conflicts. We obtained these results by bootstrapping our research model (no. of bootstraps = 2000). No significant indirect effects emerged as all 95% confidence intervals include zero (see Table  2 for full results). Therefore, our results do not support the hypotheses H3.1a, H3.1b, H3.2a, or H3.2b.

Interestingly, the autoregressive paths of both WHI ( b  = 0.824, SE  = 0.019, p  < .001) and HWI ( b  = 0.797, SE  = 0.023, p  < .001) were relatively stable between the two waves, as were the autoregressive paths of mental well-being ( b  = 0.766, SE  = 0.028, p  < .001) and work engagement ( b  = 0.784, SE  = 0.022, p  < .001). The discussion examines how this high stability, especially of life domain conflicts, could help explain the results.

Furthermore, although no hypotheses were formulated for the direct association between the WNBC facets and the outcomes, the paths were also specified in the structural equation model. Direct paths between WNBC-work at wave 1, mental well-being at wave 3, and work engagement at wave 3, resp. WNBC-nonwork at wave 1, mental well-being at wave 3, and work engagement at wave 3 were specified. Results show a significant positive association between WNBC-work and work engagement ( b  = 0.371, SE  = 0.148, p  = .012) and WNBC-work and mental well-being ( b  = 0.145, SE  = 0.061, p  = .018). No significant associations were found for WNBC-nonwork and work engagement ( b = -0.037, SE  = 0.124, p  = .763), nor WNBC-nonwork and mental well-being ( b = -0.013, SE  = 0.059, p  = .828).

We aimed to explore the role of WNBC during the COVID-19 pandemic and its longitudinal associations with mental well-being and work engagement via WHI and HWI. For our study, we referred to survey data that captured a significant part of 2020, where the onset of the pandemic and two lockdowns had major implications for the lives of many employees. Therefore, our study provides valuable information on how behavior early in the pandemic is associated with long-term health and well-being. This section discusses our main findings concerning their theoretical and practical contributions.

WNBC and life domain conflicts during the COVID-19 pandemic

We hypothesized that WNBC-work is negatively associated with HWI and WNBC-nonwork with WHI, but our results only support the first relationship (support for H1.2, but not H1.1). Considering the unique context of the pandemic, mandatory work reductions or increased workload were previously found to be associated with a perceived negative impact of the pandemic on work-life (Tušl et al., 2021 ), which might have overshadowed and impaired individual efforts. This shows that to address WHI, individual efforts were not enough, and employees were in high need of support from organizations, e.g., through more flexibility. On the other hand, individual efforts to protect the work domain prevented HWI, highlighting that employees can effectively support themselves in this area.

Further, we discuss two additional aspects that might have played a role in these findings. First, we note the relatively high stability of the life domain conflicts that emerged in our analyses. WHI and HWI turned out to be more stable than expected between wave 1 and wave 2, meaning that people’s perceived life domain conflicts between April and June/July hardly changed. This leaves little room for individual efforts such as crafting to explain remaining variance. Considering shorter timeframes to investigate the association between WNBC and life domain conflicts might be useful. Potentially, individual crafting has a more nuanced effect on life domain conflicts on a shorter, weekly to monthly basis, whereas, in more extended periods, more stable trends occur. Indeed, previous research points to short-term fluctuations in life domain conflicts, predicted by, e.g., daily workload (Ilies et al., 2007 ), but higher mean stability over mid- to long-term time frames (Smith et al., 2022 ). Similar stabilities have been reported when comparing pre-pandemic and pandemic levels of work-family conflict (Bernhardt et al., 2023 ; Reimann et al., 2022 ). Thus, we suggest that future research on the association of WNBC and life domain conflicts also considers shorter time frames.

Within our study, we used a shortened 8-item version of the WNBC-scale that better fits the context of the pandemic than the original full scale. During the iterative, theory-driven, and two-person consensus-based process, aspects of the initial scale were dropped, e.g., the aspect of crafting a physical boundary. The original scale incorporated physical WNBC as, e.g., an earlier or later start to work if needed due to obligations outside of work (Kerksieck et al., 2022 ). During the pandemic, employees may have adopted other crafting strategies, such as going grocery shopping during working hours to avoid big crowds and, therefore, limit the spread of covid viruses. Furthermore, some of the items that were omitted for the shortened scale included strategies that were thought to be deprioritized due to the crisis. For example, one item describes a cognitive/emotional strategy in which employees temporarily emphasize their work (e.g., work more before vacations to get things done; Kerksieck et al., 2022 ). Since the pandemic and its lockdown measures caused a shift in focus and impeded travelling plans, vacations were not a well-suited example during this time of crisis. In modern working times, such behaviors and possible scenarios should also be considered and captured by a revised WNBC scale.

The shortened WNBC scale focuses mainly on cognitive crafting. Therefore, we can also interpret our findings regarding the specific aspects of crafting retained in the scale: To prevent HWI, aspects of cognitive crafting are quite important. However, more action-oriented or social crafting strategies, such as communicating with others, might play a more vital role in preventing WHI. As these aspects are not reflected in our shortened scale, this might explain the absence of a link between WNBC-nonwork and WHI. However, communicating with others to secure boundaries between work and nonwork was reported as the least often used strategy by parents working from home in a study by Allen et al. ( 2021 ). Considering that the pandemic likely had lasting impacts on the accelerated new work movement, a revised balance crafting scale could be helpful to represent better the post-pandemic work context (Kniffin et al., 2021 ; Rudolph et al., 2021 ). Lastly, future use of our shortened scale would provide more information on its validity and reliability measures (Clark & Watson, 2016 ).

Life domain conflicts, work engagement, and mental well-being

Partly in line with previous findings (e.g., Karatepe & Karadas, 2016 ), we only found a significant association between HWI and mental well-being (supporting H2.1a, but not H2.1b, H2.2a, or H2.2b). Therefore, employees who experienced high levels of HWI in the middle of 2020 reported lower mental well-being at the end of 2020, highlighting them as an at-risk group in need of further support. For those employees whose life outside of work was affecting their work life, organizational support might be highly relevant, e.g., by providing appropriate flexibility and autonomy or reviewing projects and workload (Kossek et al., 2021 ). However, work engagement was not longitudinally associated with HWI, and neither was WHI with the health outcomes we reviewed. The unique context of the pandemic needs to be considered and might provide possible explanations. Research highlighted that compared to pre-pandemic states, life domain conflicts, and other stressors increased (Reimann et al., 2022 ). The WHO reported that from the onset of the pandemic onwards, the prevalence of mental health issues (e.g., anxiety) rose, yet at the same time also the awareness of mental health issues (World Health Organization, 2022 ). In milder cases, the open discussion of risk factors such as life domain conflicts and stressors might have equipped employees with more coping tools (Pfefferbaum & North, 2020 ), therefore limiting the effect of life domain conflicts on work engagement and mental well-being. Accordingly, research also found a growing resilience in mental health of the population in response to the pandemic (Daly & Robinson, 2021 ).

WNBC and long-term health and well-being during the pandemic

Lastly, we assumed a longitudinal link between WNBC, work engagement, and mental well-being via life domain conflicts. Our results do not support such an indirect effect (H3.1a, H3.1b, H3.2a, H3.2b), but we found direct significant links between WNBC-work and both outcomes. Considering the complex, differentiated associations between WNBC with the life domain conflicts and the life domain conflicts with the health outcomes, it is unsurprising that we did not find an indirect effect. The significant relationship between WNBC-work and work engagement over eight months is in line with a previous finding, which showed the same association for a three-month period (Kerksieck et al., 2022 ). Thus, we corroborate the longitudinal association, but the effect is not mediated by life domain conflicts, as was assumed in the hypotheses of this study. It is unknown whether this finding might be caused by a lagged or a cumulative effect or if interpersonal differences in traits, such as identification with one’s job, are responsible for this association between eight months. Identification with one’s job could explain why those employees who emphasized protecting their work domain also report higher work engagement, as for both the proactive behavior and high work engagement, a high priority of work might be a driver. Future research should corroborate this finding using different time lags and investigate potential third-variable explanations.

Further, as we could not shed light on a longitudinal mechanism explaining the association between WNBC and health outcomes, we suggest that future research dives into alternative mediating processes, reviewing gain spirals instead of a loss spiral, as we did in our research. Like the loss spiral, the gain spiral can be derived from the COR theory (Hobfoll, 1989 ). It describes a process where an initial resource gain enables further resource gains, leading to an upward spiral (Hobfoll, 2002 ). If, for example, a person can save time by working from home (because they do not have to commute), they can then use that time to gain other resources, such as energetic resources through recovery. Tims et al. ( 2015 ) have found that through job crafting, employees can improve their well-being (e.g., more work engagement, more job satisfaction, less burnout) through increased social job resources. Therefore, this relationship might apply to WNBC because persons who actively craft their boundaries between the work and the nonwork domains can improve their outcomes through increased resources (e.g., measured by work-home enrichment instead of interference; Kopelman et al., 1983 ). Thus, looking at WNBC and its association with the gain spiral instead of the loss spiral could be a promising next step to understanding the WNBC construct from a resource perspective.

Strengths and limitations

The research of this paper contributes to the existing literature in three main ways: First, it extends the literature by looking at a relatively new crafting construct that still offers a high research potential. We demonstrate here that a shortened version of the WNBC provides a good fit with the unique context of the pandemic, yet also that the structure of WNBC could be subject to revision in future research. Second, our study shows that WNBC partly played a role in reducing life domain conflicts at the beginning of the pandemic, which points to a strategy that could be taken up by early interventions in future times of crisis, as well as the limits of individual proactive behaviors. For the work domain, individual efforts should be coupled with organizational support to reduce life domain conflicts. Third, our study adds knowledge on the longitudinal association between life domain conflicts and health outcomes, showing that contrary to earlier findings, only HWI was associated with lower mental well-being in our study. This opens a field for new research in which the unique context of the pandemic and specific developments could be reviewed. For example, the overall more open conversation about struggles might have aided in buffering the effects of life domain conflicts on health (Bu et al., 2021 ).

Besides these strengths, the study has several limitations. The first limitation that needs to be addressed is the inability to use the full scale for WNBC due to its low fit. As outlined earlier, we attempted to increase fit in terms of both content validity to the pandemic context and statistical fit. Our shortened scale highlights those generalizable parts of WNBC that also fit the unique context of the COVID-19 pandemic, but we note that other parts still need to be included. To address this, further research is required to corroborate the shortened scale or revise the original scale to fit newer developments in working life.

Second, our study solely relies on data collected in 2020, and our findings cannot be lightly generalized to other non-pandemic periods or populations. Contrary to previous research, we did not find a link between WHI and studied health outcomes. We discussed earlier that this could be due to the unique context of the pandemic, in which the increased collective awareness about the daily struggles employees faced might have also increased awareness and individual ways of coping. To shed more light on this assumption, these findings should be corroborated in other (milder) times of crisis, e.g., financial crises or severe organizational changes, and outside of exceptional circumstances. Further, our sample consists solely of German-speaking employees from Germany, Austria, and Switzerland. Our findings may not be generalizable to other cultural contexts, e.g., more feminine cultures such as Finland (Hofstede, 2016 ). For the original WNBC scale, a cross-cultural validation has been conducted, which also showed a longitudinal correlation between WNBC-nonwork and work engagement in Finland, likely due to the restoration and spillover of relevant resources (Kerksieck et al., 2022 ). In similar fashion, future research should investigate further cultural differences in the associations between WNBC, life domain conflicts, and employee well-being.

Lastly, we note that in the dropout analysis, a significant difference was found for life domain conflicts, meaning that out of all participants participating in wave 1, those that did not participate in waves 2 and 3 reported significantly more life domain conflicts, likely because they had less time or energy for study participation. However, the remaining sample should still be representative, and severely biased results are not expected because of this dropout, especially since missing values were treated with the reliable full information maximum likelihood method in which the parameters are estimated using the available data in the sample (Newman, 2014 ).

Practical implications

We can derive two main practical implications from our findings, primarily concerning political and organizational institutions. First, we have found that WNBC focusing on the work domain is longitudinally associated with lower HWI, higher work engagement, and mental well-being. In times of crisis, organizations can support their employees in crafting by disseminating information about how proactive crafting can aid them in maintaining their own well-being. On top of that, organizations should enable employees to use these strategies for their own benefit. In any case, employees can proactively enact crafting efforts to improve their work and nonwork lives. Taking advantage of this bottom-up self-management strategy is what makes crafting a convincing concept in theory and practice since its early outlines (Wrzesniewski & Dutton, 2001 ) to a concept with obvious relevance during the COVID-19 pandemic and for the future of work (Bakker et al., 2023 ; Tims et al., 2022 ).

Second, our results also point to the limits of individual crafting. WNBC might not have enough force to reduce WHI, which could instead be addressed through support in organizing work and granting flexibility and autonomy. Other forms of crafting interventions, e.g., targeted toward job crafting (van den Heuvel et al., 2015 ; van Wingerden et al., 2017 ) or off-job/needs crafting (Kosenkranius et al., 2023 ; Laporte et al., 2022 ), as well as targeted organizational support for employees, should be considered to complement pandemic or crisis mitigation plans.

We aimed to study the role of WNBC for long-term health and well-being during the COVID-19 pandemic. Using a shortened version of the WNBC scale to fit the context of the pandemic, our results point to complex associations between WNBC and life domain conflicts, work engagement, and mental well-being. We found a direct positive association between WNBC-work and work engagement and mental well-being and a negative association between WNBC-work and HWI, yet no indirect association between WNBC-work and WNBC-nonwork with work engagement and mental well-being via life domain conflicts. We conclude that engaging in WNBC early in times of crisis is associated with better long-term health. This urges companies to take responsibility and support their workers by providing a crafting-friendly environment and helping reduce their life domain conflicts. Our findings are not only relevant during future crises but also to support employees in the future of work.

Data availability

The data that support the findings of this study are available from the authors upon reasonable request. Study participants were asked to give consent to use the data for research and within research publication, but not for open public access.

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Original research article, local perspectives on marine ecotourism development in a water-insecure island region: the case of bocas del toro, panama.

• 1 Ocean Nexus, Dalhousie University, Marine Affairs Program, Halifax, NS, Canada
• 2 Center for Tropical Island Biodiversity Studies, The School for Field Studies, Bocas del Toro, Panama

As a dimension of a blue economy, marine ecotourism should, in theory, not only increase economic viability and environmental sustainability but, most importantly, pursue socially equitable outcomes. In tropical and sub-tropical island regions, where substantial tourism development is often coupled with widespread strains on public infrastructure and services, including water access, there exists a need to better understand the expansion of this industry is felt at the community level; more importantly by individuals who are reliant on these infrastructures and services. Through a case study of the Bocas del Toro Archipelago, where water insecurity is becoming acute, we draw on and mobilize stories from local community members, alongside non-participant observations and document collection, to 1) document the experience of some community members with water insecurity and shortages, including how they perceive the roles played by the central government and marine ecotourism sector, and 2) examine how community members feel about how communities feel about policies and investment priorities of the central government regarding water insecurity, including the extent to which they view marine ecotourism development as undermining or promoting local needs. Our results underline the complex nature of marine ecotourism governance and infrastructure development outcomes in a resource-insecure island region, demonstrating that current issues are greatly impacted by historical and social underpinnings of neo-colonialism and systemic racism, misalignments of community vs. government development priorities, and eroded political trust, that shape local experiences with sustainable development and local residents’ perceptions of the ability of marine ecotourism to address issues of water insecurity. Moreover, while our focus is on the marine ecotourism industry, the significance of these findings contributes to a growing body of literature that places local experiences at the forefront of research into the implications of sustainable development in island regions.

Introduction

The marine ecotourism industry is considered to be a dimension of a ‘blue economy’; an ocean-wide sustainable development strategy proposed by Small Island Developing States (SIDS) in 2012 to “promote economic growth, social inclusion, and preservation or improvement of livelihoods, while at the same time ensuring environmental sustainability” ( World Bank and UN DESA, 2017 , p.1). In theory, marine ecotourism should not only increase economic viability and environmental sustainability but, most importantly, pursue social equity—a “distinctive system of individualized justice” ( Minow, 2021 , p.173). In island regions, where substantial tourism appeal is often coupled with widespread issues of water insecurity ( Cole, 2012 ; Gössling et al., 2012 ; Gossling, 2015 ), this study explores questions regarding the ability of a blue economy strategy, rooted in marine ecotourism, to equitably address both development and well-being in the eyes of those local to island regions. In this paper, we refer exclusively to tropical and sub-tropical islands when discussing ‘islands’ or ‘island regions.’

In island regions, local blue economies are often heavily reliant on the marine tourism industry ( UNWTO, 2023 ). However, as per Leposa (2020) , large volumes of tourists, and the services required to support them (e.g., transportation, accommodation, food and beverage, recreation, etc.), can exacerbate existing issues of local public utility access, often due to infrastructural deficiencies or inherent vulnerabilities to climate change. Important to this study, in particular, is the relationship between the marine ecotourism industry and the availability and management of water resources.

To our knowledge there exist few studies that sit at the intersection of marine ecotourism and water insecurity in island regions specifically; less so those that are guided by, and draw conclusions from, the experiences of those individuals that most closely feel their impacts. As the push for blue economic development continues to grow ( Cisneros-Montemayor et al., 2021 ; Pace et al., 2023 ), and water insecurity becomes increasingly prevalent in climate-vulnerable regions ( Winters et al., 2022 ; Crisman and Winters, 2023 ), failing to capture how the two intersect and are felt at the community level could pose risks of conducting research with communities as the ‘subject’ rather than active participants and beneficiaries of the research process ( Israel et al., 2019 ), and/or informing policies that do not capture the nuances of community interests and needs ( Freudenberg and Tsui, 2014 ; Cisneros-Montemayor et al., 2019 ).

Marine ecotourism can be described as a “nature-based; environmentally educated; and sustainably managed” ocean tourism industry involving activities such as recreational fishing, snorkelling, whale watching, and SCUBA diving, for example ( Blamey, 2001 , p.6). Modern definitions also include dimensions of local benefits ( Sakellariadou, 2014 ; Das and Chatterjee, 2015 ; Ramos-García et al., 2017 ; Tuwo et al., 2021 ). This can entail increasing market demand for locally produced goods, the use of, and investment in, local facilities and infrastructure, opportunities for local entrepreneurship, and the generation of new revenue streams that remain within a community, for example ( Sakellariadou, 2014 ).

Unlike traditional mass tourism models, marine ecotourism adopts aspects of environmental conservation and promotes community involvement. However, when these tenets are not upheld, due to a variety of reasons (e.g., poor management, lack of community involvement, limited enforcement regimes, etc.), the industry can promote unsustainable practices on all fronts—economic, social, and environmental ( Hoyman and McCall, 2013 ; Rahman et al., 2022 ; Zeng et al., 2022 ). As such, recent scholarship has called for a re-prioritization of social sustainability within blue economic development ( Pascual et al., 2014 ; Bennett et al., 2019 ; Leposa, 2020 ; Nugraheni et al., 2020 ; Osterblum et al., 2020 ; Campbell et al., 2021 ; Cisneros-Montemayor et al., 2021 ), with concerns raised regarding the implication of developing marine industries in areas where there is significant need to consume and manage resources sustainably.

The United Nations (UN) refers to water security as the ability of a population to safeguard sustainable access to adequate quantities and quality of water for the support of livelihoods, human well-being and socio-economic development ( UN Water, 2013 ). In this sense, water in security is the condition in which at least one of the above variables (i.e., quantity, quality, or accessibility) is not met, threatening human well-being. While many island regions have some degree of established water infrastructure, the coincidence of ‘dry season’ and peak tourist landings can perpetuate regional instabilities in water security, where local residents compete for this essential yet scarce resource; both with tourists and between communities ( Gheuens et al., 2019 ).

In this study, we draw on and mobilize stories of local residents in a heavily touristed island to better understand how the relationship between marine ecotourism and water insecurity manifests at the community level. We explore the case of Panama’s Bocas del Toro Archipelago (henceforth referred to as ‘Bocas del Toro’ or ‘the archipelago’), where substantial tourism appeal and infrastructural issues coexist, as a microcosm of the paradox of pursuing a marine ecotourism-based blue economy in a water insecure island region. Through integrating non-participant observations and collected documents with a series of semi-structured interview responses we aim to 1) document the experience of some community members with water insecurity and shortages, including how they perceive the roles played by the central government and marine ecotourism sector, and 2) examine whether community members feel as though water insecurity and shortages have influenced policies and economic investment and the extent to which marine ecotourism development may undermine or promote changes.

Our results underline the dynamic and complex nature of marine ecotourism governance and infrastructure development outcomes in a resource-insecure island region, highlighting the historical, political, and social underpinnings that shape perceptions of, and poor experiences with, blue economic. While our focus is on the marine ecotourism industry, the significance of these findings contributes to a growing body of literature that places local experiences at the forefront of research into the implications of sustainable development in island regions.

Island development and marine ecotourism

Although often associated with ‘paradise’ ( Baldacchino, 2012 ), island nations are considered, by the UN, to be some of the world’s ‘least developed’ nations (UN, n.d.), with island regions often referred to as ‘vulnerable,’ given their narrow resource bases, remoteness, and susceptibility to natural hazards and external economic shocks ( Baldacchino, 2012 ; Belmar et al., 2016 ; Lucas et al., 2017 ; Nunn and Kumar, 2017 ). That said, it is important to note that this explicitly reflects the barriers that may limit attempts to garner increased economic prosperity and/or development capacity rather than island societies as a whole.

As described by ( Grydehøj et al., 2021 , p.4), in reflecting upon Hau’ofa (1994) , the modern development and governance of island resources is also often heavily steeped in colonialism, where Western standards for ‘successful’ development are far too narrow in their economic, geographic, and cultural views. Dating back to the 15th century, island states have faced oppression from the United States, France, Spain, England, and the Netherlands ( Keegan and Diamond, 1987 ; Leposa, 2020 ). While there remain proponents of some aspects of the colonial legacy ( Feyrer and Sacerdote, 2009 ), Kay (2010) maintains that colonialism, in Latin America specifically, has led to harmful endo -colonial relations that sit at the root of present-day developmental inequities. In the Caribbean, Sealy (2018) notes that colonization has not only impacted the regional ethnic makeup, but that the perpetuation of globalization as a neo-colonial structure has created a larger dependence on investments from the Global North. Overall, there exists a small body of literature that discusses the role of the blue economy in perpetuating or combating neo-colonialism. However, scholarship surrounding the colonization of islands maintains that neo-colonialism can propagate harmful outcomes of sustainable development projects such as marine ecotourism ( Heim, 2017 ; Durokifa and Ijeoma, 2018 ; Grydehøj et al., 2021 ).

Typically, ‘tourism intensive’ island regions derive a substantial proportion of their economic development from the marine ecotourism industry ( Adamiak and Szyda, 2022 ). McElroy (2006) refers to tourist-driven island economies as SITES (‘Small Island Tourist Economies’), describing the expansion of tourism as a prominent development strategy for small economies, where there exist large dependencies on the industry. While, marine ecotourism can lead to a host of benefits, research in the island context specifically, more often notes the potential consequences of such development in destinations considered to be on the ‘global periphery’ ( Dodds and Graci, 2012 ). For example, while ecotourism may produce local job opportunities, Das and Chatterjee (2015) posit that community members are more often placed in low-skill and/or low-pay roles. Moreover, Harrison and Prasad (2011) found that in Fiji, for example, there exist high levels of benefit leakages to foreign investors. In Bocas del Toro, specifically ( Scott et al., 2024 , p.2), explain that tourism-related development can lead to inequitable impacts through the promotion of real estate ventures in culturally significant areas, like mangroves, where investors may view the local environment as “obstacles to achieving ‘paradise.’”

Bocas del Toro, Panama

Located off the Caribbean coast of Panama, Bocas del Toro is one of the country’s top ecotourism destinations. It consists of approximately nine islands and 200 islets and is home to a population of approximately 22,500 across the larger Bocas del Toro district ( INEC, 2021 ). Attributable to a history of colonialism, the construction of the Panama Canal, and the cultivation of a plantation economy, among other reasons, the region is also home to a variety of distinct racial and cultural groups including Ngäbe peoples (those indigenous to present-day Panama and Costa Rica), Panamanians, Afro-Antilleans, and Chinese individuals, for example ( Guerrón-Montero, 2006 ; Carse, 2014 ; Suman and Spalding, 2018 ). Moreover, Bocas del Toro’s most developed islands have become increasingly inhabited by lifestyle migrants—relatively affluent individuals with the capacity to move to destinations, typically in the Global South, with warmer climates, a lower cost of living, and a seemingly higher quality of life—from the United States ( Benson, 2013 ; Spalding, 2013 ).

Although not formally considered an autonomous state, Bocas del Toro displays many of the hallmark characteristics of a SIDS as per the UN Office of the High Representative for the Least Developed Countries, Landlocked Developing Countries and Small Island Developing States ( UN-OHRLLS, 2022 ). It is home to both a distinct societal makeup and unique marine ecosystems ( Seemann et al., 2014 ; Pleasant and Spalding, 2021 ), and faces documented issues of infrastructural development and geographic isolation from larger global markets ( Tilmans et al., 2014 ; Pleasant and Spalding, 2021 ).

Bocas del Toro’s economy is predominantly supported by the tourism industry; across the larger Bocas del Toro province, tourism makes up 95% of all economic activity, greatly exceeding the national average ( Klytchnikova and Dorosh, 2013 ). The most lucrative form of tourism is referred to by the Autoridad de Turismo de Panama (Tourism Authority of Panama; ATP) as ‘island ecotourism’ ( ATP, 2020 ), with the most popular destinations being Starfish Beach, Red Frog Beach, and Isla Bastimentos National Marine Park ( Camarca de Turismo de Bocas del Toro, 2022 ). While the ATP does not explicitly refer to ‘marine ecotourism’ in their reporting, for the purposes of this study, ‘island ecotourism’ and ‘marine ecotourism’ will be considered synonymous, as their accepted definitions align greatly.

Common marine ecotourism-based businesses in the region include boat tours and taxis, restaurants, hostels, and gift shops, with much of the region’s tourism development concentrated in Bocas Town, Isla Colón, where an average of 150,000 tourists visited annually pre-COVID-19 pandemic ( Gray et al., 2015 ). Strikingly, although Bocas del Toro now sees approximately 225,000 tourists per year, the Bocas del Toro province remains one of the poorest in the nation ( CECOMRO, 2018 ; ATP, 2020 ).

Moreover, to appreciate the nuances of Bocas del Toro’s current socioeconomic landscape, one must also understand its economic history, which is closely tied to colonial resource extraction. In the early 20 th century, the construction of the Panama Canal and the establishment of the U.S. Canal Zone cemented the United States as a major player in the Panamanian economy. In Bocas del Toro, specifically, this presence was predominantly felt through the establishment of the United Fruit Company (UFC), an American-owned corporation trading in Latin American-grown fruit, namely bananas ( Pleasant and Spalding, 2021 ). Typically supporting the UFC’s operations were Afro-Caribbean and Ngäbe workers, as well as labour migrants from China and Italy ( Spalding, 2011 ). This created harmful shifts in power, as Black and Indigenous individuals were often exploited and marginalized through the imposition of a globally capitalistic system ( Amin, 1978 ). While small-scale operations remain (now Chiquita Brands International), the UFC’s presence in the archipelago declined greatly by 1990 due to war, crop diseases, and labour losses (as a result of poor pay and working conditions) ( Guerrón-Montero, 2006 ), making way for a burgeoning tourism industry by the 2000s, as many large-scale housing developments were left vacant and global interest in the region increased following the 1991 earthquake.

Today, the archipelago’s socioeconomic and environmental systems are inextricably linked to the marine ecotourism industry, attracting individuals looking to experience its vibrant culture, beautiful beaches, and ocean life ( Klytchnikova and Dorosh, 2013 ; Spalding et al., 2015 ; Lucas, 2019 ; ATP, 2020 ; Mach and Vahradian, 2021 ; Pleasant and Spalding, 2021 ; Bocas del Toro Tourism, 2023 ). That said, tourism infrastructure across Bocas del Toro has been deemed ‘suboptimal’ by the ATP, specifically as it pertains to the limitation of physical space and the overload of basic services, such as water provisioning ( ATP, 2020 ). Critical to this study, Bocas del Toro is also home to widespread issues of water insecurity; the majority of households across archipelago do not have access to running water supplied by the Instituto de Acueductos y Alcantarillados Nacionales (Institute of Aquaducts and Sewers; IDAAN), with 23% of the population instead turning to bottled water or drinking unfiltered rainwater respectively ( CNA, 2016 ) ( Figure 1 ). In fact, just 1.9% of the total residences connected to IDAAN’s services reside in the Bocas del Toro province ( IDAAN, 2022 ). As such, water insecurity is among the region’s most precarious issues.

Figure 1 Regional water insecurity across the Bocas del Toro Archipelago represented by the percentage of households in each census region without access to running water. The population density of each region in relation to the archipelago’s total population is also represented. Uncoloured areas represent regions outside of the archipelago or those not captured by the Panamanian Census. Created using the 2010 Panamanian Census Data, accessed from the STRI GIS Data Portal (2019) .

In this study we employ a multi-method approach—the combining of two or more methods to expand one’s research base when investigating a research question or phenomenon ( Roller and Lavrakas, 2015 )—that is firmly rooted in local experiences and perceptions. This includes the use of semi-structured interviews, non-participant observation, and document collection. While our approach pulls from that of political ecology, we do not attempt to formally mobilize methods typically used in such studies (e.g., Cole, 2012 ), but rather utilize participant responses to deduce the governance processes, historical events, etc., that frame their experiences with marine ecotourism and water insecurity. It should be noted that the data collection period in Bocas del Toro (May 25 th , 2023 to June 27 th , 2023) also coincided with a water shortage; declared an environmental emergency on June 9 th , 2023.

Semi-structured interviews

A member of our research team travelled to Bocas del Toro from May 25 th , 2023 to June 9 th , 2023 to conduct semi-structured interviews; asking participants open-ended questions to elicit information regarding one’s research topic ( Adeoye-Olatunde and Olenik, 2021 ). During this time, a total of 16 individuals, including members of the Bocas del Toro Chamber of Tourism, property owners, business owners, tour guides, labourers, and concerned citizens, were interviewed. Participants in this process—those older than 18 years of age and who have lived in the region for over 5 years—were identified through a purposive snowball method ( Weiss, 1994 ), beginning with contacts provided by a local informant.

Topics discussed (i.e., water shortages, infrastructure, economic and tourism development, and overall welfare) were drawn from a pre-determined interview guide developed through preliminary document collection and with guidance from researchers in the region (see Supplementary Table 3 ). While the guide was used to facilitate conversation, it adapted as more information was provided and new events occurred (i.e., the onset of an environmental emergency during the interview period). Interviews lasted an average of one hour and, depending on the participant’s level of comfort, were conducted in both English and Spanish (with an interpreter translating responses). Due to participant location and the accessibility of each island, interviews took place across three of Bocas del Toro’s nine main islands—Isla Colón, Isla Carenero, and Isla San Cristóbal ( Table 1 ).

Table 1 Socioeconomic and geographic description of interview locations/study sites.

Non-participant observation

To support responses collected during interviews, non-participant observation—observing and documenting an event without actively participating in activities ( Becker and Geer, 1957 )—was used to explore how ecotourist attractions function across the archipelago and further understand how communities respond to, and navigate, water shortages. Observed events were identified through community contacts established during the interview period as well as local WhatsApp groups; typically used to share important information across the region. They included waiting in line at public wells, visiting an ecotourist attraction, observing protests regarding water access, and attending a public meeting with IDAAN (further event details available in Supplementary Table 4 ). The average observation process lasted approximately one hour and involved taking notes regarding what did and did not occur, what demographic of individuals were present, and the overall tone of those present.

Document collection

Given that this is the first study to investigate topics of marine ecotourism and water insecurity in Bocas del Toro, supplementary grey literature was sought out to provide wider context and breadth to the study. Documents were found by searching for qualitative phrases related to drought, water, and tourism in Bocas del Toro in Google and the Bocas Breeze Newspaper database. Documents collected include government policies, local news articles, and regional reports.

The analysis of the data was guided by an inductive, constant comparative approach, as per Hodkinson (2008) and Glaser (1965) , whereby we sought to increase our understanding of potential underlying theories and identify emergent themes through a constant back-and-forth engagement with the data. In practice, this first involved transcribing and digitizing interview responses and observation notes. The data was then coded categorically (e.g., the codes ‘GOV-TOURISM’ and ‘GOV-WATER’ were utilized whenever a participant described how they felt about and experienced tourism and water governance respectively), and supplemental documents were reviewed to compare and contrast with interview and observational data.

In an effort to mirror the anecdotal nature of the data collected, here we weave together interview responses, observational notes, and document insights to describe how the economic development of Bocas del Toro, governance processes, experiences with water shortages, and future development in the region, shape local experiences with, and perceptions of, marine ecotourism and water insecurity. Figure 2 demonstrates a timeline of events and governance developments described by participants, as well as relevant events to contextualize the case.

Figure 2 Timeline of events and developments regarding ecotourism and water security in Bocas del Toro, Panama. The timeline presented is not exhaustive of all related moments in history, but rather those relevant to this particular study. Entries on the left of the timeline represent historical events, while those on the left represent policies and plans. ATP refers to the Tourism Authority of Panama; IDAAN refers to the Institute of Aquaducts and Sewers.

Beaches as the new bananas–shifting to a tourism-based economy

With increased neoliberal capital interest, government incentives to purchase land for tourism, and an abundance of global interest, tourism in Bocas del Toro effectively ‘exploded’ by the year 2000, signifying, as put by Pleasant and Spalding (2021) , a shift from a banana-based export economy created by the UFC to a tourism-centric economy based on the region’s beaches and biodiversity. Despite this shift, the UFC’s presence in Bocas del Toro remains prominent, as it had become integrated into the region’s social and infrastructural fabric (e.g., the creation of communication networks, railway systems, power plants, medical facilities, and housing developments) (United Fruit Historical Society, n.d.). Furthermore, when asked about the UFC in Bocas del Toro, participants described how a dependency on a singular industry and foreign entity resulted in harmful losses of traditional livelihoods, such as fishing and agriculture—”we used to be farmers who could feed ourselves, now we’ve lost this completely,” said one property owner.

Among those participants directly employed by the tourism industry, all spoke positively about the renewed economic benefit it brings. As one tour operator put it, “the money is in tourism, the experiences.” Of those participants situated outside of the industry, a majority also acknowledged that marine ecotourism does play a major role in supporting the local economy— “tourism is good,” noted a construction worker we spoke with, “yeah it’s good because it makes work and brings in money to us when it’s done right.”

That said, there remains great skepticism across all participants surrounding the industry’s future in Bocas del Toro:

“I used to fully believe that tourism was the key to successful cities with no opportunities.

But then we have fragile societies like we have in Latin America, and there’s not a strong

government that actually tries to implement human development. It is not taking us to the

right place,” said a member of the Bocas del Toro Chamber of Tourism.

When asked what she believes to be the largest development project in the community, one business owner responded:

“Tourists. But it grew alone. It grows alone … It’s incredible. Bocas [del Toro] has been developed in many ways, but not in basic things. It keeps growing, growing, growing, and I don’t see [public utilities] growing with it.”

Navigating an era of sustainable development – tourism and water governance

In contextualizing participant responses, we offer a brief exploration of relevant actors, plans, and policies as they pertain to marine ecotourism and water governance in Bocas del Toro. The overarching development of Panama’s marine sector is directed by the Ministerio de Relaciones Exteriores (Ministry of Foreign Affairs), Ministerio de Ambiente (Ministry of the Environment; MiAMBIENTE), and the UN Development Programme via the Política Nacional de Océanos de Panamá ( National Ocean Policy of Panama; NOP). Ratified in 2022, the goal of the NOP is to pursue a ‘Blue Panama,’ where “marine and coastal resources are protected, conserved, valued, and used sustainably, positively impacting the quality of life of citizens in an inclusive and participatory manner” ( MiAMBIENTE, 2022 , p.13). To do so, blue economic development, internally defined as the “sustainable use of marine and coastal resources…, approaching marine-coastal activities under the prism of balance between the three social, economic and environmental dimensions,” is prioritized as one of 4 strategic axes ( MiAMBIENTE, 2022 , p.21). Central to this, under Goal M. 27, is the “promotion of sustainable tourism development linked to the oceans” ( MiAMBIENTE, 2022 , p.21), where the NOP yields much of the responsibility around this directive to the ATP.

Since 2008, the ATP has been responsible for “the development, promotion, and regulation of tourism as an activity”; maintaining tourist resources, protecting the ecological balance of the land, and respecting the customs of its inhabitants ( Decreto Ley No.4, 2008 , p.1). When asked about their feelings towards the ATP, virtually all participants expressed concern regarding tourism governance in Bocas del Toro, and its ability to “make things happen.” According to one individual, tourism in Bocas del Toro is “governed by people who don’t have morals, they are just selfish. If it doesn’t make them money, they don’t do it.” At the community level, tourism in Bocas del Toro is monitored by the Cámara Turismo Bocas del Toro (Bocas del Toro Chamber of Tourism), a non-profit community organization that works to organize the local tourism sector and protect its longevity ( CTB, 2023 ). Nonetheless, the Chamber of Tourism is not afforded government funds or jurisdiction to carry out and/or enforce such endeavours and does not play a large role in high-level decision-making regarding tourism in the archipelago ( ATP, 2020 ). According to a member of the Chamber of Tourism, this creates issues surrounding community input, whereby the community is neither adequately consulted nor are their ideas accurately integrated into development plans:

“We are a private sector, but we have no say or worth in the final decision. [The ATP] says: ‘We met with the Chamber of Tourism and the chamber is approving [the development]’. But later, when we come and tell you all the things wrong with the plan, they say ‘Oh no, you came up with this idea, the Chamber approved it’…We don’t want that; we don’t need that. We need real things.”

At large, plans for tourism development in Bocas del Toro are organized under the Plan Maestro de Desarrollo Turístico Sostenible 2020-2050 (Master Plan for Sustainable Tourism Development 2020-2050; MPSTD), with goals to promote Panamanian tourism, improve global competitiveness, decentralize tourism operations, and develop state tourism policies ( ATP, 2020 ). In Bocas del Toro, the MPSTD’s Action Plan includes a total of 19 actions and 75 projects. Of this, 6 projects fall under Action 2.4.4. Improvement of Basic Infrastructures, including a project to, in tandem with IDAAN, “improve the drinking water supply system on Isla Colón” by 2022 ( ATP, 2020 , p.316). Despite this, participants were wary as to whether these plans would ever “hit the ground,” as put by one individual. “The [MPSTD] is a plan,” said a member of the Chamber of Tourism, “but if you do nothing to implement it, it’s not going to change. I haven’t seen any real action.” “You don’t need the government. The government is not going to do it. Because the government has no brain to think,” expressed another member of the community.

The implementation of these projects is largely overseen by IDAAN, with more specific water infrastructure improvement plans for Bocas del Toro listed in Panama’s Plan Nacional de Seguridad Hídrica 2015-2050 (National Plan for Water Security 2015-2050; NPWS). The NPWS serves as a roadmap for ensuring that “every person in [Panama] has sustained access to quality water and basic sanitation,” with a focus on “eliminating inequalities of access in an inclusive and equitable manner” ( CNA, 2016 , p.65). In pursuit of this, the NPSW budgets 3.3 billion USD to address issues of drinking water in Isla Colón exclusively, including improvements to catchments and sewage systems ( CNA, 2016 ). However, while the NPSW projects that all individuals in the Bocas del Toro province will have access to drinking water by 2025, as will be described in subsequent sections, participants note that, as of 2023, they are skeptical as to whether this goal will ever be reached. As one business owner put it, “it’s only plans plans. But when you go to practice? No, nothing happens.”

Accessing water in Bocas del Toro – a myriad of methods

Very limited formal documentation on water infrastructure and distribution processes in Bocas del Toro is publicly available; as put by one participant, “nobody really knows exactly how the water works [in Bocas del Toro].” Despite this, with insights from community members, we attempt here to establish a clearer picture of water distribution across the study sites ( Figure 3 ), highlighting the intensity of water insecurity in Bocas del Toro and inform how marine ecotourism might impact water access.

Figure 3 Maps of approximate locations of examples of water infrastructure across Isla Colón/Isla Carenero (A) , and Isla San Cristóbal (B) as described by participants. Image 1—a newly constructed water reserve tank. Image 2—a typical public well in Isla Colón. Image 3—Big Creek Reservoir. Image 4—IDAAN water processing station. Image 5—a typical rain catchment system in Isla Colón. Image 6—a water tanker deployed during water shortages. Image 7—water line that connects Isla Colón and Isla Carenero. Image 8—a typical rain catchment system in Isla Carenero. Image 9—water catchment station in Isla San Cristóbal. Image 10—underground pipe system in Isla San Cristóbal. Images 1-3 and 5-10 were taken by Abigael Kim. Image 4 is reprinted from the IDAAN Water Treatment Plant Database ( https://sig-idaan.hub.arcgis.com/apps/0a722564d72f421798b33b902ebef781/explore ).

Residents of Isla Colón typically access water through IDAAN’s public distribution system, and/or via public or private wells. IDAAN services over 9,000 individuals across the southern region of Isla Colón through an underground pipe system powered by gravity and a select number of pumps. While it is widely understood this water, supplied by a local reservoir (‘Big Creek’) ( Figure 3 , Point 3), is filtered at a nearby plant ( Figure 3 , Point 4), the efficacy of this process remains highly debated ( Corea, 2016 ; Telemetro, 2022 ; Albaez, 2023 ; Godoy, 2023 ; Ortiz, 2023 ). When asked whether she would drink water from her tap, one shop owner responded, “I’m not gonna do that,” while her partner added that the water is often “yellow or brown” in colour. This system is also subject to the impacts of ‘dry season’ in the Caribbean (October to April), when services are often limited by IDAAN to two hours in the morning and evening. Regions of the island not serviced by IDAAN rely on rainwater collection ( Figure 3 , Point 5) or the use of public or private wells ( Figure 3 , Point 2). As of today, there exist eight IDAAN wells in Isla Colón, with only four in constant operation, while private wells on the island are typically located in regions populated by lifestyle migrants and affluent families. That said, virtually all wells across the archipelago require electricity, of which the local supply is highly unpredictable.

In Isla Carenero, those residing along the island’s perimeter typically rely on underwater pipes that distribute water sourced from IDAAN’s system in Isla Colón ( Figure 3 , Point 7). That said, participants noted that this process is unreliable, as there is often not enough water pressure from Big Creek to reach the shores of Isla Carenero. According to a local restaurant owner, “[Isla] Carenero has huge water problems. When there is no water there, [they] struggle the most.” Participants from Isla Carenero also noted that it is common to utilize rain collection systems ( Figure 3 , Point 8) or to travel to Isla Colón to purchase jugs of water. Furthermore, many restaurants and tourist operations on the island utilize private wells to service their patrons, while lifestyle migrants are also known to have access to private wells.

Isla Colón and Isla Carenero are the only islands (out of nine that are inhabited) to have direct access to IDAAN’s services. Other islands, like Isla San Cristóbal, rely on community-led initiatives or the purchasing of water jugs from Isla Colón. As described by a local tour guide, approximately 600 individuals on Isla San Cristóbal access water via a natural catchment system and man-made storage and distribution point developed through a fundraising project by local and international organizations ( Figure 3 , Point 9). The storage point collects water from the island’s northern mountain region, filters it for solids, and distributes it to the community via gravity and underground pipes ( Figure 3 , Point 10). According to a local tour guide, this process is quite reliable; during times of drought, residents of other islands have looked to him for water.

Frustrations run high – a history of water shortages

Bocas del Toro has faced (documented) water shortages in 2016, 2017, 2019, 2022, and 2023. One restaurant owner noted that, while “water has always been an issue in [Bocas del Toro],” the problem “has never been this bad.” Following a prolonged period of drought and water restrictions, as well as pressure from MiAMBIENTE, a State of Environmental Emergency was declared by the Cabinet of Panama in both 2022 (November 8 th ) and 2023 (May 30 th ) ( Resolución de Gabinete No. 127, 2022 ; Resolución de Gabinete No. 48, 2023 ). Doing so authorizes IDAAN to enact the region’s ‘Contingency Plan’, involving the assignment of water trucks to distribute potable water to affected businesses and residences on Isla Colón and Isla Carenero, the increase of water conduction line diameters, the activation of additional wells, and the increase of regional technical support ( IDAAN, n.d. ).

During this type of Environmental Emergency, those without private well access typically purchase water jugs from local shops, fill their household tanks at public wells, or fill up smaller jugs from IDAAN trucks ( Figure 3 , Point 6). However, participants mentioned that such alternative methods are not sufficient, leaving many without water for days on end. One souvenir vendor, for example, mentioned that she had not been able to shower in “over 8 days.” Moreover, as lines for local wells grow, business owners mentioned that these trucks are extremely challenging to access, having to “choose between running [their] shops and getting water.”

Overall, aside from climate change as a catalyst, there is no largely agreed-upon answer or government consensus as to why water management and infrastructure are so precarious or why Bocas del Toro feels droughts so intensely. However, participants speculated that they have something to do with the coinciding of ‘dry season’ and tourist season in the fall. As mentioned in the Bocas Breeze Newspaper in response to the 2016 shortage:

“In recent years, sometimes it doesn’t rain for a while or excited tourists flood the island in

record numbers and when you turn the faucet, you are met with the depressing sound of a

‘drip, drip, (silence)…’ Maybe you left your toilet running and your tank has gone empty, or

perhaps the town reservoir has gone dry” (2016).

Undoubtedly at the center of these frustrations is IDAAN, more specifically as it pertains to the uneven distribution of water and lack of government accountability. According to IDAAN, water trucks are to deliver water to both city centres and residential areas. However, almost all participants mentioned that this system is not well executed, citing disparities in where water was being delivered during the 2023 shortage. “Unfortunately, there is a bad distribution of the water and trucks,” one tour operator said, “they don’t have a good plan for giving out the water, so they pass me by.” More specifically, many participants mentioned that hotels are often prioritized, and speculated that truck drivers were being paid a premium by these establishments to visit them first. “A government truck should be for the community,” said one community member, “but it doesn’t happen in Panama.”

Participants also expressed frustration with IDAAN’s accountability during these shortages. “I don’t look to the government for water,” said one individual, “I pray to God.” During the 2023 shortage, in particular, many community members were left with unanswered questions, as the regional IDAAN phone line for Bocas del Toro was disconnected, and public meetings with IDAAN were continuously cancelled. As was seen on multiple occasions during the 2023 shortage, such feelings often led to public displays of frustration, in the form of road blockades and protests; “we don’t just wait for water, we have to block the streets for water,” said one shop owner.

In June 2023, after over a month without reliable access to running water, IDAAN announced the connection of two additional wells to supplement Big Creek while precipitation levels remained low ( Ortiz, 2023 ). Despite these developments, residents of both Isla Colón and Isla Carenero still face water insecurity at large, with water remaining a contentious issue across the archipelago.

A potential paradox? – Future plans for water infrastructure and marine ecotourism

Looking towards 2050, Bocas del Toro is the topic of numerous development projects in both marine ecotourism and water infrastructure. However, participants expressed disappointment about the priorities of the central government’s plans and were skeptical of their potential outcomes.

In 2022, under the NPSW, IDAAN announced a 10 million USD investment in the “study, design, construction, operation, and maintenance of improvements to the components of the aqueduct in Isla Colón” ( Ortiz, 2023 , p.1). According to Albaez (2023) , this includes a 3-Phase Plan to develop a more reliable 24-hour public, potable water supply system:

● Phase 1—Well drilling/maintenance and construction of a water storage tank with a 700,000-gallon capacity.

● Phase 2—Construction of well-housing units and pumping equipment.

● Phase 3—Construction of supplementary desalinization plant and improvements to water treatment plant and dispensers.

Despite reports that 60% of the project has been completed as of May 2023 ( Ortiz, 2023 ), including the totality of Phase 1 and the maintenance of public well systems from Phase 2, none of the participants indicated that they had seen improvements in their water supply, but instead questioned the efficacy of IDAAN’s projects. For example, one participant referred to the early release of 5 million USD of the 3-Phase Plan investment during the 2022 shortage to rapidly increase water infrastructure quality and capacity ( Resolución de Gabinete No. 127, 2022 ), of which they had yet to see the effects of:

“They would come around and promise us that they would solve the problem, and it never

happened … They released 5 million dollars. Where does it go? It’s like ice in the sun, nobody knows where it goes … A week after they got the money the water came like lemonade, and we got it once a day”.

All participants were critical of where the Government of Panama’s plans for the development of water infrastructure sit on the list of priorities, as compared to tourism. Those directly employed by the tourism industry made note of the Urban Development of Cities with a Tourist Vocation Plan; a 6-year 100 million USD loan (2019-2023) for the development of tourism infrastructure, management, and governance, including that of public utilities in Isla Colón ( Inter-American Development Bank , n.d.). However, when asked whether they had seen any benefits from this investment, all pointed to the development of more hotels, attractions, and restaurants rather than improvements to existing infrastructure. “When I see that [investment] here, it’s in building hotels,” mentioned one property owner, “but they’re not building up the community with it, you know? ‘Why is that?’ I ask all the time”. Another participant mentioned that “[Bocas del Toro] is so marketed as a tourism place that there is nothing else [the government] does. We have culture and needs but they don’t see.”

While not explicitly discussed with participants, an important development in this case came in July of 2023, when Panama signed on to the UN’s Water Capacity Development Initiative (CDI) for SDG 6; the first country in the world to do so. The CDI serves as a vehicle for inter-agency cooperation on capacity development related to freshwater, sanitation, and hygiene ( UN Water, 2021 , p.1). Its goal is to enable the UN system, and its partners, to coordinate support for participating countries based on their unique needs. While it is too early to predict the efficacy of this initiative, it does indeed promote “national-level ownership” and capacity building, rather than a “simple transfer of mechanisms” ( UN Water, 2021 , p.1). As Panama continues to pursue a blue economy rooted in marine ecotourism as well as improved water security, questions remain as to whether there is indeed a balance to be struck between the two; one that aligns government aspirations for development with the realities and needs of those living in Bocas del Toro.

Contextualized around the potential paradox of developing a blue economy in a resource-insecure island region, this study examines how the relationship between marine ecotourism and water insecurity, in particular, manifests at the community level through a case study of Bocas del Toro, Panama. Guided by local experiences and perceptions, our findings highlight the role that socio-historical shifts, central plans and policies, and ongoing crises play in shaping the realities of local residents and their attitudes toward sustainable development and the government as a whole. In this section, we situate key findings within the literature, teasing out applicable lessons learned, making inquiries into the reasoning behind our results, and contemplating areas for future research.

The role of colonialism and race in marine ecotourism and water governance

Our results further perpetuate the widely accepted notion that issues of island development and resource governance must be considered within the context of colonization and systemic racism. In particular, studies in the ‘island tourism’ field (e.g., Cywiński (2015) ; Guerrón-Montero (2006) ; Grydehøj et al. (2021) ) would describe the lasting impacts of losses in traditional livelihoods at the hands of the UFC, and its role in directing Bocas del Toro’s economic development, as a function of neo -colonialism. Along this vein, Grimwood et al ( Grimwood et al., 2019 , p.1) posit that the production and consumption of tourism have the propensity to “(re)inscribe colonizing structures, systems, and narratives across time and space,” while ( Eyisi et al., 2024 , p.154) note that the pace and manner of tourism development is often an artifact of “tourists from colonizers becoming the source market for the colonized”. For example, a study of wildlife tourism by ( Mach et al., 2023 , p.1474) found that wildlife tourism boat guides learned what tourists (many being from Europe and North America) “wanted to see and seemed to enjoy most (e.g. pretty beaches and charismatic wildlife) and itineraries evolved accordingly,” often changing the actual names of destination, commonly used between locals to simple English, in order attract more tourists (e.g., ‘Sloth Island’).

A discussion of colonialism in this context, that being inherently racially formed, also brings us to the role of systemic racism. While the Panamanian government has enacted laws surrounding racial discrimination, in an effort to reconcile past and present harms [e.g., the dispossession of Afro-Caribbean farming communities ( Chapman, 2014 ), infringements upon Ngäbe land rights ( Finley-Brook and Thomas, 2010 ), and the attempted assimilation of Afro-Caribbean identity into mestizo society ( Corinealdi, 2022 )], Afro-Panamanians and Ngäbe individuals still make up some of the poorest groups in the nation, often residing in some of the least invested-in regions, with limited access to social services, water included ( INEC, 2021 ). While drawing a causal relationship between race and water insecurity is not within the scope of this research, the 2020 UN World Water Report does explicitly relate water insecurity and intersectionality, especially regarding race and class ( UN Water, 2020 ). Peer-reviewed studies on this issue, however, overwhelmingly exist in the North American context (e.g., Deitz and Meehan, 2019 ; Dickin and Gabrielsson, 2023 ; Harrington et al., 2023 ; Méndez-Barrientos et al., 2023 ; Workman and Shah, 2023 ). For example, a spatial analysis of water insecurity across the United States by Deitz and Meehan (2019) found that deficiencies in household water infrastructure are concentrated in regions typically inhabited by racialized groups. Specific to Bocas del Toro, our research highlights disparities in access to water between social and racial groups, as determined by foreign and ethno-racial status. For example, participants note that, during water shortages, wealthier lifestyle migrants and hotel operators have the financial capital to purchase water and/or pay truck drivers to deliver it.

The government-community disconnect

Central to this case is an evident disconnect between the Government of Panama’s aspirations for marine ecotourism development in Bocas del Toro and the needs of those living in the region, with many participants believing the government to be prioritizing marine ecotourism development over plans to improve water infrastructure. While a more intensive study, one which highlights the interconnectedness of climate change impacts and water management within larger government policies, is required to support this notion, our findings suggest that local realities may perpetuate the narrative that the government is ‘leaving behind’ social sustainability in pursuit of a viable marine ecotourism industry. In the Caribbean context, Peterson ( Peterson, 2020 , p.20) argues that “growth, rather than development, remains the overriding focus,” whereby “the quality of life for residents and, in turn, the quality of experience for visitors have not always met the various principles of sustainable tourism.” Furthermore, Srivastava and Mehta (2023) and Scott et al. (2024) propose that this outcome can indeed be “further exacerbated by neoliberal development policies and the notion of [Bocas del Toro] as a ‘resource frontier.’

As found by Wortman et al. (2016) ’s examination of local opinions on foreign tourism investment in Mauritius, our results suggest that the sheer profitability of the marine ecotourism sector may incentivize governments to continue to pursue its growth in terms of investment and future planning. They describe the tourism industry as “a variant of outward-oriented development strategies,” where the services required to host a successful industry may eclipse the services required by the local population. This is of extreme relevance in island regions, where tourism is a major contributor to national economies, motivating governments to continue to pursue ‘tourism-led growth,’ as put by Lee and Chien (2008) , and attracting increasing amounts of foreign direct investment ( Tecel et al., 2020 ; Broner et al., 2023 ).

If Bocas del Toro’s marine ecotourism sector continues to grow without the development of essential infrastructure alongside it, the region may indeed hit the point of ‘over-tourism’, where the arrival of excessive numbers of tourists at a destination imposes negative impacts on local communities ( Dioko, 2017 ). Peterson (2023) notes that over-tourism, in the Caribbean specifically, is often an artifact of “neo-liberal outward-oriented tourism policy., largely based on private and political interests to the exclusion of societal values and community interests.” Notably, reaching this point may, in fact, incentivize governing bodies to prioritize the development of public utility infrastructure to ensure that marine ecotourism remains an economically viable industry.

The importance of trust

The prevalence of mistrust in the Government of Panama expressed by participants can be described as a lack of ‘political trust’; trust in institutions and governance actors stemming from group membership, government policies, and/or general political support or satisfaction ( Bauer and Freitag, 2016 ). Our results demonstrate that local perceptions of corruption can mold residents’ opinions of marine ecotourism development, and its ability to act on issues of water insecurity. While we are not aware of any studies that explore the role of government corruption in affecting local perceptions of sustainable development, more broadly, Karst and Nepal (2022) note that a lack of established trust between communities and actors that oversee ecotourism development can lead to an array of management challenges and stakeholder conflicts.

Political trust is also often tied to the ability of actors to deliver quality public services and respond to citizen demands ( Murtin et al., 2018 ). In this study, participant responses indicate skepticism regarding the effectiveness and accountability of government actors and policies. As described by Fragkou and McEvoy (2016) , in an investigation of community attitudes surrounding water scarcity in Latin America, traumatic and frequent experiences with water scarcity can foster concerns regarding political accountability, further erode trust in utility providers, and perpetuate poor opinions of future developments that could potentially improve water access, like desalinization plants. Enqvist and Ziervogel (2019) also found that when compounded with historically tense relationships between communities and policymakers, the mishandling of water shortages can signal to local residents that government action is ineffective and subsequently untrustworthy. Eyisi et al. (2024) review of tourism in Nigeria also found that negative opinions of tourism development can be tied to a history of unfulfilled government promises. In the case of Bocas del Toro, participants often pointed out a lack of follow-through on the MPSTD. Nilsen et al. (2023) describe what it means to be a ‘periphery’ region on an intra -national scale, where the development of rural or isolated regions may fall victim to an ‘urban bias’ ( Lipton, 1977 ). We witness this in Bocas del Toro as participants note that management schemes from the national level often overlook their interests as compared to more urbanized provinces closer to the core of Panama City.

Study limitations and future research avenues

While we believe the stories and perceptions shared with us to be of the utmost value to understanding our research questions, we acknowledge that our results represent the experiences of 16 individuals across the archipelago. Although a smaller sample size can enhance the validity of an in-depth inquiry ( Crouch and McKenzie, 2006 ), a larger sample size can better account for diversity within and between stakeholder groups ( Boddy, 2016 ). As the pool of research in this field begins to expand, we recommend that not only do future studies adequately account for community experiences and perceptions, but that they aim to include a variety of stake- and rights-holders, determining sample size as a “matter of judgment and experience … evaluating the quality of the information collected against the uses to which it will be put,” as per Sandelowski ( Sandelowski, 1995 , p.179).

This research begins to fill knowledge gaps in the literature surrounding marine ecotourism development and access to water in island regions. To ensure that community realities and interests do not effectively ‘fall through the cracks,’ there exists a need to pursue community-centric research on the impact of a blue economic agenda on a variety of essential public utilities and human needs (e.g., electricity, food, housing). Furthermore, valuable insights can be drawn from studies that compare and contrast, in-depth, cases across island regions to better understand the norms of the community impacts of blue economic development in resource-scarce societies. Concerning Bocas del Toro specifically, there is a great need for continued research into all areas of marine ecotourism development and the equitable distribution of resources (both in relation to one another and independently), as ours is one of a handful of studies within the region (e.g., Spalding, 2013 ; Spalding et al., 2015 ; Spalding, 2017 ; Mach and Vahradian, 2021 ; Pleasant and Spalding, 2021 ; Mach et al., 2023 ; Sandelowski, 1995 ; Pigram, 2000 ; McElroy, 2006 ; Pascual et al., 2014 ; Sakellariadou, 2014 ; Roller and Lavrakas, 2015 ; Pierskalla, 2016 ; Nunn and Kumar, 2017 ; Ramos-García et al., 2017 ; Murtin et al., 2018 ; Nugraheni et al., 2020 ; Osterblum et al., 2020 ; Peterson, 2020 ; Phelan et al., 2020 ; Mach and Vahradian, 2021 ; Minow, 2021 ; Pleasant and Spalding, 2021 ; Ministerio de Ambiente de Panamá, 2022 ; Rahman et al., 2022 ; Resolución de Gabinete No. 127, 2022 ; Méndez-Barrientos et al., 2023 ; Nilsen et al., 2023 ; Ortiz, 2023 ; Pace et al., 2023 ; Resolución de Gabinete No. 48, 2023 ; Scott et al., 2024 ).

In this study, we mobilize local experiences with marine ecotourism and water insecurity to better understand how the relationship between the two manifests at the community level. Our results highlight issues, of colonialism and systemic racism, misalignments of development priorities, and eroded trust, that shape local experiences with sustainable development, and residents’ perceptions of the ability of marine ecotourism to address issues of water insecurity.

Moving forward, as the Government of Panama pursues a ‘Blue Panama,’ and the global community continues to adopt the blue economy as a framework for sustainable ocean development, there exists a need to re-center and internalize social sustainability, primarily issues of equity, as the leading goal of blue economic development. More specifically, in order to adhere to the original intent of a blue economy, this must not only include the prioritization of social equity throughout marine ecotourism and water governance, but also address the issues that underpin such misalignments, as found in this study. This can include an approach that focuses on the power disparities between groups through a socio-historical lens. Singh et al. (2023) refer to this as an ‘anti-inequity’ approach, whereby it is critical to investigate and understand the processes that perpetuate inequities in, in this case, water security.

Overall, this research has demonstrated that the ‘balance’ between community well-being and development in the pursuit of a blue economy in island regions is a matter far greater than ‘growth,’ ‘infrastructure,’ or ‘development’. There exist important historical and social underpinnings that define the relationship between decision-makers and the communities in which they make decisions for, who proves to benefit from a blue economy, and perceptions of sustainable development as a whole. Ultimately, marine ecotourism cannot be considered part of a blue economy strategy if it does not prioritize social equity. As such it is pivotal that future research within this field understand how relevant plans and policies may manifest at the community level, directly from those communities that may face existing barriers to social well-being and sustainability.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving humans were approved by Marine Affairs Program Ethics Review Standing Committee, Dalhousie University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

AK: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing. CS: Conceptualization, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing – review & editing. WS: Conceptualization, Funding acquisition, Investigation, Project administration, Resources, Supervision, Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Nippon Foundation, Ocean Nexus.

Acknowledgments

We sincerely thank the communities and participants of Bocas del Toro for allowing, actively participating in, and supporting the data collection for this study. We also thank the staff of The School for Field Studies, Panama, for hosting us during our time in the field, as well as Laura Bruce and Sydney Rubinstein for their support as interpreters. Commentary and edits on the original manuscript were also provided by Ricardo de Ycaza (Oregon State University). We are grateful for the time and input from the reviewers of this paper, which have greatly improved the manuscript.

Conflict of interest

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

Publisher’s note

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

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmars.2024.1377053/full#supplementary-material

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Keywords: marine ecotourism, water security, blue economy, island systems, Bocas del Toro, sustainable development

Citation: Kim A, Scott CP and Swartz W (2024) Local perspectives on marine ecotourism development in a water-insecure island region: the case of Bocas del Toro, Panama. Front. Mar. Sci. 11:1377053. doi: 10.3389/fmars.2024.1377053

Received: 26 January 2024; Accepted: 02 May 2024; Published: 17 May 2024.

Reviewed by:

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

*Correspondence: Abigael Kim, [email protected]

† These authors have contributed equally to this work

This article is part of the Research Topic

The Potentials and Pitfalls from National Blue Economy Plans Towards Sustainable Development

Sperm whales learn the vocal styles of their neighbors

I f you thought communication was just for humans, think again. A fascinating new study has revealed that sperm whales, those majestic giants of the deep, have their own unique "vocal styles" – and they might even be picking up tips from their neighbors.

Imagine if your way of speaking – your rhythm, your pauses, your inflections – was as distinct as your fingerprint. That's the idea behind vocal style. 

Scientists have long known that sperm whales communicate using rhythmic patterns of clicks called "codas," but this study has delved deeper into the  structure  of these codas, revealing vocal patterns that are unique to each whale.

The research team, from Project Cetacean Translation Initiative ( CETI ) and collaborating institutions, developed a new method to analyze these click patterns, creating a kind of "vocal fingerprint" for each whale or whale clan. They then used this information to explore how these styles might be influenced by social interactions.

The vocal style of whale clans

Sperm whales are known for their complex social structures, living in multilevel societies that facilitate the transmission of knowledge and cultural behaviors. 

These societies are divided into "clans," groups of whales that share a common vocal repertoire. Think of it like having a regional accent – you can often tell where someone is from based on how they speak.

But what if your accent started to change based on who you were hanging out with? That's what seems to be happening with sperm whales. The study found that whales living in close proximity to other clans were more likely to develop similar vocal styles, even if they weren't part of the same clan .

Social learning in whale vocal communication

"The increase in similarity of non-identity coda vocal styles is most likely the result of social learning," explained lead author Antonio Leitao. 

"Identity codas are consistently maintained to allow the recognition of fellow clan members, but we believe that social learning between clans leads to a more similar vocal style with other whales that are within acoustic range."

This social learning isn't just about mimicry, though. It's about whales adapting their communication styles based on their social environment, much like we humans do. It's a testament to the intelligence and adaptability of these incredible creatures.

Study significance

The Atlantic dataset comprised two different clans and had rich annotations of the coda types recorded, the identity of the vocalizing whales, and their social relations. The Pacific dataset collected since 1978 was also used to determine the whales' clan membership based on the similarity of their vocal style.

These vast datasets allowed the researchers to create detailed "subcoda trees" for each whale or clan, revealing the intricate patterns that make up their unique vocal styles. Understanding how whales communicate has important implications for conservation efforts.  

"Our results strengthen previous results on the use of identity codas as symbolic markers, while supporting cultural transmission and social learning of vocalizations among whales of different clans," noted senior author Giovanni Petri.

This means that protecting whale populations isn't just about protecting individual whales ; it's about protecting their rich cultural heritage.

Future directions

This study is just the tip of the iceberg when it comes to understanding whale vocal styles and communication.

The authors suggest that future research could delve deeper into the mechanisms behind this social learning, exploring questions like: How exactly do whales learn from each other? What are the benefits of adapting one's vocal style? How does this learning impact the overall culture of a whale clan?

By investigating these questions, scientists hope to gain a more comprehensive understanding of the complexities of whale communication and the role social learning plays in their societies.

The study's findings have implications beyond the world of whales. The methodology developed by the research team could be used to study communication in other species.

Future research may give us a deeper understanding of how social learning shapes vocal and cultural transmission in the animal kingdom. Who knows, maybe one day we'll even be able to crack the code of whale language altogether.

The study is published in the journal eLife .

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• Open access
• Published: 10 May 2024

Mitochondrial DNA in bronchoalveolar lavage fluid is associated with the prognosis of idiopathic pulmonary fibrosis: a single cohort study

• Jun Fukihara 1 , 2 ,
• Koji Sakamoto 2 ,
• Yoshiki Ikeyama 2 ,
• Taiki Furukawa 3 ,
• Ryo Teramachi 2 ,
• Kensuke Kataoka 1 ,
• Yasuhiro Kondoh 1 ,
• Naozumi Hashimoto 4 &
• Makoto Ishii 2  

Respiratory Research volume  25 , Article number:  202 ( 2024 ) Cite this article

134 Accesses

Metrics details

Extracellular mitochondrial DNA (mtDNA) is released from damaged cells and increases in the serum and bronchoalveolar lavage fluid (BALF) of idiopathic pulmonary fibrosis (IPF) patients. While increased levels of serum mtDNA have been reported to be linked to disease progression and the future development of acute exacerbation (AE) of IPF (AE-IPF), the clinical significance of mtDNA in BALF (BALF-mtDNA) remains unclear. We investigated the relationships between BALF-mtDNA levels and other clinical variables and prognosis in IPF.

Extracellular mtDNA levels in BALF samples collected from IPF patients were determined using droplet-digital PCR. Levels of extracellular nucleolar DNA in BALF (BALF-nucDNA) were also determined as a marker for simple cell collapse. Patient characteristics and survival information were retrospectively reviewed.

mtDNA levels in serum and BALF did not correlate with each other. In 27 patients with paired BALF samples obtained in a stable state and at the time of AE diagnosis, BALF-mtDNA levels were significantly increased at the time of AE. Elevated BALF-mtDNA levels were associated with inflammation or disordered pulmonary function in a stable state ( n  = 90), while being associated with age and BALF-neutrophils at the time of AE ( n  = 38). BALF-mtDNA ≥ 4234.3 copies/µL in a stable state (median survival time (MST): 42.4 vs. 79.6 months, p  < 0.001) and ≥ 11,194.3 copies/µL at the time of AE (MST: 2.6 vs. 20.0 months, p  = 0.03) were associated with shorter survival after BALF collection, even after adjusting for other known prognostic factors. On the other hand, BALF-nucDNA showed different trends in correlation with other clinical variables and did not show any significant association with survival time.

Conclusions

Elevated BALF-mtDNA was associated with a poor prognosis in both IPF and AE-IPF. Of note, at the time of AE, it sharply distinguished survivors from non-survivors. Given the trends shown by analyses for BALF-nucDNA, the elevation of BALF-mtDNA might not simply reflect the impact of cell collapse. Further studies are required to explore the underlying mechanisms and clinical applications of BALF-mtDNA in IPF.

Introduction

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fibrotic lung disease with a median survival time (MST) of 3–5 years [ 1 ]. Acute exacerbation (AE) is a devastating complication of IPF with an MST of only 3 months [ 2 ]. Although some profibrotic growth factors, cytokines, and chemokines have been identified as contributing to the disease, its pathogenesis remains not fully understood. Given the poor prognosis of patients with IPF and AE-IPF, it is crucial to gain a thorough understanding of their pathogenesis and identify clinically important biomarkers.

Extracellular mitochondrial DNA (mtDNA) is one of the danger-associated molecular pattern molecules (DAMPs) released from stressed cells, binds to pathogen recognition receptors, activates immune systems, and induces an inflammatory response. In IPF, mitochondrial dysfunction and metabolic changes induced by the profibrotic stimuli and mechanical cues are assumed to trigger the release of mtDNA from lung cells such as fibroblasts [ 3 ]. and alveolar epithelial cells [ 4 ]. In accordance with this, mtDNA levels are elevated in both serum [ 3 , 4 , 5 , 6 , 7 ] and bronchoalveolar lavage fluid (BALF) [ 3 , 4 ] in IPF patients. While serum mtDNA levels are associated with survival time [ 3 , 7 ], disease severity or progression [ 4 , 5 , 7 ], and the occurrence of AE [ 6 ], the clinical significance of mtDNA in BALF (BALF-mtDNA) has not been well studied.

In the past 10–20 years, the technique of digital polymerase chain reaction (PCR), a refinement of conventional PCR methods, has become increasingly used for experimental and clinical purposes. Droplet-digital PCR (ddPCR) is one of those novel techniques. This enables precise detection of very small number of targets compared to conventional methods and absolute quantification without need for a standard curve [ 8 , 9 ] using crude clinical samples without the time- and labour-consuming DNA extraction steps [ 10 ].

In this study, we established a protocol for measuring BALF-mtDNA using ddPCR and evaluated its clinical significance in IPF including the value as a possible prognostic biomarker in both stable and AE states.

Study population and data collection

From August 2009 to May 2017, we collected BALF samples from 101 IPF patients who underwent bronchoalveolar lavage (BAL) at Tosei General Hospital. Of those, 90 patients provided BALF samples during a stable state, 38 patients provided at the time of their first AE, and 27 out of them underwent BAL both in a stable state and at the time of AE. A subset of these patients also provided blood samples. During a stable state, 57 out of 90 patients provided blood samples within 3 months before or after undergoing BAL. At the time of the first AE, 36 out of 38 patients provided blood samples at the same time as BAL.

In all patients, the validity of the IPF diagnosis was reconfirmed based on the latest guidelines [ 11 ] through multidisciplinary discussions. The AE diagnosis was also reconfirmed as a clinical event meeting the criteria described in an international report published in 2016 [ 2 ]. The treatment for AE followed a standardised protocol: methylprednisolone pulse therapy (1 g/day for 3 days/week) for two cycles, followed by 1 mg/kg/day of methylprednisolone. The steroid dosage was gradually tapered to 10 mg/day of oral prednisolone within 4–6 weeks after initiating treatment. Cyclosporine or tacrolimus was administered concurrently. Prednisolone and immunosuppressants were continued for at least a few months post-recovery.

Patient characteristics and test results were collected retrospectively from clinical charts. Blood test and pulmonary function test results were recorded within 3 months before BAL for patients in a stable state. Forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (D L CO) were expressed as a percentage of predicted values. To calculate the partial pressure of arterial oxygen (PaO 2 )/fraction of inspiratory oxygen (FiO 2 ), FiO 2 was roughly assumed to be 0.21 + 0.04 × oxygen flow (L/min) when using a nasal cannula, and as 0.60 + 0.10 × (oxygen flow – 6 L/min) when using a non-rebreather mask. For data at the time of AE-IPF, baseline FVC and D L CO had been recorded within 6 months prior to the diagnosis of AE. The final follow-up date of this study was 30th April 2022.

Sample collection

BALF and blood samples were collected from patients who provided informed written consent in accordance with the Declaration of Helsinki. BAL was carried out according to the standardised protocol [ 12 ].

See the Supporting Information for the detail protocol for processing of BALF and blood and subsequent ddPCR.

Statistical analysis

Continuous variables were presented as the median with an interquartile range due to a non-normal distribution, and Wilcoxon signed-rank test and Mann–Whitney’s U test were used for inter-group comparisons, as appropriate. Categorical variables were summarized by number and percentage. Spearman’s rank correlation test was applied to evaluate the correlation between two continuous variables. Benjamini and Hochberg’s method [ 13 ] was used to adjust the false discovery rate for multiple testing.

We measured survival time from the date of BAL to the date of death. Time-dependent receiver operating characteristic (ROC) curve analyses were performed to determine the optimal cut-off values for BALF-mtDNA and BALF- nucDNA to predict survival time and determine the area under the curve (AUC). Cox proportional hazards models were used to evaluate the associations between variables and survival time, adjusting for known demographic factors being associated with survival time.

We used a two-sided test for all statistical analyses and considered p-values < 0.05 as statistically significant. The analyses were conducted with R commander (The R Foundation for Statistical Computing, Vienna, Austria).

Factors correlated with BALF-mtDNA and BALF-nucDNA

Table 1 shows patient characteristics at the time of BAL. Among patients who provided both BALF and serum samples at the same time, we found no significant correlations between mtDNA and nucDNA levels, either in a stable state or at the time of AE (Fig.  1 A, B). Among those who provided BALF samples both in a stable state and at the time of AE, BALF-mtDNA and BALF-nucDNA levels were significantly increased at the time of AE compared to those in a stable state (Fig.  1 C).

Correlation of target genes in BALF with those in serum and the occurrence of AE. A , B Copy numbers of target genes in BALF and serum were not correlated significantly each other either ( A ) in a stable state ( n  = 57) or ( B ) at the time of first AE ( n  = 36), determined by ddPCR. C  mtDNA and nucDNA levels in BALF determined by ddPCR were significantly increased at the time of the first AE compared with those in a stable state ( n  = 27). Medians and interquartile ranges for the values of each target were: mtDNA, stable: 5575.7 (4478.6 – 8511.4) vs. AE: 15,441.4 (6467.1 – 29,678.6) copies/µL; nucDNA, stable: 137.1 (79.7 – 201.0) vs. AE: 318.9 (134.1 – 660.0) copies/µL. BALF: bronchoalveolar lavage fluid; mtDNA: mitochondrial DNA; nucDNA: nucleolar DNA, AE acute exacerbation; ddPCR: droplet-digital polymerase chain reaction; ** P  < 0.01; **** P  < 0.0001

We explored the clinical variables correlated with the levels of BALF-mtDNA and -nucDNA. In a stable state, cigarette smoke exposure (pack-year), D L CO, and PaO 2 /FiO 2 showed a negative correlation with BALF-mtDNA levels, while a positive correlation was observed with serum Krebs von den Lungen-6 (KL-6) levels (Table  2 ). BALF-nucDNA levels were negatively correlated with D L CO, FVC, and PaO 2 /FiO 2 in a stable state, but positively correlated with BALF neutrophil and eosinophil rates, and serum levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), and KL-6 (Table  3 ). On the other hand, at the time of the first AE, BALF-mtDNA levels were positively correlated with BALF neutrophil rates and negatively with age (Table  2 ). However, there were no significant correlations between BALF-nucDNA levels and clinical variables except for serum LDH levels (Table  3 ).

Thus, in a stable state, both BALF-mtDNA and BALF-nucDNA levels were found to be correlated with the degree of lung function impairment and inflammation, whereas cigarette smoking was correlated only with BALF-mtDNA levels. At the time of AE, it showed significant correlation with BALF neutrophils.

BALF-mtDNA and survival of IPF

We investigated the prognostic significance of BALF-mtDNA in comparison with the rates of neutrophils and lymphocytes in BALF, which have been reported as prognostic factors [ 14 , 15 ]. Using time-dependent ROC analyses, we revealed a relatively better prognostic value of BALF-mtDNA than that of the rates of neutrophils or lymphocytes in BALF (Fig.  2 A). A BALF-mtDNA of 4234.3 copies/µL and a BALF-nucDNA of 78.0 copies/µL in a stable state were identified to predict 5-year mortality (Fig.  2 B and Figure S 2 A). After adjusting for age, sex, body mass index (BMI), and baseline FVC and D L CO, BALF-mtDNA ≥ 4234.3 copies/µL in a stable state was significantly correlated with survival time (Fig.  2 C and Table  4 , MST: 79.6 vs. 43.1 months), while BALF-nucDNA ≥ 78.0 copies/µL was not.

Survival prediction by BALF-mtDNA. A ROC curves for BALF-mtDNA, neutrophil rates, and lymphocyte rates for predicting 5-year mortality from a stable state. B Changes in AUC values over time from a stable state for each cutoff value of BALF-mtDNA. C Patients with a higher BALF-mtDNA showed shorter survival time than those with a low BALF-mtDNA in a stable state after adjusting for age, sex, body mass index, and baseline forced vital capacity and diffusing capacity of lung for carbon monoxide (median survival time: 42.4 months in BALF-mtDNA ≥ 4234.3 copies/µL vs. 79.6 months in BALF-mtDNA < 4234.3 copies/µL, p  < 0.001). D ROC curves for BALF-mtDNA, neutrophil rates, and lymphocyte rates for predicting 6-month mortality from the time of AE. Since higher lymphocyte rates in BALF at the time of AE tended to be associated with longer survival, the lymphocyte rate values were transformed into negative numbers before conducting the time-dependent ROC analysis. E Changes in AUC values over time from the time of AE for each cutoff value of BALF-mtDNA. F Patients with a higher BALF-mtDNA showed poorer survival times than those with a low BALF-mtDNA at the time of first AE after adjusting for age, sex and partial pressure of arterial oxygen/fraction of inspiratory oxygen (median survival time: 2.6 months in BALF-mtDNA ≥ 11,194.3 copies/µL vs. 20.0 months in BALF-mtDNA < 11,194.3 copies/µL, p  = 0.03). Baseline FVC and D L CO data were recorded within 6 months prior to the AE. AUC: area under the curve; 95%CI: 95% confidence interval; mtDNA: mitochondrial DNA; Neu: neutrophils; Lym: lymphocytes; ROC: receiver operating characteristic

BALF-mtDNA and survival from AE-IPF

Because there is no firm predictor for survival of AE-IPF to date, we conducted further analyses to evaluate correlation of BALF-mtDNA at the time of AE-IPF diagnosis with the prognosis. Time-dependent ROC analyses revealed a relatively better prognostic value of BALF-mtDNA than that of the rates of neutrophils or lymphocytes in BALF (Fig.  2 D). A BALF-mtDNA level of 11,194.3 copies/µL and a BALF-nucDNA level of 602.6 copies/µL at the time of AE were identified as optimal cut-off values to predict 6-month mortality (Fig.  2 E and Figure S 2 B). BALF-mtDNA ≥ 11,194.3 copies/µL at the time of AE was significantly correlated with survival time after the diagnosis of AE, even after adjusting for age, sex, and PaO 2 /FiO 2 (Fig.  2 F and Table  4 , MST: 30.3 vs. 2.3 months). The results were similar when using BMI, serum CRP levels, or FVC and D L CO values recorded within 6 months before the diagnosis of AE, as adjusting variables instead of PaO 2 /FiO 2 (Table  4 ). It should be noted that this cut-off value sharply distinguished survivors from non-survivors. Other variables such as BALF-nucDNA, BALF neutrophil ratios, PaO 2 /FiO 2 , and serum biomarkers shown in Table  2 , did not show a significant correlation with survival time. Serum-mtDNA in BALF collected at the time of AE, which did not correlate with BALF-mtDNA, also did not show a correlation with survival time (see the Results in the Supporting Information).

Our study revealed relationships between BALF-mtDNA and lung function, smoking status, inflammatory cells in BALF, and prognosis in patients with IPF. Intriguingly, the results suggested that increased BALF-mtDNA can be a potential indicator of poor prognosis for IPF, being associated with survival time in both stable and acute phases. In particular, it clearly distinguished survivors from non-survivors in patients with AE-IPF in our cohort. Meanwhile, BALF-nucDNA did not show prognostic value in either phase. This is the first study to demonstrate the clinical significance of BALF-mtDNA on IPF, which was measured precisely using ddPCR.

mtDNA is known as a DAMP that triggers inflammatory responses via pathogen recognition receptors, such as Toll-like receptor-9 [ 16 ]. It can be released outside mitochondria through various mechanisms, including cell death and other mechanisms unrelated to cell death (active release), such as mtDNA damage and oxidative stress caused by reactive oxygen species [ 17 , 18 , 19 ]. In the field of IPF, several studies have evaluated the prognostic impact of plasma/serum-mtDNA. Extracellular mtDNA was elevated in plasma or serum from IPF patients, and was associated with shorter survival [ 3 , 7 ], disease progression [ 3 , 5 , 7 ], future development of AE-IPF [ 6 ], and clinical parameters representing disease severity, such as lower D L CO and shorter 6-min walk distance [ 4 , 7 ]. On the other hand, Bruno et al. demonstrated elevated BALF-mtDNA in IPF [ 4 ], although its clinical significance and prognostic impact have not been studied in detail, and how BALF-mtDNA levels alter depending on the disease status has never been investigated. In our study, levels of BALF-mtDNA and serum-mtDNA were poorly correlated with each other in both stable and acute phases. While the levels of BALF-mtDNA are expected to reflect the concentration of mtDNA in the epithelial lining fluid of the lungs, its kinetics, such as half-life, have seldom been studied. On the other hand, the kinetics of mtDNA levels in the bloodstream have been studied in various acute disease states, and its half-life is expected to be short. Circulating mtDNA levels are suggested to be influenced by multiple systemic parameters, including the concentration of DNase in the blood and clearance by organs such as the liver and kidney. Based on these results, we speculate that BALF-mtDNA may sensitively reflect local lung damage and be elevated even in mild disease, while serum-mtDNA may be elevated in more advanced disease and reflect systemic inflammation. To elucidate these hypotheses, further studies are warranted.

Clinical parameters such as baseline lung function [ 14 , 20 , 21 , 22 , 23 ], worse oxygenation [ 14 , 24 ], neutrophils and lymphocytes in BALF [ 14 , 15 ], and blood biomarkers like CRP [ 14 ], LDH [ 24 , 25 ], and KL-6 [ 24 ] have been identified as prognostic factors of AE-IPF, though their impact has varied between studies. Our study results may provide new insights into this area. Given that the MST of AE-IPF is generally recognized as 3–4 months [ 2 , 26 ], our findings indicate that BALF-mtDNA can distinguish between AE-IPF patients with an MST of less than 3 months (non-survivors) and those with an MST of more than 30 months (survivors). Meanwhile, serum-mtDNA was not correlated with survival after the diagnosis of AE-IPF, though the number of the assessed serum samples was limited. This suggests that the dynamics of mtDNA circulating in the local lung are distinct from that in the systemic condition in the acute setting. Given that BALF-mtDNA, but not nucDNA, which is generally released during cell death, was significantly correlated with BALF-neutrophils, active release of mtDNA from cells may be related to acute neutrophilic inflammation.

In stable IPF, age, sex, baseline FVC and D L CO are widely accepted prognostic factors [ 27 ]. Meanwhile, though there are a few reports insisting on the prognostic value of BALF biomarkers such as surfactant protein A and neutrophils [ 28 , 29 ], supporting evidence for them is still lacking. Our study found that BALF-mtDNA was associated with survival of IPF in a stable state. Additionally, it is worth noting that the disease severity in our cohort was relatively mild, as evidenced by a median FVC of approximately 80% predicted. Therefore, BALF-mtDNA may be a sensitive factor correlating with survival, even in the early stages of the disease with preserved lung function.

In this study, BALF-mtDNA levels in a stable state were correlated with the severity of lung function impairment (reduced D L CO and PaO 2 /FiO 2 ) as well as serum KL-6, which has been reported to reflect the extent of lung involvement in IPF. Similar correlations were also observed with BALF-nucDNA. The increases in both BALF-mtDNA and BALF-nucDNA may reflect the increased apoptosis in the lungs. Meanwhile, it is worth noting that, unlike BALF-nucDNA, BALF-mtDNA levels were significantly decreased in smokers compared to non-smokers. A previous study has revealed increased mtDNA damage and deletion, as well as decreased mtDNA in macrophages in BALF from smokers compared with that from non-smokers [ 30 ]. While a number of other studies have demonstrated increased mtDNA levels in blood [ 18 ] or cells exposed to cigarette smoke [ 31 , 32 ], the alteration of extracellular mtDNA levels in BALF has not been extensively studied. Although further studies investigating the effect of smoking on BALF-mtDNA are warranted, our data suggest that the increased BALF-mtDNA observed in IPF patients may reflect the pathological mechanisms correlated with disease severity and progression, rather than non-specific oxidative stress increased in the lungs of smokers.

ddPCR is a highly sensitive gene detection method increasingly used in medical and basic research. Moreover, this novel method has the great advantage of simplifying the sample preparation steps by using crude samples. It has been applied to measure various biomarkers in BALF and bronchial washing fluid, such as lung microbiota [ 33 , 34 , 35 , 36 ] and pathogenic gene mutations in lung cancer [ 37 ]. However, ddPCR has not been used to detect biomarkers of pulmonary fibrosis, and no previous study has evaluated mtDNA levels in BALF using ddPCR. We believe that the preciseness and result reproducibility of ddPCR strengthen the robustness of our findings, and the convenience supports its future application to both clinical practice and basic research.

Some limitations of this study should be acknowledged. First, it is a retrospective study with a limited number of included cases conducted in a single centre without a validation cohort. Therefore, further research is needed to confirm the results. Second, our stable IPF cohort included mainly mild cases, so it is unclear whether our findings can be applied to more severe cases. However, our study suggests that BALF-mtDNA may be prognostic at least in mild cases. Third, due to the invasiveness of BAL and limited diagnostic information which can be obtained from it, it is not routinely recommended for evaluating IPF/AE-IPF. While measuring mtDNA may extend the usefulness of BAL, a less invasive procedure for obtaining samples reflecting information in the alveolar lining fluid is expected and would further enhance the clinical value of mtDNA as a prognostic biomarker. Fourth, due to the lack of information regarding comorbidities, this report could not provide any information regarding the correlation between patients’ comorbidities and BALF-mtDNA levels. Fifth, due to the ethical limitation related with the invasiveness of BAL procedure, we could not obtain BALF samples from healthy controls. This made interpretation of our findings challenging. Lastly, the limited number of patients who provided serum samples may have led to an underestimation of the prognostic impact of serum mtDNA at the time of AE. Further study is needed to reach a conclusion.

Elevated BALF-mtDNA levels were associated with inflammation or disordered pulmonary function in a stable state, and with an elevated neutrophil ratio in BALF at the time of AE. They were also associated with shorter survival in both stable IPF and at the time of AE. Notably, higher BALF-mtDNA levels may help distinguish non-survivors from survivors in AE-IPF. Given the trends shown by analyses for serum-mtDNA and BALF-nucDNA, the elevation of BALF-mtDNA might reflect different underlying aetiology reflected by serum-mtDNA and might not simply reflect the impact of cell collapse. Further research is required to explore the underlying mechanisms and clinical applications of BALF-mtDNA in IPF.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

• Acute exacerbation

Area under the curve

• Bronchoalveolar lavage

Bronchoalveolar lavage fluid

Body mass index

C-reactive protein

Danger-associated molecular pattern molecules

Droplet digital polymerase chain reaction

Diffusing capacity of the lung for carbon monoxide

Fraction of inspiratory oxygen

Forced vital capacity

• Idiopathic pulmonary fibrosis

Lactate dehydrogenase

Median survival time

Mitochondrial deoxyribonucleic acid

Nucleolar deoxyribonucleic acid

Partial pressure of arterial oxygen

Polymerase chain reaction

Receiver operating characteristic

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Acknowledgements

The authors wish to acknowledge Ms. Moeko Marui and Mr. Tomoyasu Ito from the Division for Medical Research Engineering, Nagoya University Graduate School of Medicine, for technical support in digital droplet PCR analysis.

This work was supported by Grant-in-Aid for Scientific Research (18K15948, 21K08202) and the Hori Sciences and Arts Foundation to K. Sakamoto, and JST-CREST (Core Research for Evolutional Science and Technology; JPMJCR17H3) to N. Hashimoto and K. Sakamoto.

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KS takes responsibility for the content of the manuscript, including the data and analysis; JF was a major contributor in writing the manuscript with assistance from KS. JF and KS designed the study, performed laboratory experiments, and had full access to all the data in the study with technical assistance from YI. JF, TF and RT collected clinical data from clinical charts. JF, KS, YI, TF and KK collected and managed clinical samples; JF was a major contributor in writing the manuscript with assistance from TF. KK, YK, NH and MI contributed to the editing of the manuscript; all authors read and approved the final version of the manuscript.

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12931_2024_2828_moesm1_esm.docx.

Additional file 1. Additional methods regarding processing of BALF and blood, and ddPCR, additional results regarding optimisation of ddPCR protocol and correlation between serum-mtDNA and survival from AE-IPF, and Figure S1 and S2.

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Fukihara, J., Sakamoto, K., Ikeyama, Y. et al. Mitochondrial DNA in bronchoalveolar lavage fluid is associated with the prognosis of idiopathic pulmonary fibrosis: a single cohort study. Respir Res 25 , 202 (2024). https://doi.org/10.1186/s12931-024-02828-9

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Inotuzumab ozogamicin for the treatment of adult acute lymphoblastic leukemia: past progress, current research and future directions

• Nicholas J. Short 1 ,
• Elias Jabbour 1 ,
• Nitin Jain 1 &
• Hagop Kantarjian 1  

Journal of Hematology & Oncology volume  17 , Article number:  32 ( 2024 ) Cite this article

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Inotuzumab ozogamicin (INO) is an anti-CD22 antibody-drug conjugate that was first evaluated in B-cell lymphomas but was subsequently shown to be highly effective in acute lymphoblastic leukemia (ALL). INO improved response rates and survival in a randomized study in adults with relapsed/refractory B-cell ALL, leading to its regulatory approval in the United States in 2017. While the formal approval for INO is as monotherapy in relapsed/refractory ALL, subsequent studies with INO administered in combination with chemotherapy and/or blinatumomab both in the frontline and salvage settings have yielded promising results. In this review, we discuss the clinical development of INO in ALL, highlighting lessons learned from the initial clinical trials of INO, as well as the many ongoing studies that are seeking to expand the role of INO in ALL.

Introduction

The anti-CD22 antibody drug conjugate inotuzumab ozogamicin (INO) was developed in the early 2000s based on initial preclinical data showing promising activity in B-cell lymphoid diseases. These laboratory observations were then followed by several early phase clinical trials that showed significant efficacy of INO in acute lymphoblastic leukemia (ALL), ultimately prompting to its evaluation in a large, randomized trial in adults with relapsed/refractory CD22-positive B-cell ALL. In the pivotal INO-VATE study, INO significantly improved response rates and overall survival (OS) compared with conventional chemotherapy, leading to its approval by the Food and Drug Administration (FDA) in August 2017 [ 1 ]. Figure  1 shows a timeline of its clinical development. In this review, we discuss the lessons learned during its development and how these are being applied to current research efforts. We will also discuss the new research that is attempting to expand the potential applications of INO in B-cell ALL, including using it in combination with chemotherapy and/or other immunotherapies, in the frontline treatment of ALL, and in treatment of measurable residual disease (MRD).

Timeline of the clinical development of inotuzumab ozogamicin in acute lymphoblastic leukemia. For context, approval dates for other novel immunotherapies in adult B-cell acute lymphoblastic leukemia are also shown

Drug mechanism and preclinical development

INO is an IgG anti-CD22 monoclonal antibody drug conjugate that was developed by Celltech (a British biotechnology company) and Wyeth (a pharmaceutical company, later purchased by Pfizer in 2009). It is covalently linked to calicheamicin dimethyl hydrazide with acid-labile 4-(4’-acetylphenoxy) butanoic acid liner [ 2 ]. INO has sub-nanomolar binding affinity to CD22 and is rapidly internalized upon binding, after which it delivers the calicheamicin toxin intracellularly where it binds to the minor DNA groove and leads to double-strand cleavage and subsequent apoptosis. INO was first shown in preclinical studies to be active against B-cell lymphoma cell lines [ 2 ]. Subsequent studies were performed in mouse models of aggressive B-cell lymphomas, showing both monotherapy activity as well as synergy with rituximab or chemotherapy, including CVD and CHOP [ 3 , 4 , 5 ]. Given the clear preclinical activity in B-cell lymphoma models, INO was also tested in CD22-positive ALL models, where it induced complete tumor regression and cures in mice, warranting its clinical development in ALL [ 5 , 6 ].

Phase I and II studies

The first study of INO in humans was a phase I study in adults with relapsed or refractory CD22-positive B-cell non-Hodgkin’s lymphoma [ 7 ]. Seventy-nine patients were treated, and the maximum tolerated dose (MTD) was 1.8 mg/m 2 administered as a single dose every 3–4 weeks. Thrombocytopenia was the dose-limiting toxicity, with 90% of patients experiencing thrombocytopenia of any grade, which was grade ≥ 3 in 63%. Encouraging activity was observed, and the overall response rate was 39% among all patients, with response rates in follicular lymphoma and diffuse large B-cell lymphoma of 69% and 15%, respectively, at the MTD. Investigator-initiated pilot studies at MD Anderson Cancer Center were ongoing simultaneously, though the chosen regulatory approval path by the company was initially in lymphomas. Fortunately, by the time the phase III pivotal trial in lymphoma had failed to meet the primary study endpoint in 2014 [ 8 , 9 ], the pilot studies in ALL had shown encouraging results, thus shifting the regulatory focus to ALL.

The investigator-initiated phase II study at MD Anderson Cancer Center evaluated INO in children and adults with CD22-positive relapsed or refractory ALL (Table  1 ). In the initial publication, 49 patients received INO at a dose of 1.3 mg/m 2 to 1.8 mg/m 2 administered once every 3–4 weeks [ 10 ]. The population was heavily pretreated, with 73% of patients being treated as second or later salvage. The complete remission (CR)/CR with incomplete hematologic recovery (CRi) rate was 57%, and the median OS was 5.1 months. The most common adverse events were fever (59%), transaminase elevation (57%), and hyperbilirubinemia (29%). An important observation was that allogeneic hematopoietic stem cell transplantation (HSCT) increased the risk of toxicity. Among the 26 patients who underwent HSCT following INO, the 1-year OS rate was only 20%, driven by higher rates of non-relapse mortality (NRM) and 5 deaths due to sinusoidal obstruction syndrome (SOS) / veno-occlusive disease (VOD). To improve upon the safety/efficacy profile of INO, the study was then amended to fractionate the dose of INO and administer a dose of 0.8 mg/m 2 on day 1 and 0.5 mg/m 2 on day 8 and 15, given every 3–4 weeks, with the rationale that lower dose and more frequent schedules of INO may improve anti-ALL efficacy (which is determined primarily by the area under the curve) while reducing toxicities (which is determined primarily by the peak level of INO). In a subsequent analysis after treating 90 total patients (49 at the original schedule and 41 at the new schedule), the response rates and survival outcomes were similar [ 11 ]. However, the new dosing schedule appeared safer and resulted in lower rates of fever, hypotension and hyperbilirubinemia. The rate of SOS/VOD was also lower with the new schedule (7% versus 17% with the previous schedule), which may have been driven by the fractionated dosing as well as better understanding of the SOS/VOD risk with INO, leading to a reduced use of alkylating agents in HSCT preparative regimens.

The safety and efficacy of INO was later confirmed with a phase I/II multicenter study that evaluated INO in a similar population of adults with relapsed or refractory ALL (Table  1 ) [ 12 ]. This study also evaluated divided, weekly doses of INO (ranging from 1.2 mg/m 2 to 1.8 mg/m 2 per cycle) given for up to 6 cycles. The recommended phase II dose was 1.8 mg/m 2 per cycle, with the dose reduced to 1.6 mg/m 2 once CR/CRi was achieved. Seventy-two patients were treated, including 78% in salvage 2 or beyond and approximately one-third who had undergone previous allogeneic HSCT. The CR/CRi rate was 68% (including CR in 32%), and the median OS was 7.4 months. One-third of patients received a subsequent allogeneic HSCT, and there were 4 cases of SOS/VOD (6% total).

Phase III study (INO-VATE)

Efficacy and safety outcomes.

Based on the promising safety and efficacy data from the 2 prior clinical studies of INO in B-cell ALL, the INO-VATE study was designed as pivotal trial to compare INO to conventional chemotherapy in adults with relapsed or refractory CD22-positive B-cell ALL (Table  1 ) [ 1 ]. Three hundred and twenty-six patients were randomized 1:1 to INO or combination chemotherapy (either fludarabine, cytarabine and granulocyte-stimulating factor [FLAG], cytarabine plus mitoxantrone, or high-dose cytarabine). Given the superior safety observed with weekly dosing, INO was given at a dose of 0.8 mg/m 2 on day 1 and 0.5 mg/m 2 on days 8 and 15, for up to 6 cycles. The median age was 47 years in both arms, and 32% of patients in the INO arm and 36% in the control arm were in second salvage. INO resulted in a significantly higher rate of CR/CRi than did conventional chemotherapy (80.7% [95% confidence interval (CI), 72.1–87.7%] vs. 29.4% [95% CI, 21.0–38.8%], respectively; P  < 0.001). Superior responses with INO were observed across all subgroups, with the exception of patients with t(4;11), although the number of patients was small. Among responders, INO was also associated with significantly higher rates of MRD negativity by multiparameter flow cytometry (78.4% vs. 28.1%, respectively; P  < 0.001) and higher rates of subsequent HSCT (41% vs. 11%, respectively; P  < 0.001). Driven by the higher rates of response and HSCT realization, INO resulted in significantly better median OS (7.7 months [95% CI, 6.0 to 9.2] vs. 6.7 months [95% CI, 4.9 to 8.3]; P  = 0.04). While the numerical improvement in median OS was marginal, the greatest benefit to INO was observed in the long-term survival outcomes, where INO more than doubled the 2-year OS rate compared with chemotherapy (23% vs. 10%, respectively). Febrile neutropenia and thrombocytopenia were more common in the control group, while liver-related adverse events were more common with INO. The SOS/VOD rate with INO and chemotherapy were 11% and 1%, respectively. Based on the substantial improvement in both response rates and OS, the FDA approved INO in August 2017 for the treatment of adults with relapsed/refractory B-cell ALL.

Subgroups analyses, including transplant outcomes

Following the initial publication of the INO-VATE study, several subgroup analyses of the trial population have been published. These analyses have highlighted important considerations for the use of INO, including its good activity irrespective of bone marrow blast percentage, extramedullary involvement, or CD22 expression, and its activity in Philadelphia chromosome (Ph)-positive ALL [ 13 , 14 , 15 ]. INO is associated with a higher rate of HSCT realization, which is the most significant predictor of OS following INO therapy by multivariate analysis [ 16 ]. Among patients in the INO-VATE study who received INO and achieved CR/CRi, those who underwent subsequent allogeneic had the best outcomes (median OS 12.6 months and 2-year OS rate 39% versus median OS 7.1 months and 2-year OS rate 13% in non-transplanted). However, subsequent transplant is associated with higher risk of SOS/VOD after INO (23% versus 9% in non-transplanted patients), which contributes to INO-related non-relapse mortality. Proper patient selection for INO and mitigation strategies are therefore imperative to prevent this important potential copmlication. Similar post-transplant findings were observed in a pooled analysis of 2 INO studies, where patients who underwent allogeneic HSCT following INO had a post-HSCT median OS of 9.2 months and 2-year post-HSCT OS rate of 41% [ 17 ]. The overall rate of SOS/VOD among transplanted patients across these 2 studies was 18%.

Pooled analyses from multiple INO studies have been used to better understand the risk for SOS/VOD, which is a severe and potential toxicity with INO treatment. Across these studies, the predictors for the development of SOS/VOD include: older age, the use of double alkylator preparative regimens for HSCT, elevated pretreatment transaminases and/or bilirubin, more cycles and higher cumulative doses of INO, and multiple prior ALL therapies, especially prior HSCT [ 1 , 18 , 19 , 20 ]. Subsequent consensus guidelines have been developed to mitigate these risks. Important considerations to prevent the risk of SOS/VOD in patients receiving INO include: proper selection of patients (e.g. avoiding in patients were severe underlying hepatic dysfunction, avoiding dual alkylator conditioning regimens in transplanted patients, limiting INO to a cumulative dose of 2.7 to 3.6 mg/m 2 in patients proceeding to allogeneic HSCT, use of high dose steroids at the first sign of liver dysfunction, and distancing the last dose of INO from time of HSCT [ 21 ]. Ursodiol prophylaxis 300 mg three times daily should be considered for all patients receiving INO, although there is no clear role for defibrotide as prophylaxis, even for high-risk patients [ 22 ].

Combination therapies with INO for relapsed/refractory ALL

While single-agent INO therapy represents a therapeutic advance for patients with relapsed/refractory ALL, it is not curative for most patients when given as monotherapy, with < 20% of patients achieving long-term survival [ 16 ]. Research efforts have therefore been focused on combination therapies of INO with chemotherapy and/or other novel agents such as blinatumomab, with the goal of deepening response and further improving survival outcomes (Table  2 ). At MD Anderson Cancer Center, a regimen of mini-hyper-CVD (dose-reduced hyperfractionated cyclophosphamide, vincristine and dexamethasone alternating with dose-reduced methotrexate and cytarabine) in combination with INO was studied in relapsed/refractory Ph-negative B-cell ALL. Figure  2 shows the evolution of this regimen over the past decade. INO was originally given on day 3 of cycles 1–4 at a dose of 1.8 mg/m 2 in cycle 1 and 1.3 mg/m 2 in cycles 2–4 (cumulative dose of 5.7 mg/m 2 ) and then was later reduced to 1.3 mg/m 2 in cycle 1 and 1 mg/m 2 in cycles 2–4 (cumulative dose of 4.3 mg/m 2 ) in an effort to reduce the risk of SOS/VOD (Fig.  2 A) [ 23 ]. Among 59 patients treated, the overall response rate was 78%, with 82% of responders achieving MRD negativity by flow cytometry. Response rates were particularly encouraging in first salvage, where the overall response rate was 91%. The SOS/VOD rate was 15% using this single-dose regimen, which was similar to the 17% rate observed in the initial phase II study using a similar dosing strategy [ 10 ]. The median OS was 11 months, and the 1-year OS rate was 46%. The survival outcomes were compared to historical data with INO monotherapy using an inverse probability of treatment weighing analysis, which suggested that the combination therapy was superior to expectations with INO monotherapy.

Evolution of the hyper-CVD and inotuzumab ozogamicin ± blinatumomab regimen at MD Anderson Cancer Center. A .) Hyper-CVD plus inotuzumab ozogamicin, B .) Hyper-CVD plus inotuzumab ozogamicin with sequential blinatumomab, C .) “Dose dense” hyper-CVD, inotuzumab ozogamicin and blinatumomab

This study was then amended to further reduce and fractionate the dose of INO, add blinatumomab, and mandate ursodiol prophylaxis (Fig.  2 B) [ 24 ]. The purpose of these changes was two-fold: to deepen response with the addition of blinatumomab and to mitigate the risk of SOS/VOD by reducing the dose of INO and by increasing the interval between the last dose of INO and allogeneic HSCT. In this new design, patients received 4 cycles of mini-hyper-CVD plus INO, followed by 4 cycles of blinatumomab, and then a maintenance phase of blocks of POMP (6-mercaptopurine, vincristine, methotrexate, and prednisone) alternating with blinatumomab. INO was reduced to 0.6 mg/m 2 on day 2 and 0.3 mg/m 2 on day 8 in cycle 1 and 0.3 mg/m 2 on days 2 and 8 in cycles 2–4 (cumulative dose of 2.7 mg/m 2 ). In the most recent published analysis of the mini-hyper-CVD, INO ± blinatumomab regimen (with blinatumomab given to patients #68+), 110 patients have been treated [ 25 ]. The overall response rate was 83%, and 82% of responders achieved MRD negativity by flow cytometry. The median OS was 17 months, and the 3-year OS rate was 40%. Outcomes were best for those treated in first salvage, where the median OS was 31 months, and the 3-year OS rate was 49%. In a landmark analysis, there was no benefit for receipt of subsequent allogeneic HSCT (3-year OS 54% for both groups). The SOS/VOD rate was also observed to be lower after the amendment to reduce and fractionate INO and add blinatumomab (2% vs. 13% with the previous design; P  = 0.05). These data highlight that SOS/VOD can be substantially mitigated with use of lower doses of INO without compromising efficacy.

The mini-hyper-CVD, INO and blinatumomab regimen has now been amended to administer to deliver all agents beginning in cycle 1 (Fig.  2 C). In the latest study design, 6 cycles of “dose-dense” mini-hyper-CVD, INO and blinatumomab are given, followed by POMP/blinatumomab maintenance in non-transplanted patients. In each cycle, blinatumomab is started on day 4 (i.e. once the mini-hyper-CVD chemotherapy has been delivered) and continues through day 21 of each cycle, followed by a 7-day break before beginning the next cycle. To date, 15 patients with relapsed/refractory ALL have been treated with this regimen. All patients responded, with 92% achieving flow MRD negativity (77% after 1 cycle) [ 26 ]. High rates of early response have also been observed in a retrospective analysis of this regimen in both newly diagnosed and relapsed/refractory patients [ 27 ]. Among patients with newly diagnosed or MRD-positive ALL, 10/11 (91%) achieved MRD negativity at a level of 10 − 6 by next-generation sequencing, an endpoint shown to be associated with superior outcomes in ALL [ 28 , 29 ]. The deep and rapid MRD negative responses with the dose-dose mini-hyper-CVD, INO and blinatumomab regimen are encouraging, and this regimen is also now being evaluated in older adults with newly diagnosed B-cell ALL.

Combination therapies with INO for newly diagnosed ALL

Older adults.

Several studies are also evaluating INO in patients with newly diagnosed ALL. Most of these efforts have focused on its use in older adults, a group with poor tolerance to conventional chemotherapy and with historical long-term OS rates of only 20% [ 31 , 32 ]. Ongoing trials exploring INO in the frontline setting are shown in Table  3 , and a summary of available trial data of INO-based regimens in older adults with ALL is shown in Table  4 . At MD Anderson Cancer Center, the same mini-hyper-CVD plus INO regimen previously described was also studied in patients ≥ 60 years of age with newly diagnosed Ph-negative B-cell ALL [ 32 ]. Initially, 52 patients with a median age of 68 years were treated. The overall response rate was 98%, with 96% of patients achieving MRD negativity by flow cytometry. These high rates of response translated to encouraging long-term survival with 3-year progression-free survival (PFS) and OS rates of 49% and 56%, respectively. As with the relapsed/refractory study, this regimen was later amended to use lower, fractionated doses of INO (cumulative dose 2.7 mg/m 2 ), add blinatumomab and mandate ursodiol prophylaxis. A total of 80 older patients have been treated with the mini-hyper-CVD, INO ± blinatumomab regimen (patients #50 + treated with the updated regimen) [ 33 ]. Twelve patients (15%) have relapsed, and the 5-year PFS and OS rates are 44% and 46%, respectively. These outcomes compare favorably to the historical 5-year OS rate of approximately 20% when chemotherapy alone is used. The superiority of the mini-hyper-CVD, INO and blinatumomab regimen as compared with dose-reduced hyper-CVAD in a similar older population was confirmed in a propensity score analysis [ 34 ].

Despite the improvement over historical expectations, toxicity is still a significant concern with this regimen. Overall, 35 patients (44%) died in remission (including 9 from myelodysplastic syndrome or acute myeloid leukemia, 8 from infection and 5 from SOS/VOD). The risk of death in remission was higher in patients ≥ 70 years of age (accounting for 85% of deaths in remission), resulting in age-dependent survival outcomes (median OS 75 months, 47 months, and 35 months for patients 60–64, 65–69 and ≥ 70 years of age, respectively). Due to the specific risks related to the chemotherapy backbone (e.g. secondary myeloid malignancy and infection), patients ≥ 70 years of age will now receive INO and blinatumomab only, without the mini-hyper-CVD backbone. A similar approach has been evaluated in the Alliance A041703 study [ 35 ]. In this trial, patients ≥ 60 years of age with newly diagnosed Ph-negative B-cell ALL received induction with fractionated INO at 1.8 mg/m 2 in cycle 1 and 1.5 mg/m 2 in cycle 2, followed by consolidation with blinatumomab for 4–5 cycles. Among 33 patients treated, the overall response rate was 96% (85% after INO induction), and the 1-year OS rate was 84%. Longer term follow-up will be needed to confirm the durability of these responses.

Several other INO-based frontline regimens are being evaluated in older adults with newly diagnosed ALL. In the INITIAL-1 study, patients > 55 years of age with newly diagnosed Ph-negative B-cell ALL received induction with 3 cycles of dexamethasone plus INO (1.8 mg/m 2 in cycle 1 and 1.5 mg/m 2 in cycles 2–3), followed by 6 cycles of age-adjusted chemotherapy as consolidation/maintenance. 37 Forty-three patients were treated with a median age of 64 years (range, 56–80 years). All patients achieved CR/CRi, with 71% achieving MRD negativity at a sensitivity of 10 − 4 after the 3 cycles of INO induction. The 3-year event-free survival (EFS) and OS rates were 55% and 73%, respectively, and there was only 1 case of non-fatal SOS/VOD. The EWALL-INO study also enrolled a similar population of patients and treated them with 2 cycles of induction consisting of INO, vincristine and dexamethasone (induction 1) and INO, cyclophosphamide and dexamethasone (induction 2), followed by 6 cycles of age-adjusted consolidation and then POMP maintenance [ 37 ]. Overall, 131 patients were treated, and the CR/CRi rate after 2 cycles of induction was 90%. The estimated 2-year OS rate was 54%. Taken together, these studies show that frontline INO-based therapy is safe and effective in older adults with B-cell ALL. Building on the promising experience with the mini-hyper-CVD and INO regimen from MD Anderson, the Alliance A042001 is a randomized phase II study evaluating mini-hyper-CVD plus INO versus dose-adjusted hyper-CVAD in older adults (≥ 50 years of age) with newly diagnosed B-cell ALL [ 38 ]. No data are yet available, and this study is ongoing.

Younger adults

Combination approaches using INO are also being explored in younger adults with newly diagnosed ALL. At MD Anderson, we developed a protocol of hyper-CVAD plus blinatumomab, which has now been amended to add INO. The hyper-CVAD plus blinatumomab regimen consists of 4 cycles of hyper-CVAD, followed by 4 cycles of blinatumomab, and then POMP and blinatumomab maintenance. In the first 38 patients treated, all patients responded, with 97% becoming MRD negative by flow cytometry. This translated to encouraging 3-year relapse-free survival (RFS) and OS rates of 73% and 81%, respectively [ 39 ]. An additional 37 patients have now been treated with the addition of INO (0.3 mg/m 2 on day 1 and 8 of cycles 2, 4, 6 and 8; cumulative dose of 2.4 mg/m 2 ) [ 41 ]. With a median follow-up of 22 months, only 3 relapses have been observed. The estimated 2-year RFS and OS rates of 88% and 100%, respectively. The initial data with the addition of INO are encouraging and suggest a potential benefit with the routine use of INO in younger patients with newly diagnosed Ph-negative B-cell ALL.

Of note, the Alliance A041501 was a randomized study that also evaluated the addition of INO to standard chemotherapy (CALGB 10,403 backbone) in newly diagnosed B-cell ALL. This study was suspended due to toxicity concerns with the combination regimen, possibly related to the use of multiple hepatoxic agents in this regimen (e.g. INO and asparaginase). The lack of success of this study highlights the need for rationale combinations with INO and to avoid overlapping toxicities.

Other investigational applications of INO in ALL

Ino for mrd-positive disease.

In the INO-VATE study, INO was associated with a flow MRD negativity rate of 63% among responders [ 41 ] and provided support for the evaluation of INO for MRD-positive B-cell ALL. In a phase II study, 26 patients with MRD-positive ALL were enrolled and treated with INO at a dose of 0.6 mg/m 2 and 0.3 mg/m 2 on days 1 and 8, respectively, of cycle 1 and 0.3 mg/m 2 on day 1 and 8 of cycles 2-6 [ 42 ]. Sixteen patients (62%) had Ph-positive ALL and also received a BCR::ABL1 TKI (predominantly ponatinib). The MRD negativity response at a sensitivity of 10 − 4 was 69%, which translated to a 2-year OS rate of 60%. In another study from GIMEMA, INO was evaluated in 20 patients with MRD-positive B-cell ALL. Eleven of 20 patients (55%) achieved MRD response < 10 − 4 [ 44 ]. These encouraging data support the further of evaluation of INO as an MRD-directed therapy in ALL and also provide support for its continued evaluation in the frontline setting to induce deep, MRD-negative remissions.

INO for Ph + ALL

INO is active in relapsed/refractory Ph-positive ALL and achieves a CR/CRi rate of 73% and median OS of 8.7 months, which are similar to the findings from the broader population of the INO-VATE study [ 14 ]. In a phase I/II study, INO was combined with bosutinib in patients with relapsed/refractory Ph-positive ALL who did not harbor a T315I mutation [ 44 ]. Among 18 patients (16 with Ph-positive ALL and 2 with CML in lymphoid blast phase), the CR/CRi rate was 83%, with 56% achieving a complete molecular response. The median OS was 13.5 months, which appears superior to expectations with INO as monotherapy.

INO as post-transplant maintenance

INO has been evaluated as post-transplant maintenance in a phase I study of patients with CD22-positive ALL and high-risk for relapse [ 45 ]. INO doses of 0.3 mg/m 2 to 0.6 mg/m 2 were administered once per cycle for up to 12 cycles. The MTD was 0.6 mg/m 2 . Among 18 treated patients, no cases of SOS/VOD were observed. With a median follow-up of 18.1 months, only 2 relapses were observed, and the 1-year PFS and OS rates were 89% and 94%, respectively. This study suggests that low-dose INO can be safely administered in the peri-transplant setting and may also be helpful in preventing relapse in high-risk patients.

Sequencing of INO with CAR T-cell therapy

In clinical practice, INO is commonly given prior to CAR T-cell therapy, either as a salvage regimen and as bridging therapy. However, the data are mixed regarding whether prior INO exposure impacts the effectiveness of CAR T-cells [ 46 , 47 , 48 ]. Some studies in children have suggested that prior INO—including INO as bridging therapy—did not impact response rates or long-term outcomes following tisagenlecleucel, as compared with historical expectations [ 46 , 47 ]. However, in the ZUMA-3 study of brexucabtagene autoleucel in adult patients, those with prior INO exposure had numerically lower CR/CRi rates (59% with prior INO exposure versus 77% without prior INO exposure) and inferior OS (median OS 8.8 months and 47.0 months, respectively) [ 48 ]. Future studies evaluating the optimal sequencing of INO with other available therapies—including blinatumomab and CD19 CAR T-cells—and the use of INO as bridging therapy prior to CAR T-cell therapy are needed.

Conclusions

Along with the blinatumomab and CAR T-cells, the clinical development of INO has been a major contributor to improving outcomes of adult ALL over the past decade [ 49 ]. While INO has been shown to be more effective than conventional cytotoxic chemotherapy in relapsed/refractory B-cell ALL, its greatest potential is as combination therapy in both the frontline and salvage settings. When used along with low-dose chemotherapy and blinatumomab in relapsed/refractory ALL, a 3-year OS rate > 50% has been observed, even in non-transplanted patients. Similarly, very encouraging outcomes have been observed with INO in newly diagnosed B-cell ALL, whether combined with chemotherapy, blinatumomab or both. Over the course of these studies, the INO dose has been modified, with some studies suggesting that lower, fractionated doses of INO can be highly effective and may also reduce the risk of SOS/VOD, which is one of the feared potential toxicities of INO. Studies continue to expand the potential applications of INO, including its use for MRD-positive disease, combination with BCR::ABL1 tyrosine kinase inhibitors, and its use in low doses as post-transplant maintenance. Many of these ongoing research efforts seek to explore alternative dosing strategies of INO. New translational research is also seeking to understand the mechanisms of resistance to INO, which may help to inform future rational drug combinations [ 50 , 51 , 52 , 53 ]. The FDA approval of INO in 2017 marked a major milestone that paved the way for these important studies, but it is imperative to note that this was just one step in the clinical development of INO. The research that has followed in the years since the INO-VATE study highlight a truism in oncology: that regulatory approval of a drug is often only the beginning of its true clinical development and innovation.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Acute lymphoblastic leukemia

Confidence interval

Chronic myeloid leukemia

Complete remission

Complete remission with incomplete hematologic recovery

Event-free survival

Food and Drug Administration

Hematopoietic stem cell transplantation

Inotuzumab ozogamicin

Dose-attenuated hyperfractionated cyclophosphamide, vincristine and dexamethasone alternating with methotrexate and cytarabine

Measurable residual disease

Maximum tolerated dose

Non-relapse mortality

Overall survival

Progression-free survival

Philadelphia chromosome

6-mercaptopurine, vincristine, methotrexate, and prednisone

Relapse-free survival

Sinusoidal obstruction syndrome

Tyrosine kinase inhibitor

Veno-occlusive disease

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Acknowledgements

The authors wish to thank Lewis Nasr MD and Omer Karrar MD for their assistance with creation of tables and formatting of the manuscript.

This research is supported in part by the MD Anderson Cancer Center Leukemia SPORE CA100632, and the NIH/NCI Cancer Center Support Grant P30 CA016672.

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N.J.S. has served as consultant for Pfizer Inc., GSK, NKARTA, Autolus, and Sanofi, reports receiving research grants from Takeda Oncology, Astellas Pharma Inc., Xencor, Stemline Therapeutics, and NextCure, and has received honoraria from Adaptive Biotechnologies, Novartis, Amgen, Takeda Oncology, Pfizer Inc., Astellas Pharma Inc., Sanofi and BeiGene. E.J. reports receiving research grants and consultancy fees from AbbVie, Adaptive Biotechnologies, Amgen, Ascentage, Bristol Myers Squibb, Genentech, Incyte, Pfizer, and Takeda. N.J. reports receiving research grants from Pharmacyclics, AbbVie, Genentech, AstraZeneca, BMS, Pfizer, ADC Therapeutics, Cellectis, Adaptive Biotechnologies, Precision Biosciences, Fate Therapeutics, Kite/Gilead, Mingsight, Takeda, Medisix, Loxo Oncology, Novalgen, Dialectic Therapeutics, Newave, TransThera Sciences, Novartis, Carna Biosciences, Sana Biotechnology, Kisoji Biotechnology, and has received honoraria from Pharmacyclics, Janssen, AbbVie, Genentech, AstraZeneca, BMS, Adaptive Biotechnologies, Kite/Gilead, Precision Biosciences, Beigene, Cellectis, MEI Pharma, Ipsen, CareDX, MingSight, and Novalgen. H.K. reports receiving research grants from AbbVie, Agios, Amgen, Ariad, Astex, BMS, Cyclacel, Daiichi-Sankyo, Immunogen, Jazz Pharma, Novartis, Pfizer, Actinium, and Takeda.

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Short, N.J., Jabbour, E., Jain, N. et al. Inotuzumab ozogamicin for the treatment of adult acute lymphoblastic leukemia: past progress, current research and future directions. J Hematol Oncol 17 , 32 (2024). https://doi.org/10.1186/s13045-024-01552-7

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Received : 26 January 2024

Accepted : 29 April 2024

Published : 11 May 2024

DOI : https://doi.org/10.1186/s13045-024-01552-7

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